Perioperative intensive care (POIC)Aims and Missions
Chair and Deputy
Chair Claudia Spies - Berlin, Germany
Membership
Activities Since the last Section's meeting, the decision was taken to focus for the next year on four research areas within the working groups. All ESICM members interested in participating should contact the Section Chairs or the Working Group (WG) Chairs to receive the protocols. Meetings agenda and minutes
The next meeting will be held in Brussels during the 30th ISICEM Congress 9-12 March 2010. Details about dates and locations will be communicated as soon as available.
The minutes of the Section meeting held in Lisbon are available here. The minutes of the Section meeting held in Brussels on 25 March 2009 are available here. Attached documents: ESICM POIC Admission Discharge Criteria
Working Groups
1. ESICM Working on Abdominal problems (AP)
Acute abdominal problems (AP) like severe acute pancreatitis, intra-abdominal hypertension and abdominal compartment syndrome, abdominal sepsis, acute gastro-intestinal failure or acute bowel injury (in analogy to acute lung injury (ALI), acute hepatic failure and many others are more and more recognized as a substantial causes of morbidity and mortality in critically ill patients. These patients are faced with complex clinical conditions like e.g. open abdomen, short bowel syndrome, abdominal sepsis or renal failure. Treatment of these patients remains troublesome without good standardization for definitions and without evidence based guidelines, but good results can be achieved by multimodal, multidisciplinary treatment by dedicated teams. The primary goal of this WG AP is to establish an international collaboration group with the final aim to improve and standardize care and outcome of patients with AP. This can be achieved by collaborative research projects, guideline development, joint data registration and international exchange of health care workers and researchers. The acquired knowledge and results of research will be published in appropriate scientific journals, and shared with his peer group each year during the Sections meetings at (inter)national scientific meetings.
One part of the working group on Abdominal Problems will focus on the integration of goal-directed therapy to guide volume and fluid therapy and catecholamine therapy into an overall hemodynamic algorithm to established standardized hemodynamic perioperative targets. This approach takes into account that hemodynamic monitoring and goal directed therapy in perioperative patients have impact on outcome of patients (Goal directed hemodynamic and volume therapy proposal).
Another part of the working group on Abdominal Problems will focus on acute intestinal failure (IF) and this is the subject of a multicentric study on gastro-intestinal failure in the ICU (GIF-study). This study is endorsed by the ECCRN, WSACS and ESPEN (GIF Study protocol - GIF Invitation letter)
In up to 30% of cases antibiotics are begun without reliable signs of infection or isolation of a pathogen. The frequency of inefficient use of antibiotics is estimated to be as high as 50%. Against this background, a computerised decision support program has been developed to assist the rational use of antibiotics in critically ill patients. Existing local, national and international guidelines have been transferred into a user-friendly electronic format. Based on the ability to merge information in dependency to relevance for special scenarios this technique has the potential to help clinicians with bedside decision making based on current evidences. The program can quickly provide information regarding diagnosis, therapy and local resistance patterns and forms a basis for individual therapy decisions (here; see below addendum 2). The program basis named “ABx” is an official project of the German Society of Anaesthesiology and Intensive Care Medicine (DGAI) and is currently used in more than 100 ICUs all over Germany.
Now, the WG EWAIT (Early Web-Based Anti-Infective Treatment) is launched to bring together experts and scientists in the field of anti-infective treatment to advocate implementation of evidence based recommendations and to act as a European response panel. Thus, further development of the computer program inhere the possibility for more ICUs in different countries to participate. The Section Chair will also involve the other sections pertinent to this topic: “Infection" and “Systemic inflammation and sepsis”.)
In terms of an early and safe use of antibiotics in severe infections an international research group was founded to evaluate the use of a CDSS system in an European research project:EARLY E-GUIDED USE OF ANTIBIOTICS RELATED TO RESISTANCE DATA (EGUARD) - intended for EU FP7 funding.
Hemodynamic monitoring and goal directed therapeutic approaches in perioperative patients can reduce length of intensive care unit treatment, length of hospital stay and improve outcome. The primary goal of this working group is to establish a European consensus process with the aim to generate international guidelines for the hemodynamic and volume therapy in perioperative patients. This guideline process can be achieved by providing a basis for international experts in the field within this working group helping us to start an integrated effort in designing multicentre trials, collaborative research projects, and international exchange of researchers in the field. Further goals are to connect the activities of this group with national societies (like the DGAI-German society of anaesthesiology and intensive care medicine) and international societies (e.g. EACTA, SCCM, SCA).
Delirium is seen in every sixth of our patients in the recovery room and in 30 – 80% of the patient in the ICU. Cognitive dysfunction is seen in 30% of the surgical patients at discharge from the hospital and the relative risk to develop dementia is 10-fold elevated. As delirium and cognitive dysfunction are relevant with respect to long-term mortality, perioperative monitoring - we think - should be performed. The scores used to monitor delirium are currently not available in all European languages. The translation has to be performed according to a standardized protocol (ISPOR task force for translation and cultural adaptation. Value Health 2005; 8 94-104). The intention of the working group on postoperative delirium and cognitive dysfunction group (WG-PoDeCoD) is to improve and standardize care and outcome of patients.
Download the Protocol of the Joint Working Group Meeting (PDF) of the POIC and NICEM section at the ESICM Conference in Vienna
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