ian seppelt: icu in review

“Less is More”Advances in Intensive Care in

2012Dr Ian Seppelt

Dept of Intensive Care Medicine, Nepean Hospital,

and George Institute for Global Health,

A personal view of 2012

1. New intensive care literature and publications

2. New approaches to research methodology

3. New advances in (lack of) research ethics

A personal view of 2012

1. New intensive care literature and publications

2. New approaches to research methodology

3. New advances in (lack of) research ethics

Less is more – Don’t just do something, stand there!

A personal view of 2012

1. New intensive care literature and publications

2. New approaches to research methodology

3. New advances in (lack of) research ethics

Less is more – Don’t just do something, stand there!

Law 13: The delivery of good medical care is to do as much Nothing as possible

– The Fat Man

Perner: New Engl J Med 2012

Perner: New Engl J Med 2012

Perner: New Engl J Med 2012

Perner: New Engl J Med 2012

Updated systematic review: mortality

Gattas: Under review

Updated systematic review: RRT

Gattas: Under review

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Research Fraud - Joachim Boldt

German Medical Board Issues Sweeping Findings in Boldt CaseNinety studies implicated in probe, might require retractionby Adam Marcus

Unglaublich is the German word for unbelievable, and it's an apt description for the latest development in the case of Joachim Boldt,  MD, PhD. Dr. Boldt, a prominent German anesthesiologist, has been at the center of a research and publishing scandal since last October, when the journal Anesthesia & Analgesia retracted a 2009 article of his over concerns of data manipulation.

2012 – A new record

2012 – A new record

2012 – A new record

2012 – A new recordThe top 4 clinical

research frauds are all anaesthetists, intensivists

or perioperative physicians

2012 – A new recordThe top 4 clinical

research frauds are all anaesthetists, intensivists

or perioperative physicians

2012 – A new recordThe top 4 clinical

research frauds are all anaesthetists, intensivists

or perioperative physicians

1. YoshitakaFuji

Research Integrity

Research Integrity

Research Integrity

1. CHEST – Prespecified and

published protocol and statistical analysis plan

– Should now be standard

Research Integrity

1. CHEST – Prespecified and

published protocol and statistical analysis plan

– Should now be standard

2. 6S– Writing committee

blinded until after results section and

Research Integrity

1. CHEST – Prespecified and

published protocol and statistical analysis plan

– Should now be standard

2. 6S– Writing committee

blinded until after results section and

Research Integrity

1. CHEST – Prespecified and

published protocol and statistical analysis plan

– Should now be standard

2. 6S– Writing committee

blinded until after results section and

Where next? Choice of fluid?

Where next? Choice of fluid?

NHMRC funding announced Oct 18th, 2012 $2,384,173.35

Where next? Fluid restriction?

ARDS

ARDS

Results

Results

Nutrition in ICU

Nutrition in ICU1.Core business of critical medicine

Nutrition in ICU1.Core business of critical medicine2.We consistently deliver 2/3 of (prescribed)

target nutrition in first few days, up to 80-90% by a week– Are we just no good at it?– Or does it matter?

Nutrition in ICU1.Core business of critical medicine2.We consistently deliver 2/3 of (prescribed)

target nutrition in first few days, up to 80-90% by a week– Are we just no good at it?– Or does it matter?

3.Targets of nutrition have never been validated in the critically ill– Anorexia and catabolism is a normal adaptive

stress response– Schofield and Harris-Benedict purely empirical

guesswork– Even calorimetry gives an energy consumption

Nutrition in ICU

Nutrition in ICU

Nutrition in ICU

Nutrition in ICU

Nutrition – are the endpoints all wrong?

Nutrition – are the endpoints all wrong?

Nutrition – are the endpoints all wrong?

Nutrition – are the endpoints all wrong?

Traumatic Brain Injury

Imaging and clinical examination

Emerging infectious diseases

Emerging infectious diseases

Emerging infectious diseases

Novel research responses

Novel research responses

Novel research responses

seppelt@med.usyd.edu.au

Questions?