How do you INTERACT(2)?

Toby writes:

Hi folks,

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.

Cheers

Toby.

ACURASYS – should we paralyse early?

Toby writes:

Hi all,

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.
Cheers, Toby.

Neuromuscular Blockers in Early Acute Respiratory Distress Syndrome – The ARDS et Curarisation Systematique (ACURASYS) study

N Engl J Med 2010;363:1107-16.

On Trac?

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

FACTT or fiction?

Comparison of Two Fluid-Management Strategies in Acute Lung Injury,
N Engl J Med 2006;354:2564-75. 

Pulmonary-Artery versus Central Venous Catheter to Guide Treatment of Acute Lung Injury, N Engl J Med 2006; 354:2213-2224

Hi folks,

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.

Cheers

Toby.

Chloride – friend or foe?

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.

Hi Folks,

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.

Cheers

Toby.

Podcasts

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.

 

Food for thought…

Hi Folks,

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.

Cheers

Toby.

Early Parenteral Nutrition in Critically Ill Patients with Short-term Relative Contraindications to Early Enteral Nutrition , Doig et al.

 JAMA, May 22/29, 2013—Vol 309, No. 20 

APACHE II – back to the future?

Toby writes:

Hi folks,

Yes, it was the year that the great pioneering Australian icon, that bastion of Australian fine art and televisual excellence – Neighbours – was launched: 1985.  And in the same way that Neighbours has become an integral part of contemporary British culture, the APACHE II scoring system, published the same year, has become the accepted disease-severity classification currency in critical care publishing.  So, this week we’re taking a step back in time to again examine a significant past paper  – Ian is presenting the Knaus APACHE II paper. Are such studies of foreign populations applicable to the British populace? Do they accurately represent the people they purportedly sample? Can these models be used to predict the behaviour and outcomes of individuals?  Hope to see you there, 7:30 am on Friday as usual.

APACHE II: A severity of disease classification system 

Knaus WA, Draper EA, Wagner DP, Zimmerman JE.

Published in Crit Care Med. 1985 Oct;13(10):818-29.

Is upside down the new right way round? Maybe the Aussies got it right…

Toby writes:

So all you non-believers, the ventilatory inquisitors have the evidence, and it’s enough to make you fall prostrate at the PROSEVA altar. This week we’re looking at the paper recently published by Guerin et al in the NEJM regarding prone ventilation for ARDS. This paper has, not unexpectedly, generated much interest – it’s not often that an intervention in ICU can boast such an impressive (16.8%!) absolute reduction in mortality. Phil has agreed to present at late notice, so, as one good turn deserves another, and because I’m prone to recumbency this early in the AM, there’ll be caffeine and cakes – upside down of course – at this week’s meeting. Is the patient for turning? Why not roll out of bed early on Friday to find out!

Prone Positioning in Severe Acute Respiratory Distress Syndrome 

Claude Guérin, M.D., Ph.D.,et al for the PROSEVA Study Group

Published in N Engl J Med 2013. DOI: 10.1056/NEJMoa1214103

Stayin’ alive, stayin’ alive

Duration of resuscitation efforts and subsequent survival after in-hospital cardiac arrest

Zachary D. Goldberger, MD, MS, Paul S. Chan, MD, MSc, Robert A. Berg, MD, Steven L. Kronick, MD, MS, Colin R. Cooke, MD, MSc, Mingrui Lu, MPH, Mousumi Banerjee, PhD, Rodney A. Hayward, MD, Harlan M. Krumholz, MD SM, and Brahmajee K. Nallamothu, MD, MPH for the American Heart Association’s Get With the Guidelines®-Resuscitation (formerly, the National Registry of Cardiopulmonary Resuscitation) Investigators

Published in final edited form as:
Lancet. 2012 October 27; 380(9852): 1473–1481. doi:10.1016/S0140-6736(12)60862-9.

From Tobster:
Hi all,

Journal club this Friday deal with when to call time on resuscitation – does this tell us that we should be flogging the proverbial for better outcomes overall, or is it that, if we anticipate a better outcome, we’re more likely to resuscitate for longer? The paper is attached.

Cheers