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RESULTS FROM SIX HIGHLY ANTICIPATED RCTs

RESULTS FROM SIX HIGHLY ANTICIPATED RCTs

CARDIOVASCULAR & PERIOPERATIVE INTENSIVE CARE

In this first of special Thematic Sessions at LIVES 2014 focused on Clinical Trials in the ICU, the results of many randomised, controlled trials will be presented for the first time, and published simultaneously in major scientific journals. The first presentation of this groundbreaking session comes from Zandrie Hofman: High-protein enteral nutrition enriched with immune-modulating nutrients vs standard high-protein enteral nutrition and nosocomial infections in the ICU: a randomised clinical trial.

Enteral nutrition is the preferred route of feeding over parenteral nutrition for critically ill patients requiring nutritional support. However, controversy exists on the use of so called immune modulating nutrients like glutamine, fish-oils or antioxidants, reflected by nutritional recommendations of the European and American Society for Parenteral and Enteral Nutrition and the Society for Critical Care Medicine. 

This MetaPlus study among 301 successfully enteral  fed ventilated critically ill patients, comparing an immune modulating enriched enteral nutrition with a high protein containing enteral nutrition (Nutrison Advanced Protison), showed no benefit on the primary outcome parameter infectious complications and signs of an increased 6 months mortality rate.  For reasons of lack of efficacy and a possible harmful effect, these observations should lead to a critical evaluation of the current guidelines on use of immune ingredients in mechanically ventilated critically ill patients.

"Immune modulating high protein enteral nutrition has no benefit over standard high protein enteral nutrition and may be harmful as suggested by increased 6 months mortality " Speaker Zandrie Hofman (Utrecht, Netherlands)




Does high volume haemofiltration improve patients’ outcome after complicated heart surgery?

Alain Combes and colleagues aimed to discover the answer to this intriguing question with their recent study, The HEROICS Study: Haemofiltration to rescue severe shock following cardiac surgery.

Postcardiac surgery shock is associated with high morbidity and mortality rates. By removing toxins and proinflammatory mediators and correcting metabolic acidosis, high-volume haemofiltration might halt the vicious circle leading to death by improving myocardial performance and reducing vasopressor dependence in this situation. 

Does 48 h of high-volume haemofiltration improve outcomes of patients with severe cardiovascular dysfunction requiring high-dose catecholamines after heart surgery? 

How does this approach compare to a conservative strategy with standard-volume haemodiafiltration only for patients with persistent, severe acute kidney injury?

Participants will discover the answers to these questionsin this unmissable session presenting results from the HEROICS Study. 

Other clinical trials to be presented in this Thematic Session include:

  • A randomised trial of fenoldopam for the prevention and treatment of acute kidney injury after cardiac surgery
  • Liberal or restrictive transfusion strategy after cardiac surgery: The Transfusion Indication Threshold Reduction (TITRe 2) multi-centre randomised controlled trial. The TITRe2 Study
  • The PARAMEDIC trial
  • Hydrocortisone for prevention of pneumonia in patients with severe traumatic brain injury (CORTI)

Don't miss this opportunity to hear the results of all of these recent RCTs and interact with the investigators involved!

Thematic Session ~ CLINICAL TRIALS IN THE ICU - CARDIOVASCULAR & PERIOPERATIVE INTENSIVE CARE

29.09.2014, 16:00 – 18:00, room Vienna

 


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