Effectiveness of simulation-based learning in intravenous medication safety: a randomized controlled study

Dr Ivan L. Simoneau

doi:10.1186/S13054-018-1973-5

Effectiveness of simulation-based learning in intravenous medication safety: a randomized controlled study

Dr Ivan L. Simoneau

2018

https://doi.org/10.1186/S13054-018-1973-5

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Abstract

Introduction: Conventional assay technique to quantify vascular permeability in animal studies requires sacrifice animals; this becomes a barrier to evaluate of temporal changes or responses to therapeutic approaches in a single individual. In vivo fluorescence imaging potentially quantifies vascular permeability without sacrifice animals. However, the use of this noninvasive approach for the assessment of vascular permeability in remote organ injury caused by systemic inflammatory disease such as sepsis has not been reported. Methods: Cecal ligation and puncture (CLP)-induced septic mouse model was compared to sham and hydrocortisone pretreated (CLP + HC) mouse models. The lung was assumed as an injured remote organ and the footpad was assumed as a noninvasive observational site. The mixture of Evans blue (EB) and fluorescent dye of Genhance 750 were injected into mice, and the extraction of EB in harvested lung was assessed as a conventional indicator of vascular permeability. Fluorescent intensities in the harvested lung or footpad were assessed and their correlation was analyzed to investigate this novel, noninvasive approach to estimation of lung vascular permeability. Results: EB extraction in the harvested lung in the CLP group was significantly higher than in the other groups (CLP vs. sham, P=0.0012; CLP vs. CLP + HC, P=0.011). Fluorescent intensity in the footpad and harvested lung in the CLP group was also significantly higher than in the other groups (footpad, CLP vs. sham, P<0.0001; CLP vs. CLP + HC, P=0.0004; lung, CLP vs. sham, P<0.0001; CLP vs. CLP + HC, P<0.0001). The fluorescent intensity of the footpad was strongly correlated with that of the lung (r=0.95). Conclusions: The fluorescence imaging technique may be useful for assessment of vascular permeability based on EB quantification. The footpad fluorescent intensity was strongly correlated with that of the lung, and may be a suitable indicator in noninvasive estimation of lung vascular permeability.

Figures (380)

Fig. 1 (abstract P001). Cellular metabolism as measured in oxygen consumption rate (OCR) (n = 4). Basal denotes energetic demand of the cell under baseline condition; spare respiratory capacity denotes the capability of the cell to respond to energetic demand; proton leak denotes remaining basal respiration not coupled to ATP production, can be a sign of mitochondrial damage; ATP production shows ATP produced by the mitochondria to meet the energetic need of the cell. 38th International Symposium on Intensive ‘ Care and Emergency Medicine

Fig. 2 (abstract P0O1). Number of apoptotic cells, total cellular ROS, and mitochondrial superoxide as measured by Annexin V, DCFDA, and MitoSOX (n = 4). P002 Noninvasive technique using fluorescence imaging to assess vascular permeability in sepsis

Fig. 1 (abstract P004). boxplot of Syndecan-1 for survivors and non-survivors Conclusions: Plasma markers of glycocalyx shedding at ICU admission are predictors of 30-day mortality and correlate with APACHE II score. However, there is no correlation between these plasma markers and glycocalyx thick- ness measured by SDF imaging on ICU admission. Further studies should ad- dress the cause of this apparent discrepancy to define the role of SDF imaging in the assessment of glycocalyx shedding in sepsis. Results: Syndecan-1 levels were higher in non-survivors compared to sur- vivors (519.2 (255.6-1056.7) vs. 178.0 (58.1-298.2) ng/ml, p=0.005) (Fig. 1). PBR tended to be higher in non-survivors (2.0 (1.9-2.2)uM) than in survivors (1.9 (1.7-2.1)UM) (p=0.05) (Fig. 2). Syndecan-1 correlated positively with APACHE II (e =0.60; p=0.02) and Ang-2/Ang-1 ratio (e =0.59; p=0.004), but not with PBR. Methods: We studied 31 sepsis patients and divided them into survivors (n=17) and non-survivors (n=14) (30-day mortality). SDF measurements and blood sampling were performed within 24h of ICU-admission. ELISAs were used to quantify syndecan-1, angiopoietin-1 (Ang-1) and angiopoietin-2 (Ang-2). Non-parametric tests (Spearman for correlations, Mann Whitney for group comparison) were used to assess statistical sig- nificance. A p<0.05 was considered significant. Results are presented as median (25th-75th percentile).

Fig. 2 (abstract P004). boxplot of PBR for survivors and non-survivors P0O5

Fig. 2 (abstract POO5). Platelet adhesion and rolling Fig. 1 (abstract POO5). Glycocalyx components, IL-6 and AKI markers

Fig. 2 (abstract POO7). A. Changes in CACNAIC expression versus LPS exposure. Experimental groups are: FVB WT sham and FVB OV for Melusin Expression sham, where n=2 for both groups, B. Changes in pAKT expression versus LPS exposure. Experimental groups are the same in A C. Changes in pAKT/AKT expression versus LPS exposure. Experimental groups are the same in A. D. Western Blot E. Changes in plasmatic Troponin level before and after LPS challenge. Experimental groups are: FVB WT (in white sham and treated), FVB OV (in gray sham and treated).

Fig. 1 (abstract POO7). Panel A A. Changes in Fractional Shortening (FS) versus time. Experimental groups are: SV129 WT, SV129 KO for Melusin expression, where n=12 for both groups. B. Changes in Heart Rate (HR) versus time. The groups were the same in A. C. M-mode echography of Left Ventricle (LV) before and after LPS challenge. Panel B A. Changes in Fractional Shortening (FS) versus time. Experimental groups are: FVB WT, FVB OV for Melusin expression, where n=8 for FVB WT and n=12 for FVB OV. B. Changes in Heart Rate (HR) versus time. The groups were the same in A. C. M-mode echography of Left Ventricle (LV) before and after LPS challenge.

Table 1 (abstract PO12). Median values and interquartile ranges (IQR) of HLA-DRA and CD74 in 134 sepsis patients. Calculations were per- formed on logarithmic scale due to log-normal distribution

Fig. 1 (abstract PO16). Comparison of the quality profiles of AMM in serum and feces P018

Table 1 (abstract P026). Clinical outcomes of septic patients according to interleukin 10 release evolution between day 1 and 7 after ICU admission

Fig. 1 (abstract P026). LPS-stimulated IL10 levels in septic patients and controls at day 1 and 7 after ICU admission. Results are presented in pictograms per milliliter (9g/mL)

Fig. 2 (abstract PO26). Number of ICU-free days to day 28 between the lowest group of LPS-stimulated IL10 production (quartiles | and Il) and the highest group of LPS-stimulated IL10 production (quartiles Ill and IV) P028

Fig. 1 (abstract P027). Daily serum Procalcitonin levels post HIPEC-CR shows statistically significant difference between infected and non-infected patients only on the 4th post-operative day Exe Unetieser sae Meee Secor SICSRGien, Te Conclusions: HIPEC- CRS is associated with an early postoperative in- crease in PCT levels, independent of the presence of bacterial sepsis. The study demonstrate that HIPEC-CRS is a stimulus for PCT release and that decisions for antimicrobial therapy should not be based solely on elevated PCT values

Fig. 1 (abstract P030). Duration of ALV P031 Association of inflammatory and hemostatic biomarkers with inflammasomes in septic patients at risk of developing coaaitlonathyv

Table 1 (abstract P031). Inflammatory and hemostatic biomarkers correlated with NLRP-3 inflammasome levels in patients with sepsis and suspected DIC

Fig. 1 (abstract P033). See text for description Conclusions: We propose HBP more than 15 ng/ml and one qSOFA sign as an early score for 30-day mortality at the ED. Results: HBP was significantly greater among patients who died very early (Fig. 1). In five out of six of patients dying early HBP was greater than 15 ng/ml. We combined HBP more than 15 ng/ml and the pres- ence of one sign of qSOFA into a new score; this had 82.4% sensitiv- ity to predict 30-day mortality. The respective sensitivity of two signs of qSOFA was 23.5% (p: 0.002). The use of this new score allowed better stratification of patients originally considered at the triage as low-risk into high-risk (Fig. 2).

Fig. 2 (abstract P033). See text for description

the discretion of the physician. HBP was measured in blood samples upon admission by an enzyme immunosorbent assay.

