The aim of the ERC-ESICM guidelines on temperature control after cardiac arrest in adults is to provide evidence-based guidance in adults who are comatose after resuscitation from either in-hospital or out-of-hospital cardiac arrest, regardless of the underlying cardiac rhythm. These guidelines replace the recommendations on temperature management after cardiac arrest included in the 2021 post-resuscitation care guidelines co-issued by the European Resuscitation Council (ERC) and the European So...
Mar 09, 2022•15 min•Season 2Ep. 9
Growing evidence suggests that insufficient antibiotic exposure (defined as failure to achieve the pharmacokinetic/pharmacodynamic (PK/PD) target to kill or inhibit the growth of a pathogen) is associated with worse clinical outcomes in sepsis patients. Moreover, up to 50% of critically ill patients receiving a β-lactam antibiotic with regimens based on manufacturers' recommendations fail to reach the target. Therapeutic drug monitoring (TDM)-guided therapy has been proposed as a strategy to fur...
Mar 02, 2022•29 min•Season 2Ep. 8
Clinical and pathophysiological understanding of septic shock has progressed exponentially in the previous decades, translating into a steady decrease in septic shock-related morbidity and mortality. Even though large randomised, controlled trials have addressed fundamental aspects of septic shock resuscitation, many questions still exist. A comprehensive review was carried out to describe the current standards of septic shock resuscitation. This review targeted the evolving concepts in differen...
Feb 16, 2022•23 min•Season 2Ep. 7
Clinicians use noninvasive respiratory support interventions in the post-extubation period to mitigate the risk of extubation failure. These interventions [noninvasive positive pressure ventilation (NIPPV) and high-flow nasal cannula (HFNC)] have been shown to be efficacious in preventing initial intubation in patients with hypoxemic respiratory failure, but their efficacy in preventing post-extubation respiratory failure and reintubation is less clear. A systematic review and network meta-analy...
Feb 02, 2022•30 min•Season 2Ep. 6
Kidney transplantation is the most common solid organ transplant performed worldwide. New advances in transplant medicine have expanded the indications for kidney transplantation, and nowadays, many kidney recipients are elderly patients who possibly have more comorbidities. Up to 6% of kidney transplant recipients experience a life-threatening complication requiring intensive care unit admission, primarily in the late post-transplant period (≥6 months). The most common medical complications req...
Jan 28, 2022•28 min•Season 2Ep. 5
Neuromonitoring is considered a crucial and fundamental process to monitor patients in critical care settings. In this podcast, ESICM NEXT member Denise Battagliani interviews Chiara Robba on the ultimate findings regarding neuromonitoring, including: basics of neuromonitoring research; indications for neuromonitoring of patients who do (not) suffer any direct brain injury; the rationale in neuromonitoring patients with sepsis, COVID-19 and liver failure and the most appropriate tools to use for...
Jan 21, 2022•14 min•Season 2Ep. 4
Systemic corticosteroids decrease mortality in critically ill patients with COVID-19, and the World Health Organization, therefore, recommends dexamethasone 6 mg daily for up to 10 days for patients with severe or critical COVID-19. In addition, higher doses of systemic corticosteroids have been used in patients with COVID-19 and non-COVID-19 acute respiratory distress syndrome [3, 5, 6], and higher doses have been hypothesised to benefit patients with severe or critical COVID-19. However, the b...
Jan 19, 2022•15 min•Season 2Ep. 3
Attempts at improving cardiac arrest outcomes have increasingly included extracorporeal techniques to re-establish circulation. In particular, the application of veno-arterial extracorporeal membrane oxygenation (ECMO) during cardiac arrest is called extracorporeal cardiopulmonary resuscitation (ECPR). However, there is much debate about the impact of ECPR use on survival and neurological and functional recovery in adults suffering cardiac arrest. These issues have been evaluated in a systematic...
Jan 12, 2022•17 min•Season 2Ep. 2
Metabolic resuscitation is an adjunctive therapy for sepsis and septic shock, which consists of a combination of vitamin C, glucocorticoids, and vitamin B1 or their components. Recently, there has been considerable interest in this treatment. However, due to the wide range of combinations of its components, there is no evidence for the effectiveness of this therapy. To fill this gap, a network meta-analysis (NMA) and component NMA was conducted. This analysis summarised the available evidence co...
Jan 05, 2022•13 min•Season 2Ep. 1
Integrating palliative care in critical care is advocated as a way to mitigate physical and psychological burdens for patients and their families and improve end-of-life care. Despite the emerging literature published that supports this positive association, the quality of evidence remains limited, in large part due to limitations in the definition of interventions, poor precision of effect estimates and the large variation in study designs. In a systematic review , Dr Victoria Metaxa et al. hig...
