EuroAnaesthesia 2020

Euroanaesthesia is going virtual!

Due to unavoidable complications arising from the COVID-19 pandemic, the ESA has recently made the decision to hold Euroanaesthesia as a virtual meeting.

Instead of us meeting at a physical location this year for our annual congress, which had been previously planned for Barcelona, we will now hold the congress completely virtually and online. No travel, fewer obstacles, and more opportunities.

National outcomes and characteristics of patients admitted to Swedish intensive care units for COVID-19, March – May 2020

Denna studie redovisar 30-dagars mortalitet och riskfaktorer för dödlighet hos intensivvårdskrävande COVID-19- patienter under de första två månaderna av pandemin i Sverige. Det är den enda publicerade studien hittills som redovisar nationell data för intensivvårdsbehandlade patienter med COVID-19 och med uppföljning efter utskrivning från IVA. Studien omfattar 1563 patienter med en 30-dagars mortalitet på 26,7 %, där de flesta avlider på intensivvårdsavdelning. Mortaliteten i Sverige var mycket lägre än i tidigare publicerade studier från andra länder, förutom Kanada. Mortaliteten verkar drivna av faktorer såsom ålder, SAPS-III score och graden av respiratorisk svikt. Tidigare kronisk lungsjukdom, men inte andra komorbiditeter, var viktig prediktiv faktor, liksom förekomsten av akut njursvikt.

I tidigare studier har uppföljningen varit kortare och många patienter varit kvar i intensivvård vilket har givit falskt låga mortalitetssiffror, dessa siffror börjar nu revideras upp. Våra resultat är ett kvitto för bra svensk intensivvård under en mycket ansträngd period. Vi har mycket snabbt kunna hantera ett stort inflöde av patienter, nästan 1900 patienter på två månader. SIR gör ett fantastiskt bra jobb, det var 100 % uppföljning på alla patienter. Vi behöver dock bli bättre på att rapportera komplikationer såsom myokardskada och AKI.

Artikeln är publicerad som en pre-print och är just nu under peer-review. https://www.medrxiv.org/content/10.1101/2020.08.06.20169599v1

The European Society Of Intensive Care Medicine COVID-19 Project (UNITE-COVID)

UNITE-COVID is an observational, multicenter, international point prevalence study that will provide answers to the following questions from a global perspective:

  • What is the burden of COVID-19 in ICUs around the world?
  • How are patients with COVID-19 now managed around the world?
  • What are the outcomes of ICU patients with COVID-19?
  • What is the incidence of specific patterns such as respiratory phenotypes, AKI, infectious complications, thromboembolic events (venous and arterial), neurological complications and cardiac complications

Why?
COVID-19 is arguably the biggest challenge critical care medicine has been confronted with since its conception. Critical care services around the world are flooded by patients presenting with severe respiratory failure who require prolonged treatment in the ICU. Despite the support provided, outcomes are poor, particularly in ventilated patients.

Many unanswered questions remain regarding the pathophysiology of COVID-19, particularly in severely ill patients. No evidence-based treatment is currently available, yet different often experimental therapies are administered to patients.

As experience grows, new phenotypes are recognized, and unreported complications are observed in the most severely ill patients. Although many registries are currently including patients, few of them focus on ICU patients and their specific treatments and newly observed complications and challenges.

Although the pandemic may appear on its return in many countries that are now easing the restrictions that were put in place to limit the spread of the disease, it can be expected that COVID-19 will be a continued challenge in ICUs globally until a safe and effective vaccine is found. Efforts to study the disease should continue in order to advance our understanding of the disease as well as improve treatment options.

Design
This is a multicenter, international, anonymized point prevalence study.

Patients who were present in the ICU on the day between February 15th and June 15th 2020 with the highest number of COVID-19 patients in the unit. Data can be entered in the database until  August 2020. Retrospective data collection and entry is allowed.

Subjects believed to fulfill all eligibility criteria, and none of the exclusion criteria, detailed in the relevant section of this protocol, will be included in the study.

Data will be entered in the database anonymously.

Data will consist of two core elements: Center data (to be completed once) and Patient data

For different domains with specific, highly relevant and un(der)explored ICU research questions, a focused data set is to be completed. These domains include:

Respiratory (group lead: Giacomo Grasselli)
Coagulation and thrombo-embolic events (group lead: Andrea Liviano)
Infectious complications (group lead Andy Conway Morris)
Rehabilitation (group lead Stefan Schaller)
Renal  (group lead Marlies Ostermann)

We will collect data in all countries, academic and non-academic ICUs, and on heterogeneous populations of critically ill patients.

Patient Population: Critically ill patients diagnosed with COVID-19 present in the ICU or any other area in the hospital under the care of  the critical care team on the day between February 15 and June 15th, 2020 with the highest number of COVID-19 patients in the unit.