Fig. 1 (abstract P036). See text for description P038 The INTELLIGENCE-1 study is supported by the European Commission through the Seventh Framework Programme (FP7) HemoSpec. P037 Conclusions: Conclusions Two signs of qSOFA have significant posi- tive prognostic value for sepsis but low sensitivity. This is improved after integration with suPAR. ee (rr) | Ie CKC O48 seis th erikinneesd bheerekkv Biitnckiciik Tenet

Fig. 1 (abstract PO39). Mechanical phenotyping reveals new biophysical markers of WBC activation

Fig. 2 (abstract P039). Performance of two biophysical markers (diameter and aspect ratio) in discriminating non-septic and septic patients at the leukocyte population level

Table 1 (abstract P041). Major cardiovascular events immediately after surgery

Table 1 (abstract P043). Reasons for sample rejection

Fig. 1 (abstract P043). Timeline for rejection of samples Reference

Table 1 (abstract P045). Colonization rates per department and subtype of isolated bacteria P046 References Assessment of the variability of airborne contamination levels in an intensive care unit over a 24 hour period a 7 a

Table 1 (abstract PO51). SDD Protocol adherence & VAP rates P053 Table 2 (abstract PO51). Number of resistant organisms isolated Conclusions: Compliance with the available enteral antibiotics was reasonable but with IV antibiotics was poor. It is accepted that alter- ations and non-adherence to protocols risk development of resistant bacterial strains. Within our unit no decrease in VAP rates was seen but reassuringly no increased rates of extended bacterial resistance were identified during the treatment periods.

Fig. 1 (abstract P053). A linear regression of Acinetobacter species recovered from the intensive care unit, Aseer Central Hospital, Saudi Arabia: A one year trend analysis (y = - 0.7912x + 13.615; R? = 0.44)

Conclusions: The prehospital phase of patients with an infection pro- vides a window of opportunity for improvement of care. Patients be- come ill 3 days before the ED visit and 41.1% already visited their GP previously during the current disease episode, while 23.9% is cur- rently using antibiotics. Future research should focus on quality im- provement programs in the prehospital setting, targeting patients and/or primary care professionals.

Table 1 (abstract P060). Reasons for ICU admission Table 2 (abstract P060). Characteristics of ICU TB patients vs non-ICU TB patients

Fig. 2 (abstract P063). See text for description Fig. 1 (abstract P063). See text for description

Conclusions: In clAls an appropriate empirical antibiotic therapy and an early infection source control are closely associated with better outcomes. score at infection which was higher in IAAT (p=0.04). Secondary peri- tonitis was the main type of clAl (45.5% in IIAT and 40.9% in IAAT) followed by abdominal abscess and biliary tract infection. Secondary bacteraemia was significantly higher in IIAT (p=0.03). Conversely, IAAT had an higher rate of adequate source control (p=0.01). Empi- rical therapy of IAAT patients included more frequently anti gram- positive (p=0.016) and carbapenems (p=0.01), while empirical dual anti gram negative and antifungal coverages rate were not different (Fig. 1). MDR and polimicrobial infections rate was significantly higher in II|AT when associated with septic shock at occurrence of infection (p=0.03; Fig. 2). IAAT showed significantly lower mortality at 28 and 90 days (p<0.01) as well as higher rate of clinical cure and microbio- logical eradication than IIAT (p<0.01). At the multivariate analysis, adequate source control [p=0.04, OR 0.25 (0.09-0.65)] and IIAT [(p<0.01, OR 11.4 (4.02-32.3)] turned out to be independently related with 28 days mortality. P065

Fig. 1 (abstract PO65). ROC curve for Candida score discrimintaing between invasive candidiasis and Candida colonization Conclusions: CS was higher in patients with invasive candidiasis than those with Candida Colonization. However, its ability to discriminate between these patients was only fair. CS was not associated with hospital mortality. Results: CS was 1.6+0.9 in patients with Candida colonization (N=261) and 2.4+0.9 in those with invasive candidiasis (N=120) (p<0.001). However, only 38.7% of invasive candidiasis cases had CS >= 3 (compared with 8.0% of Candida colonization cases; p<0.001). The ROC curve (Fig. 1) showed that CS had fair ability to discriminate between invasive candidiasis and Candida colonization (area under the curve 0.71, 95% confidence interval 0.65 to 0.77; p<0.001). In patients with invasive candidiasis, CS was similar in hospital survivors and nonsurvivors (2.2+0.9 and 2.5+0.8, respectively; p=0.13). CS did not discriminate between survivors and nonsurvivors (area under the ROC curve 0.61, 95% confidence interval 0.46 to 0.75; p<0.15)

Table 1 (abstract P067). Isolated Candida species by site

Table 2 (abstract P067). Candida albicans’ antifungal resistance

Fig. 1 (abstract P069). When to start Anti-fungal therapy in my patient? Fig. 2 (abstract P069). Design of Anti-fungal module development

Fig. 1 (abstract PO78). Effect of treatment with phages, antibiotics or combination of both on survival rate Eee Te Conclusions: Phage therapy performed as well as teicoplanin for the treatment of MRSA VAP when administered intravenously. Further experiments are needed to investigate whether phage administered via aerosols could heal infection within the lungs. Results: Treatment with either phages, antibiotics or combination of both significantly increased survival (66%, 50%, 50% respectively, compared to 0% survival for controls, p<0.05). There were no statis- tical differences in survival rates between either forms of treatment (Fig. 1). Treatments hinder the systemic extension of the infection into the blood and spleen without impacting bacterial counts within the lungs, but the numbers are too small to perform statistical tests (Table 1).

Table 1 (abstract PO78). Bacterial count in lung, spleen and blood at euthanasia. Median [IQR]

Fig. 1 (abstract PO82). Cox hazard Regression analysis

Table 1 (abstract P085). Diagnostic performance of qSOFA and SIR‘ scores for sepsis-3

Fig. 1 (abstract PO86). Sensitivity and specificity of all included studies

Fig. 1 (abstract PO89). Consort diagram of reasons for referral anc various dispositions

Table 1 (abstract P091). Diagnostic categories

Fig. 1 (abstract PO98). Comparison of the area under the receiver operating characteristic curve of all scores for predicting hospital mortality in ICU sepsis patients.

Table 1 (abstract P099). Infections, 2010-2015 in Germany: Incidence, mortality and discharge disposition Table 2 (abstract P099). Sepsis, 2010-2015 in Germany: Incidence, mor- tality and discharge disposition

Fig. 1 (abstract P103). Adjusted OR for in-hospital expiration for the hyperoxic groups as compared to group 1 (lowest quartile of hyperoxic duration).

Table 1 (abstract P108). Comparison of outcomes between patients with restored perfusion and those compatible with the Sepsis-3 definition 1. Shankar-Hari M et al. JAMA 315(8):775-787, 2016.

Fig. 1 (abstract P108). Patient Flow Diagram P109 Apoptotic cells induce cytokine homeostasis following LPS treatment

Table 1 (abstract P114). Distribution of body systems involved in patients receiving Polymyxin-B therapy

Fig. 1 (abstract P114). Distribution (Percentage) of Supportive interventions required

Fig. 2 (abstract P114). Distribution (percentage) of severity of bacterial infection

Fig. 2 (abstract P115). Distribution of duration of Polymyxin B therapy Fig. 1 (abstract P115). Distribution of supportive interventions required in Intensive Care Setup

1. Garg SK et al. Critical Care Research and Practice, 3635609:1-10, 2017 Reference

Fig. 2 (abstract P116). Response rate with Polymyxin B based antimicrobial therapy Fig. 1 (abstract P116). Duration of Polymyxin B Therapy (Days)

Table 1 (abstract P116). Profile of bacterial species isolated in patients receiving Polymyxin-B based antimicrobial regimen

Table 1 (abstract P117). Demographic data Table 2 (abstract P117). SOFA scores before and after SPE

Fig. 1 (abstract P119). Parasternal approach with needle directed from medial to lateral technique.

P121 Fig. 2 (abstract P119). a: Real time needle visualisation. b: Agitated saline or micro bubble test for tip placement confirmation

Fig. 1 (abstract P120). See text for description Conclusions: Sublingual microcirculation imaging is a simple and sensitive non-invasive tool in early detection of cardiac tamponade.

Table 1 (abstract P121). Survey questions on inotropes and other cardiovascular drugs with the most frequent response

Fig. 1 (abstract P122). See text for description

Table 1 (abstract P125). 28-day mortality % (95% Confidence Interval)

Fig. 1 (abstract P126). Ninety-day mortality among patients in the LEVO-CTS trial [3] in the subgroup of isolated CABG patients (n=563)

Table 1 (abstract P130). Effects of NE on MSFP, QECMO, pressure head and hemoglobin as compared to euvolemia

Fig. 2 (abstract P130). Effects of NE on blood volume, MSFP and vascular elastance Fig. 1 (abstract P130). Effect of NE on VR curve as compared to euvolemia

Table 1 (abstract P132). Cardiovascular instability and monitoring of maternity HDU patients with either sepsis or haemorrhage

Fig. 1 (abstract P134). Serum lactate and pH with thiamine administration

Fig. 1 (abstract P136). Kaplan-Meier 90 days survival

Table 1 (abstract P142). Doppler vs 2D and 3D stroke volun. assessment

Fig. 1 (abstract P142). Bland-Altman plots for Doppler vs 3D biventricular stroke volume assessment

Fig. 1 (abstract P146). Comparison of mean activity levels of coagulation parameter factors pre and post device. Error bars correspond to standard deviation Conclusions: Pre and post HA Cytosorb® measurements for coagula- tion factor activity were not different except for a small decrease in AT and FIl activity. This might be related with intra-device consump- tion or adsorption. Further analyses accounting for CPB fluid balance, the entire study population and timepoints are pending.

