ESICM Talk

Cerebral ultrasound is a developing point-of-care tool for intensivists and emergency physicians, with an important role in diagnosing acute intracranial pathology. The use of transcranial Doppler has expanded over the last years, opening a new window to the assessment of cerebral anatomy not only in neurocritical patients but also in general ICU and emergency room patients.

To discuss the use of cerebral ultrasound for young intensivists we have interviewed Dr. Bertuetti. Listen to the interview in the following podcast. 

Nutrition plays a vital role in the management of critically ill patients, and a tailored approach based on patient assessment, nutritional requirements, and clinical status is essential for optimising outcomes and promoting recovery.

The concept of patient phenotyping and endotyping will help clinicians to better target nutrition interventions for a patient by categorising patients based on observable behaviours and underlying biological mechanisms, respectively.

About these concepts, their clinical use and limitations we have interviewed Dr. Arthur Van Zanten. Listen to his explanations in our podcast offered by NEXT. 

Sepsis is a life-threatening organ dysfunction caused by a dysregulated host response to an infection. Despite progress in the understanding of sepsis pathophysiology, no specific treatment has proven successful.  The precision therapy, a greater understanding of the heterogeneity of sepsis is needed.

Recent approaches to measuring sepsis heterogeneity used unsupervised computational methods on clinical, biomarker, or gene expression data from observational studies or clinical trial datasets. At present, more than 100 sepsis subtypes are proposed, without awareness of overlap (or clinical implications). It is unknown whether each new subtype strategy is an added value for the patient.

To address this knowledge gap, a study was conducted aiming to determine the concordance between different sub-type labels, outcomes, and biologic pathways of critically ill sepsis patients classified by previously proposed sepsis subtyping methods. Listen to the podcast and learn more about the methodology and findings of this study.

VA-ECMO outcome scores have been previously developed and used extensively for risk adjustment, patient prognostication, and quality control across time and centres. The limitation of such scores is the derivation by using traditional statistical methods which are not capable of covering the complexity of ECMO outcomes. The Extracorporeal Life Support Organization Member Centres have developed a study where they aimed to leverage a large international patient cohort to develop and validate an AI-driven tool for predicting in-hospital mortality of VA-ECMO. The tool was derived entirely from pre-ECMO variables, allowing for mortality prediction immediately after ECMO initiation.

To learn more about this study listen to the podcast.

Numerous Population Pharmacokinetic (PopPK) models have been developed for Piperacillin (PIP), most of which are based on small monocentric studies and may not be generalizable to other populations. A recent evaluation of six PIP models in 30 ICU patients receiving CI demonstrated large inter-model variability regarding predictability. The transferability of these results to other populations is uncertain due to the limited number of patients and the monocentric setting. Furthermore, a clinically oriented model assessment in conjunction with TDM (Bayesian forecasting) was lacking.

A recent study aimed to evaluate the predictive performance of available PIP PopPK models with and without TDM using an external multicenter dataset to facilitate model selection for MIPD in critically ill patients. Listen to the podcast and learn more about the methodology and findings of this study.

The concept of a "green ICU" is increasingly important in today's world, as sustainability and environmental considerations become integral to healthcare practices. Hospitals, including ICUs, can have a substantial environmental footprint due to energy consumption, waste generation, and resource use. Implementing green practices reduces this impact and contributes to overall environmental sustainability.

Integrating sustainability into healthcare practices not only benefits the environment but also supports the overall mission of providing high-quality patient care. To learn more about Green ICU implementation listen to the interview with Nicole Hunfeld. 

Acute respiratory distress syndrome (ARDS) is the term applied to a spectrum of conditions with different etiologies that share common clinical-pathological characteristics including: increased permeability of the alveolo-capillary membrane, resulting in inflammatory edema; increased non-aerated lung tissue resulting in higher lung elastance (lower compliance); and increased venous admixture and dead space, which result in hypoxemia and hypercapnia.

The new updated ESICM guidelines have been published highlighting a new approach to ARDS in terms of definitions, phenotyping, and respiratory support strategies.

To discuss ARDS from the new guidelines to bedside applied physiology we have interviewed Professor Gattinioni and invite you to follow the conversation in the following podcast.

Sepsis‐associated acute kidney injury (SA‐AKI) is a common, increasingly prevalent problem in the intensive care unit (ICU). The association between sepsis and AKI has been studied previously. However, the lack of a reproducible and standardized consensus definition has limited the interpretability of available knowledge. In order to assess SA-AKI incidence, patient characteristics, timing, trajectory, treatment, and associated outcomes a multicenter, observational study was conducted. In order to know more about the study methodology and findings we have interviewed Dr White. Listen to the interview in the following podcast.

Transportation of critically ill patients is inevitable in most health systems. Prehospital transportation (PHT) may be necessary after a major injury or as a result of a life-threatening illness – for example, myocardial infarction, intracranial haemorrhage, or metabolic coma.

On our ESICM Academy, we offer a course series on Patient Transportation, from the general introduction to conducting interfacility and intrahospital patient transportation and prehospital transport in Critical Care. Hear more from one of the authors in this podcast.

The ESICM Academy is accredited by the European Accreditation Council for Continuing Medical Education (EACCME) and offers updated, peer-reviewed, evidence-based training material, free of charge for ESICM members.

Speaker:

Michael J LAURIA. Former Pararescueman in the US Air Force and Critical Care/Flight Paramedic. Currently Emergency Medicine Physician, University of New Mexico Health Sciences Center; EMS/Critical Care Fellow, Flight Physician; Associate Medical Director for Lifeguard Air Emergency Services (US).

Intensive care units (ICU) are the most peculiar units in hospitals where the quality and safety of health care delivery should be at the highest level. The most critical patients are treated in this unit, posing all healthcare professionals working there with continuous physical and emotional challenges. 

ICU teams are composed of different profiles with the same goal of satisfying the needs of the patients. Combining each one's skills and abilities to make the best clinical decisions requires healthy multidisciplinary teamwork.

Recent studies show that the ability to work in a team in the ICU results in better patient outcomes and less or better coping with ICU staff burnout.

Learn more about the importance of interprofessional teamwork in the ICU in this podcast with Elena Conoscenti and Andreas Xyrichis.

Speakers:

Andreas XYRICHIS. King's College London (UK).

Elena CONOSCENTI. ISMETT (Mediterranean Institute for Transplantation and Advanced Specialized Therapies), Palermo (IT). ESICM Nurses & Allied Healthcare Professionals Committee member.

Multiple organ dysfunction syndrome (MODS) is common after major trauma, affecting up to two-thirds of patients with critical injuries. Post-trauma MODS is associated with a mortality of over 20% and poor long-term outcomes in those who survive. Current management is supportive, and there are no specific pharmacological agents that prevent organ dysfunction.

The TOP-ART randomised clinical trial, a two-stage study, has tested firstly the safety and efficacy of the early artesunate administration on a cohort of severely injured and bleeding trauma patients and, secondly, the outcomes of artesunate administration on trauma patients at risk of developing MODS.

Listen to Joanna Shepherd's interview in the following podcast to learn more about the study's results.

Original article: Safety and efficacy of artesunate treatment in severely injured patients with traumatic haemorrhage. The TOP-ART randomised clinical trial

Speakers:

Joanna SHEPHERD. Centre for Trauma Sciences, The Blizard Institute, Queen Mary University of London (UK).

Rahul COSTA-PINTO. Austin Hospital, Melbourne (AU). ESICM NEXT Committee Member.

Sepsis is a life-threatening acute organ dysfunction secondary to infection and affects more than 19 million people annually. In 2017, it was estimated that almost 49 million people were infected by sepsis, and half of those cases occurred in children under 5.

