ICS State of the Art Meeting, UK 2017

For those of you who have been living in a wormhole far in the Delta Quadrant, the fact that The Intensive Care Society's SOA meeting was held this week, may have passed you by.... 

A great conference that spanned a lot of the nooks and crannies of ICU.

This blog article is a 'Too Long Didn't Read'/ TLDR article to give some pertinent one-liners of the conference for those of us who were too busy to get to the conference. 

A massive shout out to the wonderful Dr. Aoife Abbey or 'Scribbling Dixie' @WhistlingDixie4 for her amazing graphics - see them, and FAR much more besides here.

Also to the ever-present Jonny Wilkinson, who of late has become my #FOAMed Partner in Crime...

More to come on some of the SOA2017 content - via podcasts and interviews!

Twitter can get quite busy, so lets dive into the best picture tweets of the conference.

Aoife Abbey's Summary Graphics from Twitter (click)

Aoife's brilliant slides illustrate some of the key messages that were flagged up during SOA:

• ICU Decision Making - end of life care - great three pics on this.
• If Judges want to be involved in the decision making in patients with brainstem death for example - should they be on-call and available on the floor?
• Possibilities of DNACPR Guidelines - what even IS 'doing everything' for a patient? Organ transplant? ECMO? We often do NOT 'do everything' when futility comes into play.
• The 'F' Word - Futility? End of life is hard to predict. Focus on discussing FUNCTION, not DEATH.
• Contrast CT does not kill your kidneys
• Transfusion targets Hb 70-90 but trigger at 70. Fresher RBC's are no better. Still unsure about 1:1:1 targets. Cardiac patients trigger at Hb75 = best practice
• It has been a poor year for Pharmacology with respect to treatment for SHOCK - still, Istaroxine (+ve inotrope via inhibition of sodium/potassium adenosine triphosphatase (Na+/K+ ATPase) looks promising
•  Post Intensive Care Syndrome - maybe the P should also stand for pre, peri and post. Is this just a declining trajectory for the majority of patients?
• Strict vs Liberal Glucose Control in diabetics in ICU? Probably could go towards liberal sugar control - awaiting more trials
• Cortisol more pulsatile in physiology than classically thought. If in doubt of steroid synthesis, give low dose steroids.
• Suggestions for distressing the stressed ICU patient- great graphic on this
• Putting patients back on ventilator after spontaneous breathing trial, BEFORE extubation reduced reintubation rates in 2017 trial by Fernandez.
•  NCEPOD said that of the 47.6% of COPD & NIV cases that were referred to ICU, only 5% required intubation.
• Fill in the Organ Donation survey at www.surveymonkey.com/r/icsconsult
• Methylnaltrexone in opioid induced constipation COULD be promising (looking at 24h success vs placebo) - MOTION trial
• Bedside alveoscopy could be coming to you ICU... infiltrate vs other processes
• Failed a spontaneous breathing trial? Randomised to NIV protocol OR continued mechanical ventilation - AWAITING THE PUBLICATION!
• VAP is the most common ICU acquired infection. VAP-RAPID results out soon. A randomised controlled trial of a biomarker based diagnosis of VAP to improve antibiotic stewardship.​

​Jonny Wilkinson's Quote Slides

​A Twitter Trawl of Slides