Fig. 1 (abstract P147). Microvascular Flow Index

Fig. 2 (abstract P147). Perfused Vessel Density

Fig. 2 (abstract P150). Description of the study Fig. 1 (abstract P150). STOP items description

ee MR) ee a Conclusions: The STOP value is correlated with hemodialysis indica- tion agreement between intensivists and nephrologists, and not cor- related with ICU LOS or mortality. The group change was correlated to increased mortality, in the study population. The significance of STOP as a tool in determining the moment of initiation of renal re- placement therapy remains a work in progress.

Fig. 1 (abstract P153). See text for description

Table 1 (abstract P158). Incidence and associations of AKI P159

Table 2 (abstract P160). Association between the studied echographic markers and clinical parameters after surgery *Multivariable model included baseline creatinine and EUROSCORE II

Table 1 (abstract P160). Assessment of echographic parameters on post-operative day 0 and the risk of AKI in the subsequent 24 hours period MMR eras EI eense UP tailsmeth ater aRrs) | SETTERS ecaae TET NESE SSR ELEM cs SiR ANS NESE SORT EO AL SER we eee nTtE TaN SMT imal roa Shea ae ee Conclusions: Abnormal portal and intra-renal venous patterns are associ- ated with early AKI after cardiac surgery. These Doppler features must be further studied as potential treatment targets to personalize management.

Fig. 1 (abstract P160). Portal vein and intra-renal venous Doppler assessment using trans-thoracic ultrasound. Probe position in showed using the Vimedix simulator (CAE Healthcare, St-Laurent, Canada). Abnormal pattern of intra-renal venous flow can be separated into a) Pattern 2 defined as discontinuous with flow in both systole and diastole and b) Pattern 3 defined as discontinuous with flow only in diastole.

Fig. 2 (abstract P160). Portal and intra-renal venous flow patterns during the peri-operative period. (PF: pulsatility fraction, POD: post-operative day)

Fig. 1 (abstract P161). Performance of the multivariate LR model for sAKI

1. Cole S et al. SICSAG Audit of critical care in Scotland 10:30-32, 2017 P165 Reference

Fig. 1 (abstract P163). Diagnostic trigger P164 Table 1 (abstract P163). Action taken Creatinine-based formula (MDRD) versus cystatin c-based formula (simple cystatin c formula) for estimation of GFR in critically ill patients mh RAW LL 1 OT RI 2 eee mw | + oh we BT

Table 2 (abstract P166). Arterial blood gas analysis at baseline for patients with and without AKI

Table 1 (abstract P166). General characteristics at baseline

Fig. 1 (abstract P166). ANOVA urinary Na during the first 7 days since admission

Fig. 2 (abstract P166). ANOVA urinary Cl during the first 7 days since admission

Fig. 1 (abstract P168). The AUROC curve of L-FABP for diagnosis of AK!

Fig. 1 (abstract P169). Longitudinal changes in 25(OH)D.No significant difference in the longitudinal profiles of patients with Ak! and those with no AK! was found.

Table 1 (abstract P173). Puchner Comfort Scale

Fig. 1 (abstract P172). Respiratory system model Conclusions: A novel experimental and physiological model of the respiratory system has been developed and confirms the existence of an alveolar oxygen supply as well as the lack of a CO2 washout during HFNC apnea oxygenation. However, these effects are only ob- served after a delay of about 1.5 to 2 minutes. Therefore, the clinical interests of this technique to reduce apnea-induced desaturation during intubation of a hypoxemic patient in the ICU seem limited without adequate preoxygenation. Combination of both preoxygena- tion and apnea oxygenation by HFNC can most likely explain positive results observed in other clinical studies.

Fig. 2 (abstract P172). Evolution of intrapulmonary gases during apnea; HFNC : high-flow nasal cannula

Fig. 1 (abstract P173). Five point Puchner scale. Group A (4% lignocaine) having more patient comfort with mean value of score 1.30 + 0.08, as compared to Group B (2% lignocaine) having mean value of 2.23 + 0.12 (p < 0.001)

Fig. 2 (abstract P173). The mean procedural time to secure airway in Group A (4% lignocaine) was 29.67 + 5.40 minutes and in Group B (2% lignocaine) it was 34.93 + 5.52 minutes. The difference in mean time duration was statistically significant (p<0.001)

Table 1 (abstract P176). C&L intubation grade Table 2 (abstract P176). Airway attempts

Fig. 1 (abstract P176). Primary and rescue airway techniques. Total number of patients: 3233

Fig. 2 (abstract P176). First pass endotracheal intubation success rates by professional background

Fig. 1 (abstract P180). Bacterial growth in both groups

*average Table 1 (abstract P184). Serial analysis of intervention groups

Table 1 (abstract P185). Final logistic regression model of factors predicting postoperative noninvasive ventilation failure

Fig. 2 (abstract P187). Forest plot for pooled analysis of need for re-intubation

Fig. 1 (abstract P187). Forest plot for pooled analysis of mortality at longest available follow-up

Faria DA, et al. Cochrane Database Syst Rev CD009134, 2015.

Fig. 1 (abstract P188). Mean difference between helmet and facemask for heart rate, respiratory rate and dyspnea scale Conclusions: CPAP delivered by helmet improves HR, RR and dys pnea in ARF with less discomfort and dryness of mucosa and it is the alternative for patients who are unable to tolerate facemask.

Fig. 1 (abstract P189). Effect of varying RR and inspiratory flow on FiO2 at a Vt of 0.250 L Templier F et al. Eur J Emerg Med 10(2):87-93, 2003

Table 1 (abstract P190). Results Table em Conclusions: In MV patients, a single respiratory deterioration event carries a 3 times higher mortality rate and Length Of Stay (LOS). Any additional event further increases both parameters. Association of lung ultrasound score with mortality in mechanically ventilated patients

Fig. 1 (abstract P194). Nomenclature For Analysis of Regional Aeration: |. Supine and ll. Prone, where quadrants were defined as: Non-PLEF Dorsal (A); Non-PLEF Ventral (B); PLEF Dorsal (QC); and PLEF Ventral (D). Ill. Lateral position with “Dependent Pleural Effusion”, where quadrants were defined as: Non-PLEF, Non-Dependent Dorsal (A); Non-PLEF, Non-Dependent Ventral (B); PLEF Dependent Dorsal (Q; and PLEF Dependent Ventral (D). lV. Lateral position with “Non-Dependent Pleural Effusion”, where quadrants were defined as: Non-PLEF, Dependent Dorsal (A); Non-PLEF, Dependent Ventral (B); PLEF, Non-Dependent Dorsal (CQ); and PLEF Non-Dependent Ventral (D). PLEF: Pleural Effusion, * anatomical distribution of PLEF Conclusions: Changes in body position in the setting of effusion- caused chest asymmetry markedly affected the internal distributions of gas volume, collapse, ventilation, and tidal recruitment, even when commonly used global FRC measurements provided little indication of these important positional changes.

Fig. 2 (abstract P194). A. Global FRC response to body position; B. Distribution of tidal ventilation; C. Positional Changes in End-Expiratory Collapsed Volume; D. Positional Changes in Tidal Recruitment

The scenario involves a patient expected to receive mechanical ventilation for at least 24 hours in the ICU. All proportions are percentages of respondents with 95% confidence intervals. *p < 0.001 for comparisons of proportions of “No change” versus adjacent lower PaO2 level (McNemar’s test) Table 1 (abstract P195). Doctors’ preferences for adjusting an FiO2 of 0.50 in a patient with acute respiratory distress syndrome (n = 654 to 655)

Fig. 1 (abstract P195). Preferred parameter in the evaluation of oxygenation (n = 677). *Most doctors preferred PaO2 in their evaluation of oxygenation in mechanically ventilated patients (p < 0.001, simple binomial test against the equally distributed proportion)

Table 1 (abstract P198). Characteristics of patient subgroups according to increase in diaphragm thickness during PSV

Fig. 1 (abstract P198). Changes in diaphragm thickness over time. Day “O" is the first day of PSV; days before “0” are days of CMV, days after “0” are days of PSV. Dashed line represents 10% cut-off value selected a priori to define clinically relevant increases in diaphragm thickness. *: p value < 0,05 versus day 0. LE Se ree See a eee! Se See ee ee eee eee Conclusions: Longer time spent in CMV and with NBDs infusion seems associated with a decrease in diaphragm thickness. Assisted ventilation promotes an increase in diaphragm thickness, associated with a reduction in the length of hospitalization.