When?
Select the day between February 15th and June 15th, 2020 with the highest number of criticaly-ill Covid-19 patients in the unit or in any other area in the hospital under the care of  the critical care team

Study duration: 1 day (with 60 day follow up)

What data is required?
Inclusion criteria: For inclusion in the study, subjects must fulfill all of the following criteria:

Age 18 or older

Patient is present in an ICU or any other area in the hospital under the care of the critical care team on the day between February 15th and June 15th 2020 with the highest number of COVID-19 patients in the unit. The exact date can be decided by the local investigator.

COVID-19 confirmed diagnosis through PCR or equivalent diagnostic technique.

Exclusion criteria: Any of the following is regarded as a criterion for exclusion from the study:

SARS-CoV2 positive without COVID-19.

Data Collection:

For each participating center we will collect center data as detailed in CenterData CRF.

Data will be recorded regarding current nurse/patient ratio, MD/patient ratio,number of beds, 24h intensivist staffing, and hospital type, as well as resources available and capacity.

This will be completed only once per center. Data entry will be facilitated by an electronic Case Report Form (eCRF). No patient identifying information will be collected.

Do I need IRB approval?
Where required by local legislation or regulation, the study protocol will be submitted to the local ethics committee for approval.  Whereas UNITE-COVID-19 is a retrospective no-risk study, a waived informed consent model can be used. Please find the Principal Investigator’s Ethical Approval (Belgium) here

How is the data that is collected managed?
Access to the database is protected via a TLS encrypted connection and a login/password combination. The data will be stored securely and all procedures regarding data management will comply with General Data Protection Regulation (GDPR) 2016/679/EU. The eCRF platform is licensed from ClinFile and administered by ESICM.

The eCRF platform is GDPR compliant.

Who owns and can access the collected data?
Each site investigator is responsible for their own data, and may request an export of their locally collected data after the UNITE-COVID-19 database is locked. The request should be addressed to the Principal Investigator.
After the primary UNITE-COVID-19 manuscript is published, investigators may publish their local data.

Authorship and publication rules: Steering Committee members will be part of the writing committee and listed as authors of the final manuscript. The primary analysis of the study will be submitted preferentially to a journal that allows all local investigators to be added as authors or collaborator if the latter is not possible, albeit that a minimum of 10 patients should have been included in the study.

Is there any financial compensation?
There is no financial compensation for participation. Participation in the trial is completely voluntary.

How do I participate?
Registration is open and you can cast your expression of interest here.
UNITE-COVID-19 Steering Committee Members
list available soon

Any further Questions?
Please read Frequently Asked Questions (FAQs) document.

You can contact the ESICM office: research@esicm.org or guy.francois@esicm.org

SPOVs rekommendationer för postoperativ vård

SPOV har skrivit rekommendationer för postoperativ vård, som nu har publicerats i riktlinjeträdet. ”Rekommendationer för postoperativ vård” skapar en nationellt gemensam referensram att använda i utvecklingen av den lokala postoperativa vården. Den beskriver viktiga förutsättningar, organisation, teknisk infrastruktur, arbetssätt och kompetens för en ändamålsenlig och säker postoperativ vård. Rekommendationerna är de första specifikt för postoperativ vård i Sverige.
SFAIs styrelse tackar för rekommendationerna, som kommer att ge god vägledning för den postoperativa vården.

SSICM Annual Meeting : SARS CoV-2 in Swiss Intensive Care Units – Different burden but same outcome?

Herewith we cordially invite you to this year’s annual congress of our Swiss Society for Intensive Care Medicine SSICM with the title «SARS-CoV 2 in Swiss Intensive Care Units – different burden but same outcome?», which will take place for the first time in a virtual format and in English language.

In light of recent events, the thematic focus of the largest SSICM conference of the year is dedicated to Covid-19. Over two days, in six different sessions, selected national and international experts will give presentations on their experience and on current state of knowledge on the pandemic in intensive medicine and intensive care.

On Thursday, 17 September 2020, for the first time in this series of sessions, you will receive insights into the pandemic scenario in Lombardy, Ticino and a Swiss university hospital from the perspective of doctors and nursing staff. On Friday, 18 September 2020, over four one-hour sessions eleven experts will present highly informative topics linked to Covid-19.

The inter-professional conference is addressed to doctors, nurses, therapists, emergency services and all professionals interested in the topic of Covid-19. Please register in advance for participation, which is offered free of charge.

More detailed information about the virtual program will follow soon under the menu item “scientific program”.

We are looking forward to the outstanding program and to your virtual participation!

Martin Siegemund                             Thierry Fumeaux                Franziska von Arx
Congress President SSICM               President SSICM                President Care SSICM

WFSA Annual Report 2019/20

Dear friends,
I am delighted to share with you the
World Federation of Societies of Anaesthesiologists Annual Report for 2019/20.

Last year, WFSA made significant advances in strengthening global anaesthesia care. Several thousand clinicians participated in our anaesthesiologist-led in-country training programmes or downloaded and utilised our ever-popular online continued medical education resources. WFSA have also been very active in advocating internationally to promote anaesthesiology as an essential element of global health.

