LIVES 2016: Opening Presentations

Daniel De Backer – President ESICM

What has happened in 2016?

7 key points

  1. Members: 8550 now (continuous increase)
  2. NEXT committee: 115 fellowships since 2014 – trainees and young specialists from across Europe. New Pain/Agitation/Delerium (PAD) and Bayer Fellowships rolling out. ICE-mentoring – 28 mentors/58 mentees
  3. Education: academy and interactive e-learning. EDIC preparation course with mock exam. New courses. New courses e.g. Mechanical ventilation + EDIC 1 and 2 preparation courses. EDEC (Extending knowledge of the diagnosis of cardiac dysfunction and advanced use of echo) – new diploma. 64 intensivists enrolled. Webinars e.g new sepsis definitions, LUNG SAFE study
  4. Research: Increasing investment in research~ €600,000. ESICM Trials Group – 10 studies and 20K patients. JAMA/ICM Journal publications. Protocol Library
  5. Journal: ICM – highest impact factor yet ~ 10.125 currently. Monthly webinars and ICM Pulse related to most relevant publications. ICMx – experimental research
  6.  Communications: Social Media, Blog
  7. Coming soon: EuroAsia 6-8 April 2017. ESICM eBook series on Lessons in ICU. Surviving Sepsis Campaign – revision of SSC Guidelines 2016 coming soon. Paediatrics SSC, Sepsis in resource limited countries.

A new physiology: Caring for the extraterrestrial (Michael Barratt)

Space medicine meets intensive care

  • Three training programs in US for space medicine – board certified
  • On cusp of commercial space flight so ?expanding
  • Informs overall knowledge base of physiology
  • Accelerates avenues of medical and tech development e.g. USS
  • Thriving international community – work closely together

Radiation – by far the biggest limitation of human space travel

International space station the main destination – much roomier than one would imagine!

Basically a functioning laboratory with centrifuge, freezer, gas analyser (VO2 max etc), EEG, animal research etc

Most common issue needing adaptation is WEIGHTLESSNESS

Most changes adaptive and not harmful but can become maladaptive on return to earth

Seconds to minutes to occur:

  • Anthropometry – neutral body posture
  • Fluid shift – headward direction. Expect CVP to increase. PAC inserted in space – decreases!
  • Neurosensory adaptation  – proprioception altered. Tremendous conflict neurovestibular and occular systems. Sensory conflict but adapt in days

Lung: evening out of V/Q distribution (though incomplete)

VT decreases, RR increases —> net decrease of 7% in ventilation overall. DLCO increases

SUBACUTE (first 10 days)

  1. Fluid regulation
  2. Blood volume
  3. Neurosensory adaptation

ACUTE (3 weeks)

20% decrease in MVO2. CO normal/contractility normal

Bone loss – starts immediately but takes while to take effect. Muscle loss too

Neuro issues too: increased ICP (likely but hard to test in space…), ophthalmic disc oedema, choroidal folds —-> USS: x2 increase in optic sheath diameter. But unsure why?

ESICM Society Medal – Rui Moreno

Extremely well deserved – huge contribution to ICM – both clinically and through research

Terror victims in the ICU (Serge Jennes)

Description of the ICU and burns management of the Brussels terror attacks this year

Hospital built as disaster hospital – entrance corridor has drop down panels with O2 and suction

Incredible response – hard hearing about paediatric admissions with severe burns. And families who lost parents – just tragic

1/3 of patients from outside of Belgium – families needing to be reunited in hospital so transfers arranged

18 admissions overall – 6 years to 49 years

9 surgical procedures

120 radiological investigations

20 dressing changes a day for 15 days

Key message: computers are not fast enough. Use paper. Whiteboard for movement of pts

Additional workload: VIP visits (King and Queen of Belgium), insurance company, arrange transfers

Plus – dont forget hospital becomes target itself. Security issues

Take home messages:

  1. Be prepared: know your enemies and treat first what kills first
  2. Rebuild: practice drills, training, improve protocols
  3. Apply and practice protocols learned from recent conflicts in the prehospital and ICU settings