Critical Care podcasts from the Intensive Care Network
Sarah Yong is an impressive person. Advocacy, Training, Representation and being a new fellow of the College of Intensive Care to boot. Theres a lot to talk about when you sit down with Dr Sarah Yong. Let’s make it easier by focussing on three big issues; Gender issues; Women in Intensive Care Network. Training issues; The Critical Care Collaborative and the Victorian Primary Examination Course for CICM. The Trainee Symposium at CICM ASM. Representation issues; New Fellows Rep on the Board of the College of Intensive Care Medicine. Where to start? The Women in Intensive Care Network or W.I.N.. (or on twitter @WomenIntensive) WIN is co-convened by Sarah and Dr Lucy Modra. Sarah gives all the credit to Lucy. I suspect Lucy might do something equally graceful. If my sources are correct there pretty much the same number of women and men out there in the world. Further it seems that there are roughly the same number of women and men presenting to intensive care units. This pattern does not repeat it self in terms of the Intensive Care doctors. Let’s talk about this. Let’s listen to the people that are raising awareness about this. The Women in Intensive Care are talking about it and publishing about it too. You may have heard about the Medical Journal of Australia article; “Female representation at Australasian specialty conferences”.
But they have not stopped proving their point. Next there was “Women in Leadership in Intensive Care Medicine” published in Jean-Louis Vincents open access e-journal “ICU Management and Practice”.
There have been only four presidents of the College of Intensive Care, all male. However the pre-cursor to the College was the Joint Faculty of Intensive Care Medicine (JFICM), which was the body that actually created the college. The first leader of JFICM was the one and only Dr Felicity Hawker. Hopefully soon to be published will be a presentation from the Noosa ANZICS CTG (Australia & New Zealand Intensive Care Society Clinical Trials Group) by Dr Naomi Yarwood about the lack of women in the ANZICS CTG studies over the last 20 years.
Next Issue; Training. After competing her Fellowship exams Sarah got involved in the Critical Care Collaborative and went on to found the Victorian Primary Examination Course for CICM (VPECC). Running that
is a big job in itself. It’s popular too and the July 2017 edition is already full. Sort of. Importantly the candidate stream is full for 2017 but there is a teaching stream too. Have a look at this if you are an aspiring educationalist.
See the Post on Intensivecarenetwork.com
Ash Banerjee talks about the history of ventilation and where we are today. He discusses in particular current concepts about lung protective ventilation strategies and how we can ventilate with the least amount of harm.
For more details on how to select the ideal PEEP for a patient, or how one would set up the ventilator for an ARDS patient, have a look at Alex Yartsev’s site Deranged Physiology, where there’s a great post on the Optimal PEEP for Open Lung Ventilation in ARDS which specifically mentions Gattinoni’s recent review paper.
Cannulation Part 2
by Roger Pye
Welcome to learnECMO podcast series. This instalment is the second part of Roger Pye’s meditations on ECMO cannulation, this time focusing on Avalon, VA and the duplicitous art of backflow cannulation.
On the subject of cannulation, places for SMACCannulate are going fast so head to the SMACC website if you fancy a crack at the title of world fastest cannulator and sign-up. Now we do realise that optimal procedural ergonomics does not prioritise speed and we have had lots of enquiries about actually learning to cannulate. As such we will be offering sessions at the pop-up SMACCannulate station where all comers will be welcome for hands-on cannulation teaching. We will teach you how to finesse and troubleshoot each element of ECMO cannulation from ultrasound guided seldinger technique to mitigating the perceived disaster of a bent wire. Go to the SMACC website to register for either of these sessions.
If you are not able to join us in berlin then we will be co-hosting a cannulation workshop at ST. Thomas’s hospital in London with the GSTT ECMO team, one of the highest volume centres in the world with a highly sophisticated intensivist led ECMO retrieval service. learnECMO London will be on Monday 3rd July and you can register via learnECMO.com, come and learn some high fidelity cannulation chicanery from some proper experts.
Associate Professor Neil Orford is the director of the intensive care unit at University Hospital Geelong. In his time as director he has overseen some major developments within his unit, including the introduction of a paediatric service. Here he shares some of his strategies on what it takes to be an effective leader.
by Steve Morgan & Sophie Connolly
Today we are going to cover the essentials of ECMO haemodynamics. Haemodynamics literally means blood movement and thus is the physical study of flowing blood and the structures through which it flows. In bedside vernacular we tend to use haemodynamics to refer to accessible surrogate measurements of cardiovascular performance, such as vascular and chamber pressures or quantifications of macrocirculatory blood flow.
To understand the haemodynamic effects of ECMO we will consider the effects of the in-parallel VA circuit and the in-series VV circuit separately. The effect on cardiac performance can be best approached and compartmentalised by examining the impact of ECMO on each of the determinants of stroke volume: preload, afterload and contractility.
This podcast covers:
How can we best describe ventricular function and the effect of ECMO?
What factors influence the net effect of VA ECMO on patient haemodynamics?
What are the general primary haemodynamic effects of VA ECMO?
How does cannulation site influence the haemodynamics of VA ECMO?
What do you do about a non-ejecting heart on VA ECMO?
What about the RV? How does the unique functional anatomy and physiology contribute to RV failure?
What are the haemodynamic effects of VA ECMO on the RV?
What are the haemodynamic effects of VV ECMO?
This round table discussion from the JICScast team asks whether Intensivists are the greatest danger to Intensive Care. They tackle why single or dual specialty training is recommended and whether this could endanger Intensive Care as a specialty field. The podcast is inspired and based on a blog post written by Aoife Abbey, trainee in intensive care https://whistlingdixietalk.wordpress.com/2016/11/16/the-biggest-threat-to-icu-intensivists/
Associate Professor Neil Orford is an intensive care specialist and Director of Intensive Care at University Hospital Geelong. Neil is the clinical lead for the i-Validate program. In this podcast he discusses this collaboration between Barwon Health and Deakin University which aims to improve patient-centred end-of-life care through training in clinical communication.
Associate Professor Sue Berney is head of physiotherapy at Austin Health.She has over 20 years experience working in the cardiorespiratory field, with a particular interest in critical care and early rehabilitation. She currently holds an NHMRC Early Career Fellowship and has a passion for research into patient outcomes in intensive care. Here she discuses cognitive dysfunction post critical illness.
Peter Brindley, an intensivist from Canada, and Jon Gatward (of the Critical Care Airway Management Course fame) discuss a recent paper by Peter and a group of airway experts, which discusses airway management outside the operating room and how to better prepare. Clearly this isn't a new concept but there hasn't been much written from the ICU perspective about this, and it's something many of us deal with all the time. Every place has their own way of managing airways but there are so many good ideas in this paper that it might just change your practice!
Kimberley Haines is a senior ICU physiotherapist and the Allied Health Research Lead at Western Health. Her academic research focusses on the long term progress of ICU survivors. Here she discusses the developing puzzle of ICU outcomes.