Fig. 1 (abstract P200). Distribution of ventilation to non-dependent lung regions. Red= obese patients; Blue = non-obese patients

Fig. 1 (abstract P201). 30 minutes after implementation of the combined renal replacement and ECCO2R circuit a moderate decrease in PaCO2 (-6.5 mmHg) corresponding to a slightly higher pH (0.04) was observed References

Fig. 2 (abstract P201). Reestablishment of initial PaCO2 resulted ir a significant decrease in tidal volume (-0.8 ml/kg, p<0.05) and plateau pressure (-2.9 cmH20, p<0.05)

Fig. 2 (abstract P203). Mean pH + DS during ECCO2R-CRRT P205

P204 Conclusions: The use of PrismaLung-Prismaflex has been safe and ef- fective: it may be argued that it could be due to the low-blood-flow used. The positive results of this preliminary study may constitute the rational for the design of a larger randomized control trial.

Fig. 1 (abstract P203). Mean CO2 + DS (mmHg) during ECCO2R-CRRT

Table 1 (abstract P206). Histopathological findings on surgical lunc biopsy and common clinico-pathologic diagnoses Table 2 (abstract P206). Histopathological findings on bronchoscopic lung biopsy and common clinico-pathologic diagnoses

Fig. 1 (abstract P205). The effect of apneas on respiratory status. (A) Distribution of apneas across a surgical population. Apneas >10sec were recorded in 99% (214 out of 216) patients in the post-operative period and 92% of the recorded apneas were <20s long. (B) Sustained MV over various time windows (30-sec — red, 60-sec — green, 90-sec — purple, 2-min — cyan) following the onset of apnea. Note that, an apnea of 30-sec will (by definition) drive MV over a 30-sec window down to 0, but will only decrease MV over a 60-sec window down to ~35% MVPRED and to less than 60% over a 2-min window. (©) Likelihood of an apnea of specific length to decrease MV below the Low MV cutoff over various time windows. Note that a single 10-sec apnea has just a 25% chance to decrease MV below 40% in a 30-sec window and less than 2% chance to decrease MV below the cutoff over a 2-min window. Even 60-sec apneas have just 20% chance of decreasing sustained MV over a 2-min window below the 40% MVPRED cutoff

Fig. 1 (abstract P213). Comorbidities on admission in Diaphragmatic Dysfunction (DD) and Non Diaphragmatic Dysfunction (NDD) Conclusions: DD was present in nearly one third of ICU patients which was largely associated with a longer ICU stay and a higher mortality. PacO2 and WBCs were associated with a negative effect on diaphragmatic function.

Table 1 (abstract P216). Differences between groups, showed in mean values + standard deviation

Fig. 1 (abstract P214). Diaphragmatic excursion at deep breathing

Fig. 1 (abstract P216). A strong correlation between end expiratory transpulmonary pressure (PLendexp) and static compliance (Cstat) at PEEP 5 Fig. 2 (abstract P216). A strong correlation between IAP and Ecw and a mild correlation between IAP and Cstat at PEEP level of 5 in patients with intraabdominal pathologies

Fig. 1 (abstract P217). Representative model between slow chest compression with time of velocity 0.61 seconds versus fast chest compression with 0.20 seconds. a) Behavior of hysteresis between Paw with Pes. b) Behavior of hysteresis between Paw and direct Ppl measurement. References SN en ge a A ER a eee Conclusions: Slow chest compressions must be used when checking position/inflation of esophageal balloon. The fast maneuver produces hysteresis and underestimation of A Pes (but not in direct A Ppl). Pes monitoring at high respiratory rates may be problematic.

Fig. 2 (abstract P217). Bland-Altman plots showing the agreemer between APes and APaw in two different strategies: a) slow chest compression and b) fast chest compression

Fig. 1 (abstract P218). A Ptp, B Flow, C Vt tracing, E, F Silent Spaces P219

Fig. 1 (abstract P219). Agreement between the two methods of measuring absolute end-expiratory Pes by Bland-Altman analysis aaltaatia ailliaasieel cent aaa einai Aiea nieiieieddinienic’ | Ii sie!” ieee, sal Conclusions: Abs end-expiratory Pes tended to be higher in the A method than in the M method. A Pes of the two methods were well correlated. In our animal model, the accuracy of Pes measured by AVEA ventilator was clinically acceptable when compared to the M method.

Fig. 2 (abstract P219). Agreement between the two methods of measuring tidal swings of Pes by Bland-Altman analysis

Fig. 1 (abstract P220). Bland-Altman analysis demonstrated that CvP-derived APpl and APes were correlated significantly I I a a MG ae a od Conclusions: In spontaneously breathing children during mechanical ventilation, CVP-derived A Ppl correlated well with A Pes. It could be used as a guide to estimate pleural pressure without using an esophageal balloon catheter. Results: Eight patients (Median age 4.8+3.3 months; median body weight 4.7+1.3 kg) were included in the analysis. CVP-derived A Ppl and A Pes were correlated significantly (y=0.59x+3.6, R2=0.56, p<0.01). Bland-Altman analysis showed that bias and precision of these two methods were -0.53 and 3.5 cmH20, respectively (Fig. 1). P221

Table 1 (abstract P222). Percent of monitored time with data reported EES a PE en el as Conclusions: Int non-intubated patients, the RVM identified all High EtCO2 events and detected the decrease in MV 7.7min before EtCO2. The RVM provides reliable measurements when capnography data is unavailable and is not subject to the EtCO2 limitations of nasal can- nula placement, dilution with O2, and mouth breathing.

Table 1 (abstract P223). Comparison of patients who Negative (a-ET) PCO2 values with Positive (a-ET) PCO2 values

Table 2 (abstract P223). Associations between negative (a-et) pco2 values and mortality in subgroups

Fig. 1 (abstract P222). MV (top) decreases in response to propofol (purple), resulting in an LMVe at 13:45. EtCO2 (middle) stays relatively constant at the start of the LMVe without triggering either high or low EtCO2 alarms. A jaw thrust (13:46), results in dislodged nasal canula. MV increased slightly, but still remained low (40% MVBaseline). EtCO72 increased to >50 mmHg and remained high Table 2 (abstract P222). Low Minute Ventilation Events and EtCO2 Alarms

Fig. 1 (abstract P223). Kaplan-Meier survival curves of patients P224

Fig. 1 (abstract P225). Biomarkers expression (copies/ml) Conclusions: IL-8, TNF, TLR-2 and MMP-7 expression detected by ex- tracted platelets RNA, may be a novel tool useful for clinicians indi- cating persistent inflammation with resulting progressive alveolar fibrosis and impaired lung function. More data are necessary to understand the real clinical significance of this biomarkers and their role in fibroproliferation and progression of ARDS.

Fig. 1 (abstract P227). Fluorescein isothiocyanate-Dextran or fluorescein isothiocyanate-BSA analysis of the effect of HGF on PMVECs permeability

Fig. 2 (abstract P227). Western blot analysis of HGF on mTOR signaling pathway

Table 1 (abstract P231). Ventilator settings, respiratory mechanics, gas exchange PEEP= Positive End-Expiratory Pressure; ICU= Intensive care Unit; PLE= Expiratory Transpulmonary Pressure; ElastanceL= Elastance of the Lung; ElastanceCW= Elastance of the Chest Wall; EELV= End-Expiratory Lung Volume; PaO2/FiO2= arterial partial pressure of oxygen to inspired fraction of oxygen ratio. § EELV is expressed as volume increment from the PEEP ICU level *p<0.05 compared to PEEP ICU (p < 0.05); # p<0.05 compared to PEEP INCREMENTAL

Fig. 1 (abstract P231). Lung Collapse and Lung Overdistension. PEEP= Positive End-Expiratory Pressure; ICU= Intensive care Unit; EIT= Electrical Impedance Tomography. *p<0.05 compared to PEEP ICU (p < 0.05); # p<0.05 compared to PEEP INCREMENTAL

Fig. 1 (abstract P233). Distribution of tidal volumes recorded over a period of 2 years on the unit

Table 1 (abstract P234). Patient characteristics

Conclusions: Over half of the patients received VT >=8ml/kg IBW. Fe- males were more likely to be over ventilated. A likely contributing factor is the disparity between ABW and IBW in this cohort. We organised staff teaching and constructed IBW charts with the appropriate corresponding tidal volumes to be displayed in all theatres to promote the use of LPV.

Fig. 2 (abstract P234). Sex specific tidal volumes P235 Protective mechanical ventilation to prevent acute respiratory distress syndrome

Fig. 1 (abstract P236). Arterial pressure of CO2 and respiratory rate at each studied tidal volume (6, 4, and 3 ml/kg) and group (with and without coaxial ventilation) P238 Conclusions: In this ARDS model, coaxial tube ventilation associated with moderately high RR allowed ultraprotective ventilation (VT=3 ml/kg) and reduced dP levels, maintaining PaCO2 at acceptable levels. This strategy might have a significant impact on mortality of severe ARDS patients.

Table 1 (abstract P239). Ventilatory settings and blood gas variables before and after TPP measurement

Table 1 (abstract P242). Ventilatory setting, oxygenation, mechanics and echocardiography measurements P243

Table 1 (abstract P243). Characteristics of pigs by study groups. Data presented as median (interquartile range)

PaO2/FiO2= arterial partial pressure of oxygen to inspired fraction of oxygen ratio. PEEP=Positive End Expiratory Pressure, TAPSE (Tricuspid annular plane systolic excursion) and S' (Velocity of the tricuspid annular systolic motion). All the results are shown as Average + Standard Deviation. * significant compared to Baseline p<0.05; “ significant compared to Incremental p<0.05.

