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32nd Annual Congress – Berlin

This year we are returning to Berlin, a cosmopolitan city of with a turbulent and fascinating history. Berlin is home to world-renowned universities, orchestras, museums, and entertainment venues and is well-known for its festivals, diverse architecture, nightlife, contemporary arts and a very high quality of living. A continental hub for air and rail traffic, Berlin is easy to reach and the congress venue, the Berlin CityCube, reflects the city well with its multi-functional and edgy design.

We can guarantee that LIVES 2019 will not disappoint and hope you will be joining us in Berlin for a memorable congress.

 

New Technology in Ventilation 25th September 2017 #LIVES2017

In respiratory failure, there is regional variability in oxygenation (and perfusion)- imaging can be used to monitor this. Point of care ultrasound for instance ncbi.nlm.nih.gov/pmc/articles/P…

Electrical Impedance tomography can monitor regional changes as well ncbi.nlm.nih.gov/pubmed/25843526

Oesophageal manometry can help us monitor transpulmonary pressure nejm.org/doi/full/10.10… – however is only used in about 1% of ARDS patients according to the LUNG-SAFE study jamanetwork.com/journals/jama/…

Respiratory muscle functioning can be done using the NAVA device journals.sagepub.com/doi/pdf/10.117… – this may end up being key to keeping intrapleural driving pressure low (Amato)

Mechanical power can be roughly calculated at the bedside as a product of driving pressure and respiratory rate- this may become our key targeted variable in future (Amato)ncbi.nlm.nih.gov/m/pubmed/27620…

However both driving pressure and mechanical power remain static measures of lung mechanics. In future we’ll need dynamic bedside tools.

Ventilator dissynchrony remains a problem and contributes to mortality…. ncbi.nlm.nih.gov/pubmed/25693449

 

And of course there’s ECMO. Some patients still require ventilation while on ECMO and the reasons for this will vary- for some it will be gas exchange, for others it will be muscular (Camporotta).

There remain several unanswered questions in the ECMO population- how to wean, who needs (and doesn’t need) mechanical ventilation… hopefully answers will come.

 

The future may well be closed-loop ventilation, such as that seen with the Hamilton ventilators in their ASV mode.

youtube.com/watch?v=4uOFPG…

 

 

 

The ICU Airway- 25th September 2017 #LIVES2017

 

10-20% of the ICU population will be difficult to intubate- and this can lead to significant morbidity and mortality, as the excellent UK NAP4 audit showed NAP4: Executive summary | The Royal College of Anaesthetists

3% of patients will have an intubation related cardiac arrest…

It’s been suggested that we treat every ICU patient as a difficult intubation. Assess the airway beforehand- the MACHOCA score has been recommended The MACOCHA score is feasible to predict intubation failure of … – NCBI

Tips to optimise intubation?

Should we use VL first line? Maybe- but MACMAN says no thebottomline.org.uk/summaries/icm/…

And what about high flow oxygen as apnoeic oxygenation? Maybe ncbi.nlm.nih.gov/pubmed/25479117 or maybe not? emcrit.org/pulmcrit/apnei…

Or combine HFNC with non-invasive ventilation for the ultimate oxygenator? bmjopen.bmj.com/content/6/8/e0…

 

So some controversies remain- hopefully with more data to come we can make ICU intubation safer.