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To date, no specific pharmacotherapy has proven effective against acute respiratory distress syndrome ARDS. Results on the research domain have been ineffective in human trials, a gap attributed in part to clinical and biological heterogeneity in human ARDS. Therefore, a precision medicine approach is intended to address explicitly how such underlying heterogeneity influences response to therapy among different patients with the same diagnosis. “You can find treatment for the disease but not for syndromes and ICU is a syndrome-forward approach to patient care” says Dr Pratik Sinha who is working on ARDS phenotyping.
Listen to his interview and learn more about ARDS from disease understanding to future bedside perspectives.
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Cardiogenic shock accounts for up to 5% of acute heart failure presentations and around 14–16% of patients reported in cardiac intensive care datasets. It complicates up to 15% of all myocardial infarctions and is the leading cause of death post-infarction. Using pharmacological agents alone may increase left ventricular afterload and myocardial oxygen demand, resulting in complications. Thus, mechanical circulatory support (MCS) devices have emerged as important therapeutic options. As evidence remains uncertain, MCS selection depends on clinician preference and local availability.
An updated systematic review and meta-analysis of high-quality RCTs and propensity score-matched studies (PSMs) was performed to compare the outcomes of MCS devices with no MCS and each other and investigate which MCS is the most effective in reducing mortality.
To learn more about the findings of this study listen to this podcast.
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The communication between families of critically ill patients who manifest prolonged disturbances in the consciousness such as patients under sedation, in a coma, or delirium, and the caregivers became very difficult during the stay of the patient in the ICU.
On the other side, the memories of the patients are distressing and confusing and make the ICU experience for this patient very unpleasant.
To overcome these difficulties and to bridge the communication, written diaries by nurses and families for and to the patients are recommended during the ICU stay.
You will get a more detailed description of ICU diaries from the guests in our next podcast – the first one of 2024 from the ESICM N&AHP group.
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Professional burnout has been described by WHO as a syndrome conceptualised as resulting from chronic workplace stress that has not been successfully managed. Intensive care unit (ICU) professionals are at high risk of experiencing burnout due to the presence of patients with life-threatening illnesses, the observed discrepancies in job demands, responsibility overload, workload, end-of-life issues, perception of futility and other constituting potential stressors. To talk about the prevalence, outcomes, ethical implications and management strategies of ICU professional burnout we have interviewed Dr. Michalsen. Listen to the interview in the following podcast.
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Acute respiratory distress syndrome (ARDS) remains a life-threatening syndrome, resulting in high morbidity and mortality. In ARDS patients and mechanically ventilated critically ill patients, two distinct subphenotypes, presenting hyper- and non-hyperinflammatory characteristics, have been identified.
Studies show that early identification of the inflammatory subphenotypes in patients at risk of ARDS could serve as a predictive or prognostic strategy that will lead to an early intervention and individualization of care.
A study has been carried out to prove the hypothesis that the inflammatory subphenotypes are present before ARDS development in at-risk patients presenting to the emergency department and remain identifiable over time.
To learn more about the methods and findings of this study listen to the next podcast.
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Cerebral ultrasound is a developing point-of-care tool for intensivists and emergency physicians, with an important role in diagnosing acute intracranial pathology. The use of transcranial Doppler has expanded over the last years, opening a new window to the assessment of cerebral anatomy not only in neurocritical patients but also in general ICU and emergency room patients.
To discuss the use of cerebral ultrasound for young intensivists we have interviewed Dr. Bertuetti. Listen to the interview in the following podcast.
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Nutrition plays a vital role in the management of critically ill patients, and a tailored approach based on patient assessment, nutritional requirements, and clinical status is essential for optimising outcomes and promoting recovery.
The concept of patient phenotyping and endotyping will help clinicians to better target nutrition interventions for a patient by categorising patients based on observable behaviours and underlying biological mechanisms, respectively.
About these concepts, their clinical use and limitations we have interviewed Dr. Arthur Van Zanten. Listen to his explanations in our podcast offered by NEXT.
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Sepsis is a life-threatening organ dysfunction caused by a dysregulated host response to an infection. Despite progress in the understanding of sepsis pathophysiology, no specific treatment has proven successful. The precision therapy, a greater understanding of the heterogeneity of sepsis is needed.