In-hospital mortality has declined over the years, resulting in a large number of sepsis survivors. Emerging data suggest that patients who survive sepsis frequently experience new symptoms, long-term disability, and worsening chronic health conditions for which they will seek care from many clinicians.

Elena Conoscenti has interviewed two experts in the field who will explain better what happens in adult and paediatric patients who survived sepsis.

Speakers:

Elsa AFONSO. Anglia Ruskin University, Cambridge (UK).

Laura Maria ALBERTO. Universidad del Salvador (AR).

Elena CONOSCENTI. ISMETT (Mediterranean Institute for Transplantation and Advanced Specialized Therapies), Palermo (IT). ESICM Nurses & Allied Healthcare Professionals Committee member.

Central nervous system (CNS) infections significantly burden ICU physicians' daily clinical work. Diagnosis can be challenging, and timely management is of the utmost importance.

Meningoencephalitis is one of the CNS infections for which the epidemiological studies conducted in adult patients suggest that approximately one in two will require care in an intensive care unit. In those patients requiring ICU admission, meningoencephalitis is associated with a poor prognosis, including refractory seizures, prolonged hospital stay, neurological disability, and death.

The EURECA study endorsed by the ESICM intended to characterise the clinical presentation, etiologies, and outcomes in adult patients with severe meningoencephalitis requiring care in the ICU. We discuss its findings in this episode.

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Speakers:

Romain SONNEVILLE. Bichat Claude Bernard University Hospital, APHP, Université Paris Cité (FR).

Laura GALARZA. Laura Galarza Hospital Universitari General de Castellón (ES). Chair, ESICM NEXT Committee.

Several studies have found an association between diabetes mellitus, disease severity and outcome in COVID-19 patients. Old, critically ill patients are particularly at risk.

A recent multicentre international prospective cohort study was performed in 151 ICUs across 26 countries to investigate the impact of diabetes mellitus on 90-day mortality in a high-risk cohort of critically ill patients over 70 years of age.

Original article: Diabetes mellitus is associated with 90-day mortality in old critically ill COVID-19 patients: a multicenter prospective observational cohort study

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Speakers

Timo MAYERHÖFER. Medical University Innsbruck (AT).

Kristina FUEST. Technische Universität München (DE). ESICM NEXT Committee member.

International guidelines recommend targeting normocapnia in adults with coma resuscitated after out-of-hospital cardiac arrest. However, normocapnia may be insufficient to restore and maintain adequate cerebral perfusion. Conversely, mild hypercapnia increases cerebral blood flow and may improve neurologic outcomes.

Nevertheless, the most effective Paco2 target in adults with coma resuscitated after out-of-hospital cardiac arrest has not been well studied in randomized trials.

Therefore, the Targeted Therapeutic Mild Hypercapnia After Resuscitated Cardiac Arrest (TAME) trial was conducted to test the hypothesis that targeted mild hypercapnia would improve neurologic outcomes at 6 months as compared with targeted normocapnia in adults with coma who had been resuscitated after out-of-hospital cardiac arrest.

Listen to the podcast for more insight into the hypothesis, methodology and findings from the TAME study.

Original paper: Mild Hypercapnia or Normocapnia after Out-of-Hospital Cardiac Arrest

Speakers

Claudio SANDRONI. Policlinico Universitario Agostino Gemelli, Rome (IT).

Markus SKRIFVARS. University of Helsinki (FI). Chair, ESICM Trauma & Emergency Medicine (TEM) Section.

Chiara ROBBA. University of Genova (IT). ESICM Neuro-Intensive Care (NIC) Section.

Severe community‐acquired pneumonia (sCAP) is a clinical entity to describe ICU-admitted patients with community‐acquired pneumonia (CAP) as they might require organ support, and it is associated with high morbidity and mortality.

While European and non‐European guidelines are available for CAP, there are no specific guidelines for sCAP. Therefore, a team of experts have joined efforts to prepare a summary document to guide the most effective treatments and management strategies for adult patients with sCAP.

Listen to the following podcast to learn more about these guidelines produced by the European Respiratory Society (ERS), the European Society of Intensive Care Medicine (ESICM), the European Society of Clinical Microbiology and Infectious Diseases (ESCMID), and the Latin American Thoracic Association (ALAT).

Original paper: ERS/ESICM/ESCMID/ALAT guidelines for the management of severe community-acquired pneumonia

Speakers

Ignacio MARTIN-LOECHES. Department of Intensive Care Medicine, Multidisciplinary Intensive Care Research Organisation (MICRO), St James’s Hospital, Dublin (IE).

Antoni TORRES. CIBER of Respiratory Diseases (CIBERES), Institute of Health Carlos III, Madrid (ES).

Pedro PÓVOA. NOVA Medical School, CHRC, New University of Lisbon (PT).

Preclinical models of acute kidney injury (AKI) consistently demonstrate that a uremic milieu enhances renal recovery and decreases kidney fibrosis.

Reduced renal clearance has the surprising and counterintuitive effect of being an effective treatment for AKI.

In this perspective, Dr Lakhmir S. Chawla suggests a hypothesis describing why the uremic milieu is kidney protective and proposes a clinical trial of ‘permissive azotemia’ to improve renal recovery and long-term renal outcomes in critically ill patients with severe AKI.

Hear more about the explanation of this hypothesis in the following podcast, organised by the ESICM AKI Section.

Speakers

Lakhmir S. CHAWLA. Chief Medical Officer, Silver Creek Pharmaceuticals. Recipient of the International Vicenza Award for Critical Care Nephrology.

Eric HOSTE. UZ Gent (BE). AKI Section Representative, ESICM Social Media & Digital Content Committee.

Marc ROMAIN. Hadassah Medical Center, Jerusalem (IL).

Coagulopathy is a severe and frequent complication in critically ill patients, for which the pathogenesis and presentation may be variable depending on the underlying disease.

Therefore, a review has been conducted to differentiate between hemorrhagic coagulopathies, characterised by a hypercoagulable and hyperfibrinolysis state, and thrombotic coagulopathies with a systemic prothrombotic and antifibrinolytic phenotype, based on the dominant clinical phenotype. 

Dr Julie Helms, our podcast guest, will explain more about the review and discuss the differences in pathogenesis and treatment of the common coagulopathies. 

Original paper: How to manage coagulopathies in critically ill patients

Speakers

Julie HELMS. Université de Strasbourg (UNISTRA), Faculté de Médecine, Hôpitaux Universitaires de Strasbourg (FR).

Ahmed ZAHER. Oxford University Hospitals (UK). NEXT Committee member, ESICM.

End-of-life care is an approach to a terminally ill patient that shifts the focus of care to symptom control, comfort, dignity, quality of life, and quality of dying rather than treatments aimed at cure or prolongation of life.

A detailed description of the concept of the end of life care and as well how to deal with end-of-life situations are discussed in the podcast.

Speakers

Julie BENBENISHTY. Hadassah Hebrew University Medical Center, Jerusalem (IL). Head of the European critical care doctoral educated nurses group.

Ahmed ZAHER. Oxford University Hospitals (UK). NEXT Committee member, ESICM.

The Surviving Sepsis Campaign (SSC) produces and regularly updates guidelines for managing patients with sepsis and septic shock. However, deviation from guidelines is frequently observed in the intensive care unit.

The last iteration of the SSC includes 79 recommendations where the impact on mortality remains unclear for some of them. Prioritising the recommendations based on their relative impact on mortality would be helpful to the clinician.

A recent study has been carried out to identify among all SSC recommendations applicable during the first 24 h following sepsis onset, a subset of guidelines that should be prioritised to minimise 28-day all-cause mortality.

Original paper: Machine-learning-derived sepsis bundle of care

Speakers

Romain PIRRACCHIO. Department of Anesthesia and Perioperative Medicine, Zuckerberg San Francisco General Hospital and Trauma Center, University of California San Francisco (US).