Anaesthesia and intensive care specialists are playing essential roles on the front-line of the global response to the COVID-19 pandemic. To support these colleagues, WFSA is working with its members to provide practical up-to-date clinical information and resources to manage and care for COVID-19 patients.

WFSA are at the forefront of efforts to develop new innovative approaches that will ensure that anaesthesia and perioperative care teams the world over continue to receive the quality continued medical education they need. This will help to close the gap for those 5 out of 7 billion people in this world who do not have access to safe anaesthesia and surgery.

I hope you will enjoy reading the Annual Report and I look forward to working and engaging with you again in person.

Yours sincerely,
Dr Jannicke Mellin-Olsen

Yttrande från SFAI resursgrupp covid-19 avseende publicerat preprint av RECOVERY-studien

Av de uppgifter som framkommer ur det publicerade preprint av manuskriptet bakom RECOVERY studien och som tillsvidare inte genomgått peer review-process följt av publicering, konstaterar vi att det saknas skäl att avråda från behandling med dexamethasone 6 mg per dygn till intensivvårdskrävande covid-19 patienter.

Av samma skäl och intill dess att studien bedömts och eventuellt kompletterats med ytterligare information, kan vi i nuläget inte utfärda en generell rekommendation om att påbörja behandling med dexamethasone eller annan steroid till intensivvårdskrävande covid-19 patienter. Skälet bakom detta är att studien redovisar betydelsefulla skillnader mellan subgrupper, signifikanta cross-over effekter mellan grupperna och det saknas uppgifter om övriga behandling som givits inom begreppet standard-of-care (ex vis antikoagulantia). Relevansen för aktuella svenska förhållande är oklar mot bakgrund av den redovisade mortaliteten.

Så snart RECOVERY studien publicerats kommer en ny bedömning göras och ställningstagande till revision av behandlingsriktlinjen för steroider i samband med intensivvårdskrävande covid-19 ”

 

 

 

LogEze – digital loggbok för narkosläkare under utbildning

Det sedan länge använda excelarket skapades av Henrik Jörnvall när han var ST-läkare på 00-talet. Nu är detta ersatt av LogEze, en elektronisk online-loggning där man kontinuerligt registrerar sina anestesiologiska aktiviteter, placeringar och andra utbildningshändelser. När du loggar i LogEze får du i realtid se din statistik för det du loggar (till exempel din lyckandefrekvens), men även samma statistik för den övriga världen (definierat som samtliga andra loggare).  Du kan enkelt exportera sammanfattningar och sammanräkningar inför utvecklingssamtal, handledarsamtal, samt ansökan om specialistbevis. Tjänsten är gratis för dig som användare – all information ägs till 100% av dig och helt enligt GDPR.

Förutom den självklara fördelen att du håller reda på det du gjort, så utgör statistiken en enorm pedagogisk informationskälla. Hur många CVKer får ST på Sahlgrenska lägga jämfört med Karolinska? Eller på Akademiska? Hur många spinaler måste jag lägga innan jag har 90% successrate? Kanske måste jag öva mer på artärer? Eller är jag kanske lika bra/dålig som alla andra? Hur många svåra luftvägar har jag haft egentligen? Och blir antalet ”svåra” luftvägar färre ju senare på STn jag är? På nedanstående graf från LogEze ser vi evidensbaserat att vi bör använda ultraljud när vi lägger CVKer!

Skapa ett konto och kom igång på direkten genom att gå till LogEze!

För dig som vill fortsätta logga manuellt och i excel, så finns ett excelark bifogat nedan. Om du i framtiden vill övergå till LogEze, kan du importera dina data från detta excelark. Kom dock ihåg att du inte får ändra några kolumner eller layout i övrigt för att det ska fungera.

Saknar du något som du vill logga så gör någon annan det säkert också – uppdateringar på LogEze är vanliga, hittills 1951 stycken och flera i veckan utan att du märker något!

Tveka inte att höra av er vid frågor/funderingar/synpunkter!

 

intubateCOVID : Avslutad och publicerad

On behalf of the entire study team, would like to extend our sincerest gratitude to your organisation for your endorsement or support of the intubateCOVID study that has been published today in Anaesthesia Journal: “Risks to healthcare workers following tracheal intubation of patients with COVID‐19: a prospective international multicentre cohort study”.

Researchers at your institution played a crucial role in the conduct of this important international study of healthcare workers involved in tracheal intubation. The key results were that around 1 in 10 clinicians involved in tracheal intubation of patients with COVID-19 later reports either symptoms or laboratory-confirmation of COVID-19 themselves. The Advanced Access manuscript can be accessed here and the final manuscript will be available in the coming days.

We thank you and your clinicians for your endorsement of this landmark study, the largest of its kind globally.

Best wishes,

Kariem El-Boghdadly (Chief Investigator, intubateCOVID)