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presentations
DR. ARI JOFFE
Dr. Ari Joffe. Ari Joffe is a pediatric critical care medicine specialist practicing in Edmonton, Canada since 1995. He obtained his Pediatrics and Pediatric Infectious Diseases specialties at the University of Calgary, Canada, and his Pediatric Critical Care specialty at the University of Toronto, Hospital for Sick Children. Heis a clinical
DR GEOFF BARKER
Dr Geoff Barker trained in anesthesia in Australia, and moved to Toronto where he spent 30 years as a full-time Critical Care Physician at the Hospital for Sick Children. He was Chief of the department for 20 years, during which time the fellowship training program developed into perhaps the leading venue for training worldwide. He was the CANADIAN CRITICAL CARE CAPACITY Canadian Critical Care Capacity . Rob Fowler MDCM, MS, FRCP . Departments of Medicine & Critical Care Medicine, Sunnybrook Hospital . Associate Professor, University of TorontoECMO BASIC CONCEPTS
ECMO Basic Concepts Anne-Marie Guerguerian Critical Care Medicine, The Hospital for Sick Children University of Toronto ecls.program@sickkids.ca ECMO/ECCO2R IN ACUTE RESPIRATORY FAILURE Cardiology Institute alain.combes@aphp.fr www.pariswww.paris-tcsecmo.org-ecmo.org ECMO and ECCO2R ECMO •Large cannulas •High extracorporeal flow •>5000 ml/min •Large membrane oxygenator •Full blood oxygenation •Full blood decarboxylation •High technicity, ECMO center ECCO2R •Double lumen catheter •Low flow, respiratory dialysis •250-1000 ml/min NIV OVERVIEW: INDICATIONS AND INTERFACES 3CPO study (N Engl J Med 2008; 359: 142) 1069 patients, 3 groups (O 2, CPAP, NIV) More rapid improvement with NIV No difference in short termmortality
MOBILIZING ECLS PATIENTS Mobilizing Patients on ECMO Vincent Lo PT Critical Care Physiotherapist Medical Surgical Intensive Care Unit University Health Network Toronto General Hospital FRAILTY: WHAT TO MEASURE? WHEN TO MEASURE? AND DOES IT ADD Fried et al (Cardiovascular Health Study)_J Gerontol Biol Sci Med Sci 2001 Physical Phenotype Model Frailty Characteristics CHS Measure Shrinking, weight loss (unintentional), sarcopenia >10 lb lost unintentionally in prior 1 year Weakness Grip strength: lowest 20% (by sex, BMI) Poor endurance, exhaustion, slowness GEETA MEHTA MD, FRCPC MOUNT SINAI HOSPITAL Daily Interruption of Sedation 0 2 4 6 8 10 Interruption Contol Duration of MV ICU LOS Days p = 0.004 p = 0.02 Kress JP et al. NEJM 2000;342:1471 4.9 7.3 6.4 9.9 HOME - CRITICAL CARE CANADA FORUMREGISTRATIONPROGRAMFACULTYCALL FOR ABSTRACTSSPONSORSHIPAFFILIATES The Critical Care Canada Forum is a world-renowned meeting for professionals involved with the care of critically ill patients. The Forum focuses on leading-edge science through informative and interactive sessions, led by an outstanding global faculty. The scientific program is ultra current and includes plenaries, panelpresentations
DR. ARI JOFFE
Dr. Ari Joffe. Ari Joffe is a pediatric critical care medicine specialist practicing in Edmonton, Canada since 1995. He obtained his Pediatrics and Pediatric Infectious Diseases specialties at the University of Calgary, Canada, and his Pediatric Critical Care specialty at the University of Toronto, Hospital for Sick Children. Heis a clinical
DR GEOFF BARKER
Dr Geoff Barker trained in anesthesia in Australia, and moved to Toronto where he spent 30 years as a full-time Critical Care Physician at the Hospital for Sick Children. He was Chief of the department for 20 years, during which time the fellowship training program developed into perhaps the leading venue for training worldwide. He was the CANADIAN CRITICAL CARE CAPACITY Canadian Critical Care Capacity . Rob Fowler MDCM, MS, FRCP . Departments of Medicine & Critical Care Medicine, Sunnybrook Hospital . Associate Professor, University of TorontoECMO BASIC CONCEPTS
ECMO Basic Concepts Anne-Marie Guerguerian Critical Care Medicine, The Hospital for Sick Children University of Toronto ecls.program@sickkids.ca ECMO/ECCO2R IN ACUTE RESPIRATORY FAILURE Cardiology Institute alain.combes@aphp.fr www.pariswww.paris-tcsecmo.org-ecmo.org ECMO and ECCO2R ECMO •Large cannulas •High extracorporeal flow •>5000 ml/min •Large membrane oxygenator •Full blood oxygenation •Full blood decarboxylation •High technicity, ECMO center ECCO2R •Double lumen catheter •Low flow, respiratory dialysis •250-1000 ml/min NIV OVERVIEW: INDICATIONS AND INTERFACES 3CPO study (N Engl J Med 2008; 359: 142) 1069 patients, 3 groups (O 2, CPAP, NIV) More rapid improvement with NIV No difference in short termmortality
