EA20 Newsletter: Session 09L1: Hot topics in intensive care medicine - Last 12 months' top publications

Saturday 28 November, 1500-1545H, Channel 2

In this session, Professor Christian Putensen, University Hospital Bonn, Germany, will review some important papers across various areas of intensive care medicine, including COVID-19, ARDS,  sepsis, vasopressor therapy, acute kidney injury, nutrition and vitamins, and sedation and delirium. Some of his selections are outlined below – to hear about these and the many other interesting research highlights of 2020, please join him for his session this afternoon.

COVID-19

Prof Putensen will cover several papers relating to remdesivir, including:

JAMA: Effect of Remdesivir vs Standard Care on Clinical Status at 11 Days in Patients With Moderate COVID-19 – A Randomized Clinical Trial

https://jamanetwork.com/journals/jama/fullarticle/2769871

Patients were given a 5-day regimen of remdesivir or a 10-day regimen, versus standard care. The loading dose was 200mg intravenously followed by 5 days or 10 days of 100mg doses intravenously each day. The data showed improved outcomes in the 5-day treatment group versus standard of care, but no improvement in the 10-day treatment group.

The Lancet: Remdesivir in adults with severe COVID-19: a randomised, double-blind, placebo-controlled, multicentre trial

https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)31022-9/fulltext

This study assessed 237 patients, randomised 2:1 to remdesivir or placebo. The loading dose was 200mg intravenously, followed by 100mg intravenously from days 2-10. The primary endpoint was time to clinical improvement up to day 28, and the results showed no difference between the groups in time to clinical improvement or drop in viral load.

NEJM: Remdesivir for treatment of COVID-19 – final report

https://www.nejm.org/doi/pdf/10.1056/NEJMoa2007764

This double blinded multicentre RCT assessed 1062 hospitalised COVID-19 patients, 15% with mild-to-moderate disease and 85% with severe disease.  Patients were randomised 1:1 to placebo or remdesivir 200mg intravenous loading dose, followed by 100mg intravenously on days 2-10. The primary outcome was time to recovery up to day 28. The median time to recovery was 10 days with remdesivir and 15 days with placebo, but only in patients receiving supplementary oxygen – not those on mechanical ventilation.

Other studies on COVID treatment with hydrocortisone and dexamethasone will also be covered in this presentation.

SEPSIS

The Lancet Respiratory Medicine: Effect of aspirin on deaths associated with sepsis in healthy older people (ANTISEPSIS): a randomised, double-blind, placebo-controlled primary prevention trial

https://www.thelancet.com/journals/lanres/article/PIIS2213-2600(20)30411-2/fulltext

This is a multi-centre double-blinded RCT, and a sub-study of ASPREE (Aspirin in reducing events in the elderly trial). This assessed 16,703 participants 70 years or over, randomised to oral aspirin 100mg a day or placebo. Sepsis was defined by infection plus 2 out of 4 systemic inflammatory response syndrome (SIRS) criteria. The study found no effect of aspirin, and concluded daily low-dose aspirin treatment did not reduce deaths associated with sepsis in older adults.

ACUTE KIDNEY INJURY

NEJM: Timing of renal replacement therapy in acute kidney injury

https://www.nejm.org/doi/pdf/10.1056/NEJMoa2000741

This multinational multicentre RCT assessed 2900 patients. In the accelerated strategy group, RRT began within 12 hours, versus the standard group strategy that used existing protocols and parameters to determine when to begin RRT. There was no difference in mortality between the groups, but at 90 days 10% of patients in the accelerated group remained dependent on dialysis compared to 6% in the standard therapy group. Thus, early RRT appears to increase the risk of long-term dependence on dialysis.

NUTRITION AND VITAMINS

NEJM: Early high-dose vitamin D3 for critically ill, vitamin D-deficient patients

https://www.nejm.org/doi/full/10.1056/NEJMoa1911124

This double blinded multicentre RCT studied 1078 critically ill patients with vitamin D levels at a critically low level, less than 20ng/mL.  Patients were randomised 12 hours after admission to a single enteral dose of 540,000 IU Vitamin D or placebo, with the primary endpoint 90-day all-cause mortality. The results showed no effect of vitamin D supplementation on mortality or other non-fatal outcomes, in contrast to a study some years ago in JAMA showing patients with a vitamin D deficiency had higher rates of ICU-mortality.

Please join Prof Putensen’s session to hear more about these and the other studies he has selected as the highlights for intensive care medicine in 2020.

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