Drug intervention trials in sepsis Armand R.J. Girbes
|
|
|
- Imogen Campbell
- 6 years ago
- Views:
Transcription
1 Drug intervention trials in sepsis Armand R.J. Girbes Professor in Intensive Care Medicine Clinical Pharmacologist VU medical center Amsterdam, NL
2 Sepsis - definition
3 Sepsis Epidemiology cases per 100,000 per year 9% increase per year! 2% hospital admissions 9% severe sepsis & septic shock = 10% of all ICU admissions peak in 6th decade of life No 3 in death cause underestimated!!
4
5
6
7
8 Epidemiology of sepsis in Germany Main points Prospective-observational observational cross sectional 1-day 1 point prevalence study 454 ICU s s in 310 stratified representative hospitals Screened patients: N = % sepsis 11% severe sepsis Hospital mortality of severe sepsis = 55% Estimated Incidence: cases per 100,000 per year Data from longitudinal survey in 371 patients: incidence 110 cases
9 Sepsis Epidemiology - Causes chest abdomen genitourinary system primary bloodstream 80% of all causes rate pneumonia/bacteraemia bacteraemia/multiple site infection
10 Main pathogens in sepsis
11 Increased knowledge of mechanism
12 Sepsis Key elements diffuse endovascular injury aberrant release of pro-inflammatory cytokines procoagulant response / dysregulated coagulation apoptosis
13 Drug intervention trials in (severe) Sepsis Since 1980s Drug intervention trials modify endotoxin release inhibition of proinflammatory cytokines > 80 trials
14 Phase III trials in severe sepsis Pattern Positive phase II studies No dose finding studies (Relative) large phase III studies Negative findings
15 Phase III trials in severe sepsis Modification of endotoxin release Failure Inhibition of proinflammatory cytokines Failure Inhibition of platelet-activating activating-factor inflammatory pathway Failure
16 Phase III trials in severe sepsis Explanation for failures Misconception & limitation of underlying models Targeting single steps is inappropriate Oversimplification Animal model incorrect [e.g. wrong animal; single exposure [e.g. wrong animal; single exposure i.o.. continuous] Difference in timing in experimental models Too late administration Inappropriate models E.g. infusion of endotoxin Inappropriate dose Dose finding studies in general lacking Insufficient attention to role of concomitant treatment
17 Phase III trials in severe sepsis Polderman & Girbes, Lancet 2004
18 Phase III trials in severe sepsis Natural anticoagulant proteins AT III Protein C Tissue Factor Pathway Inhibitor Levels decrease during sepsis Tempting target for intervention Highly promising preliminary results Only apc positive result
19 Phase III trials in severe sepsis
20 Phase III trials in severe sepsis
21 Activated protein C vs. placebo in phase III study on mortality and bleeding Mortality Severe bleeding rhapc 210/850 (24.7%) 30/850 (3.5%) Placebo 259/840 (30.8%) 17/840 (2%) RR 80.6% RR 175% RRR 19.4% RRR -75% ARR 6.1% ARR -1.5% NNT 16 NNT 66
22 PROWESS & ENHANCE 100 ENHANCE DrotA(a) EVAD DrotA(a) EVAD Placebo 90 Survival (%) 80 PROWESS DrotAA (24.7% mortality) 70 PROWESS Placebo (30.8% mortality) ENHANCE DrotAA (25.3% mortality) Days After the Start of the Infusion
23 APC long-term effect
24 Long-term effect
25 apc trial Problems Changed protocol halfway Inclusion criteria Change of drug carrier Possible interaction with heparin Effect ONLY in 2 nd part of the study Inclusion prematurely stopped (because of efficacy) Only one study; No confirmatory study done
26 Problems in apc trial Strata Total Therapy Died by Day 28 Original Amended rhapc Placebo rhapc Placebo P= P= (28) 109 (30) 108 (22) 150 (31)
27 apc in less severe sepsis
28 apc in less severe sepsis N=2613
29 Severe sepsis trial design Like in myocardial infarction? Like in cancer trials? Like in hypertension trials? Like in osteoporosis trials? ICU trials require different approach
30 ICU Mortality depends on ICU organization intensivist driven 24/24 and 7/7 presence nurse density [fte per ICU bed] size / volume - experience
31 Effect of ICU
32 Sepsis trials in the ICU Centers include only 1 or 2 patients No attention paid to concomitant treatment ICU organization different SMR (mortality corrected for severity of disease) antibiotics and infection timing correct? source control early goal directed therapy etc etc
33 Sepsis trials in the ICU
34 Sepsis trials in the ICU
35 Sepsis drug intervention trials in the ICU Ongoing trials Eritoran (TLR 4 Lipid A antagonist) Recombinant Human Antithrombin (+DIC) GR (protein-free phospholipid emulsion binding endotoxin TAK-242
36 Drug trials in sepsis CONCLUSIONS Sepsis is a complicated syndrome All drug intervention trials negative, but one Is the model appropriate? Do we jump to phase III too quickly Trial design RCT Patient inclusion criteria Source control YES or NO; antibiotics Participating ICU inclusion criteria missing
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,
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
New Strategies in the Management of Patients with Severe Sepsis
New Strategies in the Management of Patients with Severe Sepsis Michael Zgoda, MD, MBA President, Medical Staff Medical Director, ICU CMC-University, Charlotte, NC Factors of increases in the dx. of severe
Outcomes after administration of drotrecogin alfa in patients with severe sepsis at an urban safety net hospital.