MOBILIZING ECLS PATIENTS Mobilizing Patients on ECMO Vincent Lo PT Critical Care Physiotherapist Medical Surgical Intensive Care Unit University Health Network Toronto General Hospital FRAILTY: WHAT TO MEASURE? WHEN TO MEASURE? AND DOES IT ADD Fried et al (Cardiovascular Health Study)_J Gerontol Biol Sci Med Sci 2001 Physical Phenotype Model Frailty Characteristics CHS Measure Shrinking, weight loss (unintentional), sarcopenia >10 lb lost unintentionally in prior 1 year Weakness Grip strength: lowest 20% (by sex, BMI) Poor endurance, exhaustion, slowness GEETA MEHTA MD, FRCPC MOUNT SINAI HOSPITAL Daily Interruption of Sedation 0 2 4 6 8 10 Interruption Contol Duration of MV ICU LOS Days p = 0.004 p = 0.02 Kress JP et al. NEJM 2000;342:1471 4.9 7.3 6.4 9.9 NIV OVERVIEW: INDICATIONS AND INTERFACES 3CPO study (N Engl J Med 2008; 359: 142) 1069 patients, 3 groups (O 2, CPAP, NIV) More rapid improvement with NIV No difference in short termmortality
CRITICAL CARE UNIT CAPACITY IN CANADA: HAVE WE FAILED TO Division of Critical Care Medicine Impact of ICU night discharge on outcomes Author Country % Night discharges OR mortality Beck U.K. 26% 1.87 Goldfrad U.K. 6% 1.33 HIGH FLOW VV ECMO VS ECCO2R IN SEVERE ARDS OXYGENATION FiO 2 =1.0 250 mL min-1 CO 2 REMOVAL VA 9500 mL min-1 VO 2 250 mL min-1 VCO 2 200 mL min-1 Sat a 98% P a O 2 110 mmHg CO 2 cont 34 mL P a CO 2 15 mmHg Hb 15 g Sat v 82% P v O 2 47 mmHg CO 2 cont 52 mL P v CO 2 43 mmHg 7000 mL min-1 PBF EXTRACORPOREAL CO REMOVAL DEVICES ExtraCorporeal CO 2 removal Devices Alain Combes Service de Réanimation iCAN, Institute of Cardiometabolism and Nutrition Hôpital Pitié-Salpêtrière, AP-HP, Paris NEUROPROGNOSTICATION AFTER RESUSCITATED CARDIAC ARREST Neuroprognostication after Resuscitated Cardiac Arrest Damon C. Scales MD PhD Sunnybrook Health Sciences Centre • DIURETICS IN ACUTE KIDNEY INJURY: WHEN AND HOW? The prognostic value of furosemide: The furosemide stress test (FST) •AKI, especially in early stages, may follow several courses •the inability to forecast AKI progression has HOW TO DEVELOP QUALITY INDICATORS? Objectives 1. Emphasize the importance of measuring health care quality 2. Overview of quality indicators 3. Describe a quality indicator development COMPASSION & HUMANISM IN HEALTHCARE: THE LENS OF LANGUAGE Clinician Response Attributes Regarding Suffering Patient Response Adapted from Sinclair et al, 2016 Ego-based Verbal Reactive Acknowledge Pitied & Patronized PROTOCOLIZED WITHDRAWAL OF LIFE SUPPORT Protocolized Withdrawal of Life Support James Downar, MDCM, MHSc, FRCPC Assistant Professor, Divisions of Critical Care and Palliative Care Medicine, University of Toronto MECHANICAL VENTILATION IN THE BRAIN-INJURED PATIENT Mechanical Ventilation in the Brain-Injured Patient Jeffrey M Singh, MD FRCPC MSc Critical Care and Neurocritical Care Toronto WesternHospital
DR GEOFF BARKER
Dr Geoff Barker trained in anesthesia in Australia, and moved to Toronto where he spent 30 years as a full-time Critical Care Physician at the Hospital for Sick Children. He was Chief of the department for 20 years, during which time the fellowship training program developed into perhaps the leading venue for training worldwide. He ContinueReading
DR. BRONWEN CONNOLLY Dr Bronwen Connolly is a critical care physiotherapist, and Senior Lecturer in Critical Care at Queen’s University Belfast, UK. The recipient of three previous NIHR Fellowships (Doctoral, Postdoctoral, Clinical Trials), her research interests focus on acute respiratory and rehabilitation physiotherapy, the recovery, long-term outcome, and survivorship of post critical illness patients, andDR. ARI JOFFE
Ari Joffe is a pediatric critical care medicine specialist practicing in Edmonton, Canada since 1995. He obtained his Pediatrics and Pediatric Infectious Diseases specialties at the University of Calgary, Canada, and his Pediatric Critical Care specialty at the University of Toronto, Hospital for Sick Children. He is a clinical professor in the Department of Pediatrics, Continue ReadingDR. ALLAN DE CAEN
