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Outcomes from the 2015 Round Table on Sepsis The official daily newsletter of the 35th ISICEM Thursday 19 March 2015 Day 3 Outcomes from the 2015 Round Table on sepsis uring the opening session on Tues- day morning, Simon Finfer (Royal North Shore Hospital of Sydney and Sydney Adventist Hospital, Sydney, Australia) was joined by Steven DOpal (Memorial Hospital of Rhode Island, RI, USA) to summarize the major outcomes of the two-day Round Table discussion “This will be a on sepsis. This was a joint conference significant part of our conducted between ISICEM and the Inter- national Sepsis Forum, with representa- research agenda in the tives from every continent highlighting the future – making sure global nature of the problem. Beginning by addressing the current that our patients are state of knowledge in the epidemiology of doing well after they sepsis, Professor Finfer noted that we know leave the hospital.” surprising little, but that obtaining this data will be crucial if any meaningful strategy is Steven Opal to be developed: “To some degree we have data from developed countries, possibly far less than you would expect or think,” he said. “But there are certainly places in, notably, Africa, where we are completely devoid of data.” The reasons for this lack of data can in part be understood by an appreciation of how patient data are currently characterized and treated, with the Global Burden of Disease Project emerging as a central player in generating evidence and guiding is surprising because we believe that sepsis kills one comes into your ICU with community-acquired global health policy. more people than prostate cancer, breast cancer, pneumonia, you treat the pneumonia; maybe they “The only reference to sepsis in these sta- and many other high profile diseases. The reason are an elderly person with a lot of comorbidities; tistics is to neonatal sepsis,” noted Professor for that is that the Global Burden of Disease only they have sepsis, but the sepsis goes unresolved Finfer. “There is nothing else about sepsis, which counts the underlying cause of death. So if some- Continued on page 19 The protective role of Intensive “No shortcuts” Massive exercise in critical illness careers: Providing with process measures bleeding: support for our ICU staff lessons from the military . 2 . .5 . .10 . 14 2 ISICEM News Thursday 19 March 2015 Issue 3 Plenary lecture: Critical illness is top sport Arc Room Tuesday 17:30 The protective role of exercise for critical illness regular and consistent exercise regime prior to critical illness is a significant boon for Aoutcomes, offering a protective effect that means patients can expect to re- cover quicker, and have an improved quality of life. So was the message of Can Ince (Erasmus Medical Center, Erasmus University of Rotterdam, the Netherlands) who shared his perspec- tives, as a physiologist, on the role of exercise in critical illness during his plenary lecture on Tuesday. “I have been involved in critical care medicine as my main topic of interest for more than 30 years,” he told ISICEM News. “I have been interested in physiological function, the function of organs, and specifi- cally how the cardiovascular system functions in states of critical illness, and how to improve it – especially in terms of oxygen transport and the microcirculation.” During his lecture, Professor Ince relayed his experience from decades of work, paying particular attention ISICEM News Publishing and Production “When you are sick, what is MediFore Limited particularly debilitating is the Symposium Chairman to a project in the last 5-10 “What is very interesting Jean-Louis Vincent feeling of helplessness … it is years which has focused on from an academic view I think Editor-in-Chief extreme physiology. “How do important to get across the is how much emphasis there Peter Stevenson you react, when healthy, to ex- message that you might end is on drug-related interven- Editors treme conditions?” he said. “I tions to health and disease, Rysia Burmicz am talking about low oxygen, up in intensive care, but you and that exercise is a relative Becky McCall high altitude, strenuous exer- can already start working on side-show when it comes to Additional content cise, dehydration, extreme cold making sure you have a good the big journals of critical Aisling Koning etc. That has been an interest illness and perioperative Design of mine, because it is amazing chance of surviving.” medicine,” he said. Peter Williams what the human body can “If you look how you can Can Ince Industry Liaison Manager endure, but with critical illness, actually influence physiology Bethan Coulbeck the smallest glitch happens while exercising, one of the and then the alarms go off.” big problems in this area is Head Office 19 Jasper Road, Crystal Palace As part of this burgeoning work, department of surgery at the