Ana-Maria IOAN. Fundacion Jimenez Diaz University Hospital, Madrid (ES). Spain. NEXT Committe member, ESICM.

Sepsis is a life-threatening organ dysfunction caused by a dysregulated host response to infection. In this context, biomarkers could be considered indicators of either infection or dysregulated host response or response to treatment and/or aid clinicians in prognosticating patient risk.

A recently published narrative review provides current data on the clinical utility of pathogen-specific and host-response biomarkers, offers guidance on optimising their use, and proposes the need for future research. In this podcast, Dr Povoa, one of the leaders of this review, details these findings.

Original paper: How to use biomarkers of infection or sepsis at the bedside: guide to clinicians

Speakers

Pedro PÓVOA.  NOVA Medical School, New University of Lisbon (PT).

Laura BORGSTEDT. Department of Anesthesiology and Intensive Care Medicine, Klinikum rechts der Isar, Technical University Munich (DE). NEXT Committe member, ESICM.

Individualising drug dosing using model-informed precision dosing (MIPD) of beta-lactam antibiotics and ciprofloxacin has been proposed as an alternative to standard dosing to optimise antibiotic efficacy in critically ill patients. However, randomised clinical trials (RCT) on clinical outcomes have been lacking.

In this podcast, Drs Ewoldt and Abdulla relate how they conducted a multicentre RCT in 8 Dutch hospitals. It included patients admitted to the intensive care unit (ICU) treated with antibiotics and randomised to MIPD with dose and interval adjustments based on monitoring serum drug levels (therapeutic drug monitoring) combined with pharmacometrics modelling of beta-lactam antibiotics and ciprofloxacin.

Original paper: Model‑informed precision dosing of beta‑lactam antibiotics and ciprofloxacin in critically ill patients: a multicentre randomised clinical trial

Speakers

Tim M. J. EWOLDT. Department Hospital Pharmacy, Erasmus University Medical Center, Rotterdam (NL).

Alan ABDULLA. Department Hospital Pharmacy, Erasmus University Medical Center, Rotterdam (NL).

Ana-Maria IOAN. Intensive Care Medicine Unit, Fundación "Jiménez Díaz" University Hospital, Madrid (ES). NEXT Committe member, ESICM.

Bronchiolitis is a common lung infection in young children and infants. Approximately one-tenth of the affected children are admitted, and between 2 and 6% of them present a severe form and are referred to paediatric intensive care units.

Nevertheless, the definition of severe acute bronchiolitis is mainly clinical and based on low levels of evidence.

In this podcast, Dr Milési presents guidelines for managing infants under 12 months of age with severe bronchiolitis to create a series of pragmatic recommendations for a patient subgroup poorly individualised in national and international guidelines.

Original paper: Clinical practice guidelines: management of severe bronchiolitis in infants under 12 months old admitted to a paediatric critical care unit

Speakers

Christophe MILÉSI. Pediatric Intensive Care Unit, Montpellier University Hospital (FR).

Mariangela PELLEGRINI. Dept. of Surgical Sciences, Uppsala University (SE).

The outcome of very old patients admitted to the intensive care unit (ICU) is determined by both the severity of the acute condition and the age-related decline of resilience to stress.

However, that decline is characterised by substantial inter-individual heterogeneity, which is considered a hallmark of the ageing process.

A recent study investigated the heterogeneity within the very old population by clustering analysis of patient characteristics recorded on admission to the ICU.

The researchers hypothesised that acute and geriatric features result in distinct phenotypes that may help early prognosis and indicate options for preventive interventions.

Listen to Dr Sviri and Dr Beil to learn about the final findings of this study.

Original paper: Clustering analysis of geriatric and acute characteristics in a cohort of very old patients on admission to ICU

Speakers

Michael BEIL. Hebrew University and Hadassah University Medical Center, Jerusalem (IL).

Sigal SVIRI. Hebrew University and Hadassah University Medical Center, Jerusalem, (IL).

Rahul COSTA-PINTO. Austin Hospital, Victoria and the University of Melbourne (AU). ESICM Next Committee member.

Nutrition is an essential care we provide to critically ill patients aiming to avoid severe muscle wasting and weakness, which correlate with mortality and long-term burdens. Considering that the ICU patients' nutritional needs vary with the phase of critical illness, evidence-based nutrition protocols are so much needed.

Dr Tarcukovic, one of the participants of the ESICM Nutrition Pathway, shares with us her experience in this Education Programme and discusses a few key points of the physiopathology of nutrition and how to feed and treat such critical patients.

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Speakers

Janja TARCUKOVIC. Department of Anaesthesiology, Intensive Care and Pain Medicine Clinical Hospital Centre Rijeka, Rijeka (HR).

Kristina FUEST. Technische Universität München (DE). ESICM NEXT Committee member.

Pregnant women with COVID-19 are more likely to be admitted to the ICU and require invasive mechanical ventilation or venovenous extracorporeal membrane oxygenation (VV-ECMO). Nevertheless, only a few case series have focused on ventilatory management and outcomes of pregnant women with COVID-19 admitted to the ICU.

COVIDPREG study primarily aimed to assess the ventilatory management of pregnant women with COVID-19 admitted to ICU. Secondly, the study aimed to evaluate obstetric management and report maternal and neonatal outcomes.

Listen to Dr Mathieu Jozwiak for more insights from this study.

Original paper: Management and outcomes of pregnant women admitted to intensive care unit for severe pneumonia related to SARS-CoV-2 infection: the multicenter and international COVIDPREG study

Speakers

Mathieu JOZWIAK. Service de Médecine Intensive Réanimation, Centre Hospitalier Universitaire de Nice (FR).

Mariangela PELLEGRINI. Intensive Care Unit, AnOpIVA, Hedenstierna Laboratory, Dept. of Surgical Sciences, Uppsala University (SE).

Intensive care unit (ICU) sedation practices have dramatically changed over the last 20 years. Nowadays, they include light levels of sedation, SAT, and the use of non-benzodiazepines. An overview of ICU sedation practices’ evolution over the years has been recently published in the ICM Journal.

This publication highlights the challenge faced by clinicians during the COVID-19 pandemic regarding sedation practices and recommends reengaging bundled-based strategies such as the ABCDEF Bundle to promote liberation from the ventilator and promote recovery and survivorship.

We have interviewed Dr Stolling for more details relating to this study.

Original paper: Evolution of sedation management in the ICU

Speakers

Joanna STOLLINGS. Vanderbilt University Medical Center, Nashville (USA).

Rahul COSTA-PINTO. Austin Hospital, Victoria (AU). ESICM Next Committee member.

Acute kidney injury is common in critically ill patients, and 10-15% of ICU patients receive renal replacement therapy (RRT). The timing of therapy initiation is limited by heterogeneity, but until 10-15 years ago there was a trend toward early initiation, as noted by several meta-analyses.

In the past 5 years, several large PRCTs have addressed this topic: ELAIN, AKIKI, IDEAL-ICU, STARRT-AKI, and AKIKI-2.

In this ESICM NEXT educational podcast, we will find out what is the most recent consensus and what are the clinical tools to facilitate the initiation of RRT.

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Speakers

Antoine SCHNEIDER. Lausanne University Hospital (CH). Chair, ESICM Acute Kidney Injury Section.

Eric HOSTE. Universitair Ziekenhuis Ghent (BE).

Sean BAGSGAW. University of Alberta Hospital (CA); Mazankowski Alberta Health Institute (CA).

Silvia DE ROSA. San Bortolo Hospital, Vicenza (IT). ESICM Next Committee member.

Over the last few years, the assessment of frailty at admission to the ICU has become increasingly popular. Frailty is also considered one of the potential prognostic indicators in patients with COVID-19.

The degree of frailty could be used to assist both the triage into intensive care and decisions regarding treatment limitations.