Outcomes after administration of drotrecogin alfa in patients with severe sepsis at an urban safety net hospital. Aryan J. Rahbar, University Medical Center of Southern Nevada Marina Rabinovich, Emory
Assessing thrombocytopenia in the intensive care unit: The past, present, and future
Assessing thrombocytopenia in the intensive care unit: The past, present, and future Ryan Zarychanski MD MSc FRCPC Sections of Critical Care and of Hematology, University of Manitoba Disclosures FINANCIAL
INVESTIGATIONAL TREATMENTS FOR SEPSIS AN OVERVIEW
INVESTIGATIONAL TREATMENTS FOR SEPSIS AN OVERVIEW THE GLOBAL BURDEN OF SEPSIS Mortality rate estimated to be 30-50% Rates estimated to be as high as 80% in developing nations One third to one half of all
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
Recombinant Factor VIIa for Intracerebral Hemorrhage
Recombinant Factor VIIa for Intracerebral Hemorrhage January 24, 2006 Justin Lee Pharmacy Resident University Health Network Outline 1. Introduction to patient case 2. Overview of intracerebral hemorrhage
Sepsis and Multiple Organ Failure. J.G. van der Hoeven Radboud University Nijmegen Medical Centre
Sepsis and Multiple Organ Failure J.G. van der Hoeven Radboud University Nijmegen Medical Centre Sepsis - initiation Microorganism Tissue Damage Pathogen Associated Molecular Pattern (PAMP) Pattern Recognition
BLOOD COAGULATION AND INFLAMMATION IN SEPSIS. A NEW CHALLENGE. Antonio Artigas Critical Center Sabadell Hospital Autonomous University of Barcelona
BLOOD COAGULATION AND INFLAMMATION IN SEPSIS. A NEW THINKING AND THERAPEUTIC CHALLENGE Antonio Artigas Critical Center Sabadell Hospital Autonomous University of Barcelona SEVERE SEPSIS PATHOPHYSIOLOGY
DVT PROPHYLAXIS IN HOSPITALIZED MEDICAL PATIENTS SAURABH MAJI SR (PULMONARY,MEDICINE)
DVT PROPHYLAXIS IN HOSPITALIZED MEDICAL PATIENTS SAURABH MAJI SR (PULMONARY,MEDICINE) Introduction VTE (DVT/PE) is an important complication in hospitalized patients Hospitalization for acute medical illness
C. Michael Gibson, M.S., M.D. Professor of Medicine Harvard Medical School
Novel Strategies to Prevent Pulmonary Embolism and DVT: APEX Trial and Substudies C. Michael Gibson, M.S., M.D. Professor of Medicine Harvard Medical School Conflict of Interest Statement 2 Present Research/Grant
DISSEMINATED INTRAVASCULAR COAGULATION (DIC) Pichika Chantrathammachart MD Division of Hematology, Department of Medicine Ramathibodi Hospital
DISSEMINATED INTRAVASCULAR COAGULATION (DIC) Pichika Chantrathammachart MD Division of Hematology, Department of Medicine Ramathibodi Hospital Disseminated intravascular coagulation (DIC) Disseminated
Sepsis Pathophysiology
Sepsis Pathophysiology How Kids Differ From Adults Steve Standage Pediatric Critical Care Medicine Seattle Children's Hospital University of Washington School of Medicine Disclosures & Preamble No agenda,
Novel Sepsis Therapies
RSEM-GSA 17 Novel Sepsis Therapies Khaled Ahmed Alghamdi, MD, ABEM, FACEP, FAAEM Consultant Emergency Medicine Deputy program director Medical Director of Emergency Medical Services King Faisal Specialist