Allan de Caen is a Pediatric Intensivist/ Clinical Professor at Stollery Children’s Hospital/ University of Alberta in Edmonton, Canada. His research/ clinical interests include Resuscitation, and Critical Care Transport Medicine. He has held leadership positions within the International Liaison Committee on Resuscitation (ILCOR), the American Heart Association and Heart and Stroke Canada DR. GORDON RUBENFELD Gordon Rubenfeld is a Staff Physician, Tory Trauma Program at SHSC, Professor of Medicine at the UofT. Dr. Rubenfeld received his undergraduate degree in Philosophy & Comparative Literature at Johns Hopkins University; his medical degree from Jefferson Medical College; his internal medicine training at Duke University; & pulmonary & critical care training at the University Continue Reading CANADIAN CRITICAL CARE CAPACITY Canadian Critical Care Capacity . Rob Fowler MDCM, MS, FRCP . Departments of Medicine & Critical Care Medicine, Sunnybrook Hospital . Associate Professor, University of TorontoRANDALL TRESIDDER
My name is Randall (Randy) Tresidder. I am the husband of Dr. Shailini (Shelly) Sarwal. I live and work in Halifax, Nova Scotia. I met Shelly after retiring from a 22 year career in the military and I was with her for the last 10 and a half years of her life. Our ninth weddingContinue Reading
MOBILIZING ECLS PATIENTS Mobilizing Patients on ECMO Vincent Lo PT Critical Care Physiotherapist Medical Surgical Intensive Care Unit University Health Network Toronto General Hospital RV FAILURE AFTER CARDIOPULMONARY BYPASS BP = Cardiac Output x SVR First Question to ask: Is the cardiac output decreased Or Is the cardiac output normal or increased NEUROPROGNOSTICATION AFTER RESUSCITATED CARDIAC ARREST Neuroprognostication after Resuscitated Cardiac Arrest Damon C. Scales MD PhD Sunnybrook Health Sciences Centre •DR GEOFF BARKER
Dr Geoff Barker trained in anesthesia in Australia, and moved to Toronto where he spent 30 years as a full-time Critical Care Physician at the Hospital for Sick Children. He was Chief of the department for 20 years, during which time the fellowship training program developed into perhaps the leading venue for training worldwide. He ContinueReading
DR. BRONWEN CONNOLLY Dr Bronwen Connolly is a critical care physiotherapist, and Senior Lecturer in Critical Care at Queen’s University Belfast, UK. The recipient of three previous NIHR Fellowships (Doctoral, Postdoctoral, Clinical Trials), her research interests focus on acute respiratory and rehabilitation physiotherapy, the recovery, long-term outcome, and survivorship of post critical illness patients, andDR. ARI JOFFE
Ari Joffe is a pediatric critical care medicine specialist practicing in Edmonton, Canada since 1995. He obtained his Pediatrics and Pediatric Infectious Diseases specialties at the University of Calgary, Canada, and his Pediatric Critical Care specialty at the University of Toronto, Hospital for Sick Children. He is a clinical professor in the Department of Pediatrics, Continue ReadingDR. ALLAN DE CAEN
Allan de Caen is a Pediatric Intensivist/ Clinical Professor at Stollery Children’s Hospital/ University of Alberta in Edmonton, Canada. His research/ clinical interests include Resuscitation, and Critical Care Transport Medicine. He has held leadership positions within the International Liaison Committee on Resuscitation (ILCOR), the American Heart Association and Heart and Stroke Canada DR. GORDON RUBENFELD Gordon Rubenfeld is a Staff Physician, Tory Trauma Program at SHSC, Professor of Medicine at the UofT. Dr. Rubenfeld received his undergraduate degree in Philosophy & Comparative Literature at Johns Hopkins University; his medical degree from Jefferson Medical College; his internal medicine training at Duke University; & pulmonary & critical care training at the University Continue Reading CANADIAN CRITICAL CARE CAPACITY Canadian Critical Care Capacity . Rob Fowler MDCM, MS, FRCP . Departments of Medicine & Critical Care Medicine, Sunnybrook Hospital . Associate Professor, University of TorontoRANDALL TRESIDDER
