Download - 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
