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.
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
Lots of tweeting as well!!
So here it is…ANZICS 2018, Singapore!
Adrian’s Lecture Notes
Precision Resuscitation (Pinsky)
4 Questions
- Identify when patient has inadequate blood/oxygen flow to tissues to meet their metabolic demand
- Define if fluid will improve cardiac output – If they are not volume responsive, don’t give fluid!
- Define the vasomotor tone – normal or decreased
- 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
Summary
Personalised medicine in sepsis (Gordon)
Why personalise?
- We treat very heterogenous patients e.g. some cancer pts respond and others don’t
- Risk stratify
What can you measure?
Intensivists staffing on the ICU (Gershengorn)
36.8% of US ICU pts cared for by intensivists in 1997
- Intensivists add
- procedural skills
- clinical judgement
- ICU triage
- patient flow
Defining staffing by workload rather than by numbers
“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?
Future
Develop and validate tools to measure workload; evaluate the impact of intensivists
Globalisation of Critical Care (Buchman)
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
- 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
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
Problems
- Insulin resistance
- Loss of muscle
- Anabolic resistance
- Poor/lack of recovery
- Prolonged weakness
What are the challenges of Sepsis-3 (Ku)
Biomarkers in Sepsis (Kuan)
Role
Diagnosis
- Procalcitonin
- Gene expression
- MicroRNA
Prognosis
- Presepsis
- Gene expression
- Pharmacogenomics
Challenges with biomarkers
- Multisystem
- Varying effect in pts
- Cost and time
- No gold standard in sepsis definition
- Most biomarkers not yet tested properly
Early resuscitation in sepsis (Delaney)
Cardiovascular management in sepsis (Gordon)
TTM (Leong)
Post Cardiac Arrest Syndrome
Reperfusion – ROSC, Inflammation, mitochondrial damage
The need for a new paradigm in resuscitation post cardiac surgery (Levine)
ICU of the future (Tan)
- Electronic records
- SMART alarms
- SMART pumps
- A.I
Brain death and cardiac death – are there really two ways to die? (Kwek)
Code of practice for confirmation of death document here
I attach some interesting videos on the subject from the ODT website:
Epidemiology and identification of the organ donors (Pilcher)
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
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
- 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
Cultural differences – EOL, Attitude to triage, organ donation & brain death
Ultrasound
See our chest ultrasound section here
Diaphragm assessment with ultrasound (Cholley)
Diaphragmatic thickness can be used in both mechanically ventilated and spontaneously breathing patient
Adrian’s Talks
Click to download:
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