Lord JM, Midwinter MJ, Chen YF, Belli A, Brohi K, Kovacs EJ, Koenderman L, Kubes P, Lilford RJ.; Lancet. 2014 Oct 18;384(9952):1455-65.
Improvements in the control of haemorrhage after trauma have resulted in the survival of many people who would otherwise have died from the initial loss of blood. However, the danger is not over once bleeding has been arrested and blood pressure restored. Two-thirds of patients who die following major trauma now do so as a result of causes other than exsanguination. Trauma evokes a systemic reaction that includes an acute, non-specific, immune response associated, paradoxically, with reduced resistance to infection...
Balogh ZJ, Lumsdaine W, Moore EE, Moore FA.; Lancet. 2014 Oct 18;384(9952):1466-75
Postinjury abdominal compartment syndrome (ACS) is an example of a deadly clinical occurrence that was eliminated by strategic research and focused preventions. In the 1990s, the syndrome emerged with the widespread use of damage control surgery and aggressive crystalloid-based resuscitation. Patients who previously exsanguinated on the operating table made it to intensive care units, but then developed highly lethal hyperacute respiratory, renal, and cardiac failure due to increased abdominal pressure...
Seifter JL.; N Engl J Med. 2014 Nov 6;371(19):1821-31.
This review, which describes an approach to acid–base disorders, incorporates insights and examples drawn from the traditional, bicarbonate-centered approach and the physicochemical, or strong ion, theory.
Date: 18 Nov 2014; Time: 6:30-7:30pm; Speaker: Dr Alwin Yeung (ICU, RH)
Annals of Intensive Care 2014, 4:30 (11 October 2014)
Background: The decision of when to stop septic shock resuscitation is a critical but yet a relatively unexplored aspect of care. This is especially relevant since the risks of over-resuscitation with fluid overload or inotropes have been highlighted in recent years. A recent guideline has proposed normalization of central venous oxygen saturation and/or lactate as therapeutic end-points, assuming that these variables are equivalent or interchangeable. However, since the physiological determinants of both are totally different, it is legitimate to challenge the rationale of this proposal. We designed this study to gain more insights into the most appropriate resuscitation goal from a dynamic point of view. Our objective was to compare the normalization rates of these and other potential perfusion-related targets in a cohort of septic shock survivors.
2014 Oct - Timing of (supplemental) parenteral nutrition in critically ill patients: a systematic review
Annals of Intensive Care 2014, 4:31 (2 October 2014)
Supplemental parenteral nutrition (SPN) is used in a step-up approach when full enteral support is contraindicated or fails to reach caloric targets. Recent nutrition guidelines present divergent advices regarding timing of SPN in critically ill patients ranging from early SPN (<48 h after admission; EPN) to postponing initiation of SPN until day 8 after Intensive Care Unit (ICU) admission (LPN). This systematic review summarizes results of prospective studies among adult ICU patients addressing the best timing of (supplemental) parenteral nutrition (S)PN...
Annals of Intensive Care 2014, 4:29 (30 September 2014)
High-flow nasal cannula (HFNC) is a relatively new device for respiratory support. In pediatrics, HFNC use continues to increase as the system is easily set up and is well tolerated by patients. The use of nasal cannula adapted to the infant?s nares size to deliver heated and humidified gas at high flow rates has been associated with improvements in washout of nasopharyngeal dead space, lung mucociliary clearance, and oxygen delivery compared with other oxygen delivery systems...
Dr. Zoltan Lett, founding chairman of our Hong Kong Society of Critical Care Medicine (HKSCCM), passed away peacefully in the morning of 15th November 2014 at his nursing home, after a short illness, with his daughter at his side.
With deep grief, I pass onto you this sad news. Dr. Lett had been my teacher since 1980s. He was one of the founders in the critical care specialty in Hong Kong. His good vision and strong will had started the HKSCCM and paved the way for the successful development of critical care in Hong Kong. You could all look at his photo in the foreword of our recently published book “生命現場” .
Hisfuneral and memorial service will be on Thursday 20th November 2014 at St. Peter’s Church, Old Town, Bexhill-on-Sea, West Sussex TN40 2HF, United Kingdom at 2pm. Any donation is to be given to the Society of Anaesthetists of Hong Kong in lieu of flowers.
Our thoughts are with Dr. Lett’s daughter, Angela and family. Please keep them all in our prayers
May he rest in peace.
Yan Wing Wa
18 November 2014
The Hong Kong Society of Critical Care Medicine (香港危重病學會)will be holding its Annual Scientific Meeting (ASM) 2014(週年學術會議2014)on 30 November, 2014 (Sunday) at the Intercontinental Grand Stanford Hong Kong. And it is our pleasure to have the meeting supported by the Hong Kong Association of Critical Care Nurses (香港危重病學護士協會).
This is a major event for all Hong Kong doctors, nurses and allied health professionals working with critically ill patients. Similar to previous years, we will have renowned overseas and local speakers to enlighten us on important ICU topics in plenary lectures & seminars.
Continuing our tradition, SimWARS will be held and teams of doctors & nurses are invited to join this exciting competition. Young specialists and critical care nurses are encouraged to submit abstracts of original research papers for free-paper presentation, and share with the audience about their studies.
Details of the programme will be released soon. We sincerely hope to make the ASM an enjoyable and interesting event for all of you.
Looking forward to seeing you.
