This year we are celebrating our 35th ISICEM! Time has certainly flown by since the very first ISICEM back in 1980, with just 200 participants and five faculty members. This year we expect to welcome more than 6,000 active participants from more than 100 countries, with over 200 speakers giving around 700 different presentations throughout four-days!
Intensive care medicine has also evolved and one interesting session will cover the key changes in clinical practice and understanding that have occurred during the last 35 years and the likely or possible changes for the next 35.
With such a full programme, it is always difficult to select so-called ‘highlights’, but one important aspect of our meeting is to provide participants with the results of the very latest clinical trials in our field. In this year’s meeting, the results of The Protocolised Management in Sepsis (PROMISE) study will be presented for the very first time.
This trial compared early goal-directed therapy (EGDT) with usual resuscitation in cases with early signs of severe sepsis or septic shock, arriving at emergency departments in the United Kingdom. This is the third large, multicentre study to have evaluated the potential benefits of this approach to patient management and the results are eagerly awaited, particularly as the first two studies, Protocol-Based Care for Early Septic Shock (ProCESS) and Australian Resuscitation In Sepsis Evaluation (ARISE), found no specific benefit of the EGDT approach on mortality compared to current standard practice.
Another recently completed clinical trial, the results of which will be presented at the ISICEM, is the Age of Blood Evaluation (ABLE) Study designed by the Canadian Critical Care Trials Group. There has been considerable discussion regarding optimal blood transfusion triggers over recent years with an initial trend towards restricting transfusions as much as possible now swinging back towards a realisation that this restrictive approach may not be beneficial to all.
Does the age of the red blood cells being transfused influence the equation? Red cell storage has been suggested to decrease the oxygen carrying ability of red cells, but does transfusion of older red cells influence patient outcome? Data have been conflicting and the results from this randomised controlled trial comparing transfusion of standard issue red cells with transfusion of red cells stored less than eight days should help provide answers to this important question
An important but less often mentioned field is that of medical ethics. Recent years have seen increasing openness regarding the once taboo topics of death and dying. As the vast majority of ICU deaths are now preceded by an end-of-life decision to withdraw/withhold life-supporting therapy, it is crucial that these topics are openly discussed with patients, relatives and the ICU team.
Several sessions will cover ICU ethical issues, including how to integrate palliative and intensive care, differences in approaches around the world, how best to communicate with relatives, and ethical and practical approaches to organ donation.
Belgium is one of several countries where a special law permits euthanasia to be conducted in certain individuals and the latest data regarding numbers of patients who have requested and undergone euthanasia will also be presented. Finally, for this brief selection, sepsis and septic shock remain important causes of death among ICU patients and the search continues for effective therapies.
One approach that has been attracting increasing interest is the use of extracorporeal therapies to remove inflammatory mediators. Multiple extracorporeal techniques have been developed and tested with the aim of reducing the circulating levels of inflammatory mediators like cytokines and chemokines.
However, some mediators are beneficial, so questions remain regarding which technique is optimal, when it should be started, and in which patients. Data will be presented on the potential place of these techniques, including a completely new approach, in the current management of septic patients. The diverse range of subjects will certainly provide plenty to interest all our participants at the ISICEM and we look forward to welcoming you to Brussels.
The 35th ISICEM in Brussels, Belgium, from 17th-20th March 2015.