Welcome to a supplemental Critical Care Reviews Newsletter, bringing you the 5 major research studies presented and published at the 2017 ESICM Hot Topics Session in Vienna this afternoon. There have been multiple studies presented over the past few days, but not all have been published. Many were pre-published by Intensive Care Medicine and included in last week's newsletter. Unfortunately, the videos of the talks from the start of the week appear to be paywalled on the ESICM website, while the recordings of today's talks aren't up yet.
Of note, three of the trials presenting during these sessions will be discussed at the Critical Care Reviews Meeting next January. Prof Alistair Nichol will explain the findings of the TRANSFUSE trial, comparing transfusion of the freshest available blood with standard issue (oldest) red cells. Once again, fresh blood appears to offer little benefit, and may be harmful. Prof Alexandre Biasi Cavalcanti is travelling from São Paulo to talk about the ART Trial, investigating alveolar recruitment in ARDS. Interestingly, stepwise recruitment, as performed in this trial, resulted in increased mortality. The third trial presented was BREATHE, evaluating the role of extubation to non-invasive ventilation in patients failing spontaneous breathing trials. This reported multiple benefits amongst the secondary endpoints, but doesn't seem to have been published today. Two other studies were published today - ICE-CUB 2, evaluating routine admission of elderly sick patients to ICU, and a trial from Zambia, adding yet more weight to the argument against early goal-directed sepsis resuscitation. There were three other studies presented today: the preliminary results of the SUPERNOVA trial, suggesting ECCO2R is safe to use; the REDUCE trial, which reported no benefit from low dose haloperidol for the prevention of delirium in patients at high risk of this condition, and INPRESS, evaluating blood pressure targets in major surgery (whch I missed the presentation of).
If you like this newsletter containing the latest research in critical care, then you'll love the next Critical Care Reviews Meeting 2018, where you'll have a chance to discuss some of these trials with their chief investigators, as well as deliberating over the other most interesting critical care studies of the year. You'll also get a copy of the Critical Care Reviews Book 2018, summarising, critiquing and putting in context the best critical care trials of 2017.
In January, we will also have four other major RCTs to discuss. From Nantes, France, Dr Jean-Baptiste Lascarrou will consider the findings of the MACMAN trial, evaluating video laryngoscopy in the ICU. Dr Ashish Khanna, from the Cleveland Clinic, USA, will reflect on ATHOS-3 the first large clinical trial examining angiotensin II in septic shock. Prof John Simpson, from Newcastle, England, will discuss the VAP-RAPID trial, evaluating the use of a biomarker-guided approach to exclude ventilator-associated pneumonia. Lastly, From Brisbane, Australia, Prof Bala Ventakesh will explore the currently unpublished ADRENAL trial, examining hydrocortisone in septic shock in the biggest sepsis trial ever undertaken.
If that's not enough, we also have Prof Andrew Rhodes, from London, exploring the latest iteration of the Surviving Sepsis Campaign, published earlier this year and Dr Sophie Wallace (Perth, Australia), who will deliver the honorary John Hinds Trauma Lecture, entitled "Disaster on Everest - Trauma at the Top of the World". As ever, we finish with the "Informal Chat", where speakers and delegates get a drink, sit around and a huge meandering discussion about all things critical care takes place. If you want to review the best critical care research of this year, #CCR18 is the meeting for you.
- Full Text: Cooper. Age of Red Cells for Transfusion and Outcomes in Critically Ill Adults. N Engl J Med 2017;epublished September 27th
- Full Text: ART Trial Investigators Writing Group. Effect of Lung Recruitment and Titrated Positive End-Expiratory Pressure (PEEP) vs Low PEEP on Mortality in Patients With Acute Respiratory Distress SyndromeA Randomized Clinical Trial. JAMA 2017;epublished September 27th
- Editorial: Sahetya. Lung Recruitment and Titrated PEEP in Moderate to Severe ARDS. Is the Door Closing on the Open Lung? JAMA 2017;epublished September 27th
- Full Text: Futier. Effect of Individualized vs Standard Blood Pressure Management Strategies on Postoperative Organ Dysfunction Among High-Risk Patients Undergoing Major Surgery. A Randomized Clinical Trial. JAMA 2017;epublished September 27th
- Editorial: Aronson. Perioperative Management of High-Risk Patients: Going Beyond “Avoid Hypoxia and Hypotension" JAMA 2017;epublished September 27th
- Guidet. Effect of Systematic Intensive Care Unit Triage on Long-term Mortality Among Critically Ill Elderly Patients in France. A Randomized Clinical Trial. JAMA 2017;epublished September 27th
- Editorial: Angus. Admitting Elderly Patients to the Intensive Care Unit—Is it the Right Decision?. JAMA 2017;epublished September 27th
Early Goal Directed Therapy in Septic Shock in Zambia
- Full Text: Andrews. Effect of an Early Resuscitation Protocol on In-hospital Mortality Among Adults With Sepsis and Hypotension. A Randomized Clinical Trial. JAMA 2017;epublished September 27th
- Editorial: Machado. Trying to Improve Sepsis Care in Low-Resource Settings. JAMA 2017;epublished September 27th
Until the weekend
Supported by the Health Research Board