Pneumonia in the Hospitalized
Pneumonia in the Hospitalized Patient: Use of Steroids Nicolette Myers, MD Pulmonary/Sleep/Critical Care November 9, 2018 Park Nicollet Clinic Facts About Pneumonia CAP is the 8 th most common cause of
Redefining sepsis and sepsis treatment
Redefining sepsis and sepsis treatment What should we change in the treatment algorithm? Ricard Ferrer Critical Care Department Mutua Terrassa University Hospital Barcelona. SPAIN Time dependency Microorganism
PUZZLE. EARLY IMPACT ALS Jamie Syrett, MD Director of Prehospital Care Rochester General Health System PUZZLE THINKING OUTSIDE THE BOX! EARLY IMPACT?
PUZZLE EARLY IMPACT ALS Jamie Syrett, MD Director of Prehospital Care Rochester General Health System PUZZLE THINKING OUTSIDE THE BOX! EARLY IMPACT? IV ACCESS? What things do we do that make a difference?
Recombinant Activated Factor VII: Useful. Department of Surgery Grand Rounds 11/8/10 David Mauchley MD
Recombinant Activated Factor VII: Useful Department of Surgery Grand Rounds 11/8/10 David Mauchley MD Hemostasis and Coagulation Traditional cascade model Two convergent pathways Series of proteolytic
Stressed Out: Evaluating the Need for Stress Ulcer Prophylaxis in the ICU
Stressed Out: Evaluating the Need for Stress Ulcer Prophylaxis in the ICU Josh Arnold, PharmD PGY1 Pharmacy Resident Pharmacy Grand Rounds November 8, 2016 2016 MFMER slide-1 Objectives Identify the significance
New approaches to the treatment of sepsis
Clin Chest Med 24 (2003) 521 548 New approaches to the treatment of sepsis James M. O Brien, Jr, MD*, Edward Abraham, MD Division of Pulmonary Sciences and Critical Care Medicine, University of Colorado
Back to the Future: Updated Guidelines for Evaluation and Management of Adrenal Insufficiency in the Critically Ill
Back to the Future: Updated Guidelines for Evaluation and Management of Adrenal Insufficiency in the Critically Ill Joe Palumbo PGY-2 Critical Care Pharmacy Resident Buffalo General Medical Center Disclosures
Sepsis: Update on Diagnosis, Evaluation and Management
Sepsis: Epidemiology Sepsis: Update on Diagnosis, Evaluation and Management Michael J. Apostolakos, MD Professor of Medicine Director of Adult Critical Care University of Rochester ~ 750,000 cases per
Early lactate clearance rate is an indicator of Outcome in severe sepsis and septic shock
Early lactate clearance rate is an indicator of Outcome in severe sepsis and septic shock Sultana R, Ahsan ASMA, Fatema K, Ahmed F, Hamid T, Saha DK, Saha M, Nazneen S, Dr. Rozina Sultana FCPS (Medicine)
UPMC Critical Care
UPMC Critical Care www.ccm.upmc.edu CRISMA Critical Care Medicine the University of Pittsburgh Optimal use of ICU resources Derek C. Angus, MD, MPH, FRCP The CRISMA Laboratory Critical Care Medicine School
Epidemiology and Prevention of Stroke
Copyright Information Copyright protected material has been deleted from this presentation. References to the deleted material are provided for each slide. Epidemiology and Prevention of Stroke Larry B.
