Royal Adelaide Hospital Intensive Care Unit Issue 2 - Aug 2015 RAH ICU Training and Research 2014/15 SOME OF OUR 2014/2015 ACHIEVEMENTS RESEARCH 53 publications in peer-reviewed journals (thus far!) 2013 HIGHLIGHTS Number of Awards and Prizes for RAH ICU staff including; • 2015 Two PhD’s • 2014 Matt Spence Medal (ANZICS) – 2nd year in a row • 2015 Tub Worthley Travelling Scholarship – 3rd year in a row • 2014 David Murray Prize • 2014 Nimmo Professor Prize (RAH) • 2014 Florey Postgraduate Medical Research Prize It is important to recognize the hard work and achievements TEACHING AND TRAINING of our staff in ICU. CICM Fellowship Exam pass rate of 82% from 2002-2015 In addition to our clinical work, we have continued to run (cf overall Aus/NZ pass rate of 55%) highly successful teaching and research programs, and in this Newsletter we highlight some of these achievements Don Harrison Medal (CICM) 2014 over the past 12 months. We have also included a list of upcoming courses, the role of SAICA, travel logs from some Highly successful Primary and Fellowship Exam Courses of our registrars from overseas, and the imminent move to Involvement in number of other Courses including the new Royal Adelaide Hospital. commencement in 2014/2015 of; This an annual publication, so if you are aware of any other • BASIC Courses at RAH • Critical Care Ultrasound Course achievements that we have unfortunately omitted, please let • Postoperative Care of the Cardiothoracic Patient Course us know! RAH ICU Facts and Figures The Royal Adelaide Hospital ICU is the busiest Level 3 Unit in South Australia, and in the 12 months from July 2014 to June 2015, we admitted 3606 patients into the 42 beds (2282 ICU, 1324 Step Down Unit). Of the ICU-level patients admitted during that time, about 21% were direct admissions following cardiac surgical procedures, 11% were trauma, 8% following thoracic surgery, 8% ‘sepsis’, and 7.5% pneumonia without sepsis. Drug overdose, cardiac arrest and ENT surgery accounted for 3% each. The major diagnostic categories for SDU admissions were following neurosurgical procedures (15%), GI surgery (13%), trauma (13%), and sepsis (7%). Operating theatres were the source of admission for 48% of our patients (51% non-elective surgery), 31% were admitted directly from the Emergency Department, 16% from the wards, and 5% were transferred directly from another hospital to our ICU. The Unit currently has 42.5 Registrars on the roster (16 registered with the College of Intensive Care Medicine) from a variety of backgrounds and training programs, and with very different levels of experience and long-term goals. http://www.icuadelaide.com.au 12 Royal Adelaide Hospital Intensive Care Unit Issue 2 - Aug 2015 Teaching and Training Congratulations to Mark Plummer who held in February this year, with 30 State. Hao Wong, one of our Senior won the Matt Spence Medal in candidates from Australia and New Registrars, chaired the event, and we Melbourne last year at the Australian Zealand (photo below). An enormous hope to hold it 2 or 3 times a year. and New Zealand Intensive Care amount of work goes into the Course, Society ASM for his paper, with 30 faculty this year, including 12 The RAH BICMed Course was ‘Dysglycaemia in the Critically Ill and from the RAH, 5 from interstate, and recently accredited by CICM as an the Interaction of Chronic and Acute Yasmine Ali Abdelhamid, who flew in introductory ICU Course, and can now Glycaemia with Mortality’. This is from Toronto. Hot Case practice be counted towards CICM training. awarded for the best registrar research sessions were held at the RAH, QEH, presentation, and of the 6 finalists, 2 FMC and LMHS. The first Postoperative Care of the were from the RAH ICU. The other was Cardiothoracic Patient Course was Palash Kar, who presented, ‘Energy- The annual RAH Primary Examination held in June this year for ICU Dense Feeds May Worsen Enteral Feed- Course was brought forward to May in registrars at the RAH, and included Intolerance’. 2015, and was coordinated as usual by sessions on the surgery itself and Mark Finnis. There were 24 candidates cardiopulmonary bypass (given by Yasmine Ali Abdelhamid was presented and a number of the RAH Intensivists Justin Chan), common postoperative (in absentia) with the Don Harrison were involved in the teaching. issues, haemostasis, monitoring, Medal at the CICM ASM in Darwin for pacing, mechanical cardiac support, coming top of the CICM Fellowship The second South Australian Critical cardiac arrest in this group of patients, Exam last year. Care Ultrasound Course was held in and scenario discussions. Feedback February for 16 candidates, with was very positive, and we plan to run The Tub Worthley Travelling another planned for September. It is a 2- it every 6 months. Scholarship was won by Palash in May day course on focused cardiac, lung, this