Not so fast we need more data. Neill Adhikari Critical Care Medicine Sunnybrook Health Sciences Centre and University of Toronto 7 November 2018
|
|
|
- Delphia Snow
- 5 years ago
- Views:
Transcription
1 Not so fast we need more data Neill Adhikari Critical Care Medicine Sunnybrook Health Sciences Centre and University of Toronto 7 November 2018
2 Disclosures I am the co-pi of a RCT of high-dose vitamin C for sepsis (NCT )
3 Metabolic resuscitation package for sepsis N=94 aor mort 0.13 ( ) RR mort 0.21 ( ) RR surv 1.54 ( ) NNT 3 (2-8)
4 Reasons to be excited by this approach
5 Multi-mechanism rationale for benefit Thiamine Vitamin C Steroids Antioxidant Crit Care 2018;22:283
6 Reasons to be excited by this approach Multiple potential mechanisms for benefit Feasible to implement Inexpensive Uses existing medications Seems safe Investigator-initiated Potential global relevance
7 Is this cocktail a parachute for sepsis?
8 BMJ 2003;327:
9 Parachutes in medicine Insulin for diabetes Blood transfusion for hemorrhagic shock Closed reduction and splinting for displaced long bone fractures Cricothyrotomy for upper airway obstruction Suturing for hemorrhage Ether for anesthesia BMJ 2007;334:349-51
10 Treatment effect NNT ~1.5 Ann Int Med 1964;60:759-76
11 Most of our interventions are not parachutes (some may be cement boots)
12 Observational data alone our decision-making framework changes for harm Lancet 1983;1(8336):1270
13 Observational data vs. RCTs ICP monitor good ICP monitor neutral J Neurotrauma 2013;30:
14 Quasi-RCT data vs. RCTs Daily RRT good Intensive RRT neutral
15 Parachutes in sepsis therapy?
16 Sepsis therapies to date: >100 trials, zero new treatments Trend Mol Med 2014;20:195
17 Multiple statistically negative trials lead to sceptical priors JAMA, doi: /jama
18 Multiple statistically negative trials lead to sceptical priors typical scepticism of clinician reading new sepsis trial? JAMA, doi: /jama
19 Even if this were a trial, we would want additional data 10% (1-30%) chance: large RCT refutes initial RCT with very large effect 90% chance: very large effects become smaller
20 Unpacking the components
21 Vitamin C: 10 trials, 1520 patients not conclusive of benefit n=52 Langlois et al. in press
22 Vitamin C: potential downsides Increased urinary oxalate excretions Stones AKI? Risk of hemolysis with G6PD deficiency Population-dependent baseline risk Factitious hyperglycemia using POC devices
23 Steroids: 42 trials, patients still not conclusive of benefit
24 Scientific interest is high Vitamin C AND sepsis
25 Public interest is high
26 Ongoing trials (incomplete list) Country Intervention N Status VICTAS (J Sevransky) USA Vit C + HC + B Enrolling HYVCTTSSS (Zhujiang Hospital) China Vit C + HC + B1 140 Enrolling NCT (D Shapiro) USA Vit C + B1 120 Enrolling ACTS (M Donnino) USA Vit C + HC + B1 200 Enrolling OANGES (AV Vassallo) USA Vit C + HC + B1 140 Enrolling NCT (S Stefanovic) Slovenia Vit C + HC + B1 30 Enrolling NCT (U Minnesota) USA Vit C 140 Enrolling VITAMINS (R Bellomo) Australia Vit C 126 Enrolling CORVICTES (SD Mentzelopoulos) Greece Vit C + HC 400 Enrolling NCT (BJ Haines) USA Vit C + B1 60 Enrolling HYVITS (A Mohamed) Qatar Vit C + HC + B1 212 Enrolling 29
27 Summary Community is enthusiastic about vitamin C for sepsis +/- thiamine and steroids Be wary of dramatic treatment effects in observational studies and in trials prior experience explains scepticism regarding any new treatments harms underestimated by current evidence We should enroll patients in ongoing trials! Widespread adoption in usual practice will hinder acquisition of new knowledge
28 Thank you
The Use of Metabolic Resuscitation in Sepsis