Objectives. Epidemiology of Sepsis. Review Guidelines for Resuscitation. Tx: EGDT, timing/choice of abx, activated
Update on Surviving Sepsis 2008 Objectives Epidemiology of Sepsis Definition of Sepsis and Septic Shock Review Guidelines for Resuscitation Dx: Lactate, t cultures, SVO2 Tx: EGDT, timing/choice of abx,
Heparin-Induced Thrombocytopenia. Steven Baroletti, PharmD., M.B.A., BCPS Brigham and Women s Hospital
Heparin-Induced Thrombocytopenia Steven Baroletti, PharmD., M.B.A., BCPS Brigham and Women s Hospital Heparin-induced thrombocytopenia (HIT) A serious concern associated with thrombosis development following
Update on Oral Anticoagulants. Dr. Miten R. Patel Cancer Specialists of North Florida Cell
Update on Oral Anticoagulants Dr. Miten R. Patel Cancer Specialists of North Florida Cell 904-451-9820 Email miten.patel@csnf.us Overview Highlights of the 4 new approved oral anticoagulants Results from
Immune monitoring in intensive care patients
28th General annual Meeting of the Belgian Hematological Society Immune monitoring in intensive care patients Guillaume Monneret Head Cellular Immunology Unit Hôp. E. Herriot-Hospices Civilsde Lyon -F
Online Supplementary Data. Country Number of centers Number of patients randomized
A Randomized, Double-Blind, -Controlled, Phase-2B Study to Evaluate the Safety and Efficacy of Recombinant Human Soluble Thrombomodulin, ART-123, in Patients with Sepsis and Suspected Disseminated Intravascular
Disseminated intravascular coagulation (DIC) Dr. Klara Vezendi Szeged University Transfusiology Department
Disseminated intravascular coagulation (DIC) Dr. Klara Vezendi Szeged University Transfusiology Department Disseminated intravascular coagulation (DIC, consumptive coagulopathy) is a clinicopathologic
Clinical and Economic Value of Rivaroxaban in Coronary Artery Disease
CHRISTOPHER B. GRANGER, MD Professor of Medicine Division of Cardiology, Department of Medicine; Director, Cardiac Care Unit Duke University Medical Center, Durham, NC Clinical and Economic Value of Rivaroxaban
The Usefulness of Sepsis Biomarkers. Dr Vineya Rai Department of Anesthesiology University of Malaya
The Usefulness of Sepsis Biomarkers Dr Vineya Rai Department of Anesthesiology University of Malaya 1 What is Sepsis? Whole Body Inflammatory State + Infection 2 Incidence and Burden of Sepsis in US In
John Davidson Consultant in Intensive Care Medicine Freeman Hospital, Newcastle upon Tyne
John Davidson Consultant in Intensive Care Medicine Freeman Hospital, Newcastle upon Tyne Overview of coagulation Testing coagulation Coagulopathy in ICU Incidence Causes Evaluation Management Coagulation
Is there enough evidence for DAPT after endovascular intervention for PAOD?
Is there enough evidence for DAPT after endovascular intervention for PAOD? Prof. I. Baumgartner Head Clinical & Interventional Angiology University Hospital Bern Disclosure Speaker name:...i. Baumgartner...
Critical Care in the Emergency Department
Critical Care in the Emergency Department Jenny Wilson MD, MS May 29, 2014 Disclosures No conflicts to disclose Overview ED critical care by the numbers Scope of practice Collaborations Current controversies
Top 5 (Topics) Papers In GIM Rocky Mountain ACP Internal Medicine Meeting Raj Padwal November 13, 2008
Top 5 (Topics) Papers In GIM 2008 Rocky Mountain ACP Internal Medicine Meeting Raj Padwal November 13, 2008 Methods Searched ACPJC/EBM, TOC of top medical journals, MEDSCAPE Best Evidence, consultation
Anti-platelet therapies and dual inhibition in practice
Anti-platelet therapies and dual inhibition in practice Therapeutics; Sept. 25 th 2007 Craig Williams, Pharm.D. Associate Professor of Pharmacy Objectives 1. Understand the pharmacology of thienopyridine
Is the combination of antithrombotics and lowdose anticoagulants worthwhile in PAD The VOYAGER trial
Is the combination of antithrombotics and lowdose anticoagulants worthwhile in PAD The VOYAGER trial Thomas HW Stadlbauer Department of Vascular and Endovascular Surgery, Klinikum rechts der Isar, Technical
