ESICM Talk

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