Hot Topics - FFICM Preparation Course 230215

download Hot Topics - FFICM Preparation Course  230215

If you can't read please download the document

  • date post

    21-Apr-2017
  • Category

    Healthcare

  • view

    2.926
  • download

    4

Embed Size (px)

Transcript of Hot Topics - FFICM Preparation Course 230215

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