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
Importance of kinetics of procalcitonin in septic patients. János Fazakas MD, PhD Semmelweis University, Department of Transplantation and Surgery
Importance of kinetics of procalcitonin in septic patients János Fazakas MD, PhD Semmelweis University, Department of Transplantation and Surgery Host pathogen interactions the innate and the adaptive
Continuing Medical Education Post-Test
Continuing Medical Education Post-Test Based on the information presented in this monograph, please choose one correct response for each of the following questions or statements. Record your answers on
Sepsis new definitions of sepsis and septic shock and Novelities in sepsis treatment
Sepsis new definitions of sepsis and septic shock and Novelities in sepsis treatment What is sepsis? Life-threatening organ dysfunction caused by a dysregulated host response to infection A 1991 consensus
Use of surrogate inflammatory markers in the diagnosis & monitoring of patients with severe sepsis
Thursday 11 th June 2015 Use of surrogate inflammatory markers in the diagnosis & monitoring of patients with severe sepsis Dr Duncan Wyncoll Guy s & St Thomas NHS Trust, London Conflicts of Interest In
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
Role of evidence from observational studies in the process of health care decision making
Role of evidence from observational studies in the process of health care decision making Jan van der Meulen Health Services Research Unit London School of Hygiene and Tropical Medicine Clinical Effectiveness
Schematic Of Heparin Induced Thrombocytopenia Platelet Count
Schematic Of Heparin Induced Thrombocytopenia Platelet Count Normal IgG and IgG2 differentially inhibit HIT antibody-dependent platelet activation that platelet counts were lower in FcγRIIA 131RR patients
CLINICAL DECISION USING AN ARTICLE ABOUT TREATMENT JOSEFINA S. ISIDRO LAPENA MD, MFM, FPAFP PROFESSOR, UPCM
CLINICAL DECISION USING AN ARTICLE ABOUT TREATMENT JOSEFINA S. ISIDRO LAPENA MD, MFM, FPAFP PROFESSOR, UPCM Principles of Decision Making Knowing the patient s true state is often unnecessary Does my patient
(ClinicalTrials.gov ID: NCT ) Title: The Italian Elderly ACS Study Author: Stefano Savonitto. Date: 29 August 2011 Meeting: ESC congress, Paris
Early aggressive versus initially conservative strategy in elderly patients with non-st- elevation acute coronary syndrome: the Italian randomised trial (ClinicalTrials.gov ID: NCT00510185) Stefano Savonitto,
Biomarkers in sepsis. Dr S Omar University of Witwatersrand CHBAH Bara ICU
Biomarkers in sepsis Dr S Omar University of Witwatersrand CHBAH Bara ICU Procalcitonin PCT biomarker 1993- described as a sepsis associated protein Identical to the precursor protein of calcitonin which
Pharmacological treatment of sepsis
doi: 10.1111/j.1472-8206.2008.00606.x REVIEW ARTICLE Pharmacological treatment of sepsis Armand R.J. Girbes*, Albert Beishuizen, Rob J.M. Strack van Schijndel University Hospital VU Medical Centre, Amsterdam,
EDUCATIONAL COMMENTARY DISSEMINATED INTRAVASCULAR COAGULATION
EDUCATIONAL COMMENTARY DISSEMINATED INTRAVASCULAR COAGULATION Educational commentary is provided through our affiliation with the American Society for Clinical Pathology (ASCP). To obtain FREE CME/CMLE
Mark H. Meissner, MD Peter Gloviczki Professor of Venous & Lymphatic Disorders University of Washington School of Medicine
Pulmonary Embolism Response Teams Not So Fast Early Interventions is a House of Cards Mark H. Meissner, MD Peter Gloviczki Professor of Venous & Lymphatic Disorders University of Washington School of Medicine
Results of severe sepsis treatment program using recombinant human activated protein C in Poland
Med Sci Monit, 2006; 12(3): CR107-112 PMID: 16501420 WWW.MEDSCIMONIT.COM Clinical Research Received: 2006.01.19 Accepted: 2005.01.20 Published: 2006.03.01 Results of severe sepsis treatment program using
Role of Clopidogrel in Acute Coronary Syndromes. Hossam Kandil,, MD. Professor of Cardiology Cairo University