My name is Randall (Randy) Tresidder. I am the husband of Dr. Shailini (Shelly) Sarwal. I live and work in Halifax, Nova Scotia. I met Shelly after retiring from a 22 year career in the military and I was with her for the last 10 and a half years of her life. Our ninth weddingContinue Reading
MOBILIZING ECLS PATIENTS Mobilizing Patients on ECMO Vincent Lo PT Critical Care Physiotherapist Medical Surgical Intensive Care Unit University Health Network Toronto General Hospital RV FAILURE AFTER CARDIOPULMONARY BYPASS BP = Cardiac Output x SVR First Question to ask: Is the cardiac output decreased Or Is the cardiac output normal or increased NEUROPROGNOSTICATION AFTER RESUSCITATED CARDIAC ARREST Neuroprognostication after Resuscitated Cardiac Arrest Damon C. Scales MD PhD Sunnybrook Health Sciences Centre •DR. ARI JOFFE
Ari Joffe is a pediatric critical care medicine specialist practicing in Edmonton, Canada since 1995. He obtained his Pediatrics and Pediatric Infectious Diseases specialties at the University of Calgary, Canada, and his Pediatric Critical Care specialty at the University of Toronto, Hospital for Sick Children. He is a clinical professor in the Department of Pediatrics, Continue ReadingDR. KAREN CHOONG
Dr. Karen Choong is a Professor in the Departments of Pediatrics and Critical Care, and the Department of Health Research Methods, Evidence and Impact at McMaster University. A graduate of the Royal College of Surgeons in Ireland, she is board certified in Neonatology and Pediatric Critical Care Medicine. Professor Choong is a member of theContinue Reading
DR. GORDON RUBENFELD Gordon Rubenfeld is a Staff Physician, Tory Trauma Program at SHSC, Professor of Medicine at the UofT. Dr. Rubenfeld received his undergraduate degree in Philosophy & Comparative Literature at Johns Hopkins University; his medical degree from Jefferson Medical College; his internal medicine training at Duke University; & pulmonary & critical care training at the University Continue Reading LACTIC ACID & BASE EXCESS IN SEPSIS 0 10 20 30 40 50 60 70 < 2 2 –4 6 8 > 8) BASELINE LACTATE mmol/L) Sepsis Septic shock SEVERE SEPSIS SEPTIC SHOCK 1741 Patients 8CCCF ACADEMY
About Us The Critical Care Canada Forum is a world-renowned meeting for professionals involved with the care of critically ill patients. The Forum focuses on leading-edge science through informative and interactive sessions, led by an outstanding global faculty.RANDALL TRESIDDER
My name is Randall (Randy) Tresidder. I am the husband of Dr. Shailini (Shelly) Sarwal. I live and work in Halifax, Nova Scotia. I met Shelly after retiring from a 22 year career in the military and I was with her for the last 10 and a half years of her life. Our ninth weddingContinue Reading
DIURETICS IN ACUTE KIDNEY INJURY: WHEN AND HOW? The prognostic value of furosemide: The furosemide stress test (FST) •AKI, especially in early stages, may follow several courses •the inability to forecast AKI progression has COMPASSION & HUMANISM IN HEALTHCARE: THE LENS OF LANGUAGE Clinician Response Attributes Regarding Suffering Patient Response Adapted from Sinclair et al, 2016 Ego-based Verbal Reactive Acknowledge Pitied & Patronized LUNG RECRUITABILITY: HOW TO ASSESS AND DEFINE? CT analysis: Gattinoni method Gattinoni L. et al, NEJM 2006 Lower Percentage of Potentially Recruitable Lung 5 cmH 2 O of PEEP 45 cmH 2O of Pplat
EXTRACORPOREAL CO REMOVAL DEVICES ExtraCorporeal CO 2 removal Devices Alain Combes Service de Réanimation iCAN, Institute of Cardiometabolism and Nutrition Hôpital Pitié-Salpêtrière, AP-HP, Paris HOME - CRITICAL CARE CANADA FORUMREGISTRATIONPROGRAMFACULTYCALL FOR ABSTRACTSSPONSORSHIPAFFILIATES The Critical Care Canada Forum is a world-renowned meeting for professionals involved with the care of critically ill patients. The Forum focuses on leading-edge science through informative and interactive sessions, led by an outstanding global faculty. The scientific program is ultra current and includes plenaries, panelpresentations
DR GEOFF BARKER
Dr Geoff Barker trained in anesthesia in Australia, and moved to Toronto where he spent 30 years as a full-time Critical Care Physician at the Hospital for Sick Children. He was Chief of the department for 20 years, during which time the fellowship training program developed into perhaps the leading venue for training worldwide. He was theECMO BASIC CONCEPTS
