One of the things many of us found most challenging when first starting on intensive care was the array of images we might be bombarded with when we first start out – unfamiliar modalities such as MRI, CT with or without angiography are relatively commonplace within our field. Kobus Preller, Consultant Intensivist from Cambridge gave us a fantastic radiology quiz with some spectacular images.
Next up Dr. Garyphalia Poulakou from Greece gave us an excellent talk about choosing the right antibiotics, particularly where KPC carbapenemase producing bacteria are the cause. Even where ‘resistance’ may be a problem, it is important to look at how susceptible a drug may be. Combination therapies offer survival benefit and should be considered in this class of patients. ESBL bacteria hydrolyse third generation cephalosporins and aztreonam. Carbapenems and cephamycines remain stable. They are usually inhibited by beta-lactamase inhibitors but reporting these was previously difficult prior to change in susceptibility breakpoints. The use of beta-lactams with inhibitors in ESBL is a matter of ongoing debate with no proven efficacy outside of urine infection. MRSA strains are resistant to ALL beta-lactams. Vancomycin creep is an important phenomenon when looking at treatment – this is the observation that MICs tend to increase with time, therefore higher MICs predict treatment failure.
Dr. Jordi Mancebo spoke about how to deal with some of the more common yet difficult problems which can happen with the ventilator; how best to predict failure of NIV? Those who take larger tidal breaths on NIV are more likely to progress to endotracheal intubation. He discussed the potential drawbacks of recruitment manoeuvres (including necessary over distension of some lung areas) and the importance of assessing the right ventricular and pulmonary vascular contribution to oxygenation. An echocardiogram is an important investigation in these patients.