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September 24, 2017

CLINICAL TRIALS & NEW DEVELOPMENTS IN INTENSIVE CARE

PRESIDENT’S SESSION

CLINICAL TRIALS & NEW DEVELOPMENTS IN INTENSIVE CARE

#LIVES2017 

Twitter Chair: Matthew J. Rowland, Oxford, United Kingdom      

The first of our three critical trials sessions features trials selected by ESICM President Massimo Antonelli (Rome, Italy). This selection showcases some of the newest ideas and developments in clinical practice at the bedside and some of the results from these clinical trials will be published simultaneously in major scientific journals. A session not to be missed…

Watch LIVE in Vienna or ONLINE HERE!

Featured presentations:

The 2017 guidelines on critical illness related corticosteroid insufficiency (CIRCI)  

Professor Stephen Pastores from New York, and I have been designated by SCCM and ESICM, respectively, to update the 2008  guidelines that have introduced the CIRCI concept. We were honoured to gather a multidisciplinary team from North America, Europe and Australia that worked over almost three years to generate updated recommendations following a very rigorous process and using GRADE methodology.

Key Task Force findings/recommendations:

  • Three main mechanisms for CIRCI including disruption of the hypothalamic pituitary axis response to critical illness, altered cortisol metabolism, and tissue resistance to corticosteroids. 
  • No recommendation for the relative role of cortisol response to corticotropin test as compared to random cortisol for the diagnosis of CIRCI. 
  • Corticosteroids may be used in patients with septic shock and not in sepsis without shock, in patients with moderate to severe ARDS, and should not be used in the management of trauma patients.
  • Corticosteroids should be used in patients with  community acquired pneumonia, bacterial meningitis, in patients undergoing cardiopulmonary bypass, and in the resuscitation of cardiac arrest.
  • Corticosteroids should not be used in patients with severe influenza.
  • The Task Force members also suggested the use of corticosteroids in patients with vasopressor-dependent burn. However, following the editorial process, strong disagreement from one reviewer resulted in the withdrawal of the recommendation for this condition.

The key messages are summarised in three papers that will be published simultaneously shortly in Intensive Care Medicine and Critical Care Medicine.

  ~ Djillali Annane


Recommendations for mechanical ventilation of critically ill children from the Paediatric Mechanical Ventilation Consensus Conference (PEMVECC)

Much of the common practice in paediatric mechanical ventilation is based on personal experiences and what paediatric critical care practitioners have adopted from adult and neonatal experience. This presents a barrier to planning and interpretation of clinical trials on the use of specific and targeted interventions. The PEMVECC guidelines should help to harmonise the approach to paediatric mechanical ventilation and thereby propose a standard-of-care applicable in daily clinical practice and clinical research.

  ~ Martin Kneyber


Immediate interruption of sedation compared with usual sedation care in critically ill postoperative patients (SOS-Ventilation): a randomised, parallel-group, clinical trial  

Immediate interruption of sedation in critically ill postoperative patients with organ dysfunction (in sepsis or septic shock) who were admitted to ICU after abdominal surgery improved outcomes compared with usual sedation care. These findings support interruption of sedation in these patients following transfer from the operating room.

  ~ Samir Jaber


EFRAIM study

This study from the Nine-i multinational research group entitled “Caring for Critically ill immunocompromised patients: multinational network” aimed to assess the impact of initial management on intubation and mortality.  

We performed a multinational observational prospective cohort study in 16 countries (68 centres) and 1611 immunocompromised patients with acute respiratory failure were enrolled.  

We found that in immunocompromised patients, respiratory failure and oxygenation strategy clearly impact intubation rate and mortality. This suggests that initial management should as much focus on identifying ARF aetiology than on avoiding IMV.

Elie Azoulay


A prospective European study of frailty and outcomes in the very old intensive care patient (VIP).  

This population will increase considerably the next 10-20 years, and knowledge about their outcomes is important. The study recruited 5021 patients in 311 ICUs from 21 European countries. The aim was twofold: To document short term outcomes in the very old (≥80 years) ICU patients in Europe, and to study the impact of frailty on 30 day outcome. The study has revealed important features of this group, not at least highlight the role of frailty assessment in the very old.

  ~ Hans Flaatten


What do results from these trials mean to clinical practice? What questions remain?

This session will also include a cast of expert commentators, who will discuss important points following each presentation and open up discussion during this Clinical Trials Session. Here is a full list of clinical trial presentations and commentators:

WHO/WHA sepsis resolution?   
Speaker: Konrad Reinhart, Jena, Germany
Commentator: Ruth Kleinpell, Chicago, United States

Steroids guidelines
Speaker: Djillali Annane, Garches, France (on behalf also of Stephen Pastores, New York, United States)
Commentator: Ricard Ferrer Roca, Barcelona, Spain

Recommendations for mechanical ventilation of critically ill children from the Paediatric Mechanical Ventilation Consensus Conference (PEMVECC)?  
Speaker: Martin Kneyber, Groningen, Netherlands
Commentator: Pierre Tissieres, Paris, France

Immediate interruption of sedation compared with usual sedation care in critically ill postoperative patients (SOS-Ventilation): a randomised, parallel-group, clinical trial     
Speaker: Samir Jaber, Montpellier, France
Commentator: Kapil Zirpe, Pune, India

EFRAIM study    
Speaker: Elie Azoulay, Paris, France
Commentator: Charlie Corke, Geelong, Australia

LICORN study    
Speaker: Bernard Cholley, Paris, France
Commentator: Jean-Paul Mira, Paris, France

A prospective European study of frailty and outcomes in the very old intensive care patient (VIP)
Speaker: Hans Flaatten, Bergen, Norway
Commentator: Mirella Cristine Oliveira, Curitiba, Brazil

Join this exciting clinical trials session LIVE in Vienna…

Thematic Session ~ PRESIDENT’S SESSION: CLINICAL TRIALS AND NEW DEVELOPMENTS IN INTENSIVE CARE  

25.09.2017, 16:00 – 18:02, room VIENNA

Or watch LIVE ONLINE HERE!

#LIVES2017 #metabolic #sepsis #paed 

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