HOT TOPICS SESSION
Wednesday September 27th, 14:10~17:20
Twitter Chairs: Stephen Shepherd, London, United Kingdom
Richard Siviter, Reading, United Kingdom
This year our Hot Topics Session is hotter than ever! This highly anticipated session is jam packed with a record EIGHT scientific trials which will be presented publicly for the first time, with simultaneous publications in several major medical journals. Results from some trials have been embargoed until today… so do not miss this opportunity to be among the first to ask the speakers questions about their data and discuss the clinical implications of their findings!
ESICM President Massimo Antonelli and JAMA Editor-In-Chief Howard Bauchner will chair this exciting session which will open with an awards ceremony in which Lui Forni (Surrey, United Kingdom) will award winners of various ESICM and Industry awards.
Non-invasive ventilation (NIV) as an intermediate step in weaning patients from invasive mechanical ventilation (IMV) may improve clinical outcomes. The Breathe study tested the hypothesis that protocolised weaning, including early extubation to NIV, would reduce time to liberation from ventilation compared to protocolised weaning from IMV alone.
~ Gavin Perkins (Coventry, United Kingdom)
Prophylactic haloperidol for critically ill adults with a high risk for delirium: The REDUCE study
Many ICU patients suffer from delirium accompanied by impaired outcome. While most ICU delirium patients are treated with haloperidol, there are indications that patients could benefit from prophylactic haloperidol. However, the evidence is inconsistent. In a large multicentre RCT we evaluated the prophylactic efficacy of haloperidol compared to placebo in ICU patients on survival and relevant delirium related outcome measures.
The results surprised us.
~ Mark van den Boogaard (Nijmegen, Netherlands)
The TRANSFUSE study: A randomised controlled trial of standard issue transfusion versus fresher red blood cell use in intensive care.
TRANSFUSE is a 5000 patient blinded multi-centre randomised trial in 5 countries which tested whether transfusion of fresher red-cells improves outcome in high-risk critically ill patients. The final TRANSFUSE Trial results will be presented for the first time at ESICM’s annual congress LIVES 2017 in Vienna.
~Jamie Cooper (Melbourne, Australia)
Individualised blood-pressure target in patients during major surgery (INPRESS study)
Arterial hypotension during surgery is a leading cause of ischaemia-reperfusion injury and organ dysfunction. However, the optimal blood-pressure treatment strategy remains uncertain. In this multicentre parallel-group trial, we randomly assigned 292 surgical patients at increased risk of postoperative complications to a treatment strategy of targeting a systolic blood pressure of plus-or-minus 10% from usual patient blood pressure (individualised-treatment group) or a strategy of targeting a systolic pressure of more than 80 mmHg or not lower than 40% from usual patient blood pressure (standard-treatment group) during the surgical period.
Main findings of the INPRESS Study: Among patients at increased postoperative risk, a treatment strategy of targeting an individualised systolic blood pressure, as compared with routine practice, resulted in improved clinical outcomes.
~ Samir Jaber (Montpellier, France)
ART: A large-scale international randomised controlled trial
The ART trial main question was: Does use of a lung recruitment maneuver associated with positive end-expiratory pressure (PEEP) titration according to the best respiratory-system compliance reduce 28-day mortality of patients with moderate-to-severe acute respiratory distress syndrome (ARDS) compared to a conventional low-PEEP strategy?
The results of this trial which enrolled 1,010 patients may surprise many and have an impact on lung recruitment strategies and future study.
~ Alexandre B. Cavalcanti (São Paulo, Brazil)
Multicentre RCT of mandated ICU use for elderly patients versus “normal” ICU admission practices
“Does a programme to increase intensive care unit (ICU) use among critically ill elderly patients have a beneficial effect on long-term outcomes?”
The Intensive Care for Elderly–CUB-Réa 2 (ICE-CUB 2) cluster-randomised clinical trial of 3036 patients aged 75 years or older aimed to answer this question. The highly anticipated results from this trial may clarify the admission question related to this growing patient population question for many, and open new queries in our quest for best practice in our changing ICUs.
~ Bertrand Guidet (Paris, France)
Single centre RCT from Zambia of EGDT for septic shock showing harm
“Does protocolised resuscitation with intravenous fluids, vasopressors, and blood transfusion implemented early after presentation to the emergency department improve in-hospital mortality among African adults with sepsis and hypotension compared with usual care?”
In this randomised clinical trial that included 209 adults presenting to an emergency department in Zambia with sepsis and hypotension, a 6-hour sepsis protocol emphasising intravenous fluids, vasopressors, and blood transfusion increased in-hospital mortality compared with usual care (48.1% vs 33.0%).
“Although in a different population than treated in the developed world, these results provide additional data that question the benefit of aggressive fluid resuscitation in all patients with septic shock.”
~ Todd Rice, presenter (left) and author Ben Andrews (Nashville, United States)
SUPERNOVA pilot trial
“Is it possible and safe to deliver “super-protective” ventilatory strategies integrated by ECCO2R in patients with ARDS?”
“Do we have data to launch a prospective randomised clinical trial to test the hypothesis that lower VT and ECCO2R may improve outcome in patients with ARDS?”
To answer these questions, ESICM conducted the SUPERNOVA study, a pilot multicentre international trial. The study was concluded and analysed few weeks ago and preliminary results will be presented today by Alain Combes and Marco Ranieri on behalf of the SUPERNOVA investigators.
~ Alain Combes (Paris, France) and Marco Ranieri (Rome, Italy)
Don’t miss this final session of LIVES 2017! Watch it LIVE in Vienna or online HERE...
HOT TOPICS SESSION
17.09.2017, 14:10 – 17:20, room Vienna