ECMO Basic Concepts Anne-Marie Guerguerian Critical Care Medicine, The Hospital for Sick Children University of Toronto ecls.program@sickkids.ca HIGH FLOW VV ECMO VS ECCO2R IN SEVERE ARDS OXYGENATION FiO 2 =1.0 250 mL min-1 CO 2 REMOVAL VA 9500 mL min-1 VO 2 250 mL min-1 VCO 2 200 mL min-1 Sat a 98% P a O 2 110 mmHg CO 2 cont 34 mL P a CO 2 15 mmHg Hb 15 g Sat v 82% P v O 2 47 mmHg CO 2 cont 52 mL P v CO 2 43 mmHg 7000 mL min-1 PBF MOBILIZING ECLS PATIENTS Mobilizing Patients on ECMO Vincent Lo PT Critical Care Physiotherapist Medical Surgical Intensive Care Unit University Health Network Toronto General Hospital NIV OVERVIEW: INDICATIONS AND INTERFACES 3CPO study (N Engl J Med 2008; 359: 142) 1069 patients, 3 groups (O 2, CPAP, NIV) More rapid improvement with NIV No difference in short termmortality
DIURETICS IN ACUTE KIDNEY INJURY: WHEN AND HOW? The prognostic value of furosemide: The furosemide stress test (FST) •AKI, especially in early stages, may follow several courses •the inability to forecast AKI progression has GEETA MEHTA MD, FRCPC MOUNT SINAI HOSPITAL Daily Interruption of Sedation 0 2 4 6 8 10 Interruption Contol Duration of MV ICU LOS Days p = 0.004 p = 0.02 Kress JP et al. NEJM 2000;342:1471 4.9 7.3 6.4 9.9 RV FAILURE AFTER CARDIOPULMONARY BYPASS BP = Cardiac Output x SVR First Question to ask: Is the cardiac output decreased Or Is the cardiac output normal or increased CARE OF THE LIVER FAILURE PATIENT Care of the Liver Failure Patient Critical Care Canada Forum 2016 Constantine J. Karvellas MD SM FRCPC Associate Professor of Medicine Divisions of Critical Care Medicine and Gastroenterology HOME - CRITICAL CARE CANADA FORUMREGISTRATIONPROGRAMFACULTYCALL FOR ABSTRACTSSPONSORSHIPAFFILIATES The Critical Care Canada Forum is a world-renowned meeting for professionals involved with the care of critically ill patients. The Forum focuses on leading-edge science through informative and interactive sessions, led by an outstanding global faculty. The scientific program is ultra current and includes plenaries, panelpresentations
DR GEOFF BARKER
Dr Geoff Barker trained in anesthesia in Australia, and moved to Toronto where he spent 30 years as a full-time Critical Care Physician at the Hospital for Sick Children. He was Chief of the department for 20 years, during which time the fellowship training program developed into perhaps the leading venue for training worldwide. He was theECMO BASIC CONCEPTS
ECMO Basic Concepts Anne-Marie Guerguerian Critical Care Medicine, The Hospital for Sick Children University of Toronto ecls.program@sickkids.ca HIGH FLOW VV ECMO VS ECCO2R IN SEVERE ARDS OXYGENATION FiO 2 =1.0 250 mL min-1 CO 2 REMOVAL VA 9500 mL min-1 VO 2 250 mL min-1 VCO 2 200 mL min-1 Sat a 98% P a O 2 110 mmHg CO 2 cont 34 mL P a CO 2 15 mmHg Hb 15 g Sat v 82% P v O 2 47 mmHg CO 2 cont 52 mL P v CO 2 43 mmHg 7000 mL min-1 PBF MOBILIZING ECLS PATIENTS Mobilizing Patients on ECMO Vincent Lo PT Critical Care Physiotherapist Medical Surgical Intensive Care Unit University Health Network Toronto General Hospital NIV OVERVIEW: INDICATIONS AND INTERFACES 3CPO study (N Engl J Med 2008; 359: 142) 1069 patients, 3 groups (O 2, CPAP, NIV) More rapid improvement with NIV No difference in short termmortality
DIURETICS IN ACUTE KIDNEY INJURY: WHEN AND HOW? The prognostic value of furosemide: The furosemide stress test (FST) •AKI, especially in early stages, may follow several courses •the inability to forecast AKI progression has GEETA MEHTA MD, FRCPC MOUNT SINAI HOSPITAL Daily Interruption of Sedation 0 2 4 6 8 10 Interruption Contol Duration of MV ICU LOS Days p = 0.004 p = 0.02 Kress JP et al. NEJM 2000;342:1471 4.9 7.3 6.4 9.9 RV FAILURE AFTER CARDIOPULMONARY BYPASS BP = Cardiac Output x SVR First Question to ask: Is the cardiac output decreased Or Is the cardiac output normal or increased CARE OF THE LIVER FAILURE PATIENT Care of the Liver Failure Patient Critical Care Canada Forum 2016 Constantine J. Karvellas MD SM FRCPC Associate Professor of Medicine Divisions of Critical Care Medicine and GastroenterologyDR. ARI JOFFE
