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