Conference Highlights: SCCM 2018

Conference Highlights: SCCM 2018
New research was presented at SCCM 2018, the 47th annual Critical Care Congress of the Society of Critical Care Medicine, from February 25 to 28 in San Antonio. The features below highlight some of the studies emerging from the conference that focused on emergency medicine.

Balanced IV Fluids Vs. Saline
Few studies have assessed the impact on outcomes of  various IV fluid types. In a recent study, more than 15,000 hospitalized patients were given IV balanced fluids instead of saline, producing a 1% decreased incidence of mortality and serious kidney injury. The improved outcomes, seen in both criticallyand non-critically ill patients, suggest that largely replacing saline with balanced fluids in the hospital setting could result in significant mortality and morbidity reductions.



Post-Sepsis Temporal Trends
For a study, researchers examined trends in hospital-based acute care after sepsis. From 2010 to 2015, sepsis as a proportion of medical and surgical admissions increased from 3.9% to 9.4%, whereas the in-hospital mortality rate for sepsis hospitalizations declined from 24.1% to 14.8%. As a result, the proportion of discharges at-risk for readmission increased from 2.7% to 7.8%. Over 6 years, 30-day hospital readmission rates declined from 26.4%to 23.1%



ICU Acuity & Outcomes in Low-Risk Patients
Many ICU patients do not require critical care interventions, and whether aggressive care environments increase risks to low-acuity patients is unknown. Researchers studied adult ICU patients at low risk of dying. Mean ICU and hospital length of stay were 1.8and 5.2days, respectively, and the in-hospital mortality rate was 0.7%. Admission to low-acuity ICUs was associated with worse outcomes compared with higher-acuity ICUs. Compared with the highest-acuity quartile, ICU length of stay in low-acuity ICUs was 0.24 days longer; 0.16 day longer in medium-acuity ICUs; and 0.09 days longer in high-acuity ICUs.



Hyperchloremia in Pediatric Septic Shock
To determine whether hyperchloremia is associated with poor outcomes among critically ill children, as it is with adult cohorts, remains unknownresearchers assessed children aged 10 and younger with septic shock. Among participants, 25% had a complicated course and 10% died. A minimum chloride greater than or equal to 110 mmol/L was associated with increased odds of complicated courseand mortality. A mean chloride greater than or equal to 110 mmol/L was also associated with increased odds of mortality.



Functional Recovery in Critically Ill Children
In the context of currently high survival rates in critically ill children, mortality may not be the most appropriate quality indicator of pediatric critical care. For a study, post-discharge functional outcome was measured in children aged 12 months to 17 years, admitted to a PICU for at least 48 hours with one or more organ dysfunctions, were eligible.. While 43.6% had functional limitations at baseline, 81.5% experienced functional deterioration following critical illness. By 6 months, 67% demonstrated some functional recovery. Higher baseline function and a neurologic insult at PICU admission were the most significant predictors of functional deterioration. Higher baseline function and increasing age were associated with slower functional recovery.



On-Demand Vs Routine Nebulization

It remains uncertain whether nebulization of mucolytics with bronchodilators should be applied for clinical indication or preventively in ICU patients receiving invasive ventilation. Researchers sought to determine if a strategy that uses nebulization for clinical indication (on-demand) is noninferior to one that uses preventive (routine) nebulization inadults expected to need invasive ventilation for more than 24 hours. At 28 days, patients in the on-demand group had a median 21  ventilator-free days, and patients in the routine group had a median 20  ventilator-free days . There were no significant difference in length of stay or mortality, or in the proportion of patients developing pulmonary complications, between the groups.

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