ICS SOA 2015

1. Alexander Scott
ST7 Anaesthesia and ICM
Yorkshire and the Humber

2. Alexander Scott
ST7 Anaesthesia and ICM
Yorkshire and the Humber

5.  TRIUMPH
 Totally inadequate provision
 Woeful staffing
 Internationally ridiculous bed
occupancy
 Fantastic outcomes

6.  Tight Glycaemic Control
 Xigris
 Nitric Oxide
 Early Goal Directed Therapy
 Oscillation
 Therapeutic Hypothermia

7.  Tight Glycaemic Control
 Xigris
 Nitric Oxide
 Early Goal Directed Therapy
 Oscillation
 Therapeutic Hypothermia

8.  ARDS
 Sepsis
 Cardiac Arrest
 All comers!

9.  ARDS
 SOFA Scores
 Severe ARDS
 Sepsis
 Cardiac Arrest
 All comers!

10.  ARDS
 SOFA Scores
 Severe ARDS
 Sepsis
 Severe Sepsis
 Tachycardic Sepsis
 Cardiac Arrest
 All comers!

11.  ARDS
 SOFA Scores
 Severe ARDS
 Sepsis
 Severe Sepsis
 Tachycardic Sepsis
 Cardiac Arrest
 OOH VF
 OOH All comers
 Any arrest
 All comers!

12.  Two matched groups
 Only differences are the
intervention
 Yet. . . .

13.  Equipoise
 We may harm you
 We might kill you
 Oscillate
 You are doing something to help
others and maybe yourself

14.  What if. . . .?

16.  Bacterial
 Viral
 Fungal
 Parastic
 Secondary
 Bacterial
 Viral
 Fungal
 Parasitic
 Idiopathic

17.  Oscillation is the perfect thing for
TRALI
 Nitric oxide is perfect for gram
negative ARDS
 Xigris is perfect for viral
inflammatory change

18.  We have very little money.
 Every government plan for the NHS
centres around one word:
 Value

19.  We now have more than ever an
ethical duty to squeeze maximum
value.
 How to we do this?

20.  Target our Research
 Access to ITU
 Target those patients with
evidence of benefit
 Primary science – mechanisms and
pathophysiology.

21.  Improve delivery at a clinical level.
 Set ourselves for the future by
understanding pathophysiology.
 Stop testing interventions on
consequences: understand causes.