First weekend lenary session at CCSSA 2022, chaired by @BranniganLliam and Prof M Mer. Starting with a talk by Dr Francesca Rubulotta @frubulotta on 'Knowledge Transfer Across the World' - appropriately a recorded talk made half way around the world! #CCSSA2022#critcare#FOAMcc
Incidentally I met Dr Rubulotta a few years ago at a different congress - the amazing ventilation congress Ventilation Through the Ages - what a wonderful, passionate intensivist. I'm gonna plug the next one here, which will be next year! #CCSSA2022#VTA23
Dr Rubulotta starts by explaining 'Knowledge Transfer' as a mechanism to close the know-do gap. It is the synthesis, exchange and application of knowledge by relevant stakeholders in order to accelerate the benefits of global and local innovation. #CCSSA2022
The knowledge must be LEARNED and must be USEABLE in a context. If both conditions are not met, knowledge transfer has not occurred. #CCSSA2022
In medicine, knowledge transfer occurs via a set of formal, semiformal and informal processes. Formal - Journal clubs, critical incident reviews/M&Ms, workshops. Semiformal - teaching rounds, process documentation. Informal - job shadowing, story telling, mentoring. #CCSSA2022
How do professionals learn? This can be spontaneous or planned. Spontaneous learning happens all the time but is unpredictable. Planned learning is more controlled and targeted, but it has time and financial costs. doi.org/10.54026/CREM/…
Informal KT models can be very powerful, particularly with the advent of social media. Mentorship, which often starts informally, can also be formalised and globalised through social media, but often falls short if not followed by sponsorship. #CCSSA2022
This is particularly true in certain subpopulations, such as women and minorities - who are often overmentored but undersponsored during professional development in medicine. @frubulotta speaks about her IWIN initiative - check it out! iwinideal.com/home/ #CCSSA2022
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Last for this session is Prof Sean Chetty @seanC001 speaking on 'To Sedate or Not to Sedate'. Is this a ?that is the question? scenario... #CCSSA2022#critcare#FOAMcc
Sedation is the reduction of irritability or agitation by administration of sedative drugs, generally to facilitate a medical procedure or diagnostic procedure. In modern ICU practice, the modern concept is analgosedation, but this needs to be teased apart a little. #CCSSA2022
The typical modern ICU patient is older, sicker and more complex than ever before. Pain is generally a root cause of distress for many patients, but there can be others - dyspnea, delirium and sleep deprivation. #CCSSA2022
Next up is Prof Joao Batista Borges, speaking on "Individualised lung recruitment to minimise VILI - the 'Teen Lung' Concept" #CCSSA2022#critcare#FOAMcc
To understand recruitment manoeuvres, we need to have a clear understanding of regional lung mechanics, and the concepts of collapse and hyper-distension, along with the lung hysteresis curves. #CCSSA2022
The 'teen lung' concept is the idea of a lung that is stretched and overdistended, where there is inadequate or insufficient lung recruitement. It is 'partial recruitment' and may be worse than no recruitment at all. doi.org/10.1186/s13054… #CCSSA2022
Next is Giancamo Bellani, talking on 'Relationships between oxygenations indices & patient outcomes' #CCSSA2022#critcare#FOAMcc
Several indices have been proposed as bedside 'markers' for the development of VILI. They are relevant as they allow us to prognosticate patients, and therefore to determine the need for a higher level of intervention (e.g. ECMO). #CCSSA2022
PF ratio remains a very robust predictor of mortality, and is the crux for the diagnosis of ARDS. #CCSSA2022
Next up is respiratory therapist Benevides Netto on 'Optimising Patient Ventilatory Interactions' #CCSSA2022#critcare#FOAMcc
First speaks to how patient-ventilator dyssynchrony is common, and has been found in all modes of ventilation! It has significant consequences, via a variety of mechanisms - see P-SILI (but not only P-SILI!)
How to monitor asynchrony
- Graphic analysis
- Oesophageal pressure
- Diaphragmatic ultrasound
- Electrical impedence tomography #CCSSA2022
So how can we divide patients in whom we want to prevent intubation
- Those we want to prevent primarily intubating (e.g. a patient with acute hypoxaemic respiratory failure)
- THose who were previously intubated who you want to avoid re-intubating #CCSSA2022
Often to try prevent intubation, we consider alternative types of respiratory support, which include:
- Simple Oxygen Delivery
- High Flow Humidified Oxygen
- Non-Invasive Ventilation
- Continuous Positive Airway Pressure #CCSSA2022
One of two morning sessions (this one themed 'Take a Breath') at CCSSA2022 - starting with a talk by Prof Charles Feldman on 'E-cigarettes, vaping and lung injury' #CCSSA2022#critcare#FOAMcc
Prof starts by saying that vaping is not the panacea that it was hoped.
Electronic cigarettes (e-cigarettes or vapes) work by heating a liquid to produce an aerosol that users inhale into their lungs. The liquid can contain nicotine, THC, CBD, flavourants etc... #CCSSA2022
Interesting that many of the THC-containing preparation contain Vitamin E - which when injected or ingested is safe, but when inhaled as an aerosol may have a deleterious effect doi.org/10.1016/j.amjm… #CCSSA2022