Opening Plenary

Introduction and Welcome to the 6th iFAD Meeting! - Manu Malbrain

 

Notes/Discussions

Emphasising the importance of remembering that fluids are drugs.

Think about

• Drug
• Dose
• Duration
• De-escalation

Or 

• Resuscitation
• Optimisation
• Stabilisation
• Evacuation

Summary/Key points

Fluid are a drug, treat them with respect.

 

Sepsis 3.0 Was it worth the wait? - Mervyn Singer

Notes/Discussions

There was a clear need for Sepsis 3.0 to update the definitions

Prognostication better but big increase in diagnosis of “sepsis”

Sepsis-3 appears to identify patients at risk better in specific patient groups (https://t.co/yyOAw5ezdj) and outside the ICU (https://t.co/s62RjoiDFE)

qSOFA - intended to be rapid risk stratification tool in patients suspected of having infection

http://www.qsofa.org/what.php

BUT - never intended to be screening tool - ie ignore those with 0 or 1 criteria

What about in kids? pSOFA just published (https://t.co/YwldAqUhbu)

 

Summary/Key points

Sepsis 3.0 is a risk stratification device, not a screening tool.

References

Prognostic Accuracy of Sepsis-3 Criteria for In-Hospital Mortality Among Patients With Suspected Infection Presenting to the Emergency Department

Systemic Inflammatory Response Syndrome, Quick Sequential Organ Function Assessment, and Organ Dysfunction: Insights From a Prospective Database of ED Patients With Infection.

And some FOAMED:

https://t.co/uLVmrNiU4j

https://t.co/MFKZRuxQU9

 

Less is more: what is the best frequency of routine investigations? - Ruth Kleinpell

Notes/Discussions

Choosing Wisely campaign

http://www.choosingwisely.org/

 

Avoiding Massive Transfusion - Karim Brohi

Notes/Discussions

8 million cases of major haemorrhage with 2.2 million deaths

Many definitions of massive transfusion ---> 10U RBC in 24 hours

Historic term with little benefit in modern practice beyond study endpoint

Stop the bleeding

Keep them alive

Stop the bleeding

Maintain coagulation process

 

Summary/Key points

1. Early surgery/haemorrahge control
2. Permissive hypotension
3. Limiting fluids
4. Target coagulopathy

 

60 years on from Shires and Moore’s plea for ‘Moderation’: Culture eats evidence for breakfast - Monty Mythen

 

Notes/Discussions

http://bit.ly/2A2c8dN

 

Enhanced Recovery in a nutshell:

CHO preload drinks

Clear fluid till 2hr prep

Avoid salt and water excess

Individualised GDT

Minimal amount of fluid required for homeostasis

Immediate post op food and drink

Fluids down ASAP

Early mobilisation

 

Range from 1-23L surgery for colorectal surgery in some institutions

http://bit.ly/2zjg72h

 

Summary/Key points

 

Get your patients moving, eating and drinking as soon as it possible and safe.

References

http://bit.ly/2zjg72h