Clinical Trials in Intensive Care (Tuesday)

TRISS follow up

Long-term outcomes in patients with septic shock transfused at a lower versus a higher haemoglobin threshold: The TRISS randomised, multicentre, clinical trial presented by Sofie Louise Rygaard, Copenhagen, Denmark (Great – she has joined twitter! )

Great stuff from the TRISS trial – which has already told us that a lower haemoglobin target is safe in septic shock and anaemia.  In this follow up long term outcomes of mortality and health related quality of life at 1 year where not significantly different in the intervention group.

As Professor Angus commented after the presentation – this critical care trial that planned long term follow up from the beginning and has now done long term follow up is to be applauded.  It seems safe to continue with a restrictive transfusion policy.

Expecting transfusion to affect mortality 2 years later may have been a bit of a stretch:

… but I think the trial is important. The paper was published in ICM – available here

GRAVITY VAP

Lateral-trendelenburg position to avoid ventilator-associated pneumonia presented by Gianluigi Li Bassi, Barcelona, Spain.

Ive been waiting for this trial for a while because it is interesting – it was challenging a dogma – (putting the bed/patient head up reduces pneumonia) for which the evidence is pretty weak, but has made it into many bundles and guidelines.

It didn’t really work sadly, the study was stopped after 400 patients as there were several adverse events in the group put head down (lateral) and there was too a low an incidence of VAP:

I don’t think its published yet.  The trial used Facebook and Twitter to help communicate as many now do.

CLASSIC trial

Restricting volumes of resuscitation fluid in patients with septic shock: The CLASSIC randomised, parallel-group, multicentre feasibility trial presented by Peter Buhl Hjortrup, Copenhagen, Denmark (twitter)

Available to read now in Intensive Care Medicine, this trial set itself up for a win, by setting its primary endpoint as actually achieving the intervention.  Not to be flippant this is harder than it seems, and they did manage it.  A feasibility trial, they have plans for a large scale trial.

The bottom line crew are all over this of course… Thanks Segun for this review.

OPERA
Effect of postoperative high-flow nasal cannula vs conventional oxygen therapy on hypoxemia in patients after major abdominal surgery: A randomised clinical trial presented by Samir Jaber, Montpellier, France

Headline: extubating onto optiflow doesn’t change hypoxaemia and stopping optiflow doesn’t cause rebound hypoxaemia. In this study. Read the paper in JAMA.

RAPIT

Improving quality of life and psychological recovery in post intensive care patients: A pragmatic multicentre randomised controlled trial, the RAPIT study presented by Janet Froulund Jensen, Hillerød, Denmark

Trial can be read in full here.  The intervention was a programme of ICU photographs and 3 follow ups over a year post ICU discharge. It might have caused less anxiety, but overall made no impact on their primary or secondary outcomes.

Also presented where:

The association between tracheal intubation during paediatric in-hospital cardiac arrest and survival
presented by Lars W. Andersen, Aarhus, Denmar

No difference in ROSC or neurological outcome found. Read the paper in JAMA.

and

Neurally Adjusted Ventilatory Assist as an alternative to Pressure Support Ventilation – A multicentre randomised trial presented by Alexandre Demoule, Paris, France

Patients felt less breathless with NAVA, but otherwise study summed up well in this tweet: