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CICM 2021 ASM: Respiratory
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CICM 2021

Virtual ASM Scientific Program

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Welcome to Day 2 of the CICM 2021 ASM.  Our Host for today: Dr Rob Bevan will guide us through the days events.

­A number of options are available to attendees during our break times: 
Room 1 (Main stream) will broadcast a presentation from our premium sponsors - GE Healthcare, and  Device Technologies. We also provide you an update on CICM Online Education.

Don't miss this opportunity to visit the exhibition zone to receive your daily codeword.  Today's prize draw is a beautiful indigenous painting from Aotearoa New Zealand. 

A number of networking rooms are also available to catch up with friends. 

Speaker: Adrian Way (Ultrasound PoC & USIT Segment Leader)
Lung Ultrasound is a readily available, user friendly and convenient method, providing rapid, real-time feedback to support medical decision making at the patient’s bedside. Physicians are frequently using lung ultrasound in a wide variety of clinical settings for detecting different lung findings associated with pneumonia. Point-of-care lung ultrasound has been reported to be a precise tool to assist in diagnosing pneumonia. Additionally, it is cost-effective and easily repeatable without exposing the patient to ionizing radiation. The primary limitation of lung ultrasound is that standard lung scanning techniques can make comprehensive visualization of the entire lung in real-time challenging. This presentation discusses the technical aspects of scanning the lung and presents the Venue Family Ultrasound solution’s to standard lung scanning technique limitations.

Sponsor Presentation

Join us for an update on CICM Online Education

Presenter: Professor Anil Hormis (Rotheram NHS Trust, UK)
Professor Anil Hormis (Rotheram NHS Trust, UK) discusses international guidelines for sedation practice and the challenges to be anticipated in advocating for a significant in sedation practice at departmental level. He describes his experience of the adoption of the Sedana AnaConda system for inhalational sedation in his own unit. He further describes the development of local clinical protocols, equipment changes required to ensure safety, and the implementation of ongoing staff education.
Sponsored by our Premium Sponsor:
Session Sponsor: Linet

Focusing on a dialogue with ICU survivors from the Top End of Australia, we will explore what survival means.
In ICU, we have moved on from a culture of making value judgments on behalf of others. At the same time, the decisions we make are often very technical and there is just not time to phrase the information in a way that patients and their families can use to make decisions. What we are left with, in this situation, is not some new problem caused by technology. It is the simple human realities that cosmopolitan societies have always faced:
- How do we create a joint description of reality? 
- How do we take decisions together when one side will always have more information, and the other has greater need of that information? 
- How do we find out what another person cares for when we can little imagine it? 
Among the many advantages of the CICM is in the duty of its Fellows to serve people who live a cosmopolitan life every day, between two or five different languages, traditions of law and economic models. We will describe this project which aims to expand our imaginations beyond the answers we are able to demand with simple questions, to what we must intuit as humans.
Presented by: Dr Lewis Campbell

The management of patients who have suffered burn injury in bushfires can have a significant impact on an ICU. This impact is both in terms of the volume of critically ill patients with the local and systemic manifestation of severe thermal injury, but also respiratory complications related inhalational injury. Burns injury is a multisystem disease, with the ICU team playing a key role in providing wholistic care. The adverse effects of bushfires related to the increase in air pollution across a range of conditions is yet to be determined. 

Thunderstorm asthma is the triggering of an asthma attack by environmental conditions directly caused by a local thunderstorm. During thunderstorms in spring or summer, when there is a lot of pollen in the air and the weather is dry and windy, pollen grains can absorb moisture and then burst into much smaller fragments which are easily dispersed by wind. While larger pollen grains are usually filtered in the nose, the smaller pollen fragments are able to pass through and enter the lungs, triggering an asthma attack. Risk factors for emergency department presentation with thunderstorm during the largest recorded episode of epidemic thunderstorm asthma in the world in Melbourne, Australia on November 21st 2016, included Asian or Indian ethnicity, presence of allergic rhinitis with marked rye grass pollen sensitisation, and unrecognised or under-treated asthma. Management of thunderstorm asthma includes preventive therapy for management of asthma and asthma triggered in this way responds to standard management. This presentation will describe the epidemiology of epidemic thunderstorm asthma, will discuss the findings from the 2016 severe epidemic thunderstorm asthma event in Melbourne and will describe the upgraded environmental monitoring and feedback to Victorians about possible epidemic thunderstorm asthma events in the context of pollen monitoring.  

