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 h...
Sep 27, 2023•24 min•Season 3Ep. 15
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...
Sep 20, 2023•18 min•Season 3Ep. 16
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 heal...
Sep 13, 2023•25 min•Season 3Ep. 13
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 se...
Sep 06, 2023•18 min•Season 3Ep. 12
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 c...
Aug 30, 2023•10 min•Season 3Ep. 11
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 Tar...
Jun 27, 2023•26 min•Season 3Ep. 10
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 patien...
May 24, 2023•20 min•Season 3Ep. 9
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 ...
May 17, 2023•43 min•Season 3Ep. 8
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,...
May 10, 2023•20 min•Season 3Ep. 7
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 doctor...
May 03, 2023•31 min•Season 3Ep. 6
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 am...
Mar 22, 2023•26 min•Season 3Ep. 5
Sepsis is a life-threatening organ dysfunction caused by a dysregulated host response to infection. In this context, biomarkers could be considered indicators of either infection or dysregulated host response or response to treatment and/or aid clinicians in prognosticating patient risk. A recently published narrative review provides current data on the clinical utility of pathogen-specific and host-response biomarkers, offers guidance on optimising their use, and proposes the need for future re...
Mar 15, 2023•25 min•Season 3Ep. 4
Individualising drug dosing using model-informed precision dosing (MIPD) of beta-lactam antibiotics and ciprofloxacin has been proposed as an alternative to standard dosing to optimise antibiotic efficacy in critically ill patients. However, randomised clinical trials (RCT) on clinical outcomes have been lacking. In this podcast, Drs Ewoldt and Abdulla relate how they conducted a multicentre RCT in 8 Dutch hospitals. It included patients admitted to the intensive care unit (ICU) treated with ant...
Jan 25, 2023•17 min•Season 3Ep. 3
Bronchiolitis is a common lung infection in young children and infants. Approximately one-tenth of the affected children are admitted, and between 2 and 6% of them present a severe form and are referred to paediatric intensive care units. Nevertheless, the definition of severe acute bronchiolitis is mainly clinical and based on low levels of evidence. In this podcast, Dr Milési presents guidelines for managing infants under 12 months of age with severe bronchiolitis to create a series of pragmat...
Jan 18, 2023•13 min•Season 3Ep. 2
The outcome of very old patients admitted to the intensive care unit (ICU) is determined by both the severity of the acute condition and the age-related decline of resilience to stress. However, that decline is characterised by substantial inter-individual heterogeneity, which is considered a hallmark of the ageing process. A recent study investigated the heterogeneity within the very old population by clustering analysis of patient characteristics recorded on admission to the ICU. The researche...
Jan 11, 2023•13 min•Season 3Ep. 1
Nutrition is an essential care we provide to critically ill patients aiming to avoid severe muscle wasting and weakness, which correlate with mortality and long-term burdens. Considering that the ICU patients' nutritional needs vary with the phase of critical illness, evidence-based nutrition protocols are so much needed. Dr Tarcukovic, one of the participants of the ESICM Nutrition Pathway , shares with us her experience in this Education Programme and discusses a few key points of the physiopa...
Nov 23, 2022•23 min•Season 2Ep. 24
Pregnant women with COVID-19 are more likely to be admitted to the ICU and require invasive mechanical ventilation or venovenous extracorporeal membrane oxygenation (VV-ECMO). Nevertheless, only a few case series have focused on ventilatory management and outcomes of pregnant women with COVID-19 admitted to the ICU. COVIDPREG study primarily aimed to assess the ventilatory management of pregnant women with COVID-19 admitted to ICU. Secondly, the study aimed to evaluate obstetric management and r...
Oct 12, 2022•13 min•Season 2Ep. 23
Intensive care unit (ICU) sedation practices have dramatically changed over the last 20 years. Nowadays, they include light levels of sedation, SAT, and the use of non-benzodiazepines. An overview of ICU sedation practices’ evolution over the years has been recently published in the ICM Journal. This publication highlights the challenge faced by clinicians during the COVID-19 pandemic regarding sedation practices and recommends reengaging bundled-based strategies such as the ABCDEF Bundle to pro...
Sep 14, 2022•14 min•Season 2Ep. 22
Acute kidney injury is common in critically ill patients, and 10-15% of ICU patients receive renal replacement therapy (RRT). The timing of therapy initiation is limited by heterogeneity, but until 10-15 years ago there was a trend toward early initiation, as noted by several meta-analyses. In the past 5 years, several large PRCTs have addressed this topic: ELAIN, AKIKI, IDEAL-ICU, STARRT-AKI, and AKIKI-2. In this ESICM NEXT educational podcast, we will find out what is the most recent consensus...
