The State of the Art 2009 Meeting
Monday 14 to Tuesday 15 December 2009
Hilton London Metropole, Edgware Road
This event is now closed, many thanks to all delegates who attended.
If you have any enquiries regarding the meeting please call the ICS offices on 0207 280 4350 or events@ics.ac.uk
Meeting Summary
Once again the Society’s premier, multi-disciplinary meeting was another huge success with delegates and Industry members flocking to Edgware Road. Over the course of two days international experts and key note speakers delivered a first class scientific programme with state of the art topics and research forums. There was also a large exhibition from Industry showcasing all the latest developments, a networking breakfast sponsored by Fresenius Kabi and a drinks reception with wine tasting from Fine Wine Seller.
A members media training forum took place on Monday led by a highly experienced journalist and trainer providing tips and training to ensure media success.
Programme
View the SOA09 delegate handbook with programme, speaker abstracts and poster presentations.
Awards
Honorary Member - Dr Roger Eltringham
Whitaker Award - Dr John Morris
Gold Medal Award - Dr Thelma Craig
Research oral free paper presentations - Dr Andrew Conway Morris
Lilly Award - Research Posters - Dr Virginia Newcombe
B Braun MSc Award - Dr Michael Irvine
- George Mark Haslam
- Iain Robert Macleod
- Ravindra Kumar
- Elizabeth Mary Keating
- Stephen Edward Wright
- John Davidson
- Henrik Peer Rescheiter
- Catherine Louise Snelson
- Aoibhin Bernadette Hutchinson
Gillian Hanson Lecture 2009 - Prof Simon Finfer
Foundation Raffle
The winner of the luxury Fortnum and Mason Hamper kindly sponsored by Maquet was Dr Neil Soni.
Delegate Prize Draw
We are pleased to announce that the winner of the delegate prize draw is Dr Shahid Iqbal from Essex.
Note of thanks
The Society would like to thank the following for their support
Chair Summarys
Opening session
We started the program with Simon Finfer who gave use the background to the recent trend to use tight glycaemic control in critically ill patients and then followed by presenting the results of the NICE SUGAR study recently published in the New England Journal whilst warning us about believing unbelievably good results. Using 90 day all cause mortality in a trial of over 6000 patients, more severe hypoglycaemia was more common in the tightly controlled patients as was death! Djillali Annane then gave us the results of Corticosteroids treatment and Intensive Insulin Therapy for Septic Shock (COIITSS) study concluding that “The current data do not suggest, in corticosteroid treated septic shock, a superiority of a strategy of intensive insulin therapy to maintain blood glucose levels in the range of 4.4 to 6mmol/L versus SSC recommendations”. Michael Matthay followed with a state of play for ARDS and Monty Mythen gave us the state of the foundation.
Chair: Dr Bob Winter
Gold Medal Research Session
The Gold Medal Research Session heard 3 excellent presentations from young critical care researchers. Dr Craig presented data on the role of extravascular lung water as a predictor of mortality in ARDS and then went on to outline the results of the HARP-1 study. The author reported for the first time that simvastatin 80mg once daily is safe and is associated with improvement in pulmonary and non-pulmonary organ dysfunction in ALI alongside reductions in inflammatory mediators indicates a potential mechanism for these effects. Martin Duffy described his work examining the role of the endothelial function index a(EVI) s a predictor of mortality in ARDS. He demonstrated that EFI was superior to other validated severity of illness scores including APACHE II and SAPS II. It enables in vivo bedside assessment of systemic endothelial function which may help target new endothelial therapies in critical illness. He went on to report the findings of the AAAAA study which suggested that high-dose ascorbic acid may be beneficial to the endothelium during ischaemia-reperfusion injury. Finally, Dr Newcombe concluded this excellent session with her state of the art investigation in to the pathophysiology of traumatic brain imaging using MRI with diffusion tensor imaging. She presenting novel data on temporal changes in DTI following TBI linked to functional outcomes. These techniques are likely to prove important in increasing our understanding of the pathophysiology of traumatic brain injury (TBI) that remains unexplained by other approaches. The judges agreed that all 3 presentations were of the highest quality. Congratulations go to Dr Craig from Dr McAuley’s group in Belfast who won the competition and was awarded the 2010 ICS Gold Medal for Research.