This session will provide an update regarding asthma prevalence in the community and mortality rates in children over the last 10 years. The session will also highlight some of the outcomes of patients who have been admitted into Paediatric Intensive Care Units for asthma and the risk factors that lead to these presentations. Asthma adherence continues to be an ongoing problem in children with asthma, despite their level of severity and we will highlight some simple strategies to improve adherence. We will be reviewing the concept of asthma remission for children with different levels of asthma severity. Lastly we will be reviewing emerging therapies used in paediatric asthma, with a particular focus on the use of biologics.

Background: Knowledge translation literature shows a lag between publication and uptake of research findings into clinical practice.  There is uncertainty about whether this lag exists in the ICU context and whether participation in research influences changes in clinical practice.  Knowing whether ICU participation in research increases the likelihood of research findings being used in clinical care is important to funders, researchers and patients.

Research question: The overarching research question was whether participating as an ICU in a randomised controlled trial about oxygen (ICU-ROX), changes the attitudes and practices regarding oxygen management in an ICU, compared to not participating in ICU-ROX.

Methods:  The research question was examined using three different methods: a practitioner attitudes survey and an inception cohort study before ICU-ROX started; after ICU-ROX finished but before the results were known, and again after publication of the ICU-ROX results.  A retrospective cohort study (using the ANZICS Australia and New Zealand ICU adult patient database) was also conducted.

Focus of this presentation: An overview of the methods and results of the three studies (survey, inception cohort study and retrospective cohort study) will be presented.

Mackle, D1,2; Beasley1, R; Nelson, K2; Young, P1,3,4.

1 Medical Research Institute of New Zealand, Wellington, NZ

2 Victoria University of Wellington, Wellington, New Zealand

3 Intensive Care Unit, Wellington Hospital, New Zealand

4 Department of Critical Care, University of Melbourne, Parkville, Victoria, Australia.

Patients with interstitial lung disease (ILD) are often considered high-risk for prolonged stay and mortality in the intensive care unit, but ILD is a heterogenous group of diagnoses with vastly different prognoses and responsiveness to therapy. This rapid-fire update will focus on: 

·       ILD classification for the intensivist
·       Will my patient with ILD benefit from intensive care management?
·       Diagnosing ILD in the intensive care unit – focusing on management-altering principles
·       Emerging management options for ILD 

As therapy improves, more cancer patients are being admitted to the intensive care unit.  This update will review the concepts of radiation-associated lung injury and chemotherapy-associated lung injuries before finishing with a brief outline of the latest data relating to outcomes of patients admitted to ICU with lung cancer.

A bronchopleural fistula is an unnatural communication between the bronchial tree (at the level of the main stem, lobar or segmental bronchus) and pleural space as evidenced by continued and persistent air leak into the pleural cavity. It is a source of significant morbidity and mortality and can be difficult to manage/treat.  

In this rapid fire up-date we will briefly look at potential aetiologies and the diagnostic evaluation of bronchopleural fistula but spend most time reviewing management strategies. We will evaluate escalating management options for bronchopleural fistulas from chest drains to pneumonectomy and everything in between with particular attention to potential bronchscopic interventions such as occlusive devices and endobronchial stents. 

COPD is currently the fourth leading cause of death worldwide. This rapid-fire session will look at updates in chronic obstructive lung disease and how it relates to our care of these patients in ICU.  
Take time to visit our exhibition zone and support our much valued sponsors and exhibitors. To access the exhibitors, simply click on sponsors and exhibitors on the left side panel, then select the company you wish to meet with. 

We have a presentation from our Premium Sponsor: GE Healthcare.  

