ESICM Talk

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).