Dr. Ari Joffe. Ari Joffe is a pediatric critical care medicine specialist practicing in Edmonton, Canada since 1995. He obtained his Pediatrics and Pediatric Infectious Diseases specialties at the University of Calgary, Canada, and his Pediatric Critical Care specialty at the University of Toronto, Hospital for Sick Children. Heis a clinical
DR. PETER JÜNI
Dr. Jüni is the Director of the Applied Health Research Centre (AHRC) at the Li Ka Shing Knowledge Institute of St. Michael’s Hospital and a Professor at the Department of Medicine of the University of Toronto. He graduated from the Faculty of Medicine at the University of Bern, Switzerland, completed his training in Internal MedicineContinue Reading
DR. CLARE FIELDING
Dr. Clare Fielding. Clare Fielding is a Clinical Nurse Specialist (CNS) for Critical Care at Toronto General Hospital focusing on quality, patient safety, education and nursing research in the Medical Surgical, Cardiovascular and Cardiac Intensive Care Units at University Health Network. Clare came to nursing late, completingstudying Physical
FRAILTY: WHAT TO MEASURE? WHEN TO MEASURE? AND DOES IT ADD Fried et al (Cardiovascular Health Study)_J Gerontol Biol Sci Med Sci 2001 Physical Phenotype Model Frailty Characteristics CHS Measure Shrinking, weight loss (unintentional), sarcopenia >10 lb lost unintentionally in prior 1 year Weakness Grip strength: lowest 20% (by sex, BMI) Poor endurance, exhaustion, slowness CANADIAN CRITICAL CARE CAPACITY Canadian Critical Care Capacity . Rob Fowler MDCM, MS, FRCP . Departments of Medicine & Critical Care Medicine, Sunnybrook Hospital . Associate Professor, University of Toronto ECMO/ECCO2R IN ACUTE RESPIRATORY FAILURE Cardiology Institute alain.combes@aphp.fr www.pariswww.paris-tcsecmo.org-ecmo.org ECMO and ECCO2R ECMO •Large cannulas •High extracorporeal flow •>5000 ml/min •Large membrane oxygenator •Full blood oxygenation •Full blood decarboxylation •High technicity, ECMO center ECCO2R •Double lumen catheter •Low flow, respiratory dialysis •250-1000 ml/min AN END-OF-LIFE CHECKLIST Conflicts of Interest •To place your ad here, please call416-340-4800 x8577.
HOW TO DEVELOP QUALITY INDICATORS? Objectives 1. Emphasize the importance of measuring health care quality 2. Overview of quality indicators 3. Describe a quality indicator development EXTRACORPOREAL CO REMOVAL DEVICES ExtraCorporeal CO 2 removal Devices Alain Combes Service de Réanimation iCAN, Institute of Cardiometabolism and Nutrition Hôpital Pitié-Salpêtrière, AP-HP, Paris CARE OF THE LIVER FAILURE PATIENT Care of the Liver Failure Patient Critical Care Canada Forum 2016 Constantine J. Karvellas MD SM FRCPC Associate Professor of Medicine Divisions of Critical Care Medicine and Gastroenterology HOME - CRITICAL CARE CANADA FORUMREGISTRATIONPROGRAMFACULTYCALL FOR ABSTRACTSSPONSORSHIPAFFILIATES The Critical Care Canada Forum is a world-renowned meeting for professionals involved with the care of critically ill patients. The Forum focuses on leading-edge science through informative and interactive sessions, led by an outstanding global faculty. The scientific program is ultra current and includes plenaries, panelpresentations
DR GEOFF BARKER
Dr Geoff Barker trained in anesthesia in Australia, and moved to Toronto where he spent 30 years as a full-time Critical Care Physician at the Hospital for Sick Children. He was Chief of the department for 20 years, during which time the fellowship training program developed into perhaps the leading venue for training worldwide. He was theECMO BASIC CONCEPTS
ECMO Basic Concepts Anne-Marie Guerguerian Critical Care Medicine, The Hospital for Sick Children University of Toronto ecls.program@sickkids.ca HIGH FLOW VV ECMO VS ECCO2R IN SEVERE ARDS OXYGENATION FiO 2 =1.0 250 mL min-1 CO 2 REMOVAL VA 9500 mL min-1 VO 2 250 mL min-1 VCO 2 200 mL min-1 Sat a 98% P a O 2 110 mmHg CO 2 cont 34 mL P a CO 2 15 mmHg Hb 15 g Sat v 82% P v O 2 47 mmHg CO 2 cont 52 mL P v CO 2 43 mmHg 7000 mL min-1 PBF MOBILIZING ECLS PATIENTS Mobilizing Patients on ECMO Vincent Lo PT Critical Care Physiotherapist Medical Surgical Intensive Care Unit University Health Network Toronto General Hospital NIV OVERVIEW: INDICATIONS AND INTERFACES 3CPO study (N Engl J Med 2008; 359: 142) 1069 patients, 3 groups (O 2, CPAP, NIV) More rapid improvement with NIV No difference in short termmortality
