ESICM Talk

Cerebral ultrasound is a developing point-of-care tool for intensivists and emergency physicians, with an important role in diagnosing acute intracranial pathology. The use of transcranial Doppler has expanded over the last years, opening a new window to the assessment of cerebral anatomy not only in neurocritical patients but also in general ICU and emergency room patients. To discuss the use of cerebral ultrasound for young intensivists we have interviewed Dr. Bertuetti. Listen to the interview in the following podcast.

Nutrition plays a vital role in the management of critically ill patients, and a tailored approach based on patient assessment, nutritional requirements, and clinical status is essential for optimising outcomes and promoting recovery. The concept of patient phenotyping and endotyping will help clinicians to better target nutrition interventions for a patient by categorising patients based on observable behaviours and underlying biological mechanisms, respectively. About these concepts, their clinical use and limitations we have interviewed Dr. Arthur Van Zanten. Listen to his explanations in our podcast offered by NEXT.

Sepsis is a life-threatening organ dysfunction caused by a dysregulated host response to an infection. Despite progress in the understanding of sepsis pathophysiology, no specific treatment has proven successful. The precision therapy, a greater understanding of the heterogeneity of sepsis is needed. Recent approaches to measuring sepsis heterogeneity used unsupervised computational methods on clinical, biomarker, or gene expression data from observational studies or clinical trial datasets. At present, more than 100 sepsis subtypes are proposed, without awareness of overlap (or clinical implications). It is unknown whether each new subtype strategy is an added value for the patient. To address this knowledge gap, a study was conducted aiming to determine the concordance between different sub-type labels, outcomes, and biologic pathways of critically ill sepsis patients classified by previously proposed sepsis subtyping methods. Listen to the podcast and learn more about the methodology and findings of this study.

VA-ECMO outcome scores have been previously developed and used extensively for risk adjustment, patient prognostication, and quality control across time and centres. The limitation of such scores is the derivation by using traditional statistical methods which are not capable of covering the complexity of ECMO outcomes. The Extracorporeal Life Support Organization Member Centres have developed a study where they aimed to leverage a large international patient cohort to develop and validate an AI-driven tool for predicting in-hospital mortality of VA-ECMO. The tool was derived entirely from pre-ECMO variables, allowing for mortality prediction immediately after ECMO initiation. To learn more about this study listen to the podcast.

Numerous Population Pharmacokinetic (PopPK) models have been developed for Piperacillin (PIP), most of which are based on small monocentric studies and may not be generalizable to other populations. A recent evaluation of six PIP models in 30 ICU patients receiving CI demonstrated large inter-model variability regarding predictability. The transferability of these results to other populations is uncertain due to the limited number of patients and the monocentric setting. Furthermore, a clinically oriented model assessment in conjunction with TDM (Bayesian forecasting) was lacking. A recent study aimed to evaluate the predictive performance of available PIP PopPK models with and without TDM using an external multicenter dataset to facilitate model selection for MIPD in critically ill patients. Listen to the podcast and learn more about the methodology and findings of this study.

The concept of a "green ICU" is increasingly important in today's world, as sustainability and environmental considerations become integral to healthcare practices. Hospitals, including ICUs, can have a substantial environmental footprint due to energy consumption, waste generation, and resource use. Implementing green practices reduces this impact and contributes to overall environmental sustainability. Integrating sustainability into healthcare practices not only benefits the environment but also supports the overall mission of providing high-quality patient care. To learn more about Green ICU implementation listen to the interview with Nicole Hunfeld.

Acute respiratory distress syndrome (ARDS) is the term applied to a spectrum of conditions with different etiologies that share common clinical-pathological characteristics including: increased permeability of the alveolo-capillary membrane, resulting in inflammatory edema; increased non-aerated lung tissue resulting in higher lung elastance (lower compliance); and increased venous admixture and dead space, which result in hypoxemia and hypercapnia. The new updated ESICM guidelines have been published highlighting a new approach to ARDS in terms of definitions, phenotyping, and respiratory support strategies. To discuss ARDS from the new guidelines to bedside applied physiology we have interviewed Professor Gattinioni and invite you to follow the conversation in the following podcast.