Dr. SIN, Kai Cheuk
Chairman of the Organizing Committee for HKSCCM ASM 2014
Date: 4 Sep 2014
2014 Oct - Argatroban versus Lepirudin in critically ill patients (ALicia): a randomized controlled trial
Tanja A Treschan, Maximilian S Schaefer, Johann Geib, Astrid Bahlmann, Tobias Brezina, Patrick Werner, Elisabeth Golla, Andreas Greinacher, Benedikt Pannen, Detlef Kindgen-Milles, Peter Kienbaum, Martin Beiderlinden Critical Care 2014, 18:588 (25 October 2014)
Introduction: Critically ill patients often require renal replacement therapy accompanied by thrombocytopenia. Thrombocytopenia during heparin anticoagulation may be due to heparin-induced thrombocytopenia with need for alternative anticoagulation. Therefore, we compared argatroban and lepirudin in critically ill surgical patients.
2014 Nov 15 - Procalcitonin Algorithm in Critically Ill Adults with Undifferentiated Infection or Suspected Sepsis. A Randomized Controlled Trial
Yahya Shehabi, Martin Sterba, Peter Maxwell Garrett, Kanaka Sundaram Rachakonda, Dianne Stephens, Peter Harrigan, Alison Walker, Michael J. Bailey, Bronwyn Johnson, David Millis, Geoff Ding, Sandra Peake, Helen Wong, Jane Thomas, Kate Smith, Loretta Forbes, Miranda Hardie, Sharon Micallef, and John F. Fraser Am. J. Resp. Crit. Care Med. Nov 15, 2014, vol. 190, no. 10: 1102-1110
Rationale: The role of procalcitonin (PCT), a widely used sepsis biomarker, in critically ill patients with sepsis is undetermined.
2014 Oct - The effects of goal directed fluid therapy based on dynamic parameters on post-surgical outcome: a meta-analysis of randomized controlled trials
Jan Benes, Mariateresa Giglio, Nicola Brienza, Frederic Michard Critical Care 2014, 18:584 (28 October 2014)
Introduction: Dynamic predictors of fluid responsiveness, namely systolic pressure variation, pulse pressure variation, stroke volume variation and pleth variability index have been shown to be useful to identify in advance patients who will respond to a fluid load by a significant increase in stroke volume and cardiac output. As a result, they are increasingly used to guide fluid therapy. Several randomized controlled trial have tested the ability of goal-directed fluid therapy (GDFT) based on dynamic parameters (GDFTdyn) to improve post-surgical outcome. These studies have yielded conflicting results. Therefore we performed this meta-analysis to investigate whether the use of GDFTdyn is associated with a decrease in post-surgical morbidity.
2014 Nov 1 - Association of Postdischarge Rehabilitation with Mortality in Intensive Care Unit Survivors of Sepsis
Pei-wen Chao, Chia-Jen Shih, Yi-Jung Lee, Ching-Min Tseng, Shu-Chen Kuo, Yu-Ning Shih, Kun-Ta Chou, Der-Cherng Tarng, Szu-Yuan Li, Shuo-Ming Ou, and Yung-Tai Chen Am. J. Resp. Crit. Care Med. Nov 1, 2014, vol. 190, no. 9: 1003-1011
Rationale: Intensive care unit (ICU)-acquired weakness is a common issue for sepsis survivors that is characterized by impaired muscle strength and causes functional disability. Although inpatient rehabilitation has not been found to reduce in-hospital mortality, the impact of postdischarge rehabilitation on sepsis survivors is uncertain.
Renee D. Stapleton, MD, PhD, FCCP; William J. Ehlenbach, MD; Richard A. Deyo, MD, MPH; J. Randall Curtis, MD, MPH CHEST Nov 2014; 146(5): 1214-1225
BACKGROUND: Outcomes after in-hospital CPR in older adults with chronic illness are unclear.
Date: 24-26 Apr 2015; Venue: Suntec Singapore, International Convention and Exhibition Centre
2014 Nov - Sepsis Severe or Septic Shock: Outcome According to Immune Status and Immunodeficiency Profile
Violaine Tolsma, MD; Carole Schwebel, MD, PhD; Elie Azoulay, MD, PhD; Michael Darmon, MD, PhD; Bertrand Souweine, MD, PhD; Aurélien Vesin, MSc; Dany Goldgran-Toledano, MD; Maxime Lugosi, MD; Samir Jamali, MD; Christine Cheval, MD; Christophe Adrie, MD, PhD; Hatem Kallel, MD; Adrien Descorps-Declere, MD; Maïté Garrouste-Orgeas, MD, PhD; Lila Bouadma, MD, PhD; Jean-François Timsit, MD, PhD CHEST Nov 2014; 146(5): 1205-1213
OBJECTIVES: This study evaluated the influence of the immune profile on the outcome at day 28 (D28) of patients admitted to the ICU for septic shock or severe sepsis.
Ellen L. Burnham, MD; Robert C. Hyzy, MD, FCCP; Robert Paine, III, MD; Aine M. Kelly, MD; Leslie E. Quint, MD; David Lynch, MB; Douglas Curran-Everett, PhD; Marc Moss, MD; Theodore J. Standiford, MD CHEST Nov 2014; 146(5): 1196-1204
BACKGROUND: In ARDS, the extent of fibroproliferative activity on chest high-resolution CT (HRCT) scan has been reported to correlate with poorer short-term outcomes and pulmonary-associated quality of life. However, clinical factors associated with HRCT scan fibroproliferation are incompletely characterized. We questioned if lung compliance assessed at the bedside would be associated with fibroproliferation on HRCT scans obtained during the resolution phase of ARDS.
Allan J. Walkey, MD; Bradley G. Hammill, MS; Lesley H. Curtis, PhD; Emelia J. Benjamin, MD CHEST Nov 2014; 146(5): 1187-1195
BACKGROUND: New-onset atrial fibrillation (AF) is associated with adverse outcomes during a sepsis hospitalization; however, long-term outcomes following hospitalization with sepsis-associated new-onset AF are unclear.