Critical Care Medicine Continulus

As technology and medicine progress so do our options for care. But how does doing ‘what we can’ impact the ‘doing what is right’? How often do pressures related to the job cause us to act in ways that are inconsistent with our ethical values? How does that impact us and what can we do to minimise its effect?

In this talk, Andrew will review the latest evidence on brain monitoring in TBI. Does aggressive brain monitoring impact outcomes, and how? Do aggressive therapies to lower raised ICP impact outcomes, and by how much? And what is the future of brain monitoring?

Organ transplantation using organs donated after death is now the preferred treatment for many end-stage organ failures and is life-changing and life saving for recipients. Outcomes from transplantation are excellent, for example a third of liver transplant recipients are alive 30 years following transplant. Unfortunately, the demand for donor organs outstrips supply. This talk reviews current practice and recommendations.

Coming soon

Acute Kidney Injury (AKI) affects nearly 40% of intensive care unit (ICU) patients and carries significant morbidity and mortality. Once AKI is established, renal replacement therapy (RRT) is the mainstay of supportive care. The best time to initiate RRT is still unclear. Although several studies have evaluated early vs. late RRT in AKI, there is no clear consensus on how “early” or “late” should be defined. Existing evidence does not support the initiation of RRT based on any particular stage of AKI. Risk-benefit of RRT along with the host's ability to tolerate homeostatic derangements should be taken into account prior to initiating RRT. Continuous RRT (CRRT) has not been shown to be superior to intermittent hemodialysis (IHD). A CRRT dose of at least 20ml/kg/hour or an IHD dose of Kt/V 1.2 thrice a week seems to be adequate for patients with AKI in the ICU. Improvement of urine output and trend in azotemia can serve as a guide in weaning and termination of RRT. Diuretics have not been shown to decrease the need or frequency of RRT.  

Diarrhoea is a prominent cause of morbidity and mortality in children under 5 years in lower to middle-income countries (LMICs). Current recommendations for intravenous rehydration are based on limited evidence. This talk covers the epidemiology and management of gastroenteritis and examines the latest studies and their implications for practice.