Sepsis‐associated acute kidney injury (SA‐AKI) is a common, increasingly prevalent problem in the intensive care unit (ICU). The association between sepsis and AKI has been studied previously. However, the lack of a reproducible and standardized consensus definition has limited the interpretability of available knowledge. In order to assess SA-AKI incidence, patient characteristics, timing, trajectory, treatment, and associated outcomes a multicenter, observational study was conducted. In order to know more about the study methodology and findings we have interviewed Dr White. Listen to the interview in the following podcast.

Transportation of critically ill patients is inevitable in most health systems. Prehospital transportation (PHT) may be necessary after a major injury or as a result of a life-threatening illness – for example, myocardial infarction, intracranial haemorrhage, or metabolic coma. On our ESICM Academy, we offer a course series on Patient Transportation, from the general introduction to conducting interfacility and intrahospital patient transportation and prehospital transport in Critical Care. Hear more from one of the authors in this podcast. The ESICM Academy is accredited by the European Accreditation Council for Continuing Medical Education (EACCME) and offers updated, peer-reviewed, evidence-based training material, free of charge for ESICM members. Speaker: Michael J LAURIA. Former Pararescueman in the US Air Force and Critical Care/Flight Paramedic. Currently Emergency Medicine Physician, University of New Mexico Health Sciences Center; EMS/Critical Care Fellow, Flight Physician; Associate Medical Director for Lifeguard Air Emergency Services (US).

Intensive care units (ICU) are the most peculiar units in hospitals where the quality and safety of health care delivery should be at the highest level. The most critical patients are treated in this unit, posing all healthcare professionals working there with continuous physical and emotional challenges. ICU teams are composed of different profiles with the same goal of satisfying the needs of the patients. Combining each one's skills and abilities to make the best clinical decisions requires healthy multidisciplinary teamwork. Recent studies show that the ability to work in a team in the ICU results in better patient outcomes and less or better coping with ICU staff burnout. Learn more about the importance of interprofessional teamwork in the ICU in this podcast with Elena Conoscenti and Andreas Xyrichis. Speakers: Andreas XYRICHIS. King's College London (UK). Elena CONOSCENTI. ISMETT (Mediterranean Institute for Transplantation and Advanced Specialized Therapies), Palermo (IT). ESICM Nurses & Allied Healthcare Professionals Committee member.

Multiple organ dysfunction syndrome (MODS) is common after major trauma, affecting up to two-thirds of patients with critical injuries. Post-trauma MODS is associated with a mortality of over 20% and poor long-term outcomes in those who survive. Current management is supportive, and there are no specific pharmacological agents that prevent organ dysfunction. The TOP-ART randomised clinical trial, a two-stage study, has tested firstly the safety and efficacy of the early artesunate administration on a cohort of severely injured and bleeding trauma patients and, secondly, the outcomes of artesunate administration on trauma patients at risk of developing MODS. Listen to Joanna Shepherd's interview in the following podcast to learn more about the study's results. Original article: Safety and efficacy of artesunate treatment in severely injured patients with traumatic haemorrhage. The TOP-ART randomised clinical trial Speakers: Joanna SHEPHERD. Centre for Trauma Sciences, The Blizard Institute, Queen Mary University of London (UK). Rahul COSTA-PINTO. Austin Hospital, Melbourne (AU). ESICM NEXT Committee Member.