DIURETICS IN ACUTE KIDNEY INJURY: WHEN AND HOW? The prognostic value of furosemide: The furosemide stress test (FST) •AKI, especially in early stages, may follow several courses •the inability to forecast AKI progression has GEETA MEHTA MD, FRCPC MOUNT SINAI HOSPITAL Daily Interruption of Sedation 0 2 4 6 8 10 Interruption Contol Duration of MV ICU LOS Days p = 0.004 p = 0.02 Kress JP et al. NEJM 2000;342:1471 4.9 7.3 6.4 9.9 RV FAILURE AFTER CARDIOPULMONARY BYPASS BP = Cardiac Output x SVR First Question to ask: Is the cardiac output decreased Or Is the cardiac output normal or increased CARE OF THE LIVER FAILURE PATIENT Care of the Liver Failure Patient Critical Care Canada Forum 2016 Constantine J. Karvellas MD SM FRCPC Associate Professor of Medicine Divisions of Critical Care Medicine and Gastroenterology HOME - CRITICAL CARE CANADA FORUMREGISTRATIONPROGRAMFACULTYCALL FOR ABSTRACTSSPONSORSHIPAFFILIATES The Critical Care Canada Forum is a world-renowned meeting for professionals involved with the care of critically ill patients. The Forum focuses on leading-edge science through informative and interactive sessions, led by an outstanding global faculty. The scientific program is ultra current and includes plenaries, panelpresentations
DR GEOFF BARKER
Dr Geoff Barker trained in anesthesia in Australia, and moved to Toronto where he spent 30 years as a full-time Critical Care Physician at the Hospital for Sick Children. He was Chief of the department for 20 years, during which time the fellowship training program developed into perhaps the leading venue for training worldwide. He was theECMO BASIC CONCEPTS
ECMO Basic Concepts Anne-Marie Guerguerian Critical Care Medicine, The Hospital for Sick Children University of Toronto ecls.program@sickkids.ca HIGH FLOW VV ECMO VS ECCO2R IN SEVERE ARDS OXYGENATION FiO 2 =1.0 250 mL min-1 CO 2 REMOVAL VA 9500 mL min-1 VO 2 250 mL min-1 VCO 2 200 mL min-1 Sat a 98% P a O 2 110 mmHg CO 2 cont 34 mL P a CO 2 15 mmHg Hb 15 g Sat v 82% P v O 2 47 mmHg CO 2 cont 52 mL P v CO 2 43 mmHg 7000 mL min-1 PBF MOBILIZING ECLS PATIENTS Mobilizing Patients on ECMO Vincent Lo PT Critical Care Physiotherapist Medical Surgical Intensive Care Unit University Health Network Toronto General Hospital NIV OVERVIEW: INDICATIONS AND INTERFACES 3CPO study (N Engl J Med 2008; 359: 142) 1069 patients, 3 groups (O 2, CPAP, NIV) More rapid improvement with NIV No difference in short termmortality
DIURETICS IN ACUTE KIDNEY INJURY: WHEN AND HOW? The prognostic value of furosemide: The furosemide stress test (FST) •AKI, especially in early stages, may follow several courses •the inability to forecast AKI progression has GEETA MEHTA MD, FRCPC MOUNT SINAI HOSPITAL Daily Interruption of Sedation 0 2 4 6 8 10 Interruption Contol Duration of MV ICU LOS Days p = 0.004 p = 0.02 Kress JP et al. NEJM 2000;342:1471 4.9 7.3 6.4 9.9 RV FAILURE AFTER CARDIOPULMONARY BYPASS BP = Cardiac Output x SVR First Question to ask: Is the cardiac output decreased Or Is the cardiac output normal or increased CARE OF THE LIVER FAILURE PATIENT Care of the Liver Failure Patient Critical Care Canada Forum 2016 Constantine J. Karvellas MD SM FRCPC Associate Professor of Medicine Divisions of Critical Care Medicine and GastroenterologyDR. ARI JOFFE
Dr. Ari Joffe. Ari Joffe is a pediatric critical care medicine specialist practicing in Edmonton, Canada since 1995. He obtained his Pediatrics and Pediatric Infectious Diseases specialties at the University of Calgary, Canada, and his Pediatric Critical Care specialty at the University of Toronto, Hospital for Sick Children. Heis a clinical
DR. PETER JÜNI
Dr. Jüni is the Director of the Applied Health Research Centre (AHRC) at the Li Ka Shing Knowledge Institute of St. Michael’s Hospital and a Professor at the Department of Medicine of the University of Toronto. He graduated from the Faculty of Medicine at the University of Bern, Switzerland, completed his training in Internal MedicineContinue Reading
DR. CLARE FIELDING