Chair: Prof Mark Bellamy and Dr Gavin Perkins
Summary Veterinary Intensive Care Session
The veterinary intensive care session early on the 2nd day proved extremely popular; delegates were keen to see what goes on in the animal world and their curiosity was rewarded by a vibrant session. Intensive care is a relatively new discipline in veterinary medicine. It has really come in to its own in the last 10 years. Due to the increasing demands of clients, exposed to a wealth of media, there is a greater expectation of the modalities available for domestic animals. This is exemplified by the increasing availability of small animal ICUs that now exist as well as an increasing range of large animal facilities worldwide
The 1st speaker was Sophie Adamantos graduated from the University of Liverpool in 1999 and completed rotating internships in anaesthesia at the University of Bristol and small animal medicine and surgery at the Animal Health Trust shortly after qualification. She joined the Royal Veterinary College to complete a residency in small animal Emergency and Critical Care in 2002. She outlined the range of illnesses that would be dealt with in the ICU in the Royal Veterinary Hospital critical care unit and used the term new to the audience ‘euthanase’ when a decision is made to discontinue treatment.
The next speaker Jonathan Cracknell had the reputation of entertaining the delegates and this he certainly did.
He graduated in 2000 from the University of Glasgow. He worked at the RSPCA’s Stapeley Grange Wildlife Hospital, for Animal Asia Foundation’s Chengdu Moon Bear Rescue Centre in China, as locum for Port Lympne and Howletts Zoo before being taken on at the Zoological Society of London and is currently employed as Zoological Director at Marwell Wildlife.
The expectation that Intensive care should be provided has spilled into the field of zoological medicine where there are increasing pressures on the zoo clinician to provide state of the art care on charitable budgets. This creates a challenge that is compounded by huge variations in general anatomy and physiological differences across the species and by multiple issues regarding stressors that result from close proximity of wild animals to humans.
Despite these challenges intensive care is becoming a practical reality within zoological collections. This presentation highlighted the challenges that face the zoological veterinary clinician, the methods commonly employed in attempting wildlife ICU, and examples of where it works and where it can go horribly wrong.
He said that we human intensivists and anaesthetists will never know what a really difficult intubation was until we had intubated an ant-eater!
The last speaker was Professor Katharine Stark who graduated as a veterinarian from Zurich Veterinary School and obtained post-graduate qualifications from the Federal Institute of Technology (Switzerland) and Massey University (New Zealand). Over the last two decades, she has conducted applied research on infectious zoonoses as well as methodological issues related to risk analysis, surveillance and animal health decision making. She has worked in diverse environments including government, private industry and academia in numerous countries. She posed a question:-
Animals should carry a health warning – true or false?
Nobody would accept a risk if there was not a benefit. Keeping animals as a protein source has nutritional benefits. The benefits of keeping pets are perhaps not as obvious. However, research has shown that pets are important social companions, particularly in elderly people. Keeping pets can have other health benefits such as increased exercise. Finally, in children, contact with animals might play a protective role in relation to infectious diseases and allergies.
In conclusion, while it is true that animals can carry zoonotic pathogens and transmit them to their owners and to consumers of meat and dairy products, effective prevention of the most common infections is relatively easy to achieve if basic hygiene rules are observed.
The session came to an interesting end with a discussion after the Chair asked whether blind patients in intensive care should be allowed to have their dogs visit them.
Chair: Dr Carl Waldmann
Clinical Practice Free Papers
The Clinical Practice Free Papers session attracted a large audience. They were rewarded with six very interesting and well delivered presentations on a wide variety of relevant clinical topics.
