Hi all, and welcome. This site is designed to co-ordinate the activities of the Oxford Critical Care trainee community. It aims to have links to Journal Club articles which have been reviewed, along with useful information about training in the region and nationally.
If you have any comments or suggestions please do contribute.
Dogma dictates that we should slowly and scarcely reduce BP in patients with intracerebral haemorrhage, for fear of inducing ischaemia. This week Joel is presenting a recent paper on blood pressure management in ICH that challenges this assertion. Friday, 7:30, ICU seminar room as usual. The paper is attached.
This week Ignacio is presenting a significant past paper, the 2010 ACURASYS study, which investigated the early use of neuromuscular blockers in severe ARDS. Do NMB’s improve outcomes in this cohort? Does short-term paralysis lead to long-term weakness? Come along Friday 07:30 in the AICU seminar room to find out. The paper is here.
Neuromuscular Blockers in Early Acute Respiratory Distress Syndrome - The ARDS et Curarisation Systematique (ACURASYS) study
N Engl J Med 2010;363:1107-16.
This week’s journal club is on a home-grown study, TRACMAN. It took a while to get out there but now it’s here in all it’s glory. Matt F is doing the honours.
Effect of Early vs Late Tracheostomy Placement on Survival in Patients Receiving Mechanical Ventilation - The TracMan Randomized Trial
Young et al, JAMA, May 22/29, 2013—Vol 309, No. 20
This week we again look back at an important past paper, and stay on theme with a respiratory-related study, looking at fluid management in ALI/ARDS guided by CVP or PAC: the FACTT study – a study of an out-dated entity managed using obsolete technology, or a seminal study of timeless utility? Come along on Friday to express your opinions. The study was published as two papers in the NEJM – one looking at the fluid balance issue (which will be the focus of Friday’s presentation), the other comparing CVP vs PAC – both of which are attached here. Hope to see you there, 7:30 am as usual.
Association Between a Chloride-Liberal vs Chloride-Restrictive Intravenous Fluid Administration Strategy and Kidney Injury in Critically Ill Adults
JAMA. 2012;308(15):1566-1572. doi:10.1001/jama.2012.13356.
We still don’t have the ideal fluid for every occasion, but we’re getting closer to figuring out what not to give (thanks for coming starches) – should we add plain old chloride-containing fluids to the list? Are there problems beyond the concerns regarding the potential for hyperchloraemic acidosis? This week Enrico will be presenting a recent paper from JAMA that attempts to address this issue, where the authors draw some interesting conclusions. Hope to see you there, Friday 07:30.
Have a listen to Oxford’s Duncan Young being interviewed about the two international trials that he has headed this year, OSCAR and TRACMAN. These podcasts are from the ICN website, well worth a look, and he’s being interviewed by our own Segun and James.
In ICU, when, who, how, and how much to feed is about as clear as osmolite. This week we delve further into this melange with a recent paper looking at early TPN for those that cannot be fed enterally. Are we any closer to an answer to any of these questions? Come along on Friday, 7:30 am to find out. The paper is attached.
Early Parenteral Nutrition in Critically Ill Patients with Short-term Relative Contraindications to Early Enteral Nutrition , Doig et al.