Sep 07, 2022•47 min•Season 2Ep. 21
Over the last few years, the assessment of frailty at admission to the ICU has become increasingly popular. Frailty is also considered one of the potential prognostic indicators in patients with COVID-19. The degree of frailty could be used to assist both the triage into intensive care and decisions regarding treatment limitations. The COVIP study led by prof Jung sought to determine the interaction of frailty and age in elderly COVID-19 ICU patients. Listen to the podcast to learn more about th...
Aug 31, 2022•26 min•Season 2Ep. 20
A recent outbreak of acute non-A-E hepatitis with serum transaminases greater than 500 IU/L identified in children under 16 years reported in the United Kingdom (UK) has become a serious cause for concern for public health authorities and paediatric liver and critical care services. From 1 January to 16 May 2022, UK public health authorities have reported 197 cases with a median age of 3 years, male (50%), from all regions of the UK, with 11 children requiring liver transplantation (LT). A lette...
Aug 24, 2022•28 min•Season 2Ep. 19
The ECHO-COVID study investigated the effects on cardiac function in critically ill COVID -19 patients. The primary aim of this study was to investigate the incidences and patterns of left and right ventricular dysfunction in the first echocardiographic examination performed after admission to the intensive care unit (ICU) in a large series of patients hospitalised for severe COVID-19. The study referred to previous international collaborations with experts in critical care echocardiography (CCE...
Jun 22, 2022•21 min•Season 2Ep. 18
The European Society of Intensive Care Medicine (ESICM), initiated a study to describe the extent of the COVID-19 ICU surge worldwide and the clinical characteristics, management, and outcomes of critically ill COVID-19 patients. Additionally, the goal was to study the impact of critically ill COVID-19 patients admitted to a surge capacity bed on the treatment and outcomes. The study hypothesised that admission to surge capacity beds increased mortality compared to standard ICU beds and that nee...
Jun 15, 2022•13 min•Season 2Ep. 17
The haemodynamic instability most patients present in the ICU may lead to organ dysfunction, deterioration into multi-organ failure, and eventually death. Proper medical management is essential to prevent or treat organ failure and improve the outcomes for these patients. This podcast will tackle a few crucial points regarding haemodynamic monitoring starting from the first hours of patients admitted to the ICU. Listen & receive important advice from our experts Prof Xavier Monet and Prof Mi...
Jun 08, 2022•40 min•Season 2Ep. 16
The practice of neurocritical care for children with injured or vulnerable brains entails clinical assessment, a range of monitoring methods within the paediatric intensive care unit (PICU), and the follow-up of children's long-term neurodevelopment. These activities involve inherent challenges related to the diversity of the case mix and age range. Different concepts were discussed in a recently published 'state of the art' paper about critically ill children. With the paper's authors, we went ...
Jun 01, 2022•27 min•Season 2Ep. 15
Recent evidence suggests that acute hypercapnia could have harmful physiological and clinical effects in patients with ARDS, particularly impacting the haemodynamic system. A review and meta-analysis were performed to summarise the clinical consequences of acute hypercapnia in mechanically ventilated patients. The primary objective was to determine the association between acute hypercapnia and mortality in adult patients mechanically ventilated for ARDS. The secondary goal was to identify the as...
May 25, 2022•12 min•Season 2Ep. 14
Sepsis refers to a dysregulated response to infection-causing end-organ dysfunction. It is associated with short-term risks such as shock and in-hospital death. Meanwhile, long-term consequences among sepsis survivors can include clinical deconditioning, recurrent sepsis, mental health issues, and increased risk of long-term mortality. Moreover, recent investigations have demonstrated a possible association of sepsis with subsequent cardiovascular adverse events, including myocardial infarction,...
Apr 13, 2022•16 min•Season 2Ep. 13
Delirium is a condition of acute organic brain dysfunction with fluctuating disturbances of attention and cognition, and its prevalence in intensive care units (ICUs) is recorded as high as 80%. Delirium is highly distressing for patients and families and commonly reported as the worst experience of ICU admission. Melatonin has been described as an attractive intervention for delirium prevention, and a large study hypothesised that early administration of melatonin effectively reduces delirium i...
Apr 06, 2022•13 min•Season 2Ep. 12
Preclinical studies precede most clinical trials. They help identify criteria for evaluating human safety, including signs and symptoms that should be monitored closely during early clinical trials. The importance of these preclinical studies in intensive care medicine starts from developing new surgical procedures, and hands-on training to new medical devices and prescription drugs. To have more insights into preclinical research and real examples of translation of such research in clinical pra...
Mar 23, 2022•32 min•Season 2Ep. 11
The prevalence of long-term mental health symptoms in the family members of COVID-19 ICU survivors is unknown and may differ from the prevalence rate in the family members of non-COVID-19 ICU survivors, given the pandemic circumstances. A better understanding of the impact of COVID-19 ICU admission on family members is needed to provide adequate support during and after the ICU stay. Therefore, the prevalence of mental health symptoms and quality of life in family members of COVID-19 ICU survivo...
Mar 16, 2022•15 min•Season 2Ep. 10