The COVIP study led by prof Jung sought to determine the interaction of frailty and age in elderly COVID-19 ICU patients.

Listen to the podcast to learn more about the findings of the study.

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Speakers

Christian JUNG. Heinrich-Heine-University Duesseldorf (DE). Chair, ESICM Health Services Research & Outcome (HSRO) Section.

Kristina FUEST. Technische Universität München (DE). ESICM NEXT Committee member.

A recent outbreak of acute non-A-E hepatitis with serum transaminases greater than 500 IU/L identified in children under 16 years reported in the United Kingdom (UK) has become a serious cause for concern for public health authorities and paediatric liver and critical care services.

From 1 January to 16 May 2022, UK public health authorities have reported 197 cases with a median age of 3 years, male (50%), from all regions of the UK, with 11 children requiring liver transplantation (LT).

A letter to the editor was sent to the ICM journal, and in this podcast, you can listen to Dr Deep, Dr Dhawan, and Dr Verma relating their experience with this novel hepatitis.

Original article: Outbreak of hepatitis in children: clinical course of children with acute liver failure admitted to the intensive care unit.

Speakers

Akash DEEP. Paediatric Intensive Care Unit, King’s College Hospital NHS Foundation Trust, Denmark Hill, London (UK).

Anil DHAWAN. Paediatric Liver, GI and Nutrition Centre and Mowatlabs, King’s College Hospital NHS Foundation Trust, London (UK).

Anita VERMA. Department of Microbiology, King’s College Hospital NHS Foundation Trust, London (UK).

Inès Lakbar. Service Anesthésie - Réanimation Pr LEONE AP-HM - Hôpital Nord - Marseille (FR).

The ECHO-COVID study investigated the effects on cardiac function in critically ill COVID -19 patients.

The primary aim of this study was to investigate the incidences and patterns of left and right ventricular dysfunction in the first echocardiographic examination performed after admission to the intensive care unit (ICU) in a large series of patients hospitalised for severe COVID-19.

The study referred to previous international collaborations with experts in critical care echocardiography (CCE) that use it in their usual practice to manage critically ill patients. Listen to the following podcast to learn more about this study's findings and conclusions.

Original article: Echocardiography findings in COVID-19 patients admitted to intensive care units: a multi-national observational study (the ECHO-COVID study)

Speakers

Antoine VIEILLARD-BARON. Service de Médecine Intensive Réanimation, Assistance Publique‑Hôpitaux de Paris, University Hospital Ambroise Paré, 92100 Boulogne‑Billancourt, France /INSERM, UMR 1018, Clinical Epidemiology Team, CESP, Université de Paris Saclay, Villejuif (FR).

Ahmed ZAHER. Oxford Critical care, Oxford University hospitals (UK)

The European Society of Intensive Care Medicine (ESICM), initiated a study to describe the extent of the COVID-19 ICU surge worldwide and the clinical characteristics, management, and outcomes of critically ill COVID-19 patients.

Additionally, the goal was to study the impact of critically ill COVID-19 patients admitted to a surge capacity bed on the treatment and outcomes.

The study hypothesised that admission to surge capacity beds increased mortality compared to standard ICU beds and that need for early invasive mechanical ventilation was associated with higher mortality.

We have gone through the main findings of this comprehensive study with Prof Jan De Waele.

Original article: Clinical and organizational factors associated with mortality during the peak of first COVID-19 wave: the global UNITE-COVID study

Speakers

Jan DE WAELE. Department of Internal Medicine and Pediatrics, Faculty of Medicine and Health Sciences, Ghent University (BE).

Emilio RODRIGUEZ-RUIZ. Intensive Care Medicine Department, University Clinic Hospital of Santiago de Compostela (ES).

The haemodynamic instability most patients present in the ICU may lead to organ dysfunction, deterioration into multi-organ failure, and eventually death.

Proper medical management is essential to prevent or treat organ failure and improve the outcomes for these patients.

This podcast will tackle a few crucial points regarding haemodynamic monitoring starting from the first hours of patients admitted to the ICU. Listen & receive important advice from our experts Prof Xavier Monet and Prof Michelle Chew.

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Speakers

Christopher LAI. Bicêtre University Hospital, Assistance Publique-Hôpitaux de Paris, Le Kremlin-Bicêtre, France.

Ahmed ZAHER. Oxford University Hospitals (UK). ESICM Next Committee member.

Xavier MONNET. Bicêtre Hospital, Paris-South University Hospitals (FR).

Michelle CHEW. Linköping University Hospital (SE).

The practice of neurocritical care for children with injured or vulnerable brains entails clinical assessment, a range of monitoring methods within the paediatric intensive care unit (PICU), and the follow-up of children's long-term neurodevelopment.

These activities involve inherent challenges related to the diversity of the case mix and age range.

Different concepts were discussed in a recently published 'state of the art' paper about critically ill children.

With the paper's authors, we went through what is needed to take PICU survivorship to the next level.

Original paper: The brain in pediatric critical care: unique aspects of assessment, monitoring, investigations, and follow up

Speakers

Kate BROWN. Biomedical Research Centre, Great Ormond Street Hospital for Children, London (UK). Institute of Cardiovascular, Science University College London, London (UK).

Robert TASKER. Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children’s Hospital, Boston, Massachusetts (USA). Selwyn College, Cambridge University, Cambridge (UK).

Rahul COSTA-PINTO. Department of Intensive Care, Austin Hospital, 145 Studley Road, Heidelberg, Victoria (AU). Department of Critical Care, Department of Medicine, the University of Melbourne, Parkville, Victoria (AU).

Recent evidence suggests that acute hypercapnia could have harmful physiological and clinical effects in patients with ARDS, particularly impacting the haemodynamic system. A review and meta-analysis were performed to summarise the clinical consequences of acute hypercapnia in mechanically ventilated patients.

The primary objective was to determine the association between acute hypercapnia and mortality in adult patients mechanically ventilated for ARDS. The secondary goal was to identify the association between acute hypercapnia and haemodynamics (systemic and pulmonary circulation) in adult patients mechanically ventilated for ARDS.

Original paper: The role of acute hypercapnia on mortality and short-term physiology in patients mechanically ventilated for ARDS: a systematic review and meta-analysis.

Speakers:

Armand MEKONTSO DESSAP. AP-HP, Hôpitaux Universitaires Henri-Mondor, Service de Médecine Intensive-Réanimation, 94010 Créteil (FR).

Mariangela PELLEGRINI. Department of Surgical Sciences, Uppsala University Hospital (SE). ESICM NEXT member.

Sepsis refers to a dysregulated response to infection-causing end-organ dysfunction. It is associated with short-term risks such as shock and in-hospital death.

Meanwhile, long-term consequences among sepsis survivors can include clinical deconditioning, recurrent sepsis, mental health issues, and increased risk of long-term mortality.

Moreover, recent investigations have demonstrated a possible association of sepsis with subsequent cardiovascular adverse events, including myocardial infarction, stroke, and congestive heart failure.

A large, population-based matched cohort study of adult patients without pre-existing cardiovascular disease has been performed to estimate the association between surviving a first sepsis hospitalisation and subsequent major cardiovascular events during long-term follow-up. Dr Angriman explains the findings of this recent study.

Original paper: Sepsis hospitalization and risk of subsequent cardiovascular events in adults: a population-based matched cohort study

Speakers:

Federico ANGRIMAN. Sunnybrook Health Sciences Centre, Toronto, ON (CA); Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON (CA).

Mehmet YILDIRIM. Health Science University, Diskapi Training and Research Hospital, Ankara (TR). ESICM NEXT member.

Delirium is a condition of acute organic brain dysfunction with fluctuating disturbances of attention and cognition, and its prevalence in intensive care units (ICUs) is recorded as high as 80%.

