Friday, 7 April 2017

Neuromuscular blockade in ICU - the latest guidelines

Today sees the release of my latest SCCM podcast with Dr Michael Murray, who headed the Society's guideline panel on neuromuscular blockade.

Released in late 2016, the guidelines review the latest available evidence on the use of paralysis in critical care.

You can link to the podcast here

Friday, 17 March 2017

Pulmonary complications after surgery - ANZICS CTG podcast with Ianthe Boden

It's a significant problem, and there are things we can do to prevent them.

But you might be surprised by the solution, and how impressive the effect is.  In fact, if physiotherapists were a drug, they'd be worth billions.

Ianthe Boden joins me to chat about the impact of preoperative physiotherapy on high risk surgical patients on this fantastic podcast

Thursday, 16 March 2017

Do buffered solutions make a difference? Simon Finfer is hoping to find out...

It's fair to say that Simon Finfer has had a rather large impact on ICU research in the past couple of decades.

A key member of the original ANZICS Clinical Trials Group, principle investigator for several major trials and the father of this particular meeting, first convened nearly 20 years ago.

In this interview from the CTG Noosa meeting, Simon chats about the upcoming PLUS trial, looking for evidence that buffered fluids for resuscitation of ICU patients improves outcomes compared with normal saline.

Here's the podcast

Tuesday, 14 March 2017

A question of timing - early versus delayed initiation of renal replacement in ICU

In this, the tenth podcast from the 19th ANZICS CTG meeting in Noosa, Dr Sean Bagshaw discusses his new project, STARRT AKI.

This study is similar in many ways to the tracheostomy timing question.  By initiating RRT early, can we prevent some of the complications developing, thereby improving outcomes?  Or will we just subject patients to an ultimately unhelpful therapy with the attendant consequences?

The truth, hopefully, will be found at the ENND.

Here's the podcast!

Monday, 13 March 2017

Long term outcomes for ICU patients - TEAM and PREDICT with Carol Hodgson

ICU practice, until recently, has been built on its ability to defy nature and keep a dying patient alive.

But as our specialty matures, we're increasingly aware of the impact critical illness has on survivors.  Research is now focussing on these impacts, and sometimes the news is not good.  Our patients suffer greatly in the years after critical illness, with many never returning to the level of function they once had.

Sadly, this burden is often invisible to us, as (unlike most of our colleagues) we often don't see our patients again once they leave the ICU.

Carol Hodgson joins me on this podcast to chat about two important studies that aim to shed further light on this area - TEAM and PREDICT.

Sunday, 12 March 2017

ADRENAL - the final word on steroids in sepsis? Bala Venkatesh chats to me in this latest ANZICS CTG podcast

The concept of steroids in sepsis has been around for decades.  Long before I was a trainee, there was a lot of interest in whether or not the use of high dose steroids to suppress the inflammatory response could be helpful.

Subsequent trials have suggested this might not be the best approach, and lower, "physiological" doses are now proposed.

For a while, there was also a suggestion that we could tailor the use of steroids depending on whether or not the patient was a "responder" or "non-responder" to a synacthen test.  The implication was that if you were a non-responder, perhaps your adrenals had already been "exhausted" and a little extra help was required.  Nothing came of that either.

Then along came CORTICUS which suggested that at the very least, steroids might improve your responsiveness to vasopressors, and through improved perfusion might prevent end-organ disfunction.  However, the tradeoff (high sugars, pro-catabolism, weakness, superinfection) may offset or even overwhelm this benefit.

To find out, Bala Venkatesh and colleagues are conducting the ADRENAL trial.  In Noosa this week to update the ANZICS-CTG on the progress of the trial, Bala joined me for this interview.

Saturday, 11 March 2017

What's the role of nicotine replacement in the ICU? An ANZICS-CTG podcast with Dr Andrew Udy

It's something we all do from time to time - prescribe replacement nicotine therapy - but should we be taking this issue more seriously?

Determined to find out is The Alfred Hospital's Dr Andrew Udy, who presented his NRT trial plans to the CTG at it's Noosa meeting this week.

Here's the podcast