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.