Delirium is highly distressing for patients and families and commonly reported as the worst experience of ICU admission. Melatonin has been described as an attractive intervention for delirium prevention, and a large study hypothesised that early administration of melatonin effectively reduces delirium in critically ill patients.

In this podcast, Dr Wibrow details the results of this study with Dr Scaramuzzo.

Original paper: Prophylactic melatonin for delirium in intensive care (Pro-MEDIC): a randomized controlled trial

Speakers

Bradley WIBROW. Sir Charles Gairdner Hospital, Nedlands, WA, Australia and  Medical School, University of Western Australia, Perth, WA (AU).

Gaetano SCARAMUZZO. Department of Translational Medicine, University of Ferrara (IT). ESICM NEXT member.

Preclinical studies precede most clinical trials. They help identify criteria for evaluating human safety, including signs and symptoms that should be monitored closely during early clinical trials.

The importance of these preclinical studies in intensive care medicine starts from developing new surgical procedures, and hands-on training to new medical devices and prescription drugs.

To have more insights into preclinical research and real examples of translation of such research in clinical practice, we interviewed Dr Marcin Osuchowski, an expert in the field.

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Speakers

Marcin OSUCHOWSKI. Ludwig Boltzmann Institute for Traumatology, The Research Center in Cooperation with AUVA; Deputy Editor-In-Chief of the ESICM ICMx Journal.

Denise BATTAGLINI. Consultant in intensive care at San Martino Policlinico Hospital, Genoa, Italy (IT). ESICM NEXT Committee Member.

Ahmed ZAHER. Oxford University Hospitals (UK). ESICM Next Committee member.

The prevalence of long-term mental health symptoms in the family members of COVID-19 ICU survivors is unknown and may differ from the prevalence rate in the family members of non-COVID-19 ICU survivors, given the pandemic circumstances.

A better understanding of the impact of COVID-19 ICU admission on family members is needed to provide adequate support during and after the ICU stay. Therefore, the prevalence of mental health symptoms and quality of life in family members of COVID-19 ICU survivors 3 and 12 months after ICU admission was evaluated in the first study ever done.

Risk factors associated with mental health symptoms were also explored.

Original article: Mental health symptoms in family members of COVID-19 ICU survivors 3 and 12 months after ICU admission: a multicentre prospective cohort study

Speakers

Hidde HEESAKKERS. Radboud Institute for Health Sciences, Department Intensive Care Medicine, Radboud University Medical Center, Nijmegen (NL).

Burcin HALACLI. Hacettepe University, Faculty of Medicine, Department of Internal Medicine, Intensive Care Unit, Ankara (TR). ESICM NEXT Committee Member.

The aim of the ERC-ESICM guidelines on temperature control after cardiac arrest in adults is to provide evidence-based guidance in adults who are comatose after resuscitation from either in-hospital or out-of-hospital cardiac arrest, regardless of the underlying cardiac rhythm.

These guidelines replace the recommendations on temperature management after cardiac arrest included in the 2021 post-resuscitation care guidelines co-issued by the European Resuscitation Council (ERC) and the European Society of Intensive Care Medicine (ESICM).

The invited experts of this podcast, Prof Sandroni and Prof Nolan, describe the methodology followed and explain the panel suggestions on guideline implementation and the identified priorities for future research.

Listen to their interview!

Original article: ERC‑ESICM guidelines on temperature control after cardiac arrest in adults

Speakers

Claudio SANDRONI. Department of Intensive Care, Emergency Medicine and Anaesthesiology, Fondazione Policlinico Universitario A. Gemelli-IRCCS, Rome (IT). Chair of the ESICM Trauma & Emergency Medicine Section.

Jerry P. NOLAN. School of Clinical Science, University of Bristol, Bristol, UK and Department of Anaesthesia and Intensive Care Medicine, Royal United Hospital, Bath (UK).

Laura BORGSTEDT. Clinic for Anaesthesiology and Intensive Care Medicine and University of Munich (DE). ESICM NEXT Committee Member.

Growing evidence suggests that insufficient antibiotic exposure (defined as failure to achieve the pharmacokinetic/pharmacodynamic (PK/PD) target to kill or inhibit the growth of a pathogen) is associated with worse clinical outcomes in sepsis patients.

Moreover, up to 50% of critically ill patients receiving a β-lactam antibiotic with regimens based on manufacturers' recommendations fail to reach the target.

Therapeutic drug monitoring (TDM)-guided therapy has been proposed as a strategy to further optimise the achievement of the PK/PD target of β-lactam antibiotics. However, there are no data on whether piperacillin/tazobactam TDM can improve clinical outcomes.

In this context, a large RCT was performed to investigate whether TDM-based dose optimisation versus fixed dosing could improve clinical outcomes in patients with sepsis treated with piperacillin/tazobactam as a continuous infusion.

Dr Hagel shares with us the results of this study published in the ICM Journal.

Original study:

Hagel S et al. Effect of therapeutic drug monitoring-based dose optimization of piperacillin/tazobactam on sepsis-related organ dysfunction in patients with sepsis: a randomized controlled trial. Intensive Care Med. 2022 Mar;48(3):311-321. doi: 10.1007/s00134-021-06609-6

Speakers

Stefan HAGEL. Assistant medical director and consultant at the Institute for Infectious Diseases and Infection Control and Center for Sepsis Control and Care at the Jena University Hospital (DE).

Laura BORGSTEDT. Department of Anesthesiology, Klinikum rechts der Isar, Technical University of Munich, Munich (DE).

Clinical and pathophysiological understanding of septic shock has progressed exponentially in the previous decades, translating into a steady decrease in septic shock-related morbidity and mortality.

Even though large randomised, controlled trials have addressed fundamental aspects of septic shock resuscitation, many questions still exist.

A comprehensive review was carried out to describe the current standards of septic shock resuscitation.

This review targeted the evolving concepts in different domains such as clinical resuscitation targets, adequate use of fluids and vasoactive drugs, refractory shock, and extracorporeal therapies.

To know more about the study, listen to Dr Hernandez and Dr Kattan, who were interviewed for this podcast by Dr Costa-Pinto.

Speakers

Glenn HERNANDEZ. Departamento de Medicina Intensiva, Facultad de Medicina, Pontificia Universidad Cat lica de Chile, Santiago, Chile

Eduardo KATTAN. Departamento de Medicina Intensiva, Facultad de Medicina, Pontificia Universidad Cat lica de Chile, Santiago, Chile

Rahul COSTA-PINTO. Department of Intensive Care, Austin Hospital, Melbourne, Victoria, Australia and Department of Critical Care, The University of Melbourne, Melbourne, Victoria, Australia

Clinicians use noninvasive respiratory support interventions in the post-extubation period to mitigate the risk of extubation failure. These interventions [noninvasive positive pressure ventilation (NIPPV) and high-flow nasal cannula (HFNC)] have been shown to be efficacious in preventing initial intubation in patients with hypoxemic respiratory failure, but their efficacy in preventing post-extubation respiratory failure and reintubation is less clear.

A systematic review and network meta-analysis of randomised controlled trials (RCTs) to evaluate the relative efficacy of conventional oxygen therapy, NIPPV, HFNC, and the strategy of alternating NIPPV and HFNC during the post-extubation period in reducing extubation failure and short-term mortality among critically ill adults, was conducted. We have interviewed Dr Fernando and Dr Rochwerg to explain these study findings.

Speakers

Shannon FERNANDO. Division of Critical Care, Department of Medicine, University of Ottawa (CA).

Bram ROCHWERG. Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton (CA) and Department of Medicine, Division of Critical Care, McMaster University, Hamilton (CA).

Ahmed ZAHER. Oxford University Hospitals (UK). ESICM Next Committee member.

Kidney transplantation is the most common solid organ transplant performed worldwide. New advances in transplant medicine have expanded the indications for kidney transplantation, and nowadays, many kidney recipients are elderly patients who possibly have more comorbidities.

