I’ve spent the last few days in Adelaide, SA at the Australia and New Zealand Intensive Care Society (ANZICS) annual scientific meeting. ANZICS is known throughout the acute medicine community worldwide for their amazing mutli-centre clinical trials that enrol thousands of patients (SAFE, NICE-SUGAR, CHEST) and this is their annual meeting and a highly regarded ICU conference.
Day one kicked off with Prof. Warwick Anderson, CEO of the Australian National Health and Medical Research Council (NHMRC) talking about the gap between basic science and bedside clinical medicine and highlighting new initiatives from NHMRC to help translate new research into clinical practice. It is widely accepted that it can years or even decades for research to filter down to the front lines of medicine, so hopefully the NHMRC can help to combat this.
Next was Prof. Gordon Rubenfeld from Sunnybrook in Toronto on the global burden of critical illness. Prof. Rubenfeld highlighted some of the issues associated with carrying out epidemiological studies in critically ill patients. By way of example he commented on a ten fold difference in incidence of ARDS that has been noted between different medical systems. Of course this does not mean that the actual number of cases of ARDS is different, but that in order to be diagnosed with ARDS, you have to be in an ICU. In the developing world this can be a bit of a rarity. He then went on to discuss the provision of critical care in the developing world, and stated that we need to develop “simple, robust, inexpensive technology” citing the example of the BIll and Melinda Gates foundation as a charitable trust that strives to improve the plight of those in the developing world and suggesting that in addition to clean water they should be providing cheap ventilators.
He gave an interesting analogy to ventilation in ARDS, stating that we should be recruiting care in the developing world while avoiding overdistention of care in the developed world. We were grounded, however, with the fact that while apparently unnecesary care in the ICU costs ~$40,000,000 dollars per year, unnecessary imaging costs $33 billion!
Next was Prof. Christina Jones from Liverpool in the UK. Prof. Jones is a nurse consultant who has done a PhD in post-ICU rehabiliation. She spoke on the various physical and psychological scars that can remain in ICU survivors. In addition to physical rehabilitation programmes, she spoke about ICU diaries as a method of decreasing the incidence of PTSD in survivors.
Next Prof. Randal Curtis from Harborview in Seattle spoke about advanced care planning in ICU. Prof. Curtis is an intensivist with an interested in palliative and end of life care. He spoke on the well known phenomenon of elderly, co-morbid patients spending their last days in ICU receiving aggressive treatment with curative intent rather than receiving aggressive palliative care. He spoke on research carried out by his group and others on end of life communication with critically ill patients and their families. Some of the sobering statistics that he gave included the 1 in 5 deaths in the USA occur in ICU, but that if clinicians get involves in early discussions with family and patients, ICU admissions are decreased and family satisfaction with dying process increases (a so-called “good death”).
He went on to discuss techniques for conducting ICU family meetings, citing research carried out by his group showing that families only talk 29% of the time in meetings, and that family satisfaction was increased if they said more in the meeting. He spoke on the balance between paternalism and autonomy in decision making process and factors such as prognostic and diagnostic certainty that may affect this balance.
The final talk of day 1 was from Prof. Geoff Chase, an engineer from Canterbury University in NZ. He works with ICUs to provide engineering solutions to clinical problems, with research interests including closed loop systems for glucose management and breath to breath analysis of lung compliance in ventilated patients. Interesting stuff and perhaps a glimpse into the future?
Stay tuned for day 2.