All posts by Velia Antonini

The Surviving Sepsis Campaign Rapid Guidelines on the Management of Critically Ill Adults with COVID-19

The SARS-CoV-2 Coronavirus is the cause of rapidly spreading illness, Coronavirus Disease 2019 COVID-19, which became a pandemic affecting 120,000 individuals in more than 80 countries around the world. Urgent guidance to clinicians caring for the sickest group of these patients is needed! The WHO and the United States CDC have issued preliminary guidance on infection control, screening and diagnosis in the general population, but there is limited guidance on the acute management of critically ills with severe illness due to COVID-19. The COVID-19 surviving sepsis campaign panel, including 36 experts in guideline development, infection control, infectious diseases and microbiology, critical care, emergency medicine, nursing, and public health, from 12 countries, issued several recommendations:
4 best practice statements
9 strong recommendations
34 weak recommendations
support clinicians, allied health professionals, involved policymakers; some guidance to HCWs in low-middle income setting is provided. GRADE approach has been used to assess the quality of evidence. No recommendation feasible for 6 questions. Given the recent emergence of COVID-19, with consideration for limited direct evidence actually existing, indirect evidence on MERS-CoV, SARS-CoV-1, and other coronaviruses, and indirect evidence related to supportive care in ICU from studies on influenza and other respiratory viral infections, ARDS and sepsis has been applied. As relevant new evidence will emerges, it will be used by the panel to update the recommendations as needed, or formulate new recommendations, in what is known as a “living guideline” model.
Full text available, open access link.

As emerging, relevant new evidence as it emerges will be used by the panel to update the recommendations as needed, or formulate new recommendations, in what is known as a “living guideline” model.
Here a series of graphic summaries by Marta Velia Antonini @FOAMecmo

First one, on recommendations on infection Control, diagnosis & testing.

Hemodynamic support: monitoring, fluids & vasoactives.

Non-Invasive Ventilatory support in: SpO2 targets, conventional oxygen therapy, High Flow Nasal Cannula & Non-Invasive Positive Pressure Ventilation.

Invasive mechanical ventilation, recommendations on
MV settings
recruitment maneuver
prone positioning
fluids
neuro-muscolare blocking agents
inhaled vasodilators.

Recommendations on therapy: steroids, antipyretics, antivirals, IVIg, convalescent plasma, rIFNs chloroquine, tocilizumab & more!

2nd Milan Critical Care Datathon & ESICM Big Datatalk

 

The 2nd Milan Critical Care Datathon & ESICM Big Datatalk 3 days of data science meeting (involving 350 attendees, 23 faculty members & 20 mentors), held at Humanitas Hospital: lot of enthusiasm & interest, standing rooms only for the whole event, including:

  • the datathon a competition to learn how to implement/work on data at the bedside, with physicians, allied health care professionals and engineers/data scientists working together
  • the datatalk, a meeting focused on data science, artificial intelligence and machine learning, to allow attendees to learn more about these new challenges but promising strategies, including some fist examples of clinical applications showing how these tools could improve outcomes (ie in perioperative setting, in septic pt, in radiology…), reflections on potential ethical and legal/regulatory issues, and some practical demonstration on to do the query
  • an important European Society of Intensive Care Medicine ESICM &  Society of Critical Care Medicine  SCCM joint meeting, involving:
    ESICM President Jozef Kesecioglu
    ESICM President Elect Maurizio Cecconi
    ESICM Past President Massimo Antonelli
    SCCM President Heatherlee Bailey
    SCCM President Elect Lewis J. kaplan
    SCCM President Elect Greg S. Martin
    with a related joint initiative between the two Societies been announced.

We need to share data in order to improve clinical outcomes and scientific progress: free databases are now available, ie MIMIC (Medical Information Mart for Intensive Care)-III (Johnson AEW et al, Sci Data. 2016), and the new Amsterdam one, and more are expected to come in the next future. ESICM launched a new, really active section dedicated to data science.
It is not just artificial intelligence (AI) & machine learning (ML) but data science (DS): using (all) health care related data that we are not actually able to use as data volume is overwhelming, & physicians and all healthcare professionals are overworked. And the human?? As part of out job is caring the patient, not only curing, and sometimes what we should do in taking the patient’s hand, we hope these tools could give us the time we need to be (more) human again (take. a moment to read Topol E. Deep Medicine: how Artificial Intelligence can make healthcare human again). In the infographic, some notes from the talks given during the three days, enjoy!! PS you could also look for the official hashtag #ESICMdata20 to recall all the posts from the meeting! 

Here group pics of the team competing in the datathon!

And the winners!

Trauma: which fluid? when?

Which fluids need to be administered in the trauma patient? when? In trauma patients, fluid resuscitation aims at restoring circulating volume to prevent cardiac arrest due to severe hypovolemia, and at achieving a satisfying level of mean arterial pressure to ensure adequate tissue perfusion, limiting coagulation disorders. Lot of potential secondary adverse effects could be associated to  fluid resuscitation, ie hemodilution, acidosis & coagulation disorders.

In this infographic,  the concepts of permissive hypotension and remote damage control resuscitation RDCR, and some notes on on crystalloids, colloids & blood products.  

graphics by Marta Velia Antonini @FOAMecmo

content based on the talk given by Sophie Hamada, ICU Hôpital Bicêtre University Paris Sud, Groupe Traumabase.EU during the Trauma & surgery session  of the EDIC I Refresher Course at #LIVES2019 Congress

 

Consolidation on Lung Ultrasound

The 7 principles of Lung Ultrasound in the Critically Ill LUCI and echographic diagnosis of lung consolidation in this LIVES2019 infographic!

1 – a simple equipment is the best

2 – thorax is a mingling of air (gas) and water (fluids)

3 – lung is the most voluminous organ: here some advices on where to apply the probe?

4 – all arises from pleural line

5 – LUCI is the science of artifacts

6 – Lung: is a vital organ

7 – Most life-threatening disorders reach the wall and and have usually extensive surface

Why and how looking for consolidation?? here the Blue protocol with its profiles and some notes on the Pink protocol. How to distinguish between translobar and non translobar consolidation? Do we have an obstructive atelectasis or it’s just compression? take a look…

graphics by Marta Velia Antonini @FOAMecmo

content based on Daniel Lichtenstein masterclass at #LIVES2019