Up to 6% of kidney transplant recipients experience a life-threatening complication requiring intensive care unit admission, primarily in the late post-transplant period (≥6 months). The most common medical complications requiring ICU admission in the immediate postoperative period are cardiac events and infections.

Approximately 40% of recipients throughout their ICU stay require renal replacement therapy. In-hospital mortality can be as high as 30% and is related to the severity of the acute illness and the reason for admission to the ICU.

To further discuss the challenges involved in managing these patients in the ICU, we invited Dr Clare MacEwen, a specialist in the field.

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Speakers

Clare MACEWEN. Intensive care, Renal and a critical care echocardiography consultant, Oxford university hospitals (UK).

Ahmed ZAHER. Oxford University Hospitals (UK). ESICM Next Committee member.

Neuromonitoring is considered a crucial and fundamental process to monitor patients in critical care settings.

In this podcast, ESICM NEXT member Denise Battagliani interviews Chiara Robba on the ultimate findings regarding neuromonitoring, including:

• basics of neuromonitoring research;
• indications for neuromonitoring of patients who do (not) suffer any direct brain injury;
• the rationale in neuromonitoring patients with sepsis, COVID-19 and liver failure and the most appropriate tools to use for each of this cohort of patients;
• the use of neuromonitoring tools during the perioperative period for neurosurgical patients and patients who undergo cardiac and vascular surgeries.

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Speakers

Chiara ROBBA. Consultant in Neuro and General Intensive Care, Policlinico San Martino Genoa, (IT). Chair-Elect of the Neuro Intensive Care section of the ESICM.

Denise BATTAGLINI. Consultant in intensive care at San Martino Policlinico Hospital, Genoa, Italy (IT). ESICM NEXT Committee Member.

Systemic corticosteroids decrease mortality in critically ill patients with COVID-19, and the World Health Organization, therefore, recommends dexamethasone 6 mg daily for up to 10 days for patients with severe or critical COVID-19. In addition, higher doses of systemic corticosteroids have been used in patients with COVID-19 and non-COVID-19 acute respiratory distress syndrome [3, 5, 6], and higher doses have been hypothesised to benefit patients with severe or critical COVID-19. However, the balance between benefit and harm remains uncertain.

The COVID STEROID 2 trial compared a higher (12 mg) versus recommended dose (6 mg) of dexamethasone daily, for up to 10 days, in patients with COVID-19 and severe hypoxaemia.

Dr Granholm was interviewed by ICM Associate Editor Dr Shankar-Hari about the methodology and the findings of the study.

Original paper: Dexamethasone 12 mg versus 6 mg for patients with COVID-19 and severe hypoxaemia: a pre-planned, secondary Bayesian analysis of the COVID STEROID 2 trial

Speakers

Anders GRANHOLM. Department of Intensive Care, Rigshospitalet—Copenhagen University Hospital (DK) and Collaboration for Research in Intensive Care (CRIC), Copenhagen (DK).

Manu SHANKAR-HARI. Usher Institute, University of Edinburgh (UK) and Centre for Inflammation Research, University of Edinburgh (UK)and School of Immunology and Microbial Sciences, King's College London, (UK). ICM Associate Editor.

Attempts at improving cardiac arrest outcomes have increasingly included extracorporeal techniques to re-establish circulation. In particular, the application of veno-arterial extracorporeal membrane oxygenation (ECMO) during cardiac arrest is called extracorporeal cardiopulmonary resuscitation (ECPR).

However, there is much debate about the impact of ECPR use on survival and neurological and functional recovery in adults suffering cardiac arrest.

These issues have been evaluated in a systematic review conducted by Dr Abrams et al.

Listen to the following podcast to hear more about which patients are most likely to benefit from EPCR, required resources and relevant ethic issues on using EPCR.

Original article: Extracorporeal cardiopulmonary resuscitation in adults: evidence and implications

Speakers:

Darryl ABRAMS. Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York (USA).

Laura BORGSTEDT. Department of Anesthesiology, Klinikum rechts der Isar, Technical University of Munich, Munich (DE).

Metabolic resuscitation is an adjunctive therapy for sepsis and septic shock, which consists of a combination of vitamin C, glucocorticoids, and vitamin B1 or their components. Recently, there has been considerable interest in this treatment. However, due to the wide range of combinations of its components, there is no evidence for the effectiveness of this therapy.

To fill this gap, a network meta-analysis (NMA) and component NMA was conducted. This analysis summarised the available evidence concerning these therapies and determined any incremental effect of each component when added to sepsis treatment.

In the following podcast, Dr Fuji explains the methodology employed and details the study results.

Original paper: Effect of adjunctive vitamin C, glucocorticoids, and vitamin B1 on longer-term mortality in adults with sepsis or septic shock: a systematic review and a component network meta-analysis.

Speakers:

Tomoko FUJII. Intensive Care Unit, Jikei University Hospital, 3-25-8, Nishi-Shimbashi, Minato-ku, Tokyo, 105-8461 (JP). Australian and New Zealand Intensive Care Research Centre.

Inès LAKBAR. Service Anesthésie - Réanimation Pr LEONE - AP-HM - Hôpital Nord - Marseille (FR).

Integrating palliative care in critical care is advocated as a way to mitigate physical and psychological burdens for patients and their families and improve end-of-life care.

Despite the emerging literature published that supports this positive association, the quality of evidence remains limited, in large part due to limitations in the definition of interventions, poor precision of effect estimates and the large variation in study designs.

In a systematic review, Dr Victoria Metaxa et al. highlight the heterogeneous interventions and diverse outcome metrics used and propose a new classification of interventions to facilitate future comparisons.

Follow our conversation with Dr Victoria Metaxa and Dr Christiane Hartog in the following podcast.

Speakers:

Ahmed ZAHER. Oxford University Hospitals (UK). ESICM Next Committee member.

Victoria METAXA. King’s College Hospital, London (UK).

Christiane HARTOG. Charité Universitätsmedizin, Berlin (DE).

Given the rapidity with which critically ill patients with bleeding can deteriorate, having a standardised approach to transfusion in these patients can be of great assistance to clinicians working in time-pressured circumstances.

An expertise task force created within ESICM has developed an international guideline that provides guidance for clinicians caring for critically ill patients with massive and non-massive bleeding.

26 clinical practice recommendations (2 strong recommendations, 13 conditional recommendations, 11 no recommendations), and 11 PICO (population, intervention, comparison, and observation) with insufficient evidence to make recommendations were generated and published.

To understand and clarify further this research, Dr Helms, ICM Associate Editor, has interviewed one of the leading experts of this study Dr A. Vlaar. Check out the following podcast to learn more.

Speakers:

Julie HELMS. Service de Médecine Intensive-Réanimation, Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg (FR). Associate Editor of Intensive Care Medicine

Alexander P.J. VLAAR. Department of Intensive Care Medicine, Amsterdam UMC, Amsterdam (NL).

Ultrasonography is an evolving skill in critically ill patients. We provide a large number of statements regarding the required ultrasonographic basic skills for the management of critically ill patients.

Original article:

Speakers: Basic ultrasound head-to-toe skills for intensivists in the general and neuro intensive care unit population: consensus and expert recommendations of the European Society of Intensive Care Medicine

Chiara ROBBA. Anesthesia and Intensive Care, Ospedale Policlinico San Martino, IRCCS per l’Oncologia e le Neuroscienze, Genoa (IT) and Department of Surgical Sciences and Integrated Diagnostics (DISC), Genoa (IT). Chair, ESICM Neuro Intensive Care Section.

Adrian WONG. Department of Critical Care, King’s College Hospital, London (UK). Chair, ESICM Social Media & Digital Content Committee.