Recent approaches to measuring sepsis heterogeneity used unsupervised computational methods on clinical, biomarker, or gene expression data from observational studies or clinical trial datasets. At present, more than 100 sepsis subtypes are proposed, without awareness of overlap (or clinical implications). It is unknown whether each new subtype strategy is an added value for the patient.
To address this knowledge gap, a study was conducted aiming to determine the concordance between different sub-type labels, outcomes, and biologic pathways of critically ill sepsis patients classified by previously proposed sepsis subtyping methods. Listen to the podcast and learn more about the methodology and findings of this study.
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VA-ECMO outcome scores have been previously developed and used extensively for risk adjustment, patient prognostication, and quality control across time and centres. The limitation of such scores is the derivation by using traditional statistical methods which are not capable of covering the complexity of ECMO outcomes. The Extracorporeal Life Support Organization Member Centres have developed a study where they aimed to leverage a large international patient cohort to develop and validate an AI-driven tool for predicting in-hospital mortality of VA-ECMO. The tool was derived entirely from pre-ECMO variables, allowing for mortality prediction immediately after ECMO initiation.
To learn more about this study listen to the podcast.
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Numerous Population Pharmacokinetic (PopPK) models have been developed for Piperacillin (PIP), most of which are based on small monocentric studies and may not be generalizable to other populations. A recent evaluation of six PIP models in 30 ICU patients receiving CI demonstrated large inter-model variability regarding predictability. The transferability of these results to other populations is uncertain due to the limited number of patients and the monocentric setting. Furthermore, a clinically oriented model assessment in conjunction with TDM (Bayesian forecasting) was lacking.
A recent study aimed to evaluate the predictive performance of available PIP PopPK models with and without TDM using an external multicenter dataset to facilitate model selection for MIPD in critically ill patients. Listen to the podcast and learn more about the methodology and findings of this study.
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The concept of a "green ICU" is increasingly important in today's world, as sustainability and environmental considerations become integral to healthcare practices. Hospitals, including ICUs, can have a substantial environmental footprint due to energy consumption, waste generation, and resource use. Implementing green practices reduces this impact and contributes to overall environmental sustainability.
Integrating sustainability into healthcare practices not only benefits the environment but also supports the overall mission of providing high-quality patient care. To learn more about Green ICU implementation listen to the interview with Nicole Hunfeld.
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Acute respiratory distress syndrome (ARDS) is the term applied to a spectrum of conditions with different etiologies that share common clinical-pathological characteristics including: increased permeability of the alveolo-capillary membrane, resulting in inflammatory edema; increased non-aerated lung tissue resulting in higher lung elastance (lower compliance); and increased venous admixture and dead space, which result in hypoxemia and hypercapnia.
The new updated ESICM guidelines have been published highlighting a new approach to ARDS in terms of definitions, phenotyping, and respiratory support strategies.
To discuss ARDS from the new guidelines to bedside applied physiology we have interviewed Professor Gattinioni and invite you to follow the conversation in the following podcast.
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Sepsis‐associated acute kidney injury (SA‐AKI) is a common, increasingly prevalent problem in the intensive care unit (ICU). The association between sepsis and AKI has been studied previously. However, the lack of a reproducible and standardized consensus definition has limited the interpretability of available knowledge. In order to assess SA-AKI incidence, patient characteristics, timing, trajectory, treatment, and associated outcomes a multicenter, observational study was conducted. In order to know more about the study methodology and findings we have interviewed Dr White. Listen to the interview in the following podcast.
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Transportation of critically ill patients is inevitable in most health systems. Prehospital transportation (PHT) may be necessary after a major injury or as a result of a life-threatening illness – for example, myocardial infarction, intracranial haemorrhage, or metabolic coma.
On our ESICM Academy, we offer a course series on Patient Transportation, from the general introduction to conducting interfacility and intrahospital patient transportation and prehospital transport in Critical Care. Hear more from one of the authors in this podcast.
The ESICM Academy is accredited by the European Accreditation Council for Continuing Medical Education (EACCME) and offers updated, peer-reviewed, evidence-based training material, free of charge for ESICM members.
Speaker:
Michael J LAURIA. Former Pararescueman in the US Air Force and Critical Care/Flight Paramedic. Currently Emergency Medicine Physician, University of New Mexico Health Sciences Center; EMS/Critical Care Fellow, Flight Physician; Associate Medical Director for Lifeguard Air Emergency Services (US).