Fig. 2 (abstract P243). Levels of Heparin binding protein (HBP)(ng/ ml) in bronco alveolar lavage (BAL) fluid. HBP levels were significantly higher in the group receiving harmful ventilation at 2 (p=0.03), 4 (p<0.01) and 6 (p=0.02) hours of ventilation. Fig. 1 (abstract P243). Schematic overview of protocol

Fig. 2 (abstract P244). Forest plot showed incidence of nosocomial infection Fig. 1 (abstract P244). Forest plot showed effect of steroid on mortality

Meduri GU et al. Chest 131(4):954-63, 2007 References

Fig. 1 (abstract P245). Forest plots of subgroup analyses on the effect of surfactant based on different days mortality. Cl Confidence interval, M-H Mantel-Haenszel. Conclusions: Surfactant administration may improve oxygenation but has not been shown to improve mortality for adult ARDS pa- tients. Large rigorous randomized trials are needed to explore the ef- fect of surfactant to adult ARDS patients.

Fig. 2 (abstract P245). Forest plots of the effect of surfactant basec on PaO2/FiO2. Cl Confidence interval, M-H Mantel-Haenszel.

Fig. 1 (abstract P249). SatO2 according to progressive QECMO increment, in different VO2 levels and a QLshunt fixed at 95%. Panel A shows this relation with QCO of 10 L/minute and Panel B shows this relation with QCO of 5.5 L/minute. VO2: oxygen consumption; QCO: Cardiac Output; QECMO: ECMO blood flow; QLshunt: Shunt fraction

Fig. 2 (abstract P249). Oxygen partial pressure responsible for the hypoxic pulmonary vasoconstriction inhibition in four different clinical scenarios. The dotted line at PstimulusO2 of 19.2 mmHg represents the partial pressure during breathing of a healthy person. The other clinical scenarios reproduce mechanical ventilation in a severe ARDS patient with hypercapnia, pulmonary shunt fraction of 45%, and PvO2 = 20 mmHg (closed triangle); the closed squares represent this same patient after ECMO initiation, when the pulmonary shunt increased to 60% (Whitening-up phenomenon) and the PvO2 increased to 180 mmHg; at last, the open circles represent this same patient with a pulmonary shunt of 95% and a PvO2 of 300 mmHg

Fig. 1 (abstract P254). Change in mechanical power after ECMO initiation Gattinoni L, et al. Intensive Care Med. 42(10):1567-1575, 201€

Fig. 2 (abstract P254). Change in driving pressure and plateau pressure after ECMO initiation P255 Attributable mortality of acute respiratory distress syndrome: a systematic review and meta-analysis

Fig. 1 (abstract P257). The HEART Score for chest pain patients in the ED P258 Influence of hypoxic and hyperoxic preconditioning on endothelial function markers in a model of myocardial ischemia/reperfusion injury: experimental study

Fig. 1 (abstract P261). See text for description Conclusions: Skin blood flux measured with two different LSCI de- vices are linearly correlated with each other. However care should be taken when assessing patients with low blood flux such as occurs during shock and ischemic organs.

Fig. 1 (abstract P262). Changes in microvascular density

Fig. 1 (abstract P266). Forest plot showing odds ratio of overall cannulation success rate at study level and pooled analysis level (USG guided short axis out of plane versus digital palpation)

Fig. 2 (abstract P266). Forest plot showing odds ratio of first attempt cannulation success rate at study level and pooled analysis level (USG guided short axis out of plane versus digital palpation)

Fig. 1 (abstract P269). Summary of Fluid Responsiveness Decisions and Effect of LiDCOplus Conclusions: The use of LiDCO monitoring only appropriately chan- ged the decision made with information from basic haemodynamic monitoring in 7% of patients. This augmentation of decision making was only seen in patients whose basic haemodynamic parameters did not respond to fluid. It changed a correct decision inappropri- ately in 9%. Overall, no improvement in the assessment of fluid re- sponsiveness was seen.

Table 1 (abstract P270). Correlation between systolic blood pressure and PPG related variables

Fig. 2 (abstract P272). Emax, LV dP/dtmax and aortic, femoral and radial dP/dtmax changes.

Fig. 1 (abstract P272). Experimental protocol.

Table 2 (abstract P273). Analysis of trending. Concordance analysis suggests inability to track changes in Cl, while polar plot analysis shows adequate ability considering systematic error in CS and PA P274

Table 1 (abstract P273). Analysis of agreement using Bland-Altman statistics. Test devices vs. TD and TD vs. TD (reference vs. reference)

Fig. 1 (abstract P273). Bland-Altman plots of the three test devices and TD vs. TD. Data of 25 patients at up to nine points in time are plotted. Solid lines indicate bias and limits of agreement, dotted lines indicate 95%-Cl of each solid line. These plots indicate similar performance of CS, FT and PA vs. TD

Fig. 2 (abstract P273). Polar plots showing trending capability of CS, FT, PA vs. TD between T4 (start HIPEC) and T6 (end of HIPEC). Exclusion zone is 14% (least significant change in CITD). All devices show satisfactory radial LOA (+<30°), but only FT shows acceptable radial bias (2°)

Fig. 1 (abstract P277). The area under cSO2<50% was significantly lower in survivors Fig. 2 (abstract P277). Prognosis of patients with cSO2<50%time above 50%h was poor

Conclusions: Cerebral oxygen desaturation below 50% was signifi- cantly associated with outcome in patients undergoing vaECMO. In patients with cSO2<50%time above 50h%, prognosis was especially poor. Prospective trials are needed to evaluate if cSO2 is a viable tar- get for therapeutic interventions.

Fig. 1 (abstract P278). Detection of single erythrocytes using a novel advanced computer vision algorithm in a representative capillary ribbon extracted from a video frame of the sublingual microcirculation | iia aie dnanta int hnh emailemail etiesinmmaaliitininilel SE sii tiriteiaes inl iatilinitieteinetaiaieniieetee~ jeaialieieiiaininial Conclusions: Accurate measurement of cHct is possible using ad- vanced computer vision, and it reflects hemodilution induced by ini- tiation of CPB. cHct further is a determinant of capillary delivery of oxygen. Combined with the assessment of functional capillary vol- ume, blood flow velocity, and capillary hemoglobin saturation, cHct may enable direct optical quantification of capillary delivery of oxy- gen as an integrated functional parameter of the microcirculation.

Fig. 2 (abstract P278). Correlation and Bland-Altman analysis of pe patient capillary hematocrit (cHct) as measured manually and using a novel advanced computer vision algorithm

Table 1 (abstract P279). ECHO Documented LV/RV Dysfunction Fig. 1 (abstract P279). Physiologic Phenotypes Based on PLR anc Trending Cardiac Output

Fig. 1 (abstract P280). There was excellent agreement with Nadler's formula for PV in normal subjects aie rere ee caer stein NO Conclusions: This novel bedside approach allowed for rapid and accurate determination of PV, BV, mGFR (data not shown) and dy- namic monitoring following clinical maneuvers such as fluid adminis- tration, with a high level of safety, accuracy and reproducibility. This approach should assist the Intensivist especially with volume admin- istration and removal in septic and cardiorenal patients.

Fig. 2 (abstract P280). Following an intravenous bolus of 350 ml 5% albumin solution the mean +/-(SD) measured increase in PV was 326.8 ml +/- 49.9 ml post infusion

Fig. 2 (abstract P281). Kidney wet-dry weight ratio. There is a significant difference between normal and restrictive fluid regimen in adult rats, however not in infants. Data are presented as median and interquartile range (IQR); whiskers present 1.5 IQR. * p<0.05 Fig. 1 (abstract P281). Lung wet-dry weight ratio. There is a signifi- cant difference between normal and restrictive fluid regimen in adult rats, however not in infants. Data are presented as median and interquartile range (IQR); whiskers present 1.5 IQR. * p<0.05

SE SS STM ee (ere ee wena ee gE eS gee eee Sea RAPE ceene ee Smee enw nts Says ee ern Ow Conclusions: There is an age-dependent effect of early fluid restric- tion on the formation of interstitial edema in local and distant organs in the disease process of acute lung injury. Further investigation of the effects of fluid therapies in experimental models may help steer- ing towards better treatment in critically ill patients.

