Paul Young (@DogICUma): Should we treat the HEAT?
What is the point of fever?
Helps fight infection in animals…
- Mice and klebsiella
- Pigeons and pneumococcus
- Bees and fungal infections
In pre-defined analysis of survivors and non-survivors, paracetamol seem to prolong life of these non-survivors
Reasons that this might be:
- No reason i.e. random
- Fever matters
- Paracetamol matters
- Paracetamol wasn’t given long enough
Paracetamol blocks oxidative stress. Maybe it’s useful in delaying death and facilitate a window for recovery in ICU?
Anthony Gordon (@agordonICU): Vasopressin or Noradrenaline: should either VANISH?
VANISH isn’t published yet (its not quite through the peer review process!) but it has been presented at meetings so is fair game for a quick summary…
The role of vasopressin differs in health and shock/septic shock.
Vasopressin did point towards an increase in digital ischaema vs norad (although Confidence interval crosses zero)
As promised Anthony Gordon would:
- 1st line Noradrenaline
- add vasopressin earlier but no magic number
- Especially if renal dysfunction developing or arrhythmias/tachycardias
- Care with vasopressor combination especially in combination
Pending Rob releasing this talk or the paper coming out, try this from December:
Tim Walsh (@Ed_TimWalsh): Does Rehab help ICU patients RECOVER?
Pts refused trial as they were “too tired”.
NO benefit shown except for some pt satisfaction scores – but is this a reflection of their premorbid state? So RECOVER hasn’t shown a benefit despite all the investment and application of “seems like a good idea”
Cost of intervention is £700 per patient treated
Christopher Nutt (@nuttchristopher) 2015 Critical Care Literature: The Best of the Rest
*Chris stepped up when Rob “The Machine” MacSweeney broke down.
Amongst the numerous studies discussed……. YOU HAVE TO LISTEN TO THE RECORDING. All the important 2015 trials summarised in 25 minutes! And try and beg/borrow/steal the outstanding conference book.
EUROTHERM – worse neuro outcome and mortality in intervention group
ICEREA – Endovascular versus External Targeted Temperature Management for Out-of-Hospital Cardiac Arrest Patients: A Randomized Controlled Study