IFAD 2015 Day 1

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.
• https://en.wikipedia.org/wiki/Guinea_Pig_Club
• www.gilliesarchives.org.uk
• McGill’s forcep originated from needs of facial reconstruction surgery.
• McIndoe – facial reconstruction
• Burns resuscitation
• https://journals.viamedica.pl/anestezjologia_intensywnaterapia/article/view/AIT.a2015.0063
• https://journals.viamedica.pl/anestezjologia_intensywnaterapia/article/view/AIT.a2015.0064
• 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

http://www.nature.com/ki/journal/v86/n6/full/ki2014105a.html

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

SPLIT Trial - http://jama.jamanetwork.com/article.aspx?articleid=2454911

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/

Conclusion

• Lack of standardization
• Lack of compliance
• Evidence applied inconsistently

Closed-loop automated GDT system - https://journals.viamedica.pl/anaesthesiology_intensivetherapy/article/view/43466

http://www.ncbi.nlm.nih.gov/pubmed/24378044

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 

 

Comments (1)

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  Manu Malbrain

  26 May 2016 at 14:51 | #

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