hot topics - fficm preparation course 230215
TRANSCRIPT
Hot Topics.FFICM Preparation Day London February 23rd 2015
Rob Mac Sweeney
Hot Topics2015
2014
2013
2012
Major Research
Major Guidelines
Major Research Studies2015
Amato Study
Post hoc review of 9 RCTs
Multilevel Mediation Analysis
Functional Lung Size
P = (Pplt PEEP) = (Vt /CRS)
Vt / Pplat / PEEP P
P 7 cmH20 = 41% mortality
Requires validation
PROPPR
Pragmatic multicentre RCT
680 severely ill trauma patients
1:1:1 with 1:1:2 FFP / Plt / RC
mortality: Day 1
Day 30
Reduced exsanguination deaths
1:1:2 group caught up
Chlorhexidine Bathing
Pragmatic, Cluster Randomized Crossover study
9340 patients
Once daily 2% chlorhexidine
2 x 10 week periods each
in infections55 vs 60
2.86 vs 2.90 / 1000 pt days
Major Guidelines2015
SSAI - Fluid Resuscitation
Ascites Club
Major Research Studies2014
ALBIOS
Multicentre Open Label RCT
1795 patients with sepsis / shock
20% albumin + crystal vs crystal
Target serum albumin > 30g/l
28 day mortalityAlbumin: 31.8% vs 32%
90 day mortalityAlbumin: 41.1% vs 43.6%
ARISE
Australian / NZ RCT
EGDT vs Usual Care
Rivers algorithm
1600 patients with septic shock
90 mortalityEGDT 18.6% vs 18.8%
EGDT - more fluids, vasopressors, RC, dobutamine
ProCESS
American multicentre RCT
Testing Rivers EGDT protocol
EDGT vs Standard vs Usual care
1341 patients with septic shock
day 60 mortality21% vs 18.2% vs 18.9%
day 90 or 1 year mortality
CALORIES
Pragmatic, open label RCT
Enteral vs Parenteral nutrition
Could be fed by either route
2400 emergency ICU pts
Day 30 mortalityPN: 33.1% vs EN: 34.2%
PN less hypos or vomiting - no effect on infection
CIRC
Mechanical CPR vs Manual CPR
USA / European - OOHCA
4753 randomized, 522 excluded
ROSC: 28.6% v 32.3%
24 hour survival: 21.8% v 25%
Hosp discharge: 9.4% vs 11%
LINC
European open label RCT
Mechanical CPR & defibrillation
2589 OOHCA patients
4 hr survival: 23.6% vs 23.7%
CPC 1-2 survivalAt ICU / Hospital discharge
At 1 or 6 month
HARP-2
Multicentre, UK/Ireland RCT
Simvastatin vs Placebo
540 patients with ARDS
Ventilator-free days
Non-pulmonary organ failure -free days
28 day mortality
METAPLUS
European multi-centre RCT
301 pts expected ventilated >3/7
Immune enhancing nutrients
High protein diet both groups
new infections (53% vs 52%)
6/12 mortality with IMN54% vs 35%
PEITHO
European Multi-centre RCT
1,006 pts intermediate risk PE
Tenecteplase & heparin vs placebo & heparin
Death / CVS decompensation 2.6% vs 5.6%
Deaths: 1.2% vs 1.8%; P=0.42
Stroke: 2.4% v 0.2%; Bleeding
SEPSISPAM
Multi-centre open label RCT
776 pts with septic shock
MAP 80 - 85 vs 65 70
D28 mortality 36.6% vs 34%
D90 mortality 43.8% vs 42.3%
serious adverse event
AF with higher BP
RRT with lower BP chronic HTN
TRISS
European multi-centre RCT
1005 pts septic shock & anaemia
Transfuse Hb