Adrian Wong does ANZICS 2018! #FOAMed #FOAMcc #POCUS #ANZICS

I must offer my thanks to Dr Adrian Wong (@avkwong) for this. He was speaking out at the ANZICS meeting and decided he would like Critical Care Northampton to feature his notes from the meeting, as well as his talks.

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Below are the lectures he attended and his thoughts. There are also screen shots of many of the poignant slides, as well as live reference click points.

It looked like a full programme and one that contained many new speakers, with novel topics. Many of those are featured here.

Take a look at the full programme here

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Lots of tweeting as well!!

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So here it is…ANZICS 2018, Singapore!

Adrian’s Lecture Notes

Precision Resuscitation (Pinsky)

4 Questions

  1. Identify when patient has inadequate blood/oxygen flow to tissues to meet their metabolic demand
  2. Define if fluid will improve cardiac output – If they are not volume responsive, don’t give fluid!
  3. Define the vasomotor tone – normal or decreased
  4. Define if ventricle can handle demand without going into failure

Surrogate preload markers do not reflect ventricular volumes or volume responsiveness

Arterial Elastance defines gain in SV/Arterial pressure relation – PPV/SVV

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Summary

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Personalised medicine in sepsis (Gordon)

Why personalise? 

  • We treat very heterogenous patients e.g. some cancer pts respond and others don’t
  • Risk stratify

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What can you measure?

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Intensivists staffing on the ICU (Gershengorn)

36.8% of US ICU pts cared for by intensivists in 1997

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  • Intensivists add
    • procedural skills
    • clinical judgement
    • ICU triage
    • patient flow

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Defining staffing by workload rather than by numbers

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“Nurses are constantly staffed based on the number of patients they have to care for.”

What is the best ICU bed/ICU patients:Intensivist ratio?

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Future

Develop and validate tools to measure workload; evaluate the impact of intensivists

Globalisation of Critical Care (Buchman)

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The next wave of ‘globalisation’

  • Migration of medical professionals
  • Communication: asynchronous, on-demand and (near) synchronous 
  • Education – SoMe and blurring distinctions among website and face-to-face presentations

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  • Professional society collaborations e.g. 2001 International Sepsis Definitions Conference
  • Multinational companies/corporations selling their products

Barriers to globalisation

  • Resource limitation(s)
  • Licensure and credentialing
  • Customs, adaptations, norms

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Muscle wasting (Phillips)

Older population in particular

Dose and timing of intake important

Older people need more protein compared to younger people

Leucine triggers

Whey protein better than casein at stimulating muscle synthesis

Protein requirement for older patientt on ICU

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Problems 

  • Insulin resistance
  • Loss of muscle
  • Anabolic resistance
  • Poor/lack of recovery
  • Prolonged weakness

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What are the challenges of Sepsis-3 (Ku) 

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Biomarkers in Sepsis (Kuan)

Role

Diagnosis

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  • Procalcitonin 
  • Gene expression
  • MicroRNA

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Prognosis

  • Presepsis
  • Gene expression
  • Pharmacogenomics

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Challenges with biomarkers

  • Multisystem
  • Varying effect in pts
  • Cost and time
  • No gold standard in sepsis definition
  • Most biomarkers not yet tested properly 

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Early resuscitation in sepsis (Delaney)

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Cardiovascular management in sepsis (Gordon)Screen Shot 2018-05-23 at 11.55.41.png

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TTM (Leong)

Post Cardiac Arrest Syndrome

Reperfusion – ROSC, Inflammation, mitochondrial damage

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The need for a new paradigm in resuscitation post cardiac surgery (Levine)

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ICU of the future (Tan)

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  • Electronic records
  • SMART alarms
  • SMART pumps
  • A.I

 

Brain death and cardiac death – are there really two ways to die? (Kwek)

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Code of practice for confirmation of death document here

Death diagnosis form here

I attach some interesting videos on the subject from the ODT website:

 

Epidemiology and identification of the organ donors (Pilcher)

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DCD (D’Costa)

  • 15% of deaths in ventilated patients are brain death
  • 85% of deaths in ventilated patients are non-brain dead
  • Clinicians (alone) are poor at identifying potential DCD donor so opting for ROUTINE REFERRAL
  • As DCD referrals increases, the actual donation rate increases
  • Logistic support
    • organ donor coordinators
    • support/admin staff
  • Consider
    • theatre availability
    • retrieval team availability

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Collaboration in research

Challenges 

  • Lack of fund
  • Lack of mentor

Solution

  • collaboration
  • ‘funding’
  • mentor
  • facilities
  • subjects

Why do research?

To find the answer to the question YOU want answered

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  • Research course
    • BASIC clinical research course
    • Research novice
    • 2 days
    • Practical 

Asia comprises 50% of the world’s population but data contribution in clinical ICM research is low

Dengue and critical care – 18 papers

TB and critical care – 17 papers

Simple observational study needed – prevalence, outcome and prognosis

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Cultural differences – EOL, Attitude to triage, organ donation & brain death

 

Ultrasound

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See our chest ultrasound section here

Diaphragm assessment with ultrasound (Cholley)

Diaphragmatic thickness can be used in both mechanically ventilated and spontaneously breathing patient

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Adrian’s Talks

Click to download:

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