Dec 21, 2021•32 min•Season 1Ep. 21
Given the rapidity with which critically ill patients with bleeding can deteriorate, having a standardised approach to transfusion in these patients can be of great assistance to clinicians working in time-pressured circumstances. An expertise task force created within ESICM has developed an international guideline that provides guidance for clinicians caring for critically ill patients with massive and non-massive bleeding. 26 clinical practice recommendations (2 strong recommendations, 13 cond...
Dec 07, 2021•14 min•Season 1Ep. 20
Ultrasonography is an evolving skill in critically ill patients. We provide a large number of statements regarding the required ultrasonographic basic skills for the management of critically ill patients. Original article: Speakers: Basic ultrasound head-to-toe skills for intensivists in the general and neuro intensive care unit population: consensus and expert recommendations of the European Society of Intensive Care Medicine Chiara ROBBA. Anesthesia and Intensive Care, Ospedale Policlinico San...
Nov 30, 2021•12 min•Season 1Ep. 19
Critical illness occurs frequently after a new diagnosis of hematologic malignancy and has high associated mortality. Baseline characteristics at diagnosis can help identify those patients at the highest risk of critical illness. Original article: Critical illness in patients with hematologic malignancy: a population-based cohort study Speakers: Bruno L. FERREYRO . Interdepartmental Division of Critical Care Medicine, University of Toronto (CA). Laveena MUNSHI . Interdepartmental Division of Cri...
Nov 10, 2021•23 min•Season 1Ep. 18
We report the results of a consensus conference based on a systematic review of the literature and experts opinions assessing the management of cancer patients in the ICU. Original article : Critically ill cancer patient’s resuscitation: a Belgian/French societies’ consensus conference Speakers: Rahul COSTA-PINTO . Austin Hospital, Melbourne - Australia; ESICM NEXT Committee Member. Anne-Pascale MEERT : Service de Médecine Interne, Soins Intensifs et Urgences Oncologiques, Institut Jules Bordet ...
Oct 25, 2021•10 min•Season 1Ep. 17
In this network meta-analysis, as compared to normothermia (37–37.8 °C), we found that deep hypothermia (31–32 °C), moderate hypothermia (33–34 °C) and mild hypothermia (35–36 °C) may have no effect on survival and functional outcome among comatose survivors of out-of-hospital cardiac arrest. However, both deep and moderate hypothermia were associated with an increased risk of arrhythmia compared to normothermia. Original paper : Targeted temperature management following out-of-hospital cardiac ...
Oct 13, 2021•15 min•Season 1Ep. 16
The updated version of the guidelines will be presented during the ESICM LIVES virtual conference , LIVES 2021. The evidence-based guidelines, published in Critical Care Medicine and Intensive Care Medicine, reflect best practices and recommendations for the treatment of sepsis and septic shock in adults and are revised regularly to account for new research. Speakers: Manu SHANKAR-HARI . Department of Critical Care Medicine, Guy's and St Thomas' NHS Foundation Trust, London, UK; School of Immuno...
Oct 04, 2021•7 min•Season 1Ep. 15
The manipulation of arterial carbon dioxide levels (PaCO2) is easy, and hyperventilation (HV) has been a common ICP-lowering strategy for over half a century. However, hyperventilation-induced vasoconstriction is a double-edged sword. It reduces cerebral blood volume and intracranial volume, and therefore, lowers ICP. We observed huge variability among centres in PaCO2 values and use of HV. Although causal inferences cannot be drawn from these observational data, our results suggest that, in pat...
Sep 28, 2021•15 min•Season 1Ep. 14
Sepsis is associated with an increased long-term risk of cardiovascular events, which is observed for at least 5 years after the index admission. This risk represents a critical area of potential intervention to improve post-sepsis outcomes. Systematic Review and Meta-Analysis Speakers: Ignacio MARTIN-LOECHES . Department of Anaesthesia and Intensive Care, St. James's Hospital, Dublin (IE) and Multidisciplinary Intensive Care Research Organization (MICRO), Trinity College Dublin, Dublin (IE). As...
Sep 13, 2021•17 min•Season 1Ep. 13
In this multicenter international cohort in 19 ECMO centres from five countries in the Middle East and India, 307 critically ill COVID-19 patients received ECMO therapy, of whom 138 (45%) survived to home discharge. The current study showed that new satellite ECMO centres could be safely implemented with appropriate close supervision of regional experts and may provide favourable outcomes in highly selected critically ill patients. Original study : Implementation of new ECMO centres during the C...
Aug 24, 2021•16 min•Season 1Ep. 12
For family members of survivors, the ICU diary is an important source of medical information, provides a way for them to register their presence at the patient’s bedside and express their feelings, and contributes to humanizing the ICU staff. For relatives of non-survivors, the diary also works as a concrete memory of their loved one’s last days before dying, helping relatives to cope with bereavement. Systematic Review: Exploring family members’ and health care professionals’ perceptions on ICU...