year. This is awarded for the best abdominal and procedural ultrasound We also conducted a BASIC Course at registrar research presentation at the relevant to critical care. the RAH in November, with another annual South Australian ANZICS planned for later this year. meeting. Other presenters of their The first of the Trainee Lecture Series research on the night included Sam days was held at Ayres House in May, A list of upcoming local ICU Courses Gluck, Mark Plummer and David Reid. with 4 speakers including Prof Jack is included at the end of this Iwashyna (Ann Arbor, Michigan) and Newsletter. The 30th running of the Australian Short Prof Andrew Bersten (FMC), and was Course in Intensive Care Medicine was attended by 32 registrars from across the ICU Registrar Positions If you are interested in a position as an Intensive Care Registrar at the RAH, further details are available at http://www.icuadelaide.com.au, or contact Dr Alex Wurm at [email protected]. If you are thinking about ICU as a career and would like to discuss your options, Dr Nick Edwards ([email protected]) and Dr Peter Sharley ([email protected]) are the ICU (CICM) Supervisors of Training at the RAH – and we are always happy to have a chat. http://www.icuadelaide.com.au 2 Royal Adelaide Hospital Intensive Care Unit Issue 2 - Aug 2015 Research Research Publications July 2014 - June 2015 1. Kar P, Plummer MP, Chapman MJ, Cousins CE, Lange K, Horowitz M, Jones KL, Deane AM Energy-dense feeds may slow gastric emptying in the critically ill JPEN J Parenter Enteral Nutr. 2015 Jun 2 (Epub ahead of print). 2. Plummer MP, Jones KL, Cousins CE, Trahair LG, Meier JJ, Chapman MJ, Horowitz M, Deane AM. Hyperglycemia potentiates the slowing of gastric emptying induced by exogenous GLP-1. Diabetes Care 2015 Mar 17. pii: dc143091. [Epub ahead of print] 3. Gluck S, Headdon WG, Tang DW, Bastian IV, Goggin MJ, Deane AM. The incidence of ocular candidiasis and evaluation of routine ophthalmic examination in critically ill patients with candidaemia. Anaesthesia and Intensive Care 2015 (in press). 4. Reddi BAJ, Iannella SM, O’Connor SN, Deane AM, Willoughby SR, Wilson DP. Attenuated platelet aggregation in patients with septic shock is independent from the activity state of myosin light chain phosphorylation or a reduction in Rho kinase- dependent inhibition of myosin light chain phosphatase. Intensive Care Medicine Experimental 2015, 3:5. 5. Nguyen NQ, Debreceni T, Bambrick J, Wishart J, Deane AM, Rayner CK, Horowitz M, Young RL. Accelerated intestinal glucose absorption in morbidly obese humans - relationship to glucose transporters, incretin hormones and glycaemia Journal of Clinical Endocrinology and Metabolism 2015 Mar;100(3):968-76. 6. Kar P, Cousins CE, Annink CE, Jones, KL, Chapman MJ, Meier JJ, Nauck MA, Horowitz M, Deane AM. Effects of glucose- dependent insulinotropic polypeptide on gastric emptying, glycaemia and insulinaemia during critical illness. Critical Care 2015 Jan 23;19(1):20. 7. Poole A, Deane AM, Summers MJ, Fletcher J, Chapman MJ. The relationship between fasting plasma citrulline concentration and small intestinal function in the critically ill. Critical Care 2015 Jan 20;19(1):16. 8. Reintam Blaser A, Starkopf L, Deane AM, Poeze M, Starkopf J. Comparison of different definitions of feeding intolerance: a retrospective observational study. Clinical Nutrition 2014 October. [Epub ahead of print] 9. Czapran A, Headdon W, Deane AM, Lange K, Chapman MJ, Heyland DK. International observational study of nutritional support in mechanically ventilated patients following major burn injury. Burns 2014 Oct 22;41(3). 10. Nguyen NQ, Debreceni T, Bambrick J, Chia B, Deane AM, Rayner CK, Wittert GA, Horowitz M, Young RL. Up-regulation of intestinal glucose transporters after Roux-en-Y gastric bypass to prevent carbohydrate malabsorption. Obesity 2014 Oct;22(10):2164-71. 11. Sundararajan K, Wills S, Chacko B, Kanabar G, O’Connor S, Deane AM. Impact of delirium and suture-less securement on accidental vascular catheter removal in the Intensive Care Unit Anaesthesia and Intensive Care 2014 Jul;42(4):473-9. 12. Ali Abdelhamid Y, Cousins CE, Sim JA, Bellon MS, Nguyen NQ, Horowitz M, Chapman MJ, Deane AM. Effect of critical illness on triglyceride absorption. JPEN J Parenter Enteral Nutr. 2014 Jun 24. [Epub ahead of print] 13. Peake SL, Davies AR, Deane AM, Lange K, Moran JL, O’Connor SN, Ridley EJ, Williams PJ, Chapman MJ. Use of a concentrated enteral nutrition solution to increase calorie delivery to critically ill patients: a randomized double-blind clinical trial. American Journal of Clinical Nutrition 2014 Jul 2;100(2):616-625. 14. Plummer MP, Bellomo R, Cousins CE, Annink CE, Sundararajan K, Reddi BAJ, Raj JP, Chapman MJ, Horowitz M, Deane AM. Dysglycaemia in the critically ill and the interaction of chronic and acute glycaemia with mortality.