Role of Clopidogrel in Acute Coronary Syndromes Hossam Kandil,, MD Professor of Cardiology Cairo University ACS Treatment Strategies Reperfusion/Revascularization Therapy Thrombolysis PCI (with/ without
INTENSIVE CARE MEDICINE CPD EVENING. Dr Alastair Morgan Wednesday 13 th September 2017
INTENSIVE CARE MEDICINE CPD EVENING Dr Alastair Morgan Wednesday 13 th September 2017 WHAT IS NEW IN ICU? (RELEVANT TO ANAESTHETISTS) Not much! SURVIVING SEPSIS How many deaths in England were thought
Using DOACs in CAD Patients in Sinus Ryhthm Results of the ATLAS ACS 2, COMPASS and COMMANDER-HF Trials
Using DOACs in CAD Patients in Sinus Ryhthm Results of the ATLAS ACS 2, COMPASS and COMMANDER-HF Trials 19 th Annual San Diego Heart Failure Symposium for Primary Care Physicians January 11-12, 2019 La
Disseminated Intravascular Coagulation. M.Bahmanpour MD Assistant professor IUMS
به نام خدا Disseminated Intravascular Coagulation M.Bahmanpour MD Assistant professor IUMS Algorithm for Diagnosis of DIC DIC Score factor score Presence of known underlying disorder No= 0 yes=2 Coagolation
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
CORTICOSTEROID USE IN SEPTIC SHOCK THE ONGOING DEBATE DIEM HO, PHARMD PGY1 PHARMACY RESIDENT VALLEY BAPTIST MEDICAL CENTER BROWNSVILLE
CORTICOSTEROID USE IN SEPTIC SHOCK THE ONGOING DEBATE DIEM HO, PHARMD PGY1 PHARMACY RESIDENT VALLEY BAPTIST MEDICAL CENTER BROWNSVILLE 1 ABBREVIATIONS ACCP = American College of Chest Physicians ARF =
Sepsis Story At Intermountain Healthcare Intensive Medicine Clinical Program
Sepsis Story At Intermountain Healthcare 2004-2012 Intensive Medicine Clinical Program The International Surviving Sepsis Campaign Was Organized In 2002 During The ESICM International Meeting In Barcelona,
Blood is serious business
Transfusion at RCH BLOOD TRANSFUSION Anthea Greenway Dept of Clinical Haematology >10000 fresh blood products per year Supports craniofacial and cardiac surgery Support bone marrow, liver transplant and
Ontario s Paediatric Referral and Listing Criteria for Small Bowel and Liver- Small Bowel Transplantation
Ontario s Paediatric Referral and Listing Criteria for Small Bowel and Liver- Small Bowel Transplantation Version 3.0 Trillium Gift of Life Network Ontario s Paediatric Referral and Listing Criteria for
Endothelium as a part of septic Multiple Organ Dysfunction Syndrome (MODS)-is endocan an answer?
Endothelium as a part of septic Multiple Organ Dysfunction Syndrome (MODS)-is endocan an answer? Małgorzata Lipinska-Gediga Department of Anaesthesiology and Intensive Therapy Medical University Wroclaw,
Cardiac Rehabilitation after Primary Coronary Intervention CONTRA
DEBATE SESSION Is there a role for cardiac rehabilitation in the modern era of Percutaneous coronary intervention and coronary artery bypass grafting? Cardiac Rehabilitation after Primary Coronary Intervention
ACS: What happens after the acute phase? Frans Van de Werf, MD, PhD Leuven, Belgium
ACS: What happens after the acute phase? Frans Van de Werf, MD, PhD Leuven, Belgium 4/14/2011 Cumulative death rates in 3721 ACS patients from UK and Belgium at ± 5 year (GRACE) 25 20 15 19% TOTAL 14%
John J.P. Kastelein MD PhD Professor of Medicine Dept. of Vascular Medicine Academic Medial Center / University of Amsterdam
Latest Insights from the JUPITER Study John J.P. Kastelein MD PhD Professor of Medicine Dept. of Vascular Medicine Academic Medial Center / University of Amsterdam Inflammation, hscrp, and Vascular Prevention
PACT module High risk surgical patient. Intensive Care Training Program Radboud University Medical Centre Nijmegen
PACT module High risk surgical patient Intensive Care Training Program Radboud University Medical Centre Nijmegen Intravascular volume effect of Ringer s lactate Double-tracer BV measurement Blood 1097
STEMI Presentation and Case Discussion. Case #1
STEMI Presentation and Case Discussion Scott M Lilly MD PhD, Interventional Cardiology The Ohio State University Contemporary Multidisciplinary Cardiovascular Conference Orlando, Florida September 17 th,
Index. Note: Page numbers of article titles are in boldface type.