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Intensive care units (ICU) are the most peculiar units in hospitals where the quality and safety of health care delivery should be at the highest level. The most critical patients are treated in this unit, posing all healthcare professionals working there with continuous physical and emotional challenges.
ICU teams are composed of different profiles with the same goal of satisfying the needs of the patients. Combining each one's skills and abilities to make the best clinical decisions requires healthy multidisciplinary teamwork.
Recent studies show that the ability to work in a team in the ICU results in better patient outcomes and less or better coping with ICU staff burnout.
Learn more about the importance of interprofessional teamwork in the ICU in this podcast with Elena Conoscenti and Andreas Xyrichis.
Speakers:
Andreas XYRICHIS. King's College London (UK).
Elena CONOSCENTI. ISMETT (Mediterranean Institute for Transplantation and Advanced Specialized Therapies), Palermo (IT). ESICM Nurses & Allied Healthcare Professionals Committee member.
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Multiple organ dysfunction syndrome (MODS) is common after major trauma, affecting up to two-thirds of patients with critical injuries. Post-trauma MODS is associated with a mortality of over 20% and poor long-term outcomes in those who survive. Current management is supportive, and there are no specific pharmacological agents that prevent organ dysfunction.
The TOP-ART randomised clinical trial, a two-stage study, has tested firstly the safety and efficacy of the early artesunate administration on a cohort of severely injured and bleeding trauma patients and, secondly, the outcomes of artesunate administration on trauma patients at risk of developing MODS.
Listen to Joanna Shepherd's interview in the following podcast to learn more about the study's results.
Original article: Safety and efficacy of artesunate treatment in severely injured patients with traumatic haemorrhage. The TOP-ART randomised clinical trial
Speakers:
Joanna SHEPHERD. Centre for Trauma Sciences, The Blizard Institute, Queen Mary University of London (UK).
Rahul COSTA-PINTO. Austin Hospital, Melbourne (AU). ESICM NEXT Committee Member.
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Sepsis is a life-threatening acute organ dysfunction secondary to infection and affects more than 19 million people annually. In 2017, it was estimated that almost 49 million people were infected by sepsis, and half of those cases occurred in children under 5.
In-hospital mortality has declined over the years, resulting in a large number of sepsis survivors. Emerging data suggest that patients who survive sepsis frequently experience new symptoms, long-term disability, and worsening chronic health conditions for which they will seek care from many clinicians.
Elena Conoscenti has interviewed two experts in the field who will explain better what happens in adult and paediatric patients who survived sepsis.
Speakers:
Elsa AFONSO. Anglia Ruskin University, Cambridge (UK).
Laura Maria ALBERTO. Universidad del Salvador (AR).
Elena CONOSCENTI. ISMETT (Mediterranean Institute for Transplantation and Advanced Specialized Therapies), Palermo (IT). ESICM Nurses & Allied Healthcare Professionals Committee member.
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Central nervous system (CNS) infections significantly burden ICU physicians' daily clinical work. Diagnosis can be challenging, and timely management is of the utmost importance.
Meningoencephalitis is one of the CNS infections for which the epidemiological studies conducted in adult patients suggest that approximately one in two will require care in an intensive care unit. In those patients requiring ICU admission, meningoencephalitis is associated with a poor prognosis, including refractory seizures, prolonged hospital stay, neurological disability, and death.
The EURECA study endorsed by the ESICM intended to characterise the clinical presentation, etiologies, and outcomes in adult patients with severe meningoencephalitis requiring care in the ICU. We discuss its findings in this episode.
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Speakers:
Romain SONNEVILLE. Bichat Claude Bernard University Hospital, APHP, Université Paris Cité (FR).
Laura GALARZA. Laura Galarza Hospital Universitari General de Castellón (ES). Chair, ESICM NEXT Committee.
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Several studies have found an association between diabetes mellitus, disease severity and outcome in COVID-19 patients. Old, critically ill patients are particularly at risk.
A recent multicentre international prospective cohort study was performed in 151 ICUs across 26 countries to investigate the impact of diabetes mellitus on 90-day mortality in a high-risk cohort of critically ill patients over 70 years of age.
Original article: Diabetes mellitus is associated with 90-day mortality in old critically ill COVID-19 patients: a multicenter prospective observational cohort study
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Speakers
Timo MAYERHÖFER. Medical University Innsbruck (AT).
Kristina FUEST. Technische Universität München (DE). ESICM NEXT Committee member.
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