Sepsis is a life-threatening acute organ dysfunction secondary to infection and affects more than 19 million people annually. In 2017, it was estimated that almost 49 million people were infected by sepsis, and half of those cases occurred in children under 5. In-hospital mortality has declined over the years, resulting in a large number of sepsis survivors. Emerging data suggest that patients who survive sepsis frequently experience new symptoms, long-term disability, and worsening chronic health conditions for which they will seek care from many clinicians. Elena Conoscenti has interviewed two experts in the field who will explain better what happens in adult and paediatric patients who survived sepsis. Speakers: Elsa AFONSO. Anglia Ruskin University, Cambridge (UK). Laura Maria ALBERTO. Universidad del Salvador (AR). Elena CONOSCENTI. ISMETT (Mediterranean Institute for Transplantation and Advanced Specialized Therapies), Palermo (IT). ESICM Nurses & Allied Healthcare Professionals Committee member.

Central nervous system (CNS) infections significantly burden ICU physicians' daily clinical work. Diagnosis can be challenging, and timely management is of the utmost importance. Meningoencephalitis is one of the CNS infections for which the epidemiological studies conducted in adult patients suggest that approximately one in two will require care in an intensive care unit. In those patients requiring ICU admission, meningoencephalitis is associated with a poor prognosis, including refractory seizures, prolonged hospital stay, neurological disability, and death. The EURECA study endorsed by the ESICM intended to characterise the clinical presentation, etiologies, and outcomes in adult patients with severe meningoencephalitis requiring care in the ICU. We discuss its findings in this episode. Help us review our educational podcasts! Complete this short survey here. Speakers: Romain SONNEVILLE. Bichat Claude Bernard University Hospital, APHP, Université Paris Cité (FR). Laura GALARZA. Laura Galarza Hospital Universitari General de Castellón (ES). Chair, ESICM NEXT Committee.

Several studies have found an association between diabetes mellitus, disease severity and outcome in COVID-19 patients. Old, critically ill patients are particularly at risk. A recent multicentre international prospective cohort study was performed in 151 ICUs across 26 countries to investigate the impact of diabetes mellitus on 90-day mortality in a high-risk cohort of critically ill patients over 70 years of age. Original article: Diabetes mellitus is associated with 90-day mortality in old critically ill COVID-19 patients: a multicenter prospective observational cohort study Help us review our educational podcasts! Complete this short survey here. Speakers Timo MAYERHÖFER. Medical University Innsbruck (AT). Kristina FUEST. Technische Universität München (DE). ESICM NEXT Committee member.

International guidelines recommend targeting normocapnia in adults with coma resuscitated after out-of-hospital cardiac arrest. However, normocapnia may be insufficient to restore and maintain adequate cerebral perfusion. Conversely, mild hypercapnia increases cerebral blood flow and may improve neurologic outcomes. Nevertheless, the most effective Paco2 target in adults with coma resuscitated after out-of-hospital cardiac arrest has not been well studied in randomized trials. Therefore, the Targeted Therapeutic Mild Hypercapnia After Resuscitated Cardiac Arrest (TAME) trial was conducted to test the hypothesis that targeted mild hypercapnia would improve neurologic outcomes at 6 months as compared with targeted normocapnia in adults with coma who had been resuscitated after out-of-hospital cardiac arrest. Listen to the podcast for more insight into the hypothesis, methodology and findings from the TAME study. Original paper: Mild Hypercapnia or Normocapnia after Out-of-Hospital Cardiac Arrest Speakers Claudio SANDRONI. Policlinico Universitario Agostino Gemelli, Rome (IT). Markus SKRIFVARS. University of Helsinki (FI). Chair, ESICM Trauma & Emergency Medicine (TEM) Section. Chiara ROBBA. University of Genova (IT). ESICM Neuro-Intensive Care (NIC) Section.