Index Note: Page numbers of article titles are in boldface type. A Abdomen, acute, in oncological surgery patients, critical care issues in, 101 102 Acquired factor VIII inhibitors, in critically ill cancer
Medical Patients: A Population at Risk
Case Vignette A 68-year-old woman with obesity was admitted to the Medical Service with COPD and pneumonia and was treated with oral corticosteroids, bronchodilators, and antibiotics. She responded well
Updated and Guideline Based Treatment of Patients with STEMI
Updated and Guideline Based Treatment of Patients with STEMI Eli I. Lev, MD Director, Cardiac Catheterization Laboratory Hasharon Hospital, Rabin Medical Center Associate Professor of Cardiology Tel-Aviv
SESSION 3 11 AM 12:30 PM
SESSION 3 11 AM 12:30 PM for the Primary Prevention of Cardiovascular Disease: A Personalized Approach SPEAKER Samia Mora MD, MHS Presenter Disclosure Information The following relationships exist related
David M Kent, MD, MS
David M Kent, MD, MS 2 While RCTs can determine the better treatment on average, they do not answer the practicing doctor's question: what is the most likely outcome when this particular drug is given
TACO Est ce que cette complication transfusionnelle peut être prédite et prévenue?
TACO Est ce que cette complication transfusionnelle peut être prédite et prévenue? Jeannie Callum, BA, MD, FRCPC, CTBS En vertu des règles de divulgation, je suis tenu de vous Nothing dire que je suis
Clopidogrel vs New Antiplatelet Therapy (Prasugrel) Adnan Kastrati, MD Deutsches Herzzentrum, Technische Universität München, Germany
Clopidogrel vs New Antiplatelet Therapy () Adnan Kastrati, MD Deutsches Herzzentrum, Technische Universität München, Germany Seoul, April 3, 21 Dual Antiplatelet Therapy for Stenting MACE, % 12 1 8 6 In
What s new with DOACs? Defining place in therapy for edoxaban &
What s new with DOACs? Defining place in therapy for edoxaban & Use of DOACs in cardioversion Caitlin M. Gibson, PharmD, BCPS Assistant Professor, Department of Pharmacotherapy University of North Texas
Shock, Hemorrhage and Thrombosis
Shock, Hemorrhage and Thrombosis 1 Shock Systemic hypoperfusion due to: Reduction in cardiac output Reduction in effective circulating blood volume Hypotension Impaired tissue perfusion Cellular hypoxia
Management of Acute Myocardial Infarction
Management of Acute Myocardial Infarction Prof. Hossam Kandil Professor of Cardiology Cairo University ST Elevation Acute Myocardial Infarction Aims Of Management Emergency care (Pre-hospital) Early care
Nighttime ICU Physician Staffing
Nighttime ICU Physician Staffing Scott D. Halpern, M.D., Ph.D. Assistant Professor of Medicine, Epidemiology, and Medical Ethics & Health Policy Director, Fostering Improvement in End-of-Life Decision
oxiris A single CRRT set with multiple benefits for managing critically ill patients with AKI Adsorption of inflammatory mediators
oxiris A single CRRT set with multiple benefits for managing critically ill patients with AKI Adsorption of inflammatory mediators Heparin-grafted for reduced thrombogenicity Supports renal function POWERED
VASOPRESSORS AND INOTROPES CLINICAL PROFESSOR ANDREW BEZZINA FACEM MAY 2017
VASOPRESSORS AND INOTROPES CLINICAL PROFESSOR ANDREW BEZZINA FACEM MAY 2017 CONFLICTS OF INTEREST OVERVIEW Why? When? What? How? WHY? Circulation WHY? - SHOCK!!! Pump (Heart) HYPOVOLAEMIC the pipes have
DVT Pathophysiology and Prophylaxis in Medically Hospitalized Patients. David Liff MD Oklahoma Heart Institute Vascular Center
DVT Pathophysiology and Prophylaxis in Medically Hospitalized Patients David Liff MD Oklahoma Heart Institute Vascular Center Overview Pathophysiology of DVT Epidemiology and risk factors for DVT in the
Prevention of Acute Renal Failure Role of vasoactive drugs and diuretic agents
of Acute Renal Failure Role of vasoactive drugs and diuretic agents Armand R.J. Girbes Prof.dr. A.R.J. Girbes Chairman department of Intensive Care VU University Medical Center Netherlands (Failure of)
9/29/2015. Primary Prevention of Heart Disease: Objectives. Objectives. What works? What doesn t?
