ESICM Talk

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.