Antoine VIEILLARD-BARON. Intensive Care Medicine Unit, Assistance Publique-Hôpitaux de Paris, University Hospital Ambroise Paré, Billancourt, Boulogne (FR) and INSERM UMR-1018, CESP, Team Kidney and Heart, University of Versailles Saint-Quentin en Yvelines, Villejuif (FR). ESICM Secretary.

Laura GALARZA. Hospital General Universitario, Castellón (ES); Chair-Elect, ESICM NEXT Committee

Critical illness occurs frequently after a new diagnosis of hematologic malignancy and has high associated mortality.

Baseline characteristics at diagnosis can help identify those patients at the highest risk of critical illness.

Original article: Critical illness in patients with hematologic malignancy: a population-based cohort study

Speakers:

Bruno L. FERREYRO. Interdepartmental Division of Critical Care Medicine, University of Toronto (CA).

Laveena MUNSHI. Interdepartmental Division of Critical Care Medicine, University of Toronto (CA).

Gaetano SCARAMUZZO. Department of Translational medicine, University of Ferrara (IT).

We report the results of a consensus conference based on a systematic review of the literature and experts opinions assessing the management of cancer patients in the ICU.

Original article: Critically ill cancer patient’s resuscitation: a Belgian/French societies’ consensus conference

Speakers:

Rahul COSTA-PINTO. Austin Hospital, Melbourne - Australia; ESICM NEXT Committee Member.

Anne-Pascale MEERT: Service de Médecine Interne, Soins Intensifs et Urgences Oncologiques, Institut Jules Bordet (Université Libre de Bruxelles, ULB), Brussels (BE).

In this network meta-analysis, as compared to normothermia (37–37.8 °C), we found that deep hypothermia (31–32 °C), moderate hypothermia (33–34 °C) and mild hypothermia (35–36 °C) may have no effect on survival and functional outcome among comatose survivors of out-of-hospital cardiac arrest. However, both deep and moderate hypothermia were associated with an increased risk of arrhythmia compared to normothermia.

Original paper: Targeted temperature management following out-of-hospital cardiac arrest: a systematic review and network meta-analysis of temperature targets

Speakers:

Claudio SANDRONI. Institute of Anesthesiology and Intensive Care Medicine, Università Cattolica del Sacro Cuore, Rome (IT) and Department of Intensive Care, Emergency Medicine and Anesthesiology, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome (IT). Associate Editor of the ICM Journal.

Jerry P. NOLAN. Department of Anaesthesia and Intensive Care Medicine, Royal United Hospital, Bath (UK) and Warwick Clinical Trials Unit, University of Warwick, Coventry (UK).

Shannon M. FERNANDO. Division of Critical Care, Department of Medicine, and Department of Emergency Medicine, University of Ottawa, Ottawa, ON (CA).

The updated version of the guidelines will be presented during the ESICM LIVES virtual conference, LIVES 2021. 

The evidence-based guidelines, published in Critical Care Medicine and Intensive Care Medicine, reflect best practices and recommendations for the treatment of sepsis and septic shock in adults and are revised regularly to account for new research. 

Speakers:

Manu SHANKAR-HARI. Department of Critical Care Medicine, Guy's and St Thomas' NHS Foundation Trust, London, UK; School of Immunology and Microbial Sciences, Kings College London, London, UK.

Andrew RHODES. St George's Hospital, London, UK

Laura EVANS. Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, University of Washington, USA

The manipulation of arterial carbon dioxide levels (PaCO2) is easy, and hyperventilation (HV) has been a common ICP-lowering strategy for over half a century.

However, hyperventilation-induced vasoconstriction is a double-edged sword. It reduces cerebral blood volume and intracranial volume, and therefore, lowers ICP.

We observed huge variability among centres in PaCO2 values and use of HV. Although causal inferences cannot be drawn from these observational data, our results suggest that, in patients with severe intracranial hypertension, HV is not associated with worse long-term clinical outcomes.

Original article: Management of arterial partial pressure of carbon dioxide in the first week after traumatic brain injury: results from the Center-TBI study

Speakers:

David K. MENON. Neurocritical Care Unit, Addenbrooke’s Hospital, Cambridge, UK

Laura BORGSTEDT. Clinic for Anaesthesiology and Intensive Care Medicine - Klinikum rechts der Isar of the Technical University of Munich

Sepsis is associated with an increased long-term risk of cardiovascular events, which is observed for at least 5 years after the index admission. This risk represents a critical area of potential intervention to improve post-sepsis outcomes.

Systematic Review and Meta-Analysis

Speakers:

Ignacio MARTIN-LOECHES. Department of Anaesthesia and Intensive Care, St. James's Hospital, Dublin (IE) and Multidisciplinary Intensive Care Research Organization (MICRO), Trinity College Dublin, Dublin (IE). Associate Editor of Intensive Care Medicine.

Patrick LAWLER. Peter Munk Cardiac Centre, University Health Network, Toronto (CA).

Leah B. KOSYAKOVSKY. Peter Munk Cardiac Centre, University Health Network, Toronto (CA); Beth Israel Deaconess Medical Center, Harvard Medical School.

In this multicenter international cohort in 19 ECMO centres from five countries in the Middle East and India, 307 critically ill COVID-19 patients received ECMO therapy, of whom 138 (45%) survived to home discharge.

The current study showed that new satellite ECMO centres could be safely implemented with appropriate close supervision of regional experts and may provide favourable outcomes in highly selected critically ill patients.

Original study: Implementation of new ECMO centres during the COVID-19 pandemic: experience and results from the Middle East and India

Speakers:

Prof Alain COMBES. Professor of Intensive Care Medicine at Sorbonne Université, Paris (FR) and head of the ICU department at La Pitié-Salpêtrière Hospital, Assistance Publique Hopitaux de Paris (FR). Associate Editor of ICM.

Dr Ahmed RABIE. Critical Care Acting ECMO Consultant - Head of CCD-ECMO committee at King Saud Medical City, Critical Care Department, Riyadh (SA).

For family members of survivors, the ICU diary is an important source of medical information, provides a way for them to register their presence at the patient’s bedside and express their feelings, and contributes to humanizing the ICU staff.

For relatives of non-survivors, the diary also works as a concrete memory of their loved one’s last days before dying, helping relatives to cope with bereavement.

Systematic Review: Exploring family members’ and health care professionals’ perceptions on ICU diaries: a systematic review and qualitative data synthesis.

Imaging in Intensive Care Medicine from the inside: Caring for COVID‑19 patients and their relatives with the ICU diary

Speakers:

Dr Rahul COSTA-PINTO. Austin Hospital, Melbourne - Australia; ESICM NEXT Committee Member.

Mr Johannes MELLINGHOFF. Critical Care Nurse & Senior Lecturer Kingston & St Georges University of London. Current Chair N&AHP Committee of the ESICM.

Dr Bruna BRANDAO BARRETO. Intensive Care Unit, Hospital da Mulher, Salvador, Brazil.

Intracranial pressure monitoring in patients with acute brain injury in the intensive care unit (Synapse-ICU): an international, prospective observational cohort study.

The practice of continuously measuring intracranial pressure (commonly referred to as ICP) in comatose patients after haemorrhagic stroke or head injury is standard practice in many countries.

However, it is uncertain whether monitoring-guided therapies will yield significant results. Nevertheless, data collected from the study confirms what already seemed evident from experience.

Furthermore, it offers valuable scientific support for both those realities where monitoring had not been used and for those where this nonetheless invasive practice has already been used for years.

Speakers:

Dr Segun OLUSANYA. Specialty Trainee in Intensive Care Medicine in London (UK).

Prof Giuseppe CITERIO. Associate Professor, School of Medicine and Surgery of the University of Milano-Bicocca, Monza, (IT). Director of the NeuroIntensive Care Unit, San Gerardo Hospital, Monza (IT).