Fig. 1 (abstract P282). Cumulative fluid balance in the first 12 hours after start of cardiac surgery Conclusions: The main findings of this study substantiated the hy- pothesis that the introduction of continuous FB-tracking throughout the entire care process, is associated with a significant reduction in the administration of fluids in post-cardiac surgery patients, inde- pendent of differences in their baseline characteristics. Demonstrat- ing that certain organizational changes can influence medical behavior beyond the scope of teaching and instruction, and there- fore serves to provide awareness to the current issue known as ‘knowledge-to-care gap’. P283

Table 1 (abstract P289). Binary regression analysis for prolonguec mechanical ventilation

Fig. 1 (abstract P288). The contribution of nutritional support (enteral and parenteral) and fluids regarding the overall intake per day Conclusions: The nutritional support is an factor to take into account regarding fluid balance in Intensive Care Units. In this study after the 4th day the nutritional support, it was responsible for more than 25% of the total volume that was delivered to the patient and with an higher impact with the increase in LOS

Fig. 1 (abstract P289). Quartiles of fluid balance in relation to mechanical ventilation Table 2 (abstract P289). Binary regression analysis for LOS ICU

Table 1 (abstract P290). General characteristics

Fig. 2 (abstract P289). Quartiles of fluid balance in relation to LOS ICU

Fig. 2 (abstract P290). cumulative survival in patients with >20% of volume gain since the 6th day Fig. 1 (abstract P290). 28th day mortality according to percentage of fluid accumulation

Table 2 (abstract P290). Logistic regression

Fig. 1 (abstract P292). Distribution of delta SOFA score, cumulative fluid balance and fluid intake in patients with or without fluid overload status

Fig. 2 (abstract P292). Distribution of delta SOFA score, cumulative fluid balance and fluid intake considering length of fluid overload

Fig. 1 (abstract P293). Plasma hyaluronan (geometric mean fold-change, 95% confidence interval) in dogs (n=6 per group) with hemorrhagic shock given 20 mL kg-1 of either fresh whole blood (FWB), hydroxyethyl starch 130/0.4 (HES), 4% succinylated gelatine (GELO) or 80 mL kg-1 of balanced isotonic crystalloid (CRYST). Data represents fold-change in biomarker concentration from baseline. Grey line (fold-change of 1.0) represents no change from baseline Conclusions: Rapid large-volume crystalloid given for hemorrhagic shock was associated with increased hyaluronan, a biomarker of endothelial gly- cocalyx damage, and inflammation, including increased IL10, IL8 and KC.

Fig. 2 (abstract P293). Plasma interleukin-10 (geometric mean fold-change, 95% confidence interval) in dogs (n=6 per group) with hemorrhagic shock given 20 mL kg-1 of either fresh whole blood (FWB), hydroxyethyl starch 130/0.4 (HES), 4% succinylated gelatine (GELO) or 80 mL kg-1 of balanced isotonic crystalloid (CRYST). Data represents fold-change in biomarker concentration from baseline. Grey line (fold-change of 1.0) represents no change from baseline

[1] Joosten et al. Anesthesiology 128:55-66, 2018

Table 1 (abstract P296). Initial albumin MUE data (doses) collected (3 months)

Table 2 (abstract P296). ICU monthly data collected from 2016 -Ser 2017

Fig. 2 (abstract P296). ICU Albumin cost pre & post interventions cost reduction (29%) Fig. 1 (abstract P296). Albumin doses comparing usage in 3 months

Fig. 1 (abstract P301). Protocol flowchart 1. Molnar Z et al. Curr Opin Anaesthesiol 171-177, 2017 P303 Reference

Fig. 2 (abstract P304). Regression between hematocrit and SID variation observed in the whole study population Fig. 1 (abstract P304). Changes in SID and bicarbonate concentration induced in whole blood by acute in vitro PCO2 variations

Fig. 1 (abstract P305). GOS at 3 months Table 1 (abstract P305). Logistic regression analysis to identify independent predictors for poor outcome (3 month GOS 1-3)

Fig. 1 (abstract P306). Length of stay between the two groups (note logarithmic scale for LOS) 1. Dean P et al. Crit Care 17:443, 2013

Table 2 (abstract P308). Accuracy and observer variability in bowe' obstruction, ileus and healthy volunteers P309 Stress ulcer prophylaxis in critically ill patients; when to stop?

Table 1 (abstract P308). Auscultation for the presence of audible peristalsis in relation with intestinal transit

1. Darmon M et al. Crit Care 17(1);R12, 2013 Reference

Table 2 (abstract P310). Length of stay (LOS) data in days for patients initially admitted to medicine and surgery

Table 1 (abstract P310). Presence of a senior review in ED for those patients admitted to medicine and surgery

Table 1 (abstract P315). Unadjusted and adjusted analysis of the association of fluid balance per day in the intensive care unit (liter) wit intensive care unit mortality

Table 1 (abstract P316). Percentage change in psoas muscle cross sectional area at three different levels Conclusions: In critically ill patients with acute severe pancreatitis, there are significant losses in both psoas muscles throughout the L4 level. Further prospective studies are required to determine if inflam- matory markers and cytokines have a role in these losses, and to determine the functional effects of these losses.

Fig. 1 (abstract P315). Unadjusted predicted probability of intensive care unit mortality based on fluid balance per day in the intensive care unit (liter)

Fig. 2 (abstract P318). Correlation coefficients between measured and calculated energy requirements

Fig. 1 (abstract P318). Comparison of median values and distribution of measured and calculated energy requirements

Only one AE (diarrhea in the metoclopramide group) was considered to be potentially treatment-related One patient reported each of the following: cerebral hemorrhage, respiratory failure and decubitus ulcer “One patient reported each of the following: hemmorhage intracranial, subarachnoid hemmorhage, disease progression, hypertension 4No serious AEs (including deaths) were considered to be treatment-related in either group “One patient reported each of the following: cerebral hemorrhage and respiratory failure ‘One patient reported each of the following: hemmorhage intracranial, subarachnoid haemorrhage and disease progression AE, adverse event Table 1 (abstract P320). please see text description

Fig. 1 (abstract P320). Grastric retention assessed by individual scintigraphy in the (a) intervention (TAK-954 0.5 mg; n=7) and (b) control (metoclopramide 10 mg; n = 6) treatment groups

Fig. 1 (abstract P325). Stakeholders involved. ICU, intensive care unit; SLT, speech and language therapy; NCHDs, non-consultant hospital doctor Table 1 (abstract P325). International Nutrition Survey Results 2011 and 2014. MMUH, Mater Misericordiae University Hospital

1. McClave S et al. Enteral Nutr 40:159-211, 2016

Table 1 (abstract P331). Summary of population

Fig. 2 (abstract P331). Protein intake based on sex and age

Fig. 1 (abstract P335). Nitrogen Balance in 1st, 3rd and 5th ICU day Conclusions: Among adult patients with solid cancer in the postop- erative period in the ICU, NB was persistently negative in the survi- vors between 1st and 5th ICU day, but among the patients who died NB tended to be more positive on the 3rd day. NB monitoring could allow a more adequate individualization of nutritional management in this group of patients.

Fig. 1 (abstract P337). 30 minute post-burn IL-6 levels in all major organs Conclusions: Experimentally, a single, early post-burn dose of estro- gen significantly mitigates the associated detrimental inflammatory response in all major organs up to 45 days. In turn, this may present a promising potential therapy to decrease the widespread multiple- organ dysfunction seen in severe burn injury patients.

Fig. 2 (abstract P337). 45 day post-burn IL-6 levels in all major organs P338 Early, single-dose estrogen increases levels of brain-derived neurotrophic factor (BDNF), a neurotrophin for neuronal survival and neurogenesis following indirect brain inflammation caused by severe torso burns

Conclusions: Early, single-dose estrogen administration following remote severe burn injury significantly elevated levels of BDNF in brain tissue. This finding may represent an extremely novel and important pathway to enhance both neuroprotection and neuror- egeneration in burn patients. ~~“

Fig. 1 (abstract P340). Example of one patient undergoing 24 hour sampling of cortisol and ACTH (Patient survives).

Fig. 2 (abstract P340). Example of one patient undergoing 24 hour sampling of ACTH and cortisol (Patient dies at hour 23).

Fig. 1 (abstract P342). Cortisol Levels Stratified by Sepsis and DID Status

*Mann-Whitney U test Table 1 (abstract P347). Baseline characteristics, statistic analysis with Chi-square test Table 2 (abstract P347). Glycemic variability and ICU mortality, statistic analysis with Mann-Whitney U test Conclusions: Maximal glycemic gap independently correlated to ICU mortality and was the best GV to predict ICU mortality in medical critically ill patients.

