News
26th annual congress of the European Society of Intensive Care Medicine Published Online October 21, 2013 http://dx.doi.org/10.1016/ S2213-2600(13)70198-X The 26th annual congress of the European Society of Intensive Care Medicine was held on Oct 5–9, 2013, in Paris, France For videos of Hot Topic sessions see http://www.esicm.org/newsarticle/lives2013hottopics For the muscle wasting study see JAMA 2013; published online Oct 9. DOI:10.1001/ jama.2013.278481 For the Surviving Sepsis Campaign guidelines see http://www.sccm.org/ Documents/SSC-Guidelines.pdf
Optimising perioperative cardiovascular management Rupert Pearse (Barts and the London School of Medicine and Dentistry, London, UK) presented the results of the OPTIMISE (Optimisation of Peri-operaTive cardIovascular Management to Improve Surgical outcomE) trial, which investigated whether a haemodynamic therapy algorithm guided by cardiac output monitoring would decrease the number of patients who developed complications within 30 days of major gastrointestinal surgery (ISRCTN04386758). The investigators screened 1735 patients at 16 centres in the UK to enrol 734 patients (367 in both the intervention group and the usual care group). The main reasons for failure to enrol in the study were absence of patient consent, absence of clinician consent, and insufficient research staff available to implement the treatment algorithm. However, implementation of the haemodynamic therapy algorithm did not require admission to a critical care unit and was designed to be implemented irrespective of the patient’s location. Overall compliance was more than 90% in both trial
groups. “The intervention was readily implementable into routine clinical practice”, Pearse told the conference, “which is an achievement we are very proud of”. The primary outcome measure of complications or death within 30 days of surgery was not significantly different between the intervention group (36·6%) and the usual care group (44·4%; relative risk [RR] 0·84, 95% CI 0·71–1·01; p=0·070). Pearse also reported no significant difference in secondary outcome measures of death at 180 days (RR 0·66, 0·41–1·05; p=0·079) or infection (RR 0·80, 0·63–1·02; p=0·079). Five patients in the intervention group had a severe cardiac adverse event within 24 h of beginning the trial, whereas no such events were reported in the usual care group. However, at 30 days no significant difference in adverse events was seen between the intervention group and the usual care group. In his conclusion, Pearse stated: “Because this intervention is so routine in some countries, and almost unheard of in others, you should re-evaluate your clinical practice in light of these findings, this being the largest clinical trial to be conducted in this area so far.”
Muscle wasting in critical illness
Deep Light/Science Photo Library
Muscle wasting occurs early and rapidly in critical illness, and is more severe in patients with multiorgan failure than in those with single organ failure, according to the results of a collaborative study presented by Nicholas Hart (King’s College London, London, UK). Between 25% and 50% of critically ill patients develop muscle wasting, resulting in muscle weakness and physical disability that can last up to 5 years, but the time course and underlying mechanisms are poorly understood. The study investigators prospectively recruited 63 critically ill patients admitted to the intensive care 674
units (ICUs) of a teaching hospital and a community hospital in the UK. By day 7, the cross-sectional area (CSA) of the rectus femoris, as measured on ultrasound, had decreased by 10·3% (95% CI 6·1–14·5) and the fibre CSA by 17·5% (95% CI 5·8–29·3). The decrease in rectus femoris CSA continued to day 10 and was greater in patients with multiorgan failure that in those with single organ failure (p
26th annual congress of the European Society of Intensive Care Medicine Published Online October 21, 2013 http://dx.doi.org/10.1016/ S2213-2600(13)70198-X The 26th annual congress of the European Society of Intensive Care Medicine was held on Oct 5–9, 2013, in Paris, France For videos of Hot Topic sessions see http://www.esicm.org/newsarticle/lives2013hottopics For the muscle wasting study see JAMA 2013; published online Oct 9. DOI:10.1001/ jama.2013.278481 For the Surviving Sepsis Campaign guidelines see http://www.sccm.org/ Documents/SSC-Guidelines.pdf
Optimising perioperative cardiovascular management Rupert Pearse (Barts and the London School of Medicine and Dentistry, London, UK) presented the results of the OPTIMISE (Optimisation of Peri-operaTive cardIovascular Management to Improve Surgical outcomE) trial, which investigated whether a haemodynamic therapy algorithm guided by cardiac output monitoring would decrease the number of patients who developed complications within 30 days of major gastrointestinal surgery (ISRCTN04386758). The investigators screened 1735 patients at 16 centres in the UK to enrol 734 patients (367 in both the intervention group and the usual care group). The main reasons for failure to enrol in the study were absence of patient consent, absence of clinician consent, and insufficient research staff available to implement the treatment algorithm. However, implementation of the haemodynamic therapy algorithm did not require admission to a critical care unit and was designed to be implemented irrespective of the patient’s location. Overall compliance was more than 90% in both trial
groups. “The intervention was readily implementable into routine clinical practice”, Pearse told the conference, “which is an achievement we are very proud of”. The primary outcome measure of complications or death within 30 days of surgery was not significantly different between the intervention group (36·6%) and the usual care group (44·4%; relative risk [RR] 0·84, 95% CI 0·71–1·01; p=0·070). Pearse also reported no significant difference in secondary outcome measures of death at 180 days (RR 0·66, 0·41–1·05; p=0·079) or infection (RR 0·80, 0·63–1·02; p=0·079). Five patients in the intervention group had a severe cardiac adverse event within 24 h of beginning the trial, whereas no such events were reported in the usual care group. However, at 30 days no significant difference in adverse events was seen between the intervention group and the usual care group. In his conclusion, Pearse stated: “Because this intervention is so routine in some countries, and almost unheard of in others, you should re-evaluate your clinical practice in light of these findings, this being the largest clinical trial to be conducted in this area so far.”
Muscle wasting in critical illness
Deep Light/Science Photo Library
Muscle wasting occurs early and rapidly in critical illness, and is more severe in patients with multiorgan failure than in those with single organ failure, according to the results of a collaborative study presented by Nicholas Hart (King’s College London, London, UK). Between 25% and 50% of critically ill patients develop muscle wasting, resulting in muscle weakness and physical disability that can last up to 5 years, but the time course and underlying mechanisms are poorly understood. The study investigators prospectively recruited 63 critically ill patients admitted to the intensive care 674
units (ICUs) of a teaching hospital and a community hospital in the UK. By day 7, the cross-sectional area (CSA) of the rectus femoris, as measured on ultrasound, had decreased by 10·3% (95% CI 6·1–14·5) and the fibre CSA by 17·5% (95% CI 5·8–29·3). The decrease in rectus femoris CSA continued to day 10 and was greater in patients with multiorgan failure that in those with single organ failure (p