The Use of Metabolic Resuscitation in Sepsis Jennifer M. Roth, PharmD, BCPS, BCCCP Critical Care Clinical Specialist - Surgical Trauma ICU Baylor University Medical Center Disclosures No conflicts of interest
Updates in Critical Care Sepsis, Fluids, Epi and Long-Term Outcomes
Updates in Critical Care Sepsis, Fluids, Epi and Long-Term Outcomes Matt Anderson, MD USD SSOM, Clinical Assistant Professor Regional Health, Critical Care Medicine mjanderson972@gmail.com Disclosure(s)
Inhaled nitric oxide: clinical evidence for use in adults
Inhaled nitric oxide: clinical evidence for use in adults Neill Adhikari Critical Care Medicine Sunnybrook Health Sciences Centre and University of Toronto 31 October 2014 Conflict of interest Ikaria provided
THE BEST I HAVE READ THIS YEAR (IN PULMONARY AND CRITICAL CARE)
23 March 2018 Boca Raton, Florida THE BEST I HAVE READ THIS YEAR (IN PULMONARY AND Johnson.margaret2@mayo.edu No disclosures or off label uses CRITICAL CARE) Margaret M. Johnson, MD Chair, Division of
Blood transfusions in ICU: double-edged sword. Paul Hébert, MD MHSc(Epid) Physician-in-Chief, CHUM Professor, University of Montreal
Blood transfusions in ICU: double-edged sword Paul Hébert, MD MHSc(Epid) Physician-in-Chief, CHUM Professor, University of Montreal Canadian Critical Care Trials Group Collaborating for Impact Leading
FLUID RESUSCITATION AND MONITORING IN SEPSIS PROTOCOLIZED VS USUAL CARE DEEPA BANGALORE GOTUR MD, FCCP ASSISTANT PROFESSOR, WEILL CORNELL MEDICAL
FLUID RESUSCITATION AND MONITORING IN SEPSIS PROTOCOLIZED VS USUAL CARE DEEPA BANGALORE GOTUR MD, FCCP ASSISTANT PROFESSOR, WEILL CORNELL MEDICAL COLLEGE NOVEMBER 10 TH 2017 TEXAS SCCM SYMPOSIUM Disclosures
Management of Severe ARDS: Current Canadian Practice
Management of Severe ARDS: Current Canadian Practice Erick Duan MD FRCPC Clinical Scholar, Department of Medicine, Division of Critical Care, McMaster University Intensivist, St. Joseph's Healthcare Hamilton
Caring for the AKI Survivor: What is Required?
Caring for the AKI Survivor: What is Required? Ron Wald, MDCM MPH FRCPC Division of Nephrology St. Michael s Hospital and University of Toronto February 28, 2019 A patient in your ICU 65M with DM, HTN,
Controversies in Hospital Medicine: Critical Care. Vasopressors, Steroids, and Insulin Therapy
Controversies in Hospital Medicine: Critical Care Vasopressors, Steroids, and Insulin Therapy Douglas Fish, Pharm.D. Professor of Pharmacy, University of Colorado Denver Clinical Specialist in Critical
EFFECT OF EARLY VASOPRESSIN VS NOREPINEPHRINE ON KIDNEY FAILURE IN PATIENTS WITH SEPTIC SHOCK. Alexandria Rydz
EFFECT OF EARLY VASOPRESSIN VS NOREPINEPHRINE ON KIDNEY FAILURE IN PATIENTS WITH SEPTIC SHOCK Alexandria Rydz BACKGROUND- SEPSIS Sepsis is defined as life-threatening organ dysfunction caused by a dysregulated
New options in Stroke Prevention in AF Paul Dorian University of Toronto St Michael s Hospital
New options in Stroke Prevention in AF Paul Dorian University of Toronto St Michael s Hospital Disclosures: Honoraria, research support, and consulting f Sanofi, Boehringer-Ingleheim, Portola, BMS, Bayer,
Bicarbonates pour l acidose : BICAR-ICU
JAVA Créteil 1 décembre 2019 Bicarbonates pour l acidose : BICAR-ICU Samir JABER Department of Critical Care Medicine and Anesthesiology (DAR B) Saint Eloi University Hospital and Montpellier School of
What is the right fluid to use?
What is the right fluid to use? L McIntyre Associate Professor, University of Ottawa Senior Scientist, Ottawa Hospital Research Institute Centre for Transfusion Research CCCF, November 2, 2016 Disclosures
Anaemia in the ICU: Is there an alternative to using blood transfusion?