Jul 13, 2021•19 min•Season 1Ep. 11
Intracranial pressure monitoring in patients with acute brain injury in the intensive care unit (Synapse-ICU): an international, prospective observational cohort study. The practice of continuously measuring intracranial pressure (commonly referred to as ICP) in comatose patients after haemorrhagic stroke or head injury is standard practice in many countries. However, it is uncertain whether monitoring-guided therapies will yield significant results. Nevertheless, data collected from the study c...
Jun 16, 2021•17 min•Season 1Ep. 10
Evolving changes in mortality of 13,301 critically ill adult patients with COVID-19 over 8 months. Age, frailty and adjusted mortality of critically ill patients have progressively reduced over the course of the COVID-19 pandemic. Non-invasive respiratory support has been increasingly used and was independently associated with improved 30-day survival in our study. Future randomised trials are needed to determine if a management strategy based on early non-invasive support for respiratory failur...
Jun 15, 2021•11 min•Season 1Ep. 9
Natural history, trajectory, and management of mechanically ventilated COVID-19 patients in the United Kingdom. In a cohort of COVID-19 patients treated in the United Kingdom, progressive respiratory failure was increasingly associated with mortality. Evidence-based triggers for ARDS interventions, in particular prone position, were not implemented, had delayed application, or showed poor responsiveness in a sizeable proportion of patients with progressive hypoxaemia. How this implementation gap...
Jun 08, 2021•19 min•Season 1Ep. 8
In this randomized clinical trial that included 999 patients, the use of a stylet for tracheal intubation in critically ill adult patients resulted in significantly higher first‑attempt intubation success than the use of tracheal tube alone. The incidence of serious adverse events evaluated by the rate of traumatic injuries related to tracheal intubation was similar in the two groups. Speakers: Prof Sheila MYATRA. Consultant Critical Care Specialist, Department of Anaesthesiology, Critical Care ...
Jun 01, 2021•25 min•Season 1Ep. 7
We are confronted daily with complex ethical issues during the care of our patients in intensive care units. The principles of biomedical ethics may guide us with regard to concerns for ethical decision-making. Although globalisation brings enormous richness and diversity through multicultural structures, ethical issues may challenge intensivists in these conditions. However, the 'moral stresses' that health professionals experience are almost always ignored. Speakers: Dr Burcin Halacli. Interni...
May 28, 2021•19 min•Season 1Ep. 6
In Africa, in children hospitalised with severe pneumonia with oxygen saturations between 80 and 91% who did not receive oxygen, mortality assessed at 48 h (1.4%) was comparable to the usual method of oxygen delivery (low-flow oxygen; LFO (2.5%)) and in those receiving high-flow nasal therapy (HFNT, 1.1%). The potential impact of HFNT on patient-centred outcomes and on resources, particularly oxygen supplies, should stimulate further exploration particularly in children with severe pneumonia man...
May 26, 2021•23 min•Season 1Ep. 5
Expanding controlled donation after the circulatory determination of death: statement from an international collaborative. This International Collaborative Statement aims at expanding cDCDD in the world to help countries progress towards self-sufficiency in transplantation and offer more patients the opportunity of organ donation. The Statement addresses three fundamental aspects of the cDCDD pathway: First, it describes the process of determining a prognosis that justifies the WLST (withdrawal ...
May 11, 2021•15 min•Season 1Ep. 4
Following on from the recent ESICM webinars on haemodynamic monitoring and vasopressors , Dr Wong interviews Dr Rola on his thoughts on a range of issues, from the use of ultrasound, venous congestion to the Pulmonary Artery Catheter as well as his predictions for the direction of future research. Speakers: Dr Adrian WONG . Consultant in Intensive Care Medicine and Anaesthesia, King's College Hospital, London (UK) and current Chair of the ESICM Editorial and Publishing Committee (EPC). Dr Philip...
Apr 27, 2021•25 min•Season 1Ep. 3
Ultrasound has become an indispensable tool while caring for critically ill patients. Increasing availability at bedside and the role that it plays in the diagnosis and management of patients had made that clinicians incorporate ultrasound as a part of their bedside clinical examination. Some colleagues argue that it can be a good hemodynamic tool too, however, others disagree. Speakers: Dr Laura GALARZA . Intensivist at the University General Hospital in Castellon, Spain and Deputy Chair of the...
Apr 23, 2021•13 min•Ep. 2
Severe traumatic brain injury (TBI) is a leading cause of morbidity and mortality, particularly in young adults, where 50% of survivors cannot live independently six months post injury. Speakers: Dr Rahul COSTA-PINTO . Austin Hospital, Melbourne - Australia; ESICM NEXT Committee Member. Prof Andrew UDY . The Alfred Hospital, Melbourne - Australia; principal investigator of the BONANZA study (Brain Oxygen Neuromonitoring in Australia and New Zealand Assessment Trial)....
Mar 23, 2021•21 min•Season 1Ep. 1