Don't miss this opportunity to visit the exhibition zone for the last chance to receive your daily codeword to win todays amazing indigenous painting from Aotearoa New Zealand.  

Presenter: Emma Gall (Applications Specialist - Perioperative & Critical Care)
Throughout the course of a shift in an intensive care unit, there are multiple alarms, from various sources. Monitor alarms should work to alert clinicians to a patient’s changing condition, but sometimes only work to annoy the clinician and to increase their stress. The stress load of clinicians in an intensive care unit is already high enough. It has a direct impact on labour turnover and clinician burnout. Taking any step to reduce stress in the workplace can only be a good thing to benefit clinicians and patients alike. In this session, you will learn about the Alarm Reporting Tool that delivers data that helps nurses make educated choices on how to manage GE bedside and telemetry alarms. The concise, customisable reports help them spot trouble areas, identify possible opportunities and measure & sustain improvements so that they can create a quieter care environment.     

Sponsor Presentation:
SESSION CHAIR: Dr Lewis Campbell
Session Sponsor: Pfizer

The influence of ethnic background on incidence and outcomes in COVID-19 is an evolving story with strong socio-political as well as clinical repercussions. Definitions and perception of ethnic background is an enormously complex topic which vary greatly within and between countries. Given the importance placed on ethnic identification and the persistent healthcare inequalities experienced by minority ethnic groups in many nations it is important to address these issues in the context of the current pandemic.
To illuminate these issues, we present a summary of analyses describing disparate outcomes between ethnic groups in almost 2000 COVID-19 associated admissions during the first wave to Barts Health NHS Trust. With a catchment of around 2.5 million people living in east London, Barts Health serves one of the most ethnically and economically diverse communities in the UK. In the first wave patients from (South) Asian and Black backgrounds had higher age-adjusted mortality from COVID-19 infection despite controlling for all previously identified confounders and frailty. These patient groups suffered disproportionate rates of premature death from COVID-19 and greater acute disease severity.
Importantly since the first wave of COVID-19 there have been changes in public behaviours, COVID-19 treatments and processes of care. Analysis of patients admitted in the second wave demonstrated that although hospital outcomes and overall mortality were improving, increased risk of death associated with Asian ethnicity persisted. Furthermore, Asian and Black patients continued to have higher rates of admission and acquired more severe disease at a younger age. Comparative analysis of acute hospital admissions over a 6-year period preceding COVID-19 showed an earlier age at presentation and distinct and earlier burden of comorbid disease in patients from minority ethnic groups. Some of these features may explain the adverse outcomes seen in COVID-19 in our community.

The COVID19 pandemic has posed numerous challenges to education generally (as any parent of school age children will know!), and intensive care education is no exception. These challenges called for rapid adaptation and many of the changes introduced are likely to remain the norm in the future. As all intensivists are teachers, we will use this perspective to explore the impact of the pandemic on trainees and intensive care training, and how as teachers we have had to rethink what we teach, innovate how we teach it, and develop as teachers.

The challenges of the 2020 and now 2021 have been unique in our lifetimes. There has been an extra-ordinary loss of life globally and an incredible impact on every individual’s way of life. It must be said that there at every level of the pandemic response there are areas to improve and do better. 
While treating individual patients at the bedside is the mainstay of intensive care practice the pandemic is teaching us that working in a safe, reliable system impacts on the quality of the individual’s patient care and also the safety and well-being of our staff. It is the development of systems at the bedside, the intensive care unit, the hospital and the region that we need to urgently develop and improve. 

As part of the NSW response to COVID-19 Pandemic we explored what was required to quadruple ICU capacity. It involved hospitals identifying surge capacity, ordering of essential equipment and the Intensive Care Operations Team as part of the overall Health response having visibility of all aspects of planning. As expected, true ICU capacity is not dependent so much on the physical ICU bed and ventilators but workforce (skill mix as well as availability), baseline non-COVID ICU activity as well as availability of PPE. Further, the impact of COVID on ICU capacity would not be uniform across the state. Lead by the Agency of Clinical Innovation, in conjunction with the Ministry of Health and the Sax Institute, modelling was developed to demonstrate predicted ICU capacity using ANZICS Adult Patient Database and workforce information in response to different levels of COVID surge as well as staff availability. The proof of concept modelling has far reaching potential for ICU service planning beyond responding to threats such as a pandemic.

