29th ISICEM OPEN!

The 29th ISICEM was opened by Prof Jean-Louis Vincent, Head of the Dept of Intensive Care at Erasme Hospital in Brussels and the meeting’s chairman. After a brief word of welcome to the packed auditorium, Prof Vincent focused on the difficulties in conducting clinical trials in critically ill patients. He presented results of a recent review showing that of 72 multicenter randomized controlled studies conducted in the ICU, only 10 showed a positive effect of the intervention on mortality. He proposed that although randomized controlled trials may be at the top of the pyramid of evidence in terms of quality they do not provide all the answers. Other study types must also be considered. Observational studies, for example, when conducted with adequate statistical analysis can provide important data with more generalizability and are cheaper to conduct. In closing, Prof Vincent encouraged us to carefully listen to all the results that will be presented during the meeting from whatever study type.

Each year prior to the ISICEM, a closed Round Table meeting is held on a topic of current importance and interest. This year’s subject was ICU-acquired weakness and, led by the chairmen, Dr Richard Griffiths and Dr Jesse Hall, an international panel of 21 experts spent 2 1/2 days debating and brain-storming all aspects of this condition which can have important implications for morbidity and long-term outcomes. The chairmen briefly summarized the discussions, stressing our general lack of knowledge in this field, the importance of prevention by early mobilization and reduced sedation, and of greater awareness, recognition and diagnosis.

Mechanical ventilation: With sessions covering lung mechanics in health and disease, basic ventilator design, patient-ventilator interactions, non-invasive ventilation, and potential strategies for the future of mechanical ventilation, this 2-day course, run by three experts in the field, Dr Neil MacIntyre, Dr Arthur Slutsky and Dr Marco Ranieri, provided participants with a real opportunity to update their understanding of the various technical and physiologic aspects of mechanical ventilation. All the participants particularly enjoyed the chance to put some of the theory into practice during the hands-on workshops when they could themselves set up and explore different ventilator devices.
 

Echocardiography: Course directors, Dr Anthony McLean, Dr Michel Slama, Dr Antoine Vieillard-Baron and Dr Jan Poelaert, gave participants the opportunity to develop (for the beginners) and improve (for the advanced) their skills in echocardiography, a technique which is becoming increasingly important in the diagnosis and monitoring of various cardiac-related disease processes in the ICU. Hands-on sessions offered participants the chance to practice some of their new-found skills and familiarize themselves with some of the measurement techniques, and case-presentations helped bring the theory to life demonstrating the real clinical application and usefulness of critical care echocardiography.
 

Abdominal compartment syndrome: Despite potential implications for many areas of ICU patient care, the importance of intra-abdominal hypertension is still under-appreciated. This comprehensive course, lead by two leaders in the field, Dr Manu Malbrain and Dr Jan de Waele,  provided a full review of the basic physiology, epidemiology, measurement and monitoring, and management of intra-abdominal hypertension and abdominal compartment syndrome. Skills sessions provided a chance to practice measuring intra-abdominal pressure and to apply temporary abdominal closure.

ICU follow-up clinics?

Increasingly we are being encouraged to think outside the ICU box and concentrate on what effect critical illness and ICU admission can have on longer term outcomes. ICU survivors are known to have higher mortality rates than the general population for up to 17 years after discharge and worse health-related quality of life. Dr Brian Cuthbertson presented the results of a study in the UK in which severely ill ICU patients were randomized to standard follow-up or a nurse-led program of extended follow-up with clinic visits at 3 and 9 months and including case-review, psychological assessment and referral where necessary, physical rehabilitation, occupational therapy, drug review. At 12 months, there were no differences between groups in health-related quality of life, depression scores, patient satisfaction, back to work rates, or mortality.

Selective digestive decontamination (SDD) has been promoted as a means of reducing the incidence of nosocomial infections, but does it actually work? In an interesting pro-con debate, Dr Zandstra from Amsterdam concisely presented his viewpoint that SDD can reduce nosocomial infections and improve survival rates without increasing antimicrobial resistance, with minimal adverse effects, and at low or neutral costs. Dr Wiener-Kronish, however, suggested that, although SDD may work in the Netherlands, where resistance rates are low and the structure of care is somewhat different, she did not believe it would be effective in her ICU in the USA. She also raised the point that selective oropharyngeal decontamination alone may be sufficient and this could be achieved by methods other than antibiotics, such as chlorhexidne mouth washes or early tracheostomy which would limit any possible effects on resistance.

In rebuttal, Dr Zandstra claimed that chlorhexidine was not efficacious at reducing Gram-negative infections, that early tracheostomy could actually increase infections, and that the Netherlands was not in fact the no-resistance paradise it was widely reported to be so that results could be relevant in other units. At the end of the debate, the two speakers clearly remained firmly on their respective pro and con fences!