Dr Catherine Snelson from Birmingham described the presentation and management of critically ill patients with H1N1 influenza including experiences from the unit in which she works. Dr Matthew Wayman (Newcastle) reviewed the results of an audit of procalcitonin use in Sunderland Royal Hospital Intensive Care Unit focusing on its use as a tool for identifying those who may benefit from alteration to antibiotic therapy. Dr Sara-Catrin Cook (Bristol) talked about a survey of trainees examining airway complications in the Intensive Care Unit. Dr Rebecca Grey (Brighton) talked on the Intensive Care management of patients post cardiac arrest at the Royal Sussex County Hospital and Dr Benjamin Brown (Chester) described an audit and education programme to improve prescribing practice in intensive care.
All the talks stimulated questions from the audience. The winner of the Clinical Practice Free Papers went to Miss Charmaine Buss on her audit of current practice relating to the use of midazolam and brain stem testing.
Chair: Dr. Malcolm Sim
The Nurse And AHP Session
The highlight of this session was ‘the session’.
Recognising the input from non medical colleagues in critical care is testimony to the work the ICS has achieved in collaborating at a mulitprofessional level. Catherine Plowright presented on behalf of three UK professional critical care nursing associations the latest evidence surrounding safe and effective nurse staffing of critical care areas. ‘Standards for Nurse Staffing in Critical Care’ is a culmination of work from three important bodies, the RCN, BACCN and CCN nurse leads. The physiological impact of exercise in the critically ill was explored by Mandie Thomas a specialist physiotherapist who has an interest in rehabilitation which was an interesting and useful review of the underlying aims of early rehabilitation.
Chair: Sara Bolton
Blood
The TRICC trial defined and actually changed blood transfusion practice, so why the need for this session ? Ravi Gill set the scene authoritatively, with a balanced yet cautionary view of the current position of both evidence and practice. As a microcosm of transfusion lore, that ‘old blood is bad’ is well established so it was stimulating to hear Leo van der Watering give a master class on identifying the statistical errors or tricks pervading literature in this field. It cannot have escaped the audience that this approach could be fruitfully deployed across the macrocosm of blood literature. Who better than Tim Walsh to finish a great session by looking at blood, its use and unanswered questions hinting heavily that this is an area in need of more work. Transfusion practice in critical care is far from done and dusted.
Chair: Dr Neil Soni
MISCELLANEOUS
Gilbert Park started off by trying to cast doubt on the utility of intensive care training or indeed intensivists in his usual fashion. This was followed by Kathy Rowan who gave us a series of breakdowns of the variability in organ support utilisation from the initial returns on the critical care minimum dataset based on unit type, survival and lengths of stay with more analysis possible…
Simon Finfer then gave us his spin on why the Antipodes had stolen the march on the UK in the development of the speciality. But there is hope for the future
Chair: Dr Gilbert Park
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Speakers
Key Note Speaker - Prof Simon Finfer from Sydney, Australia
Miss Sophie Adamantos, London
Prof Djillali Annane, Paris
Dr Dominic Bell, Leeds
Ms Catherine Plowright, Gillingham
Dr Tim Bowling, Nottingham
Dr Don Chalfin, Chicago
Mr Jonathan Cracknell, Winchester
Dr Wes Ely, Nashville
Prof Ruth Endacott, Plymouth
Dr Helen Galley, Aberdeen
Dr Ravi Gill, Southampton
Dr Mike Grocott, London
Prof Cheng Hok-Toh, Liverpool
Dr Patrick Honore, Brussels
Dr Anand Kumar, Winnipeg
Prof Marcel Levi, Amsterdam
Dr Alex Manara, Bristol
Prof Michael Matthay, San Francisco
Dr Danny McAuley, Belfast
Prof Monty Mythen, London
Dr Laurent Papazian, Marseille
Dr Gilbert Park, Cambridge
Dr Rupert Pearse, London
Dr Gavin Perkins, Warwick
Prof Kathy Rowan, London
Dr Neil Soni, London
Prof Katarina Stärk, North Mymms
Dr Mike Stroud, Southampton
Ms Amanda Thomas, London
Prof Leo van de Watering, Leiden
Prof Tim Walsh, Edinburgh
Dr James Wigfull, Sheffield
Dr Tom Woodcock, Southampton
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