Evolving changes in mortality of 13,301 critically ill adult patients with COVID-19 over 8 months.

Age, frailty and adjusted mortality of critically ill patients have progressively reduced over the course of the COVID-19 pandemic. Non-invasive respiratory support has been increasingly used and was independently associated with improved 30-day survival in our study.

Future randomised trials are needed to determine if a management strategy based on early non-invasive support for respiratory failure improves outcomes.

Speakers:

Dr Otavio RANZANI. ICM Associate Editor. Barcelona Institute for Global Health, ISGlobal, Barcelona (ES) Pulmonary Division, Heart Institute (InCor), Hospital Das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo (BR).

Dr Fernando BOZZA. Instituto Nacional de Infectologia Evandro Chagas (INI), FIOCRUZ, and D’Or Institute for Research and Education (IDOR), Rio de Janeiro (BR).

Natural history, trajectory, and management of mechanically ventilated COVID-19 patients in the United Kingdom.

In a cohort of COVID-19 patients treated in the United Kingdom, progressive respiratory failure was increasingly associated with mortality. Evidence-based triggers for ARDS interventions, in particular prone position, were not implemented, had delayed application, or showed poor responsiveness in a sizeable proportion of patients with progressive hypoxaemia. How this implementation gap and lack of response to conventional ARDS interventions may have contributed to excess mortality across the pandemic deserves further interrogation.

Speakers:

Prof Stefan SCHALLER. Charité, Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Dpt of Anesthesiology and Operative Intensive Care Medicine, Berlin (DE).

Dr Brijesh V. PATEL. Division of Anaesthetics, Pain Medicine & Intensive Care, Department of Surgery & Cancer, Faculty of Medicine, Imperial College London (UK). Department of Adult Intensive Care, The Royal Brompton and Harefield NHS Foundation Trust, Sydney Street, London (UK).

In this randomized clinical trial that included 999 patients, the use of a stylet for tracheal intubation in critically ill adult patients resulted in significantly higher first‑attempt intubation success than the use of tracheal tube alone. The incidence of serious adverse events evaluated by the rate of traumatic injuries related to tracheal intubation was similar in the two groups.

Speakers:

Prof Sheila MYATRA. Consultant Critical Care Specialist, Department of Anaesthesiology, Critical Care and Pain, Tata Memorial Hospital, Mumbai (IN). Secretary, Indian College of Critical Care Medicine of the Indian Society of Critical Care Medicine (ISCCM).

Prof Samir JABER. Head of the Critical Care and Anesthesia Department of Saint-Eloi University Hospital, Montpellier (FR). Full "exceptional class" (highest degree) professor in Anesthesiology and Critical Care, Faculty of Medicine of Montpellier. Senior Deputy Editor of the ICM Journal.

We are confronted daily with complex ethical issues during the care of our patients in intensive care units. The principles of biomedical ethics may guide us with regard to concerns for ethical decision-making.

Although globalisation brings enormous richness and diversity through multicultural structures, ethical issues may challenge intensivists in these conditions. However, the 'moral stresses' that health professionals experience are almost always ignored.

Speakers:

Dr Burcin Halacli.  Internist and intensivist at Hacettepe University, Faculty of Medicine, Department of Internal Medicine, Division of Intensive Care Medicine, Ankara, Turkey and ESICM NEXT Committee member.

Prof Erwin Kompanje. Consultant in Clinical ethics at Erasmus University Medical Center, Department of Intensive Care in Rotterdam (NL), and interestingly he is Honorary curator and senior taxidermist at the Natural History Museum Rotterdam. He has lots of papers, more than 4000 citations about biomedical ethics, clinical ethics and intensive care medicine.

In Africa, in children hospitalised with severe pneumonia with oxygen saturations between 80 and 91% who did not receive oxygen, mortality assessed at 48 h (1.4%) was comparable to the usual method of oxygen delivery (low-flow oxygen; LFO (2.5%)) and in those receiving high-flow nasal therapy (HFNT, 1.1%).

The potential impact of HFNT on patient-centred outcomes and on resources, particularly oxygen supplies, should stimulate further exploration particularly in children with severe pneumonia managed in low resource settings.

Read the article in the ICM Journal: https://rdcu.be/ckTgA.

Speakers:

Prof Mark PETERS. Professor of Paediatric Intensive Care, Infection, Immunity & Inflammation Dept - UCL GOS Institute of Child Health (Faculty of Pop Health Sciences).

Prof Kathryn MAITLAND. British paediatrician, professor of infectious diseases at Imperial College London, director of the ICCARE Centre at the Institute of Global Health Innovation and an Honorary Fellow at MRC Clinical Trials Unit, University College, London. Since 2000 she has been based at the KEMRI-Wellcome Trust Research Programme, in Kilifi, Kenya.

Expanding controlled donation after the circulatory determination of death: statement from an international collaborative. This International Collaborative Statement aims at expanding cDCDD in the world to help countries progress towards self-sufficiency in transplantation and offer more patients the opportunity of organ donation. The Statement addresses three fundamental aspects of the cDCDD pathway:

1. First, it describes the process of determining a prognosis that justifies the WLST (withdrawal of life-supporting therapies).
2. Second, it establishes the permanent cessation of circulation to the brain as the standard to determine death by circulatory criteria.
3. Finally, the Statement highlights the value of perfusion repair for increasing the success of cDCDD organ transplantation.

Speakers:

Prof Giuseppe CITERIO. Associate Professor, School of Medicine and Surgery of the University of Milano-Bicocca in Monza, (IT); director of the NeuroIntensive Care Unit, San Gerardo Hospital in Monza (IT).

Prof Francis L. DELMONICO. Chief Medical Officer, New England Donor Services (US), Professor at Harvard Medical School at Massachusetts General Hospital and Emeritus Director of Renal Transplantation.

Dr Beatriz DOMÍNGUEZ-GIL. General Director, Organización Nacional de Trasplantes, Madrid (ES).

Following on from the recent ESICM webinars on haemodynamic monitoring and vasopressors, Dr Wong interviews Dr Rola on his thoughts on a range of issues, from the use of ultrasound, venous congestion to the Pulmonary Artery Catheter as well as his predictions for the direction of future research.

Speakers:

Dr Adrian WONG. Consultant in Intensive Care Medicine and Anaesthesia, King's College Hospital, London (UK) and current Chair of the ESICM Editorial and Publishing Committee (EPC).

Dr Philippe ROLA. Chief of Service, Intensive Care Unit, Santa Cabrini Hospital, Montreal, Canada.

Ultrasound has become an indispensable tool while caring for critically ill patients. Increasing availability at bedside and the role that it plays in the diagnosis and management of patients had made that clinicians incorporate ultrasound as a part of their bedside clinical examination. Some colleagues argue that it can be a good hemodynamic tool too, however, others disagree.

Speakers:

Dr Laura GALARZA. Intensivist at the University General Hospital in Castellon, Spain and Deputy Chair of the ESICM NEXT committee.

Prof Xavier MONNET. Professor of Intensive Care at the Paris-South University, working in the Medical Intensive Care Unit of the Bicêtre Hospital. Prof. Monnet’s main fields of research are acute circulatory failure and its treatment, haemodynamic monitoring and heart-lung interactions. He is the Chair of the ESICM cardiovascular dynamics section. 

Severe traumatic brain injury (TBI) is a leading cause of morbidity and mortality, particularly in young adults, where 50% of survivors cannot live independently six months post injury. 

Speakers:

Dr Rahul COSTA-PINTO. Austin Hospital, Melbourne - Australia; ESICM NEXT Committee Member.

Prof Andrew UDY. The Alfred Hospital, Melbourne - Australia; principal investigator of the BONANZA study (Brain Oxygen Neuromonitoring in Australia and New Zealand Assessment Trial).