Severe community‐acquired pneumonia (sCAP) is a clinical entity to describe ICU-admitted patients with community‐acquired pneumonia (CAP) as they might require organ support, and it is associated with high morbidity and mortality. While European and non‐European guidelines are available for CAP, there are no specific guidelines for sCAP. Therefore, a team of experts have joined efforts to prepare a summary document to guide the most effective treatments and management strategies for adult patients with sCAP. Listen to the following podcast to learn more about these guidelines produced by the European Respiratory Society (ERS), the European Society of Intensive Care Medicine (ESICM), the European Society of Clinical Microbiology and Infectious Diseases (ESCMID), and the Latin American Thoracic Association (ALAT). Original paper: ERS/ESICM/ESCMID/ALAT guidelines for the management of severe community-acquired pneumonia Speakers Ignacio MARTIN-LOECHES. Department of Intensive Care Medicine, Multidisciplinary Intensive Care Research Organisation (MICRO), St James’s Hospital, Dublin (IE). Antoni TORRES. CIBER of Respiratory Diseases (CIBERES), Institute of Health Carlos III, Madrid (ES). Pedro PÓVOA. NOVA Medical School, CHRC, New University of Lisbon (PT).

Preclinical models of acute kidney injury (AKI) consistently demonstrate that a uremic milieu enhances renal recovery and decreases kidney fibrosis. Reduced renal clearance has the surprising and counterintuitive effect of being an effective treatment for AKI. In this perspective, Dr Lakhmir S. Chawla suggests a hypothesis describing why the uremic milieu is kidney protective and proposes a clinical trial of ‘permissive azotemia’ to improve renal recovery and long-term renal outcomes in critically ill patients with severe AKI. Hear more about the explanation of this hypothesis in the following podcast, organised by the ESICM AKI Section. Speakers Lakhmir S. CHAWLA. Chief Medical Officer, Silver Creek Pharmaceuticals. Recipient of the International Vicenza Award for Critical Care Nephrology. Eric HOSTE. UZ Gent (BE). AKI Section Representative, ESICM Social Media & Digital Content Committee. Marc ROMAIN. Hadassah Medical Center, Jerusalem (IL).

Coagulopathy is a severe and frequent complication in critically ill patients, for which the pathogenesis and presentation may be variable depending on the underlying disease. Therefore, a review has been conducted to differentiate between hemorrhagic coagulopathies, characterised by a hypercoagulable and hyperfibrinolysis state, and thrombotic coagulopathies with a systemic prothrombotic and antifibrinolytic phenotype, based on the dominant clinical phenotype. Dr Julie Helms, our podcast guest, will explain more about the review and discuss the differences in pathogenesis and treatment of the common coagulopathies. Original paper: How to manage coagulopathies in critically ill patients Speakers Julie HELMS. Université de Strasbourg (UNISTRA), Faculté de Médecine, Hôpitaux Universitaires de Strasbourg (FR). Ahmed ZAHER. Oxford University Hospitals (UK). NEXT Committee member, ESICM.

End-of-life care is an approach to a terminally ill patient that shifts the focus of care to symptom control, comfort, dignity, quality of life, and quality of dying rather than treatments aimed at cure or prolongation of life. A detailed description of the concept of the end of life care and as well how to deal with end-of-life situations are discussed in the podcast. Speakers Julie BENBENISHTY. Hadassah Hebrew University Medical Center, Jerusalem (IL). Head of the European critical care doctoral educated nurses group. Ahmed ZAHER. Oxford University Hospitals (UK). NEXT Committee member, ESICM.

The Surviving Sepsis Campaign (SSC) produces and regularly updates guidelines for managing patients with sepsis and septic shock. However, deviation from guidelines is frequently observed in the intensive care unit. The last iteration of the SSC includes 79 recommendations where the impact on mortality remains unclear for some of them. Prioritising the recommendations based on their relative impact on mortality would be helpful to the clinician. A recent study has been carried out to identify among all SSC recommendations applicable during the first 24 h following sepsis onset, a subset of guidelines that should be prioritised to minimise 28-day all-cause mortality. Original paper: Machine-learning-derived sepsis bundle of care Speakers Romain PIRRACCHIO. Department of Anesthesia and Perioperative Medicine, Zuckerberg San Francisco General Hospital and Trauma Center, University of California San Francisco (US). Ana-Maria IOAN. Fundacion Jimenez Diaz University Hospital, Madrid (ES). Spain. NEXT Committe member, ESICM.