Eras- actually getting people to do it in the London SE19 1ST, UK Professor Ince has been involved in mus Medical Center, at which they first place, because for true benefit Telephone: +44 (0) 20 8761 2790 Xtreme Everest – a unique research are thinking of how to improve the you have to do it for a lengthy period [email protected] project at Mount Everest which outcomes of their patients by preop- of time, and it has to be done consist- www.medifore.co.uk has been exploring the response of erative exercise,” said Professor Ince. ently.” Copyright © 2015: Université Libre de the body to oxygen-thin air at high “There is this whole of idea of how Specifically, Professor Ince spoke Bruxelles. All rights reserved. No part of this altitudes.1 In fact, oxygen levels in is fitness related to outcomes, and of a ‘sweet-spot’ of around 200 publication may be reproduced, stored in a the infamous ‘Death Zone’ were so whether you can you do something minutes of exercise per week to see etrieval system, transmitted in any form or by any other means, electronic, mechanical, low they were barely able to sustain preoperatively to influence it.” substantial benefit, which in practice photocopying, recording or otherwise without human life, thus providing enlighten- The third piece of the puzzle that can be difficult for busy individuals prior permission in writing of ISICEM. The ing data as to the conditions faced by Professor Ince is concentrating on is to do. Furthermore, this must be content of ISICEM News does not necessarily reflect the opinion of the ISICEM 2015 intensive care patients. how the body actually responds to ex- moderately intense exercise, not just Symposium Chairman, the ISICEM Scientific “The second area of interest ercise, exploring its beneficial effects a walk in the park: “This is cycling Advisors or Collaborators. concerns my involvement in the from a physiological perspective. Continued on page 4 4 ISICEM News Thursday 19 March 2015 Issue 3 Plenary lecture: Critical illness is top sport Arc Room Tuesday 17:30 The protective role of exercise for critical illness Continued from page 2 in abdominal surgery, for example. “So when I look at it from my point and proactively work for better out- or running where your heart beat This is one of our main interests. of view in physiology, I see a cluster comes. “When you are sick, what is is going high,” he said. “Or playing “From my physiological perspec- of lots of different little contributors, particularly debilitating is the feeling tennis, swimming etc. tive, I think you have to look at a like the ‘Butterfly Effect’ – i.e. they all of helplessness, and I think that from “200 minutes is quite a lot actual- bigger picture, as looking at gross can contribute to an adverse outcome, that point of view, it is important to ly, if you try and do it, but neverthe- get across the message that you less if you do that for a consistent might end up in intensive care, period of time, you do notice your “Now people are much more interested in quality of but you can already start working gait is better, your general feeling life: can you think, can you walk, can you do simple on making sure you have a good is better, and people who have chance of surviving,” said Professor previously not done it, but start to – things, are you enjoying the fact you are alive, and Ince. “Popping pills is not the way… and keep it up for a period of time have survived critical illness? And from this point of but exercise is something that you – will certainly notice a difference in view you need all of the help you can get.” can already start investing in.“ their general wellbeing.” Indeed, in the United States, Getting into the meat of the Can Ince there is already a public program data, and looking at how we encouraging exercise, called ‘Ex- can assess the positive influence ercise is Medicine’, which acts to of exercise for critically ill patients, clinical outcome parameters is the and that itself is also a fuzzy concept. boost awareness and take-up of a Professor Ince commented: “It is dif- way to go. If you have a serious Obviously being alive or dead is the good exercise regime. ficult because you have to objectively disease, and it can be anything from ultimate outcome parameter, but now For Professor Ince, his take-home measure parameters of fitness, which renal transplantation to cancer, etc., people are much more interested in message was clear: exercise is a pow- is a whole murky area of trying to there are a number of clusters of quality of life: can you think, can you erful way to improve the chance of find out if someone is fit or not.” pathogenic issues that will contrib- walk, can you do simple things, are superior outcomes in many diseases, He added: “But the British Medi- ute to the ultimate outcome of that you enjoying the fact you are alive, including critical illness.
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