ESICM Talk

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.

Help us review our educational podcasts! Complete this short survey here.

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.

Help us review our educational podcasts! Complete this short survey here.

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.

Help us review our educational podcasts! Complete this short survey here.

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).