IFAD 2015 Day 1
IFAD 2015: November 26, 2015
Introduction and Welcome to the 5th IFAD Meeting! (M. Malbrain)
- Encourages the use of SoMe and interaction with each other. Its only through discussion that genuine learning takes place.
- The 4Ds of fluid therapy
- ROSE fluid strategy
Honorary IFAD Opening Lecture: The Guinea Pig Club: The advent of salt water resuscitation (D. Muckart)
- The guinea pig club – injured airmen from second world war. Not sure how they were going to treat them, therefore experimented on.
- McGill’s forcep originated from needs of facial reconstruction surgery.
- McIndoe – facial reconstruction
- Burns resuscitation
- Inspiring talk by trauma surgeon – dedicated to the medical professionals looking after the victims of the Paris Attack. I would rate this talk as one of the top talks of the meeting so far. WATCH IT!
PRO-CON Debate: Perioperative Goal Directed Therapy
PRO: A Joosten
- Extensive variation in amount of fluid given to the patient
- Definition of goal-directed therapy
- Wet, dry or something else
- OPTIMISE Trial
- Perioperative GDT from ESA
- Have protocols but not adherent
CON: A. Perel
- GDT means different things to different people
- Review - http://www.ccforum.com/content/17/2/209
- https://healthmanagement.org/c/icu/issuearticle/perioperative-goal-directed-therapy by Perel
- Cecconi - http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3218998/
- GDT and optimizing SV is inherently going to lead to fluid overload
- Do we really want all our patients to be pre-load independent? A bit of fluid responsiveness may not be a bad thing.
Rebuttal & Voting
Define your goal!
BALANCED SOLUTIONS (Chairs: P. Elbers - M. Mythen)
What everyone should know about balanced solutions! (P. Caironi)
The history of balanced solution –
Effects of intravenous solutions on acid-base equilibrium: from crystalloids to colloids and blood components - https://journals.viamedica.pl/anaesthesiology_intensivetherapy/article/viewFile/AIT.2014.0059/27795
Stewart and strong ion difference - http://lifeinthefastlane.com/ccc/strong-ion-difference/
Crossover study – chloride is bad. http://www.ncbi.nlm.nih.gov/pubmed/22580944
PRO: D. Lobo
A history of normal saline - https://archive.org/stream/HistoryOf0.9Saline/SalineHistory_djvu.txt
Kidney and AKI - http://jama.jamanetwork.com/article.aspx?articleid=1383234
BUT a significant proportion did not need fluid and were therefore excluded from trial recruitment
CON: N. Van Regenmortel
Saline not associated with increased mortality (pic)
It’s the DOSE of normal saline that may be the problem – its not the fluid but the amount of fluid given that is the problem in trials showing the detrimental effect of saline.
TRACK B - MONITORING
PiCCO Pitfalls, tips & tricks (M. Malbrain)
A monitor without a treatment protocol is useless.
You need to know the pitfalls and how to obtain the most accurate result
Not trying to promote but here are a couple of PICCO movies for those interested (my unit doesn’t have PICCO and I haven’t got any contact with Pulsion) - http://www.pulsion.com/international-english/academy/education-movie/picco-plus/
The site of the CVC and PICCO device does affect the measurements. Equally the arrangements of CVC and Vascath and PICCO relative to each also affects it.
Valvulopathy affects measurements
MAQUET-GETINGE How to get the most out of a ventilator and NAVA (D. Gommers)
The cost of positive pressure ventilation - http://bja.oxfordjournals.org/content/101/4/446.full
Berlin definition of ARDS - http://jama.jamanetwork.com/article.aspx?articleID=1160659
NAVA review - http://www.ccforum.com/content/pdf/cc11297.pdf
Electrical Impedence Tomography to optimize PEEP -http://www.biomedcentral.com/content/pdf/cc8860.pdf
Rapid Disuse Atrophy of Diaphragm Fibers in Mechanically Ventilated Humans - http://www.nejm.org/doi/full/10.1056/NEJMoa070447
Ventilation distribution measured with EIT at varying levels of pressure support and Neurally Adjusted Ventilatory Assist in patients with ALI - http://icmjournal.esicm.org/Journals/abstract.html?doi=10.1007/s00134-013-2898-8
EDWARDS Perioperative GDT; something for us? (A. Joosten)
240 million anaesthetic procedures performed worldwide each year
Most of the references mentioned above
Hemodynamic monitoring and management in patients undergoing high risk surgery: a survey among North American and European anesthesiologists - http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3387639/
- Lack of standardization
- Lack of compliance
- Evidence applied inconsistently
Closed-loop automated GDT system - https://journals.viamedica.pl/anaesthesiology_intensivetherapy/article/view/43466
ULTRASOUND MONITORING Chairs: D. Lichtenstein
What everyone should know about critical care ultrasound! (A. Vieillard-Baron)
ESICM statement - http://www.esicm.org/document/685d594ec99881e4a652e23a5f0f230e.pdf
PRO-CON Debate: US Monitoring (LOOK OUT FOR THE VIDEOS AND MAKE YOUR OWN MIND UP)
PRO: J. Poelaert
CON: A. Wong