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
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