Anaemia in the ICU: Is there an alternative to using blood transfusion? Tim Walsh Professor of Critical Care, Edinburgh University World Health Organisation grading of the severity of anaemia Grade of
Let the Sun Shine in: Vitamin D and other Supplements in the ICU
Let the Sun Shine in: Vitamin D and other Supplements in the ICU Kimberly Zammit, PharmD, BCPS, BCCCP, FASHP Clinical Pharmacy Coordinator, Critical Care and Cardiology Buffalo General Medical Center Disclosures
Implementing Health Technology Related Decisions: Opportunities and Challenges in a Local Health Care Setting
Implementing Health Technology Related Decisions: Opportunities and Challenges in a Local Health Care Setting Eric A Cohen MD, FRCPC Deputy Head, Schulich Heart Program Sunnybrook Health Sciences Centre
TORCH: Salmeterol and Fluticasone Propionate and Survival in COPD
TORCH: and Propionate and Survival in COPD April 19, 2007 Justin Lee Pharmacy Resident University Health Network Outline Overview of COPD Pathophysiology Pharmacological Treatment Overview of the TORCH
TARGETED TISSUE PERFUSION VERSUS MACROCIRCULATORY-GUIDED STANDARD CARE IN PATIENTS WITH SEPTIC SHOCK (TARTARE-2S).
Author s response to reviews Title: TARGETED TISSUE PERFUSION VERSUS MACROCIRCULATORY-GUIDED STANDARD CARE IN PATIENTS WITH SEPTIC SHOCK (TARTARE-2S): STUDY PROTOCOL AND STATISTICAL ANALYSIS PLAN FOR A
Dr David Spriggs. General Physician and Geriatrician Auckland City Hospital Auckland. 16:30-16:55 The Sceptics View of Evidence Based Medicine.
Dr David Spriggs General Physician and Geriatrician Auckland City Hospital Auckland 16:30-16:55 The Sceptics View of Evidence Based Medicine. David Spriggs General Physician/Geriatrician Auckland District
Sepsis Management: Past, Present, and Future
Sepsis Management: Past, Present, and Future Benjamin Ferrell, MD Tennessee ACP Meeting October 28, 2017 Learning Objectives Identify the most updated definition and clinical criteria for sepsis Describe
Resuscitation Symposium Resuscitation Literature Update. Abdullah Al Reesi, MD, MSc, FACEP, FRCPC Sr. Consultant and HoD SQUH
Resuscitation Symposium Resuscitation Literature Update Abdullah Al Reesi, MD, MSc, FACEP, FRCPC Sr. Consultant and HoD SQUH Objectives Review recent articles in sepsis New sepsis definition High versus
Paramedic CAT (Critically Appraised Topic) Worksheet
Paramedic CAT (Critically Appraised Topic) Worksheet Title: Manual CPR Vs. Mechanical CPR Report By: Meghan Beals 2 nd Party Appraiser: Clinical Scenario: You are called to the home of a 65 year old female
JUST SAY NO TO DRUGS?
JUST SAY NO TO DRUGS? THE EVIDENCE BEHIND MEDICATIONS USED IN CARDIAC RESUSCITATION NTI 2014 CLASS CODE 148 Nicole Kupchik RN, MN, CCNS, CCRN, PCCN Objectives 1. Discuss the historical evidence supporting
Update in Critical Care Medicine
Update in Critical Care Medicine Michael A. Gropper, MD, PhD Professor and Executive Vice Chair Department of Anesthesia and Perioperative Care Director, Critical Care Medicine UCSF Disclosure None Update
Outcomes From Severe ARDS Managed Without ECMO. Roy Brower, MD Johns Hopkins University Critical Care Canada Forum Toronto November 1, 2016
Outcomes From Severe ARDS Managed Without ECMO Roy Brower, MD Johns Hopkins University Critical Care Canada Forum Toronto November 1, 2016 Severe ARDS Berlin Definition 2012 P:F ratio 100 mm Hg Prevalence:
BAXTER LAUNCHES FIRST 3-IN-1 SET FOR USE IN CONTINUOUS RENAL REPLACEMENT THERAPY AND SEPSIS MANAGEMENT PROTOCOLS
FOR IMMEDIATE RELEASE Media Contact Beth Mueller, (224) 948-5353 media@baxter.com Investor Contact Clare Trachtman, (224) 948-3085 BAXTER LAUNCHES FIRST 3-IN-1 SET FOR USE IN CONTINUOUS RENAL REPLACEMENT
Red Cell Transfusion triggers: A moving target When, who, and how much?
