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CICM 2021 ASM: Respiratory
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CICM 2021

Virtual ASM Scientific Program

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Dr Mary Pinder &  Dr Bronwyn Avard open the CICM 2021 Virtual ASM.  Dr Avard will host the day, leading us through our inspiring and educational program. 
SESSION CHAIR: Professor Andrew Udy
Session Sponsor: Pfizer
In order to distinguish moderate treatment effects of a treatment from no effect, randomization of large numbers of patients is required. The RECOVERY trial was set-up rapidly as the COVID-19 pandemic reached the UK to ensure that large numbers of patients from hospitals across the UK could be recruited without interfering with the clinical care of the patients while the hospitals were under significant stress. By keeping the trial procedures simple and only asking hospitals to do what was absolutely required, the RECOVERY trial randomized 10,000 patients in 8 weeks and provided robust information on three potential treatments within 3 months. The methods used in RECOVERY could and should be applied to many other diseases beyond COVID-19 and address many of the important uncertainties in patient care and population health.

SESSION CHAIR: A/Professor Shailesh Bihari
Session Sponsor: baxter

Pneumonia remains a global healthcare challenge associated with substantial morbidity and mortality. Antimicrobial therapy is the primary intervention used by clinicians, but variable effectiveness exists which in part can be related sub-optimal dosing. To be maximally effective, antimicrobial dosing should ensure therapeutic concentrations at the site of infection, which in the context of pneumonia, is measured in the epithelial lining fluid (ELF). Of course, defining which concentration is ‘therapeutic’ is affected by the susceptibility of the pathogen to the antimicrobial (pharmacodynamics). Concentrations in the ELF for most antimicrobial are affected by typical factors like renal function and body size, as well as sickness severity, lung inflammation and presence of fibrosis from chronic pathologies like chronic obstructive airways disease. Careful interpretation of data is also important as concentration-time profiles in the lung do not match plasma and so singular time-point comparisons can provided misleading estimates of drug penetration. Available data demonstrates highly variable antimicrobial exposures in ELF, both between antimicrobials and between patients receiving the same antimicrobial. Antimicrobials considered to have consistently adequate penetration into the lung include linezolid and macrolides like azithromycin. Beta-lactams have variable penetration (e.g. meropenem ELF exposure is <5% to >200% in ventilator associated pneumonia patients). Other drugs have low and variable penetration including glycopeptides, whilst the aminoglycosides have such low penetration that they are considered not a clinical option in monotherapy. The importance of antimicrobial penetration into the lung is being recognized by pharmaceutical industry, with some drugs like ceftolozane-tazobactam now having a pneumonia-specific dose which is twice the urinary tract and intra-abdominal infection doses to account for ~50% lung penetration.
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. 
Session Sponsor: GE Healthcare
This talk will review the definition, burden, and prognosis of chronic and persistent critical illness. Historically, prolonged ICU stays have been thought of as being synonymous with prolonged mechanical ventilation, which was termed “chronic critical illness”. However, many patients remain stuck in the ICU for reasons other than persistent mechanical ventilation. While some patients have persistent organ failure necessitating ICU care, other patients experience a cascade of problems, such that what keeps them in the ICU may differ substantially from what brought them to the ICU in the first place. A new syndrome of “persistent critical illness” has been defined to encompass the broad scenarios by which patients remain ICU-dependent due to ongoing illness and clinical instability that is no longer directly attributable to the original organ dysfunction prompting ICU admission.  In several large-scale epidemiologic studies across multiple countries, persistent critical illness had been empirically determiend to begin around 10 days after ICU admission. This is the point at which characteristics at ICU admission (admission diagnoses and physiologic derangements) are no longer more predictive of mortality than antecedent characteristics (age, sex, chronic health status). While persistent critical illness occurs in just 5% of ICU admissions, it has a disproportionate impact on ICU resource use—accounting for nearly a third of all ICU bed-days. Furthermore, rates of persistent critical illness vary more than 3-fold across hospitals, suggesting the importance of contextual as well as patient factors in the development of persistent critical illness.
As we look beyond ICU to the impact of critical illness and intensive care therapy on survivors, we also recognise the impact on the bereaved.  Complicated or difficult grief and post traumatic distress are common experiences after a bereavement in ICU.   Follow up by intensive care teams can help address questions that may be barriers to grieving.  Learning more about the experience of the bereaved in our units can help us improve the care we provide to dying patients and their families, and the support we provide to clinicians caring for patients. 
This presentation will discuss what we know about grief after a death in ICU.  The evidence for bereavement follow up will be reviewed.  Guiding principles for follow up teams, which acknowledge the limitations of the evidence and the vulnerability of those followed up, will be discussed.