@NWCriticalCare

Andy Campbell - No affiliations with any organisation, this account and views are my own. - @andyfresher #NWCCEducation #WEDucation

Joined January 2016
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Pandemic uncertainty pushed #SAVEICU to a hierarchy of outcomes. Does that feel right for ICU trials? Death matters if you die, but for survivors, ventilator-free days, QoL, ICU-free days & recovery matter. Maybe more ICU trials need to stop asking one blunt question.? #CCR26
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The @SaveIcu concept is compelling: A superior sedation → early liberation → expedited extubation → survival → recovery. But if both groups remain deeply sedated for prolonged periods, perhaps the key determinant isn’t which sedative we choose, but how we use them. #CCR26
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#SAVEICU found no major safety signal and no clinically important excess of serious adverse events, although small numerical imbalances were seen in hypercapnia, abnormal liver function and severe adverse events. #CCR26
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#SAVEICU at #CCR26 Volatile proved feasible across a large multicentre RCT. But the headline result is neutral: • No difference in hospital mortality • Survival curves almost completely overlap An important reminder that physiological promise doesn’t always = outcome benefit.
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#SAVEICU: Patients receiving inhaled sedation appear to have spent significant time at RASS -4/-5. If volatile sedation was expected to improve outcomes through lighter, more easily titratable & reversible sedation, does this finding challenge that in clinical practice? #CCR26
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#CCR26 #SAVEICU SAVE-ICU ran into Covid-19! Will it tell us whether volatile sedation worked during the pandemic or can it answer the harder question of whether it should change practice in 2026!
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Over 70% of patients had Non-Covid related disease
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Was SAVE-ICU really volatile sedation vs IV sedation, or volatile sedation + some IV sedation vs IV sedation alone?
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Day 3, post-lunch at #CCR26 and we’re straight into #SAVEICU. Can volatile anaesthetic sedation improve outcomes in ICU patients with acute hypoxaemic respiratory failure? A pragmatic multicentre RCT from the Canadian Critical Care Trials Group.
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#Gastric_PICU #CCR26 Where do we go next, an Adult Trial on GRV? & If we stop using GRV as a proxy for feed tolerance, Do we need to replace it with better clinical assessment, and bowel function as part of our GI Organ assessment.
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Replying to @GASTRIC_PICU
@GASTRIC_PICU Discussions about need for further trials in adults vs neonates vs children. Considering gastric motility, autonomic control, vagal tone and gut perfusion differences. Is GRV evidence age-specific rather than automatically transferable across ICU populations? #CCR26
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Can we assume that adult, paediatric and neonatal gastrointestinal physiology are equivalent enough? Or whether those physiological differences are clinically important enough to change the effect of GRV monitoring on outcomes in adults - @CritCareReviews @ICNARC @GASTRIC_PICU
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"Amongst critically ill children receiving mech’ vent in PICU, routine GRV assessments to guide enteral feeding do not improve outcomes & reduce the achievement of nutritional goals. This practice should be stopped and undertaken for specific clinical indications." #CCR26 @ICNARC
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@GASTRIC_PICU @ICNARC Could abandoning it also improve patient comfort or worsen it? Certainly reduce unnecessary NG handling. Sometimes the benefit of stopping a procedure isn’t what happens, it’s what no longer happens. #CCR26
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Are volume-based feeding and routine GRV assessment philosophically incompatible? VBF is designed to maximise nutritional delivery by making up for interruptions. GRV checks can often trigger feed cessation, ⬇️ rates, and further failure to meet prescribed targets. @tata_glucosa
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If routine GRV measurement does not improve clinical outcomes, does not improve safety, and reduces nutritional goal achievement, what is the remaining justification for continuing it as standard practice? Paediatric trial translatable to adults? #CCR26 #gastricpicutrial
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Are we more comfortable translating animal studies to humans vs Children to Adults?
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The framing may not be that routine GRV assessment doesn’t help. It’s that despite a 90% reduction in GRV measurements, there was no detectable penalty in clinical outcomes, while nutritional targets were achieved more effectively. #CCR26
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#CCR26 GASTRIC-PICU challenges one of the most embedded rituals in critical care nutrition. “No” routine GRV assessment was non-inferior to usual care for ventilator-free survival at 30 days, while reducing GRV checks by almost 90%. @ICNARC
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The question now becomes: Were we measuring something clinically useful, or simply measuring it because we’ve always measured it? 🦒
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The intervention wasn’t complete elimination of GRV measurement. In the “no routine GRV” arm, 56% still had at least one GRV assessment for clinical reasons. Yet despite this, non-inferiority was maintained in ITT, PP and CACE analyses, strengthening confidence in the findings.
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