Red Cell Transfusion triggers: A moving target When, who, and how much? Tim Walsh Professor of Critical Care, Edinburgh University A transfusion threshold of 70 g/l or below, with a target Hb range of
Should Roids Be the Rage in Septic Shock? Lauren Powell, MSN, RN, CCRN, AGACNP-BC CHI Baylor St. Luke s Medical Center, Houston, TX
Should Roids Be the Rage in Septic Shock? Lauren Powell, MSN, RN, CCRN, AGACNP-BC CHI Baylor St. Luke s Medical Center, Houston, TX Learning Objectives 1. Review the mechanism of action for the use of
Getting smart with fluids in the critically ill. NOR AZIM MOHD YUNOS Jeffrey Cheah School of Medicine & Health Sciences Monash University Malaysia
Getting smart with fluids in the critically ill NOR AZIM MOHD YUNOS Jeffrey Cheah School of Medicine & Health Sciences Monash University Malaysia Isotonic Solutions and Major Adverse Renal Events Trial
DEFINITION, CLASSIFICATION AND DIAGNOSIS OF ACUTE KIDNEY INJURY
DEFINITION, CLASSIFICATION AND DIAGNOSIS OF ACUTE KIDNEY INJURY JOSÉ ANTÓNIO LOPES, MD, PhD Faculty of Medicine, University of Lisbon Department of Nephrology and Renal Transplantation Centro Hospitalar
Transfusion for the sickest ICU patients: Are there unanswered questions?
Transfusion for the sickest ICU patients: Are there unanswered questions? Tim Walsh Professor of Critical Care Edinburgh University None Conflict of Interest Guidelines on the management of anaemia and
Supplementary Online Content
Supplementary Online Content Yunos NM, Bellomo R, Hegarty C, Story D, Ho L, Bailey M. Association between a chloride-liberal vs chloride-restrictive intravenous fluid administration strategy and kidney
What is the Role of Albumin in Sepsis? An Evidenced Based Affair. Justin Belsky MD PGY3 2/6/14
What is the Role of Albumin in Sepsis? An Evidenced Based Affair Justin Belsky MD PGY3 2/6/14 Microcirculation https://www.youtube.com/watch?v=xao1gsyur7q Capillary Leak in Sepsis Asking the RIGHT Question
Understanding NNT- Patient s and Physicians Perspective
Understanding NNT- Patient s and Physicians Perspective A K Ghosh, K Ghosh Department of Internal Medicine Mayo Clinic Rochester, Minnesota, USA Number needed to treat - NNT Useful yardstick to describe
Emerging Areas Relating Vitamin D to Health
ILSI SEA Region Vit D Conference, Australia, June 2012 (www.ilsi.org/sea Region) Emerging Areas Relating Vitamin D to Health Peter R Ebeling MD FRACP NorthWest Academic Centre and Dept Endocrinology The
Immunomodulation and Sepsis in Oncological Patients. Imad Haddad, M.D. Medical Director, PICU Banner Children s Hospital at BDMC
Immunomodulation and Sepsis in Oncological Patients Imad Haddad, M.D. Medical Director, PICU Banner Children s Hospital at BDMC 1 Objectives Immune dys-regulation in oncological septic patients Implementation
Intravenous Fluid Therapy in Critical Illness
Intravenous Fluid Therapy in Critical Illness GINA HURST, MD DIVISION OF EMERGENCY CRITICAL CARE HENRY FORD HOSPITAL DETROIT, MI Objectives Establish goals of IV fluid therapy Review fluid types and availability
Fluid balance in Critical Care
Fluid balance in Critical Care By Dr HP Shum Nephrologist and Critical Care Physician Department of Intensive Care, PYNEH Fluid therapy is a critical aspect of initial acute resuscitation in critically
Strategies for Starting Renal Replacement Therapy in Acute Kidney Injury
Strategies for Starting Renal Replacement Therapy in Acute Kidney Injury Sean M Bagshaw, MD, MSc Department of Critical Care Medicine, University of Alberta, Edmonton, Canada 2nd Inter-Congress Conference
Alpha blockers have no role in renal colic
Alpha blockers have no role in renal colic HARRY WINKLER Director, section of Endourology Kidney stone center Dept.of Urology Sheba Medical Center Financial and Other Disclosures Off-label use of drugs,
Experiences with interim trial monitoring, particularly with early stopped trials
Experiences with interim trial monitoring, particularly with early stopped trials 1 Robert J Glynn, ScD Divisions of Preventive Medicine and Pharmacoepidemiology & Pharmacoeconomics, Brigham & Women s
Evidence-Based. Management of Severe Sepsis. What is the BP Target?