Presenters: Dr Paul Young & Dr Kalinda Griffiths

Data has value. Just ask Facebook or Google. The one constant is that the people who get the access, and the benefit, are rarely the ones who pay. The questions we can ask are constrained by the collective imagination of those who set up the process for data collection, who choose what and when to record; who choose when silence or absence are the only signifiers of things we don't understand. Clearly this causes problems for the people who are not involved, and if we care about fairness, we should all seek to be involved and to make sure that all voices are heard. If you are on the profit side of this inequality and need more investment, consider that this is not a niche issue, it's not a minorities issue, it's a struggle for no less than the nature of reality. And if that's too dramatic for a webinar, then relax and let the enthusiasm and hope of these speakers carry you to a new level of understanding of why data matters.
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Virtual Social Event

Presentation - Room 1

Join us for a Night on Broadway

Pull out that ballgown and dinner suit, take a seat at your desk chair, dim those lights and let us entertain you for a Night On Broadway, in the comfort of your home. Featuring songs from off-Broadway hits to the mega-musicals, performed by Australian artists. As a onetime offer, you will have the best seats in the house, up close and personal with our stars for our virtual concert.

Songs featured will include:

Maria – West Side Story
Till I hear you Sing – Phantom of the Opera
Lily’s Eyes – Secret Garden
Evermore – Beauty and the Beast
And many more…

FEATURING:  Hew Wagner

Hew Wagner has performed with the State Opera of South Australia, the Adelaide Symphony Orchestra, Lyric Opera of Melbourne, CitiOpera, Emotionworks Cut Opera, and Co-Opera, including tours of regional Australia, China, and Malaysia. 
Stage roles include Ted Pickles in Cloudstreet, Balthasar Zorn in Die Meistersinger von Nürnberg, Hoffman in Tales of Hoffman, Virtue in L’incoronazione di Poppea, Silvio in Le Docteur Miracle, Luke in The Handmaid’s Tale, Monostatos in Die Zauberflöte, Marco in The Gondoliers, and Molina in Kiss of the Spider Woman. Roles covered include Tamino in Die Zauberflöte, Ernesto in Don Pasquale, Nemorino in L’elisir d’amore, and Camille de Rosillon in The Merry Widow.  
Hew has performed as the soloist in Bach’s St Matthew Passion, Mendelssohn’s Elijah, Handel’s Messiah, Mozart’s Requiem, and Orff’s Carmina Burana. He has performed in the Adelaide Cabaret and Cabaret Fringe Festivals, and participated in masterclasses taken by Nicholas Braithwaite, Adam Guettel, and Jason Robert Brown.

: Michaela Burger

Michaela Burger is the recipient of the inaugural Adelaide Fringe Frank Ford Award 2019, Best Cabaret Adelaide Fringe 2019 weekly award, Best Cabaret Adelaide Fringe 2016, and has been nominated for a Helpmann Academy Award for Best Cabaret Performer 2016 and 2019. She has performed throughout Australia and in New Zealand, Europe, the UK and New York. She is the co-creator and star of the successful stage show Exposing Edith, about the life and songs of Edith Piaf. Currently touring with her award-winning show, A Migrant's Son, the show has received critical acclaim and features original music written by Burger.  Her recent credits include Aftertaste (ABC/Closer Productions), Rouge (Highwire Entertainment), Apocalypse Meow (Malthouse/BAM, NY) and Rumpelstiltskin (Windmill/State Theatre SA/Southbank Centre, London).

Paul Brand is a Trumpeter from South Australia, currently residing in Melbourne. Playing for over 15 years, (with an AMEB Grade 4 standard), he has studied with teachers including Hal Hall, David Clark and Veronica Boulton. Paul currently sings with the Royal Melbourne Philharmonic, under the artistic direction and chief conductor Andrew Wailes.