CT23 WHAT’S NEW IN ICU

Intensive care medicine is at the intersection of medical, surgical and engineering sciences. While the lion’s share of attention in medical research focuses on magic bullets, these have largely failed to deliver in intensive care. Specifically, significant improvements have come from improving what might be regarded as the ‘bread and butter’ of clinical practice. Improvements the management of sedation, ventilation, glycaemic control, sepsis, shock and renal support have resulted in significant improvements in patient outcomes. Simple measures such as switching off sedation on morning rounds can reduce duration of mechanical ventilation and length of intensive care stay by 32 to 35% 1 . Reduction of tidal volumes in acute respiratory distress syndrome (ARDS) from 12 to 6 ml per kilogram has reduced mortality from 39.8% to 31% in a landmark study of 861 patients 2 . This is consistent with findings from smaller clinical trials and animal data linking shear forces in the lung, produced by mechanical ventilation, with biological injury. A recent study of 1548 mainly cardiothoracic surgical patients found that intensive insulin therapy reduced intensive care mortality from 8.0% with conventional treatment to 4.6%, with the greatest reduction in death due to multiple‐organ failure with a proven septic focus 3 . Bloodstream infections, acute renal failure, red‐cell transfusions, and critical‐illness polyneuropathy were also all reduced by over 40%. Early goal directed therapy reduced in‐hospital mortality from 46.5% to 30.5% in a cohort of 263 patients admitted to an emergency department in patients with severe sepsis or septic shock 4 . Significant benefits resulted from early resuscitation of shocked patients using predefined protocols. Summary  Targeted protocolised therapies across a wide range of intensive care conditions have resulted in the greatest outcome benefits for critically ill patients.