Evidence-Based Management of Severe Sepsis Michael A. Gropper, MD, PhD Professor and Vice Chair of Anesthesia Director, Critical Care Medicine Chair, Quality Improvment University of California San Francisco
PGY1 Learning activities-ebcp Scripts
PGY1 Learning activities-ebcp Scripts Interns will meet in small groups, once per month, to discuss EBCP scripts designed to promote understanding of basic EBCP concepts. EBCP scripts (see example below)
Lesson learnt from big trials. Sung Phil Chung, MD Gangnam Severance Hospital, Yonsei Univ.
Lesson learnt from big trials Sung Phil Chung, MD Gangnam Severance Hospital, Yonsei Univ. Trend of cardiac arrest research 1400 1200 1000 800 600 400 200 0 2008 2009 2010 2011 2012 2013 2014 2015 2016
JUST SAY NO? THE LATEST LOOK AT ACLS MEDICATIONS BRIDGETTE SVANCAREK, MD
JUST SAY NO? THE LATEST LOOK AT ACLS MEDICATIONS BRIDGETTE SVANCAREK, MD OBJECTIVES Review the progression of the American Heart Association s ACLS cardiac arrest medication guidelines Identify the latest
Common Confounding Consults In Pulmonary & Critical Care
Common Confounding Consults In Pulmonary & Critical Care Lekshmi Santhosh, M.D. Assistant Professor, Pulm/Critical Care & Hosp Med Management of the Hospitalized Patient 10.20.2018 Disclosures None. 1
Maria B. ALBUJA-CRUZ, MD ALBUMIN: OVERRATED. Surgical Grand Rounds
Maria B. ALBUJA-CRUZ, MD ALBUMIN: OVERRATED Surgical Grand Rounds ALBUMIN Most abundant plasma protein 1/3 intravascular 50% of interstitial SKIN Synthesized in hepatocytes Transcapillary escape rate COP
Hazards and Benefits of Postnatal Steroids. David J. Burchfield, MD Professor and Chief, Neonatology University of Florida
Hazards and Benefits of Postnatal Steroids David J. Burchfield, MD Professor and Chief, Neonatology University of Florida Disclosures I have no financial affiliations or relationships to disclose. I will
Disclosures. Acute Kidney Injury. Outline. Do electronic alerts improve the care of patients with AKI? 5/9/2015
Disclosures Acute Kidney Injury Kathleen D. Liu, MD, PhD May 2015 Consultant: Achaogen, Chemocentryx, Durect, Z Pharma Clinical trials adjudication: Astute Funding: NIH Stockholder: Amgen Outline patients
Sepsis care and the new core measures
Sepsis care and the new core measures Daniel S. Hagg, MD January 15, 2016 Outline What is sepsis? A brief history of sepsis care How should we take care of septic patients now? Core measures What strategies
Department of Clinical Pharmacy, University of Michigan College of Pharmacy, Pharmacy Faculty, Siam University, Bangkok, Thailand
1 2 Article Type: Guest Ed Mistakes We Make in Dialysis 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 We underdose antibiotics in patients on CRRT Alexander R. Shaw Weerachai Chaijamorn Bruce A. Mueller 1 Ann
The Cure For Sepsis! A Real World Experience. Paul Marik, MD,FCCM,FCCP. Disclosures. Stocks Advisory boards Grants Speakers Bureau.
The Cure For Sepsis! A Real World Experience Paul Marik, MD,FCCM,FCCP Disclosures Stocks Advisory boards Grants Speakers Bureau None 1 2 Ongoing Sepsis Trials Sepsis in a Global Problem Global burden 17-19
Canadian Society of Internal Medicine Annual Meeting 2018 Banff, AB
Canadian Society of Internal Medicine Annual Meeting 2018 Banff, AB Mortality and morbidity in acutely ill adults treated with liberal vs. conservative oxygen therapy: systematic review and meta-analysis
Early goal-directed therapy Where to from here? Rinaldo Bellomo ANZIC Research Centre Melbourne, Australia
Early goal-directed therapy Where to from here? Rinaldo Bellomo ANZIC Research Centre Melbourne, Australia Early goal-directed therapy in septic shock 2001 Proof-of-concept EGDT trial published NEJM 16%
Reducing the pressure on our health and economy. A call to action from the Victorian Salt Reduction Partnership
Reducing the pressure on our health and economy A call to action from the Victorian Salt Reduction Partnership Australia has a hidden health problem 30% of Australian adults have high blood pressure 3
Specific Question: In an adult population is a corticosteroid injection a safe and effective treatment for tennis elbow compared to usual care.