Fig. 1 (abstract P347). AUROC between glycemic variability and ICU mortality, Maximum BG gap 0.693(0.638-0.747), CV 0.677(0.619-0.736), SD 0.672(0.614-0.730), J-index 0.634(0.571-0.698), All p-value < 0.05

Fig. 1 (abstract P348). Concordance CG vs PG (Bland and Altman Method)

Table 1 (abstract P351). Overview of patient characteristics and outcomes. Patients with cancer had divergent clinical characteristics and higher 28-day and 1-year mortality

Fig. 2 (abstract P351). Results of the logistic regression analysis for (A) 28-day and (B) 1-year mortality. All covariates were statistically significant except for white race in the 1-year mortality model. ***p-value<10-16, **p-value<0.001, *p-value<0.01

Table 1 (abstract P352). Analysis of SIRS, ASOFA and qSOFA regarding sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and hazard ratio

Table 1 (abstract P354). Argatroban dosing and bleeding rate

Fig. 1 (abstract P352). Number of non-survivors with sepsis that did not fulfill the sepsis criteria of SIRS, ASOFA or qSOFA Table 2 (abstract P352). Predictive performance of SIRS, ASOFA and qSOFA for in-hospital mortality in patients with and without sepsis in the hematological cohort

Fig. 1 (abstract P354). 4T score plotted against ELISA optical density score

Fig. 1 (abstract P359). Blood and blood component usage in first time CABG References

P360 Predictors of red blood cell transfusion in cardiac surgery patients

Coagulation factors = concentrations of coagulation factors FIl, FV, FVII, FVIII, FIX, FX, FXI, FXIll antithrombin, protein C, thrombin peak. ROTEM parameters = extrinsically activated coagulation time, alpha angle and and clot firmness at 10 min, fibrin polymerization at 10 min. Table 1 (abstract P366). The loading of a variable on one or more of the three factors corresponds to the correlation of that variable and the factor

Table 1 (abstract P367). PPV and NPV of the three scores

Fig. 1 (abstract P366). Boxplots show the factors Concentration, Clot and Hypoperfusion, extracted from the performed factor analysis (see Table 1) for the CFC (blue, n=46) and the FFP (yellow, n=42) group, as well as for patients without (white, n=40) and with (grey, n=48) multiple organ failure. Each factor is given at the measurement time point baseline (R1) and following haemostatic resuscitation at admission to ICU, 24 and 48 hours thereafter (R2 to R4).

Fig. 2 (abstract P366). Boxplots show available measurements of extrinsically activated clot firmness at 10 min (ExA10), fibrin polymerizatior at 10 min (FibA10) and platelet count at baseline (R1) and after therapy at admission to ICU, 24 and 48 hours thereafter (R2 to R4) for the CFC (blue, n=46) and the FFP (yellow, n=42) group as well as for patients without (white, n=40) and with (grey, n=48) multiple organ failure.

Fig. 1 (abstract P367). Probability for emergent transfusion with TICCS.BE values.

Table 1 (abstract P370). Baseline characteristics

Table 2 (abstract P372). Filter related complications

Table 2 (abstract P378). Relationship between tomographic and TBI characteristics according to ICP monitoring in an adults TBI population admitted to San Gerardo Hospital NICU during a 20 years’ time horizon Uanuary 1997 - December 2016) P379 Trajectories of early secondary insults after traumatic brain injury: a new approach to evaluate impact on outcome. SF, Bese, Meee Bee Ceeamtics See Seinen tae ne nari ae Se ~

Fig. 1 (abstract P379). Trajectories of hypoxia, hypotension and pupillary abnormalities Conclusions: Trajectories could better define the dynamic and the burden of SI and their impact on outcome of TBI patients. Early treat- ments can influence evolution of SI and improve outcome.

Fig. 2 (abstract P379). Trajectories of SI in relation to 6-months out- come as measured by GOS.

Fig. 1 (abstract P380). Brain Perfusion Parameters after 23.4% NaC| Boluses Fig. 2 (abstract P380). Serum Sodium & Chloride After 23.4% NaCl Boluses

1. Kochanek PM et al. Pediatric Crit Care Med 13:51-S82, 2012 2. Sutherland SM et al. Clin J Am Soc Nephrol 10:554-561, 2015

Table 2 (abstract P383). Correlation (Pearson) between EEG Z-Ratio and ICP before, during and after episodes of intracranial hypertension. ICP epochs grouped based on preserved/impaired cerebral autoregulation

Table 1 (abstract P383). Patients Demographics |. Albertario CL et al. Sleep 18(10):836-43,1995 References

Fig. 1 (abstract P383). Plot of: A. Intracranial pressure during intracranial hypertensive events (Gray - Preserved Cerebral Autoregulation, Black - Impaired Cerebral Autoregulation). B. Cerebral Perfusion Pressure during intracranial hypertensive events (Gray - Preserved Cerebral Autoregulation, Black - Impaired Cerebral Autoregulation).

Fig. 2 (abstract P383). A. Correlation Scatter Plot and Moving Average (lines) between Average EEG Z-Ratio and Intracranial Pres- sure before (empty round orange marker), during (full orange square marker) and after (full blue round marker) intracranial hypertension events. A. Preserved cerebral Autoregulation. B. Impaired Cerebral Autoregulation.

Table 1 (abstract P385). Correlation aniscoria - death

Table 2 (abstract P385). Correlation work impairment - QOLIBRI

PaCO2 AvsC p<0.0001 CvsD p<0.05 CvsE p<0005 DvsE p<0.0001 AvsE p<0.001 AvsD p<0.0001; CPP AvsC p<0.005 CvsE p<0.05; ICP AvsC p<0.0001 AvsD p<0.0001 CvsE p<0.0001 DvsE p<0.005; PbrO2 CvsD p<0.05; MFV right AvsC p<0.0001 AvsD p<0.005; MFV left AvsC p<0.05 AvsD p<0.001 CvsE p<0.05 DvsE p<0.05 Table 1 (abstract P386). Changes during the test. Data are expressec as mean with standard deviation

Table 2 (abstract P386). Cerebral metabolism during the test. Data are expressed as mean + standard deviation PaCO2 arterial partial pressure of CO2, CPP cerebral perfusion pressure (mmHg), ICP intracranial pressure (mmHg), PbrO2 brain tissue oxygen tension (mmHg), MFV mean flow velocity in the middle cerebral artery

Fig. 1 (abstract P386). Study protocol. At different time points several variables were collected and TCCD measurements were performed. A baseline, B increasing minute ventilation, C begin moderate hyperventilation with target PaCO2 4-4.7 kPa, D after mod- erate hyperventilation for 50 minutes, E return to baseline. ABG arter- ial blood gas. Glucose, Lactate and Pyruvate concentrations in the extracellular fluid are sampled by microdialysis one hour before A (1h-A) and one (D+1h) and two hours after D (D+2).

Table 1 (abstract P390). SET score Table 2 (abstract P390). Demographic data of the patients 1. Schdnenberger S et al. Neurocrit Care 25:94-104, 2016 References

Fig. 1 (abstract P390). Distribution of tracheostomy by the SET score among the studied patients (N=164)

Fig. 2 (abstract P390). Specificity for the cutoff point of SET SCORE. Cut point of 9 is the best to predict tracheostomy with sensitivity of 85.0% and specificity of 80.4%. Cut point of 9 is the best to predict early tracheostomy with sensitivity of 86.1% and specificity of 81.5%. Since no patients had score 9 so the previous analysis that consider cut-point of 8 should remain the same but just change the number in the text to 9

Table 1 (abstract P396). Results 1. Nishiyama T, et al. Can J Anaesth 47(12):1196-201, 2000

Table 1 (abstract P399). Demographic characteristics

Table 2 (abstract P399). Frequency of main complications

Fig. 1 (abstract P400). The black bars represent the percentage of abnormalities of factors shown in the x-axis during brain tissue hypoxia 1. Okonkwo DO et al. Crit Care Med 45:1907-1914, 2017 References

Fig. 1 (abstract P412). Major factors associated with good-quality bystander-performed chest compressions Conclusions: Provision. of good- -quality C CCs before EMS arrival but not prehospital ALS was essential for neurologically favourable survival. lack of BLS training experience (0.47; 0.36-0.62), elderly-only rescuers (0.53; 0.44-0.65), CC initiation following dispatcher-assisted cardiopul- monary resuscitation (0.71; 0.55-0.91), and female-only rescuer (0.77; 0.65-0.90) were associated with poor-quality CCs. CC quality in at- home OHCAs remained low throughout the day, whereas that in out- of-home OHCAs decreased during night-time.

Table 1 (abstract P415). Demographic data, CPR intervals, Rhythm on EMS arrival, reperfusion

Fig. 2 (abstract P413). Trend in neurologically favourable 1-Y survival Fig. 1 (abstract P413). The effect of early CCs on the proportions ¢ definitive cardiac arrest that followed respiratory arrest and circulatory depression in initial patient evaluation

P417 Table 2 (abstract P415). ICU stay, mortality and disability data

Table 1 (abstract P417). Description comorbidity in relation to ECC changes after cardiac arrest 1.lschemic heart disease. 2.Kidney disease, acute or chronic. 3.Chronic obstructive pulmonary disease. 4.Diabetes mellitus. 5.Right bundle branch block. 6.Left bundle branch block

Table 2 (abstract P417). Coronary angiographic findings in relation to ECG changes after cardiac arrest 1.Significant stenoses diagnosed during angiography in main stem or 1-3 of the coronary artery regions. Patients with stenoses in both main stem and other coronary arter regions are classified as main stem stenoses. 2.Left bundle branch block. 3.Right bundle branch block. 4.0ther ECG changes, e.g.pacemakerrhytms

Data is presented as No. (%) unless otherwise indicated. *96 men and 53 women had missing data Table 1 (abstract P418). Background characteristics and treatment Conclusions: Our study suggests, that despite no gender differences in rate of ECG findings indicating a prompt CAG, men seems to have a more severe coronary artery disease while women have more frequently normal angiograms. However, this did not influence 1 year survival. Be ee 20 is et! Results: ‘There was no ) difference in age or comorbidity except for men having more ischemic heart disease, 21.5 vs 15.0% (p=0.006). Rates of previous myocardial infarction did not differ, 8.2 vs 6.3%. No difference was seen in rates of ECG indicating prompt CAG according to guidelines. Still, more men underwent CAG but no difference in numbers of CAG leading to PCI was seen (Table 1). Furthermore, in patients with ST elevation or LBBB, no gender difference in CAG and subsequent PCI was found. Men had lower rates of normal CAG find- ings but more triple vessel and left main coronary artery disease (Table 2). 1 year survival did not differ, 49.1 vs 45.0%.

