Has PHARLAP run its race? Where to now for open lung ventilation strategies in ARDS?

While high PEEP, low tidal volume, pressure limited ventilation is well established in the management of ARDS patients, a range of open lung strategies are variably used and of unproven value.

The ANZICS CTG endorsed PHARLAP trial set out to explore a protocolised set of these interventions.

Sadly PHARLAP has run into a hurdle.

So has it run its race?  Or is there still more to the open lung story?

Primary investigator for the PHARLAP trial, Carol Hodgson of the ANZICS Research Centre, joined me to chat about PHARLAP at the 2018 ANZICS Clinical Trials Group meeting in Noosa

Listen to the podcast here

ARISE-fluids – vasoconstrictors to reduce fluid administration in early sepsis

When should we give fluids in sepsis?  How much?

These questions have troubled emergency physicians, intensivists and anaesthetists for decades.  Given how common the condition is, it is surprising that there is such a paucity of quality evidence to guide practice.

Dr Stephen McDonald is an emergency physician from Perth, Australia, and is heading up the ARISE-Fluids trial that will explore the question of whether earlier vasoconstrictor support and restriction of fluids in the early resuscitation period improves outcomes.

This interview was recorded at the 20th annual meeting of the ANZICS Clinical Trials Group in Noosa, Queensland

Podcast : Rebecca Hahn – Sleep management practices in the ICU

“To die, to sleep – to sleep, perchance to dream – ay, there’s the rub, for in this sleep of death what dreams may come…” (Hamlet)

Shakespeare may not have been talking about the tumult of the ICU survivor, but you could be forgiven for thinking so.

Sleep deprivation is familiar to us all.  It's clear that our patients experience it frequently, and it is not hard to believe that it affects them greatly, both acutely in the ICU, and following discharge.

So what are we doing about it?

Rebecca Hahn is exploring the attitudes and behaviours of fellow ICU nurses with respect to sleep practices, to inform a wider research interest.  She joined me on the podcast at the 20th Annual ANZICS CTG meeting in Noosa Heads, Queensland.

And you have to wonder what it might show.  The recently released ADRENAL study spent nearly 10 years and $5M Australian on exploring the role of steroids in sepsis, and found that at best, they reduce ventilation times and ICU length-of-stay

Could a pair of noise cancelling earphones do the same?

Listen to Rebecca's podcast here