Short Question: Specific Question: In an adult population is a corticosteroid a safe and effective treatment for tennis elbow compared to usual care. Clinical bottom line There is evidence to suggest that
Fluid Treatments in Sepsis: Meta-Analyses
Fluid Treatments in Sepsis: Recent Trials and Meta-Analyses Lauralyn McIntyre MD, FRCP(C), MSc Scientist, Ottawa Hospital Research Institute Assistant Professor, University of Ottawa Department of Epidemiology
Sepsis Care and the New Core Measures. Daniel S. Hagg, MD January 15, 2016
Sepsis Care and the New Core Measures Daniel S. Hagg, MD January 15, 2016 Outline What is sepsis? A brief history of sepsis care How should we take care of septic patients now? Core measures What strategies
Delirium: Prevention with Melatonin
Delirium: Prevention with Melatonin Lisa Burry, PharmD Department of Pharmacy, Mount Sinai Hospital Leslie Dan Faculty of Pharmacy, University of Toronto Disclosures Centre for Collaborative Drug Research,
Sepsis 3.0: The Impact on Quality Improvement Programs
Sepsis 3.0: The Impact on Quality Improvement Programs Mitchell M. Levy MD, MCCM Professor of Medicine Chief, Division of Pulmonary, Sleep, and Critical Care Warren Alpert Medical School of Brown University
Care of older people in surgery (COPS)
Care of older people in surgery (COPS) Who, what, and does it make a difference Professor Jacqueline Close Geriatrician - POWH Clinical Director Falls, Balance and Injury Research Centre Early Mobilisation
The Berlin Definition: Does it fix anything?
The Berlin Definition: Does it fix anything? Gordon D. Rubenfeld, MD MSc Professor of Medicine, University of Toronto Chief, Program in Trauma, Emergency, and Critical Care Sunnybrook Health Sciences Centre
Resuscitation fluids in critical care
Resuscitation fluids in critical care John A Myburgh MBBCh PhD FCICM UNSW Professor of Critical Care Medicine The George Institute for Global Health University of New South Wales St George Hospitals, Sydney
Pre-hospital Administration of Blood Products (PHBP) and Tranexamic acid (TXA): Is the Jury Still Out?
Pre-hospital Administration of Blood Products (PHBP) and Tranexamic acid (TXA): Is the Jury Still Out? Jessica K. Reynolds, MD Assistant Professor of Surgery University of Kentucky, Department of Trauma
Update in Hospital Medicine
Update in Hospital Medicine 2017-2018 Brad Sharpe, MD SFHM UCSF Division of Hospital Medicine 2017-2018 Updated literature March 2017 March 2018 Process: CME collaborative review of journals Including
Impact of Fluids in Children with Acute Lung Injury
Impact of Fluids in Children with Acute Lung Injury Canadian Critical Care Forum Toronto, Canada October 27 th, 2015 Adrienne G. Randolph, MD, MSc Critical Care Division, Department of Anesthesia, Perioperative
Acute Kidney Injury (AKI) How Wise is Early Dialysis in Critically Ill Patients? Modalities of Dialysis
Acute Kidney Injury (AKI) How Wise is Early Dialysis in Critically Ill Patients? A common condition in ICU patients Associated with high mortality and morbidity Renal Replacement Therapy (RRT) is the cornerstone
Outline. Basic principles of lung protective ventilation. The challenging areas. Small tidal volumes Recruitment
ARDS beyond 6/kg Gordon D. Rubenfeld, MD MSc Professor of Medicine, University of Toronto Chief, Program in Trauma, Emergency, and Critical Care Sunnybrook Health Sciences Centre Outline Basic principles
Nutritional concepts for the prevention and treatment of osteoporosis: what, for whom, when? Objectives
Nutritional concepts for the prevention and treatment of osteoporosis: what, for whom, when? Bess Dawson-Hughes, MD Disclosures: Amgen, DSM, Nestle, Opko, Pfizer, Roche, Tricida Interrelationships of muscle
Critical Appraisal Series
Definition for therapeutic study Terms Definitions Study design section Observational descriptive studies Observational analytical studies Experimental studies Pragmatic trial Cluster trial Researcher
VOLUME RESPONSIVENESS IS DIFFERENT FROM NEED FOR FLUIDS BLOOD PRESSURE TARGETS IN SEPSIS
Department of Intensive Care Medicine VOLUME RESPONSIVENESS IS DIFFERENT FROM NEED FOR FLUIDS BLOOD PRESSURE TARGETS IN SEPSIS SEPTIC SHOCK : THE CLINICAL SCENARIO HYPOTENSION DESPITE ADEQUATE VOLUME RESUSCITATION
Year in Review Intensive Care Training Program Radboud University Medical Centre Nijmegen