Fig. 1 (abstract P417). Participant flow

Table 2 (abstract P418). Early Angiography findings, patients with data P419 Circadian variation of outcomes in out-of-hospital cardiac arrest of cardiac etiology

Fig. 1 (abstract P421). Mean + SD time percentage of signal capture from ROSC to hospital admission during total time for each variable

Table 1 (abstract P422). Results P1 vs P2

Table 1 (abstract P426). Univariate and multivariate analysis for the prediction of 30-day mortality after OHCA CA: cardiac arrest, ACS: acute coronary syndrome

Table 2 (abstract P426). Parameters associated with CAD in patients with cardiac aetiology and absence of ST-segment elevation CAD: coronary artery disease, CVRF: cardiovascular risk factor

Fig. 1 (abstract P425). Characterizing metabolites in return of spontaneous circulation (ROSC) versus cardiac arrest (CA). Reference Conclusions: It appears that different metabolic pathways are being activated in the ROSC period. Further studies are needed to accur- ately define the metabolic pathways.

Fig. 1 (abstract P429). Effecting neurologically-intact survival fol children with out-of-hospital cardiac arrest

Fig. 1 (abstract P430). Laboratory studies leading to concept of improved cerebral perfusion pressures with head-up CPR Conclusions: The head/torso-up CPR bundle was not only feasible, but also associated with an immediate, steady rise in resuscitation rates during the transition phase with a sustained doubling of resuscitation rates, mak- ing a compelling case that this bundled technique may improve OOHCA outcomes in future clinical trials.

Fig. 2 (abstract P430). Immediate and Sustained Doubling of Resuscitation by EMS after Introducing the Novel Approach to CPR

Fig. 1 (abstract P431). Healthcare costs stratified by cardiac arrest location

Table 1 (abstract P438A). Laboratory data

Table 1 (abstract P444). Medical PPR and TTHR observed and expected for the two events

Fig. 1 (abstract P454). Proportion patients with 21 MTE Table 1 (abstract P454). Patient characteristics

Fig. 1 (abstract P455). Qic pic particles analyser References

Fig. 1 (abstract P456). In line filtration

P457 Worldwide management of brain dead organ donor: a systematic review of guidelines - a: ~ os Pe

Fig. 1 (abstract P463). Monte Carlo simulations of bed occupancy under 1) normal, 2) increased referral, 3) increased referral and increased capacity conditions

Fig. 1 (abstract P466). Funnel plot depicting for each ICU its relation between the number of treated patients (x-axis) and the percentage of these patients with imprecise coding of the diagnosis (y-axis). The red (dotted) lines denote the 99.8% (95%) Confidence Intervall. The central line represents “local medians” estimated by the Locally Weighted Scatterplot Smoother — method.

Fig. 1 (abstract P467). Trends of advanced lung cancer patients admitted to intensive care unit Table 1 (abstract P467). Clinical outcomes according to intensivist’s intervention

Fig. 2 (abstract P467). Run chart of hospital mortality of advanced lung cancer patients admitted to intensive care unit

Fig. 1 (abstract P470). Braden scale on 1st, 3rd and 9th ICU day. ee OE FN I EE DENSE! St AEESOI DDSI LIANE! NII AE Conclusions: In addition to its role as a predictor of the incidence of PU in critically ill patients, BS was strongly correlated to ICU mortality. P471

Fig. 1 (abstract P471). Triage tool for ICU referral Conclusions: Adopting a triage tool for ICU referrals could reduce the overall proportion of inappropriate referrals and admissions. End-of-life discussion would also be proactively clarified prior to ICU admission.

Fig. 1 (abstract P472). Association of the implementation of the decision-aid tool with ICU admission overall and in each priority strata, according to (A) 1999 SCCM’s triage guidelines and (B) 2016 SCCM's triage guidelines Conclusions: The implementation of a decision-aid tool for ICU triage was associated with a reduction of potentially inappropri- ate ICU admissions.

Conclusions: The acute care non-physician provider in the ICU seems a promising clinician on the ICU with regard to quality and continuity of care. Whether they also can reduce mortality remains to be deter- mined by designing studies, which adequately measure the contribu- tion of the non-physician providers in ICU care overall and per task. Their role in Europe remains to be elucidated.

Fig. 2 (abstract P478). Forest plot demonstrating comparison in hospital length of stay between ICUs with NP/PA and with residents Fig. 1 (abstract P478). Forest plot demonstrating in hospital mortality between ICUs with NP/PA and residents

Fig. 1 (abstract P481). Cognitive functioning in patients prior to ICU admission. Fig. 2 (abstract P481). Patients with delirium vs no delirium in different groups of cognitive functioning.

Conclusions: Almost half of the patients admitted to the ICU have cognitive dysfunction prior to ICU admission. To assess ones cognitive function after ICU treatment one has to take in to account the patients pre-existing cognitive functioning. Pa- tients with a moderate to severe pre-existing cognitive dysfunc- tion develop significantly more delirium during ICU treatment.

Fig. 1 (abstract P488). Proportion of Perfused small Vessels at to, t1, t2

Fig. 1 (abstract P495). Intranasal fentanyl compared to parenteral opioid for acute pain relief

Table 1 (abstract P496). Endoscopy protocol sedation

Fig. 1 (abstract P496). PEG) procedure in Parkinson's Disease patient; Overlapped Figure: Endoscopy view of bumper placement

Table 1 (abstract P499). Characteristics of patients prescribed APs for treatment of delirium in critical care

Fig. 1 (abstract P499). Delirium screening and assessment audit vs. survey Table 2 (abstract P499). Comparison of actual and perceived APs prescribed doses when treating critical care delirium

Fig. 2 (abstract P499). 12 Lead ECG as APs ADE monitoring tool, audit vs. survey

Table 1 (abstract P500). Demographics of respondents

Table 2 (abstract P500). Attitudes on Sedation

Fig. 2 (abstract P500). Drug Choices for Analgesia Fig. 1 (abstract P500). Drug Choices for Sedation

Table 1 (abstract P504). Demographic characterization of patients. Results are expressed as median and range

P506 Fig. 1 (abstract P504). The prediction-corrected VPC plots for dexmedetomidine PK. The VPC plots show the simulation-based 95% confidence intervals around the 10th, 50th, and 90th percentiles of the PK data in the form of blue (50th) and gray (10th and 90th) areas. The corresponding percentiles from the prediction corrected observed data are plotted in black color

Table 1 (abstract P506). Please see text description P507 References

Table 1 (abstract P507). Regression coefficients and odds ratios for predictors of psychological morbidity

Table 1 (abstract P515). Baseline and in-hospital characteristics by primary admission diagnosis group

Fig. 1 (abstract P515). Cumulative incidence of return to work with death as competing risk Table 2 (abstract P515). Baseline and in-hospital characteristics by primary admission diagnosis group

Fig. 2 (abstract P515). Multivariable cox regressions of return to work by: 1. Number of organ support in all 8660 |CU-survivors. 2 A-H: Analysis of organ support stratified on hospital-admission-diagnosis group Adjusted for age, sex, educational level, status of living alone. Data show return to work for survivors to hospital discharge. The hazard ratio (HR) denotes the relative hazard rate of return to work for the parameter compared to its reference after adjustment for confounders

Fig. 1 (abstract P517). Graph of admission age in LD vs all patients

Fig. 2 (abstract P517). Graph of total mortality in LD vs all patients

Fig. 1 (abstract P520). Association of physician's prognosis with hospital mortality (p<0.001).

Table 1 (abstract P523). Comparison of the total score and sub scores across different studies P524 Breaking bad news in the emergency department: a randomized controlled study of a training using role-play simulation so a7 oe roo, mnie “7 7 : a ee yoo

Fig. 2 (abstract P527). Differences in competency, patient wishes and patient discussions Fig. 1 (abstract P527). Differences in EOLP by region

Sprung CL et al. JAMA 2003; 290: 790-797

Fig. 1 (abstract P528). Differences in EOLP by region

Fig. 2 (abstract P528). Patient mental compentency by region

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Effectiveness of simulation-based learning in intravenous medication safety: a randomized controlled study

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