Primary Prevention of Heart Disease: What works? What doesn t? Samia Mora, MD, MHS Associate Professor, Harvard Medical School Associate Physician, Brigham and Women s Hospital October 2, 2015 Financial
Clopidogrel and ASA after CABG for NSTEMI
Clopidogrel and ASA after CABG for NSTEMI May 17, 2007 Justin Lee Pharmacy Resident University Health Network Objectives At the end of this session, you should be able to: Explain the rationale for antiplatelet
Mabel Labrada, MD Miami VA Medical Center
Mabel Labrada, MD Miami VA Medical Center *1-Treatment for acute DVT with underlying malignancy is for 3 months. *2-Treatment of provoked acute proximal DVT can be stopped after 3months of treatment and
Pathologic Mechanisms of Septic Shock
Pathologic Mechanisms of Septic Shock Kenneth J. Goodrum, Ph.D. Dept. Biomedical Sciences Ohio University College of Osteopathic Medicine Outline of Topics Definitions: SIRS, sepsis, shock, MODS Morbidity/mortality
The Management of Sepsis: What s New in 2013
The Management of Sepsis: What s New in 2013 Mitchell M. Levy MD, FCCM Professor of Medicine Chief, Division of Pulmonary, Sleep, and Critical Care Warren Alpert Medical School of Brown University Providence,
Evidence-based Diagnosis: A Workshop on Evaluating and Using Medical Tests Small Group 3: Friday, June 10, 11:00 12:30. Problems Without Answers
Evidence-based Diagnosis: A Workshop on Evaluating and Using Medical Tests Small Group 3: Friday, June 10, 11:00 12:30 A B C D E Objectives: RCT Checklist RRR vs. ARR NNT = 1/ARR NNH = 1/ARI NNT Treatment
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
Critical Appraisal of Evidence
Critical Appraisal of Evidence A Focus on Intervention/Treatment Studies Bernadette Mazurek Melnyk, PhD, CPNP/PMHNP, FNAP, FAAN Associate Vice President for Health Promotion University Chief Wellness Officer
Disclosures. Objectives. Procalcitonin: Pearls and Pitfalls in Daily Practice
Procalcitonin: Pearls and Pitfalls in Daily Practice Sarah K Harrison, PharmD, BCCCP Clinical Pearl Disclosures The author of this presentation has no disclosures concerning possible financial or personal
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
Adsorbtion of Cytokines Early in Septic Shock: the ACESS trial
Adsorbtion of Cytokines Early in Septic Shock: the ACESS trial Prof. Zsolt Molnár zsoltmolna@gmail.com Department of Anaesthesia and Intensive Care University of Szeged Hungary Pathophysiology Local insult
Thursday, February 26, :00 am. Regulation of Coagulation/Disseminated Intravascular Coagulation HEMOSTASIS/THROMBOSIS III
REGULATION OF COAGULATION Introduction HEMOSTASIS/THROMBOSIS III Regulation of Coagulation/Disseminated Coagulation necessary for maintenance of vascular integrity Enough fibrinogen to clot all vessels
Study 2 ( ) Pivotal Phase 3 Study Top-Line Results. October 29, 2018
Study 2 (1002-047) Pivotal Phase 3 Study Top-Line Results October 29, 2018 Safe Harbor Forward-Looking Statements These slides and the accompanying oral presentation contain forward-looking statements
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
Primary Prevention of T2DM. KW Chan Endocrine & Diabetes Team Department of M&G, PMH 22 March 2009
Primary Prevention of T2DM KW Chan Endocrine & Diabetes Team Department of M&G, PMH 22 March 2009 Primary Prevention of T2DM Why to intervene? When to intervene? Lifestyle intervention Pharmacological