Year in Review 2013 Intensive Care Training Program Radboud University Medical Centre Nijmegen Contents ARDS Ventilator associated pneumonia Tracheostomy and endotracheal intubation Enteral feeding Fluid
3/16/15. Management of the Bleeding Trauma Patient: Concepts in Damage Control Resuscitation. Obligatory Traumatologist Slide
Management of the Bleeding Trauma Patient: Concepts in Damage Control Resuscitation Courtney Sommer, MD MPH Duke Trauma Symposium March 12, 2015 Obligatory Traumatologist Slide In 2010 trauma was leading
ARDS and Lung Protection
ARDS and Lung Protection Kristina Sullivan, MD Associate Professor University of California, San Francisco Department of Anesthesia and Perioperative Care Division of Critical Care Medicine Overview Low
Experience with Low Flow ECCO2R device on a CRRT platform : CO2 removal
Experience with Low Flow ECCO2R device on a CRRT platform : CO2 removal Alain Combes, MD, PhD, Hôpital Pitié-Salpêtrière, AP-HP Inserm UMRS 1166, ican, Institute of Cardiometabolism and Nutrition Pierre
Subclinical Problems in the ICU:
Subclinical Problems in the ICU: Corticosteroid Insufficiency C. S. Cutillar, M.D., FPCP, FPSEM Associate Professor Cebu Institute of Medicine H-P-A Axis during Critical Illness CRH ACTH H-P-A Axis during
9/13/2018. Palliative Care and Hospice Research Updates from Objectives. Disclosure: White, Patrick, M.D.
Palliative Care and Hospice Research Updates from 2017-2018 Patrick White MD, HMDC, FACP, FAAHPM Chief Medical Officer, BJC Home Care Assistant Professor of Medicine, Washington University School of Medicine
Reporting Heterogeneity of Treatment Effect in Critical Care Trials
Reporting Heterogeneity of Treatment Effect in Critical Care Trials CCCF, Toronto November 1, 2016 B. Taylor Thompson MD Professor of Medicine Massachusetts General Hospital Harvard Medical School Boston,
Outcomes With "Watchful Waiting" in Prostate Cancer in US Now So Good, Active Treatment May Not Be Better
1 sur 5 19/09/2009 07:02 www.medscape.com From Medscape Medical News Outcomes With "Watchful Waiting" in Prostate Cancer in US Now So Good, Active Treatment May Not Be Better Zosia Chustecka September
Pharmaconutrition in PICU. Gan Chin Seng Paediatric Intensivist UMMC
Pharmaconutrition in PICU Gan Chin Seng Paediatric Intensivist UMMC Pharmaconutrition in Critical Care Unit Gan Chin Seng Paediatric Intensivist UMMC Definition New concept Treatment with specific nutrients
Steroids for ARDS. Clinical Problem. Management
Steroids for ARDS James Beck Clinical Problem A 60 year old lady re-presented to ICU with respiratory failure. She had previously been admitted for fluid management and electrolyte correction having presented
Index. Note: Page numbers of article titles are in boldface type.
Index Note: Page numbers of article titles are in boldface type. A Acid base balance pregnancy-related changes to, 640 Acquired heart disease, 731 Acute fatty liver of pregnancy (AFLP), 618 Acute kidney
JAMA. 2011;305(24): Nora A. Kalagi, MSc
JAMA. 2011;305(24):2556-2564 By Nora A. Kalagi, MSc Cardiovascular disease (CVD) is the number one cause of mortality and morbidity world wide Reducing high blood cholesterol which is a risk factor for
Calcium Nephrolithiasis and Bone Health. Noah S. Schenkman, MD
Calcium Nephrolithiasis and Bone Health Noah S. Schenkman, MD Associate Professor of Urology and Residency Program Director, University of Virginia Health System; Charlottesville, Virginia Objectives:
Year in Review 2014: Critical Care Medicine
Disclosures Year in Review 2014: Critical Care Medicine I receive laboratory support from CytoVale Diagnostics for research on early sepsis diagnostics Eric J. Seeley, M.D., F.C.C.P. Assistant Professor
JOURNAL CLUB: THE FLUIDS DEBATE. Veronica Ueckermann
JOURNAL CLUB: THE FLUIDS DEBATE Veronica Ueckermann INTRODUCTION The selection and use of resuscitation fluids should be based on physiological principles. However, historically, clinical practice has
Fluid resuscitation in specific patient populations: sepsis and traumatic brain injury
Fluid resuscitation in specific patient populations: sepsis and traumatic brain injury John A Myburgh MBBCh PhD FCICM UNSW Professor of Critical Care Medicine The George Institute for Global Health University
Varenicline and cardiovascular and neuropsychiatric events: Do Benefits outweigh risks?
