Section on Perioperative Intensive Care
Claudia Spies, Chair
Michael Hiesmayr, Vice-Chair
Minutes of the GDT WG Section on POIC Meeting
held at the 40th ISICEM Congress in Brussels
Date:
Time:
Location:
Location :
Thursday 11th March 2010
12.30 - 14.00
Room 206
Glass Entrance, Square, Brussels Meeting Centre
The meeting was opened by Michael Sander, who welcomed the participants to the
meeting of the GDT WG of the Perioperative Intensive Care (POIC) section. Then the
agenda of the meeting was presented.
Proposal for a Simulation Workshop hemodynamic monitoring at the next
ESICM congress
Michael Sander presented the concept of the simulation workshop. The idea is to
start with a scientific session on general methods and concepts of hemodynamic
monitoring. Then, in the afternoon, there will be the possibility to attend a hands-on
workshop with the full scale METI simulator to learn to use these different tools in
clinical situation. The benefit for those attendees will be an active learning
environment and teaching of soft skills, like leadership management etc in critical
situations evolving hemodynamic monitoring.
In the discussion a preliminary program was developed by the group. This proposal is
provided below.
The suggested proposal will be discussed with the program committee of the next
ESICM. The decisions on these proposals will be communicated via the POIC
website as soon as a decision is reached.
From intubation to management of the haemodynamic instable ventilated patient. A practical approach
(joint section PG Course of the Perioperative Intensive Care, Acute Respiratory Failure, Infection Section and the
Education and Training Committee)
PG Course Concept
23nd ESICM Annual Congress
Difficult airway management (Anders Larsson, Michael Hiesmayr, Hans Flaatten, Jean-Louis Teboul):
Objectives
The course is designed for physicians working in an ICU environment who are frequently confronted with securing the airway of critical ill
patients. Several publications show that the incidence of difficult intubation in critical ill patients is significantly higher than in the OR.
Therefore intensivists should receive fundamental training in endotracheal intubation. Part of successfully securing the airway is also
substantial knowledge of the pharmacology of RSI. It is also important for the physician to have a check list or algorithm present which
can be used if standard direct laryngoscopy fails. The course is divided in lectures and hands-on practice. Lectures focus on the current
standards in the area of airway management, such as airway algorithm, new devices for endotracheal intubation and surgical airway.
Hands-on stations include practice with different instruments (e.g. flexible fibre scope, videolaryngoscopy) and code stations to train
typical situations and complications while securing the airway.The objectives of this course are e.g. to:
- know the incidence of, and recognize a difficult airway.
- know all commonly used supraglottic airway devices and has used them in an airway trainer in hands on practice
- identify patients for awake endotracheal intubation
Know airway algorithms and can apply them in difficult airway situations (full scale human simulator)
Know different devices and techniques for percutaneous and surgical cricothyrotomy and has trained the techniques in an airway
simulator
- identify special airway situations and knows how to approach these situations (e.g. morbid obesity, immobilized cervical spine)
The knowledge acquired by this course will facilitate the management of the difficult airway and to reduce the likelihood of adverse
outcomes.
-
The hemodynamic instable ventilated patient (Rupert Pearse, Michael Sander; Torsten Schröder, Bernard Walder/Cigdem Inan, Azriel
Perel):
Objectives
Hemodynamic monitoring and goal directed therapeutic approaches in ventilated patients could reduce length of intensive care unit
treatment, length of hospital stay and improve outcome. As early as 1988 Shoemaker et al., published a positive effect on outcome in non
cardiac high risk patients undergoing surgery (EGDT, early goal-directed therapy). Goal-directed therapy aiming on optimization of stroke
volume could improve outcome and reduce length of hospital stay in non-cardiac surgery of various kinds e.g. traumatology, abdominal
and cardiac surgery. Nevertheless the indications for stroke volume optimization has still to be defined more clearly to understand which
patients show substantial benefit by this approach. A goal-directed volume management aiming at preventing hypovolaemia and PEEP
trails may improve the outcome after surgery. Therefore, in critical patients correct estimation of the volume status using static volume
parameters and dynamic volume parameters should be the first step prior to volume optimization.
Unsuccessful insertion of CVCs may occur in up to 20% of cases. The hazards associated with multiple attempts and blind insertion
techniques include arterial puncture, hematoma, pneumothorax, haemothorax, chylothorax, brachial plexus injury, arrhythmias, air
embolus, catheter malposition, and catheter knotting. Ultrasound assisted vascular access provides a safe and efficient means of
obtaining both peripheral and central venous access, thus reducing morbidity and increasing the success rate and efficiency.
After this course all participants will be able to establish vascular access using modern approaches, understand and interpret the
technologies of modern hemodynamic monitoring tools including echocardiography and will be able to apply goal directed treatment
algorithms according to the monitored hemodynamic condition.
Audience: All intensivists who are interested in a comprehensive refreshment of important issues in intensive care.
Proposal for European multicenter study on high risk surgery – EuSOS
Rupert Pearse presented the study concept for a multicenter study that will define the
outcome and the management during and after high risk surgery in Europe on
Tuesday, 9th March 2010 during the meeting. During this WG group meeting the
basic ideas and next steps were presented again.
Below the minutes of this meeting is attached.
1.
Protocol: The protocol was discussed in detail. It was emphasised that
previous versions of the protocol have in effect been discussion documents to frame
the discussion on what we wish to achieve. After a lively and very useful debate the
following decisions were agreed:
a)
We should aim to recruit approximately 20,000 patients from whom we would
hope to recruit 2000 admissions to intensive care.
b)
The definition of intensive care will be framed to reflect the care that such
patients will need and so will include ’overnight intensive recovery’ units where postoperative patients may be ventialted as routine.
c)
Eligibility criteria will be broadened. Adult patients over 16 years of age
undergoing in-patient surgery (ie planned overnight stay) will be included. Cardiac,
obsteterics and neurosurgery patients will be excluded but all other types of surgery
will remain eligible. This will include minor, intermediate and major procedures.
d)
Data will be collected in participating centres on patients undergoing surgery
at any time in a seven days period (168 hours). These patients will then be followed
up until discharge.
e)
A brief datset will be collected on all patients and a more detailed ICU dataset
describing the first admission to ICU after surgery (if any).
f)
Allowance will be made in the datasheet for patients already in intensive care
who then undergo surgery.
2.
National co-ordinators: The problem of identifying enthusiastic national coordinators who are also able to act on behalf of their national societies was
discussed. It was agreed that we should approach both national societies and known
individuals in each country to ensure optimal participation. All national co-ordinators
will be appointed by the steering committee.
3.
Funding: An application to the European Sciety of Anaesthesiology has been
submitted and an application to the European Society of Intensive Care Medicine is
in preparation. The proposal has excellent support in both societies and is planned
as a joint study.
4.
Next meeting: To be held at the European Sciety of Anaesthesiology meeting
at Helsinki in June. The agenda will be circulated early to allow comments from those
not planning to attend.
ACTION POINTS
1.
Finalise basic surgery dataset
2.
Finalise the ICU admission dataset
3.
Revise protocol on the basis discussed above and circulate to steering
committee members
4.
Commence the process if informing key individuals about the proposed study
utilising ESICM and ESA national representitives.
The GDT WG meeting ended at 14:00. The next GDT WG POIC section meeting will
be held at the ESICM congress in Barcelona 2010; date and location will be
communicated as soon as possible.
Michael Sander
Rupert Pearse