Future sepsis therapies session💉🦠

Disease tolerance by Christopher Seymour @seymoc

🔸Difficulties in measurement
🔸May become a new focus in future clinical trials

@ISICEM #isicem23
Immune stimulation by Anthony Gordon @agordonICU

🔸Sepsis occurs as a result of dysregulated immune reactions.

🤔What happens when stimulating the immune system in patients with immune suppression?

A large RCT on GM-CSF is ongoing.

europepmc.org/grantfinder/gr…
@ISICEM #isicem23
Coagulation therapies in sepsis🩸

Essential tasks before planning and performing future clinical trials
-risk stratification when assessing eligibility (= personalization)😷
-identification of optimal treatment timing/duration⏰

@ISICEM #isicem23
Personalized therapies in sepsis by @Lennie333

🔸We have changed how we see sepsis: moving from “syndrome” to “personalization”

🔸Clustering patients to small subgroups using POC techniques: “treatable trait”

🔸Umbrella trials/Basket trials/Platform trials

@ISICEM #isicem23
A question from @BellomoRinaldo was relevant given that platform trials are and will be more and more common in ICU settings.

“How can the complicated findings of platform trials be correctly conveyed to clinicians?”

There might be no clear answer now...
@ISICEM #isicem23

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More from @YukiKotani5

Mar 23
Day 3 of #ISICEM23 begins with
Sepsis: the first steps

There are many things to do in the first few hours of sepsis care, e.g.,
🦠Sampling for pathogens
💉Antibiotics
📝Severity assessment
🫀Resuscitation

This session will address a whole picture of the initial TO DOs!
@ISICEM Image
Sepsis prediction is challenging

🔸Heterogeneity
🔸High AUROC ≠ High utility in clinical context
🔸Poor generalizability to different settings (units, department)
🔸Necessity of prediction??

@ISICEM #ISICEM23 Image
Septic shock prediction @KhannaAshishCCM

🔸Hypotension increases the risk of death
🔸Patients at risk of shock development are the target population (proactive🟡 rather than reactive🔴)
🔸But continuous monitoring is lacking because they are out of ICU

@ISICEM #ISICEM23 Image
Read 4 tweets
Mar 22
The #vasopressor session has started with 1️⃣“When is radial artery pressure unreliable?”

Detection
🔸Invasive vs Non-invasive
🔸Brain monitoring
🔸Mitral valve gradient
🔸Artery stenosis
🔸Waveform

👇Possible mechanisms of radial vs femoral differences
@ISICEM #isicem23 ImageImage
2️⃣Peripheral vasopressor use @HalliePrescott

🔸Low rates of complications reported up to 48 h with monitoring protocol

🔸Peripheral administration may avoid central line insertion (& its complications)

🔸Peripheral administration is becoming more common.

@ISICEM #isicem23 Image
3️⃣Early #norepinephrine infusion by Prof. JL Teboul.

🔸In 2018, 12% of intensivists used early norepinephrine but experts seemed to like it.

🔸Norepinephrine may increase preload/cardiac contractility

🔸Small RCTs suggest a trend of clinical benefits

@ISICEM #isicem23 Image
Read 8 tweets
Jan 21
✅Updated norepinephrine equivalent score

How can you compare the potency of the following vasopressors?

1️⃣Norepinephrine: 0.2 μg/kg/min
2️⃣Vasopressin: 0.04 U/min
3️⃣Angiotensin II: 20 ng/kg/min

Our new publication gives you the answer👇

🔓link.springer.com/content/pdf/10…
#FOAMcc
The norepinephrine equivalent (NEE) score tells you the dose of each vasopressor necessary to reach the target MAP with reference to norepinephrine.

You can find one example of NEE in the table below.
🔗journal.chestnet.org/article/S0012-…
You may notice that some vasopressors are missing in the table above.

Therefore, we have included new vasopressors (e.g., angiotensin II, methylene blue) and updated the NEE score.

We also described the history, utility, and pitfall of NEE score.
Read 4 tweets

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