Thread by @WhistlingDixie4

Last up we have Hot Topics…. #LIVES2022

First comes @JAMyburgh with #SuDDICU looking at selective decontamination (SDD) of the digestive tract on hospital mortality

(To know- Aim of SDD is to prevent VAP caused by pathogenic gram negatives organisms and overgrown of fungus from upper GI tract)

The paper is open access here

jamanetwork.com/journals/jama/…

And summarised in graphic by @JAMA_current.

Infographic doesn’t highlight what @JAMyburgh has explained- that there is some benefit conferred and the non-inferiority…

I presume that’s standard approach by @JAMA_current but i think it has missed an opportunity to be a truly useful graphic so do read the paper #LIVES2022

Next up is this systematic review on

Association Between Selective Decontamination of the Digestive Tract and In-Hospital Mortality in Intensive Care Unit Patients Receiving Mechanical Ventilation

Which is available here @JAMA_current jamanetwork.com/journals/jama/…

Speaker runs with the highlight that the posterior probability lower mortality of SDD for *hospital* mortality for SDD v standard care was 99.3%

The forest plot is here:

They conclude that in mechanically ventilated patients that SDD is associated with reduced hospital mortality and that the evidence regarding anti-microbial resistance is of very low certainty #LIVES2022

The discussions following this in the room are about balancing the individual benefit with potential (not care) societal impact related to anti microbial resistance and antibiotic stewardship.

Again open access by @JAMA_current is here
📖 jamanetwork.com/journals/jama/…

Next we are here for TiP-EX: pressure support ventilation V T-piece for spontaneous breathing trials. Available here and free if you register an account on @NEJM #LIVES2022

nejm.org/doi/full/10.10…

N = 983 Patients chosen had high risk of extinction failure (= >65yes or comorbid respiratory or cardiac disease)

Primary outcome was the total time without exposure to invasive ventilation

Please note the PSV was
PEEP 0
PS =8

I’m saying that because already this doesn’t compete with what I do and so the chance this will give me useful information is low.

Prophylactic NIV was encouraged in all patients

The primary outcome outcome was not significant.

A secondary outcome on prolonged weaning risk between groups was (see below)

Someone has asked ‘why no PEEP’

(Thanks)

I couldn’t really understand the answer though.
Answers welcome …..
#LIVES2022

We have @chodgsonANZICRC now looking at early active mobilisation or ventilated adults in ICU

Strong Australian showing here at this hot topics session! #LIVES2022 🇦🇺

This article is @NEJM here nejm.org/doi/full/10.10…

They exclusions should be noted and include life expectancy <180days

I think I’d find that really hard

The protocol they used is really clear and @chodgsonANZICRC is clear the dose of intervention was adjusted for individual patients daily

Primary outcome was 180 minus days in hospital, nursing home etc

….and was not significant

Peak IMS (mobility score) in was not different in intervention group but they *did* get there quicker

They then talk about adverse events (OR 2.55 in intervention group)

7 of these were serious adverse v 1 in the usual care

(I think remember what they’re doing before you take in the ‘adverse’ effects and read what they were doing - pts standing by day 5)

Still the conclusion is that the adverse events are notable and @chodgsonANZICRC said the “genuinely believe they found a ‘safety limit’ here”

Usual care was favoured at all point estimates

She concludes by thanking the patients and their families

We’re on EXACT Trial now - Lowe be Higher Oxygen Saturation targets on survival after OOHCA

As a recruiter into @UKRoxTrial I’m pretty interested

The paper is here @jama #LIVES2022
jamanetwork.com/journals/jama/…