Varenicline and cardiovascular and neuropsychiatric events: Do Benefits outweigh risks? Sonal Singh M.D., M.P.H, Johns Hopkins University Presented by: Sonal Singh, MD MPH September 19, 2012 1 CONFLICTS
Early Goal-Directed Therapy
Early Goal-Directed Therapy Where do we stand? Jean-Daniel Chiche, MD PhD MICU & Dept of Host-Pathogen Interaction Hôpital Cochin & Institut Cochin, Paris-F Resuscitation targets in septic shock 1 The
Brain under pressure Impact of vasopressors
Brain under pressure Impact of vasopressors Brain dysfunction in sepsis Incidence: - Varying nomenclature: sepsis-associated encephalopathy, delirium, brain dysfunction - Consistently recognized as frequent:
Steroid in Paediatric Sepsis. Dr Pon Kah Min Hospital Pulau Pinang
Steroid in Paediatric Sepsis Dr Pon Kah Min Hospital Pulau Pinang Contents Importance of steroid in sepsis Literature Review for adult studies Literature Review for paediatric studies Conclusions. Rationale
UPDATE IN HOSPITAL MEDICINE
UPDATE IN HOSPITAL MEDICINE FLORIDA CHAPTER ACP MEETING 2016 Himangi Kaushal, M.D., F.A.C.P. Program Director Memorial Healthcare System Internal Medicine Residency DISCLOSURES None OBJECTIVES Review some
Therapeutic Hypothermia
Objectives Overview Therapeutic Hypothermia Nerissa U. Ko, MD, MAS UCSF Department of Neurology Critical Care Medicine and Trauma June 4, 2011 Hypothermia as a neuroprotectant Proven indications: Adult
N of 1 trials: planning, conduct, and evaluation
N of 1 trials: planning, conduct, and evaluation Sunita Vohra MD MSc FRCPC FCAHS Director, CARE Program Director, Integrative Health Institute Centennial Professor, Dept. of Pediatrics Faculty of Medicine
Science Behind Resuscitation. Vic Parwani, MD ED Medical Director CarolinaEast Health System August 6 th, 2013
Science Behind Resuscitation Vic Parwani, MD ED Medical Director CarolinaEast Health System August 6 th, 2013 Conflict of Interest No Financial or Industrial Conflicts Slides: Drs. Nelson, Cole and Larabee
Traumatic brain Injury- An open eye approach
Traumatic brain Injury- An open eye approach Dr. Sunit Dr Sunit, Apollo children's hospital Blah blah Lots of head injury Lot of ill children Various methods of injury Various mechanisms of brain damage
Continuous vs Intermittent Dosing of Antibiotics in Critically-Ill Patients
Continuous vs Intermittent Dosing of Antibiotics in Critically-Ill Patients Jan O Friedrich, MD DPhil Associate Professor of Medicine, University of Toronto Medical Director, MSICU St. Michael s Hospital,
Nothing to disclose 9/25/2017
Jessie O Neal, PharmD, BCCCP Critical Care Clinical Pharmacist University of New Mexico Hospital New Mexico Society of Health-System Pharmacists 2017 Balloon Fiesta Symposium Nothing to disclose 1 Explain
STRESS Trial: Steroids to Reduce Systemic inflammation after Neonatal Heart Surgery
STRESS Trial: Steroids to Reduce Systemic inflammation after Neonatal Heart Surgery Leveraging Existing Resources to Improve Clinical Trials U01 TR001803-01 Duke University (Jennifer S. Li, Kevin D. Hill)
Evidence-based medicine and guidelines: development and implementation into practice
Evidence-based medicine and guidelines: development and implementation into practice PD Dr D. Aujesky, MSc MER Médecin-adjoint Service de Médecine Interne CHUV 1 Goals To discuss the basics of evidence-based