NEXT Day – HOT TOPICS 2015

Multimodal monitoring (Oddo)

Monitoring devices does not replace clinical examination

ICP can be elevated despite absent mass lesion on CT brain

No possible to have continuous neuroimaging as monitor

Sedation interruption among TBI with intracranial hypertension is not recommended

ICP and CPP monitoring are recommended as part of a protocol-guided, individualised care

References

Consensus statement on multimodal monitoring on neurocritical care

NEJM ICP trial 2012

Monitoring the brain and systemic oxygenation in neurocritical care patients

Multimodal neuromonitoring to detect brain hypoxia in TBI

Guidelines for night shift (Bion)

Night time ICU admission not associated with increased mortality

Out of hours discharge from ICU is associated with increased mortality (OR 1.44)

Conclusions

  • Intensivist delivered care probably beneficial
  • Dose of intensivists (shifts) still unknown
  • No night-time discharge from ICU
  • The WHOLE HEALTHCARE SYSTEM may need to be reconfigured for optimal patient care

References

Nightime intensivists and mortality

Continuity of care and staffing

Meta-analysis of intensivist staffing

Out of hours ICU discharge

Improving ICU outcomes in patients with malignancies (Azoulay)

ICU resources are used for – more pts, sicker pts, pts with different goals of care. BUT long and short term survival is increased and hence predictors of death are not relevant.

More and more people are living with cancer and surviving their ICU admission

ICU acts as a bridge to haematological pts to survival

References

Cancer and intensive care

Outcomes of oncology pts on ICU

 

Post ICU (Wunsch)

General suggestions

  • Minimise sedation
  • ICU diaries
  • Patient/family navigator
  • Early physical therapy
  • Early cognitive therapy

Post ICU Care Syndrome is real but we need to be better identify these patients

References

The burden of ICU

Psychiatric issues post ICU

The PRaCTICaL Study

 

Renal Biomarkers (Kellum)

Phenotype of AKI on ICU

  • Mild, patchy tubular injury
  • Profound loss of GFR
  • Late fibrosis leading to CKD

Kidneys (especially proximal tubules) are vulnerable; exposed to waste, toxin, inflammatory molecules, mediator

TIMP-2 and IGFBP7 outperform all current biomarkers

References

Review of renal biomarkers

Sepsis induced AKI

Discovering the biomarkers for AKI

KDIGO Consensus Guidelines