Dr. Clare Fielding. Clare Fielding is a Clinical Nurse Specialist (CNS) for Critical Care at Toronto General Hospital focusing on quality, patient safety, education and nursing research in the Medical Surgical, Cardiovascular and Cardiac Intensive Care Units at University Health Network. Clare came to nursing late, completingstudying Physical
FRAILTY: WHAT TO MEASURE? WHEN TO MEASURE? AND DOES IT ADD Fried et al (Cardiovascular Health Study)_J Gerontol Biol Sci Med Sci 2001 Physical Phenotype Model Frailty Characteristics CHS Measure Shrinking, weight loss (unintentional), sarcopenia >10 lb lost unintentionally in prior 1 year Weakness Grip strength: lowest 20% (by sex, BMI) Poor endurance, exhaustion, slowness CANADIAN CRITICAL CARE CAPACITY Canadian Critical Care Capacity . Rob Fowler MDCM, MS, FRCP . Departments of Medicine & Critical Care Medicine, Sunnybrook Hospital . Associate Professor, University of Toronto ECMO/ECCO2R IN ACUTE RESPIRATORY FAILURE Cardiology Institute alain.combes@aphp.fr www.pariswww.paris-tcsecmo.org-ecmo.org ECMO and ECCO2R ECMO •Large cannulas •High extracorporeal flow •>5000 ml/min •Large membrane oxygenator •Full blood oxygenation •Full blood decarboxylation •High technicity, ECMO center ECCO2R •Double lumen catheter •Low flow, respiratory dialysis •250-1000 ml/min AN END-OF-LIFE CHECKLIST Conflicts of Interest •To place your ad here, please call416-340-4800 x8577.
HOW TO DEVELOP QUALITY INDICATORS? Objectives 1. Emphasize the importance of measuring health care quality 2. Overview of quality indicators 3. Describe a quality indicator development EXTRACORPOREAL CO REMOVAL DEVICES ExtraCorporeal CO 2 removal Devices Alain Combes Service de Réanimation iCAN, Institute of Cardiometabolism and Nutrition Hôpital Pitié-Salpêtrière, AP-HP, Paris CARE OF THE LIVER FAILURE PATIENT Care of the Liver Failure Patient Critical Care Canada Forum 2016 Constantine J. Karvellas MD SM FRCPC Associate Professor of Medicine Divisions of Critical Care Medicine and Gastroenterology Critical Care Canada Forum* Home
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In Memoriam: Dr. Brian KavanaghABOUT CCCF
CCCF is proud to host the 2019 NCS North/Central American ChapterMeeting this year.
CRITICAL CARE CANADA FORUM OFFICIAL MEETING OF: * More than 900 delegates * 150 international faculty* Fellow’s Day
* Neurocritical Care Masterclass * Deceased Organ Donation stream The Critical Care Canada Forum is a world-renowned meeting for professionals involved with the care of critically ill patients. The Forum focuses on leading-edge science through informative and interactive sessions, led by an outstanding global faculty. The scientific program is ultra current and includes plenaries, panel presentations, specialty workshops, hands-on courses, Fellows Day, oral and poster presentations plus exhibits showcasing the latest products and services for the critical care professional. 2019 Presentations Now Online!VENUE & TRAVEL
VENUE
Immerse yourself in the excitement of the city at Sheraton Centre Toronto Hotel. Perfectly situated in the heart of downtown’s Financial and Entertainment districts, this 4-star hotel is ideal forevery visitor.
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TRAVEL
CCCF 2019 delegates will benefit from a discount on eligible Air Canada fares. UP Express offers a 25% discount on an adult return ticket. VIA Rail offers 10% off the best available fare in Economy, Economy Plus, Business, Business Plus, Sleeper class. *More Information
VISITORS TO CANADA
Travellers wishing to travel to Canada will either need a visa or an Electronic Travel Authorization (eTA). The only exception is US Citizens, who require only their passport.More Information
IMPORTANT DATES
Pre-Conference Sun. November 10, 2019 Main Conference Mon. Nov 11 – Wed. Nov. 13, 2019JOIN US!
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CME Accreditation
* Royal College of Physicians and Surgeons of Canada – 21.5Section 1 hours;
* American Medical Association – 21.5 Category 1 credits (via a reciprocal agreement with the Royal College of Physicians and Surgeonsof Canada);
* European Union of Medical Specialists – 21.5 ECMEC credits (via a reciprocal agreement with the Royal College of Physicians and Surgeons of Canada);×
Mark Your Calendars!CCCF FUTURE DATES
2020 – Sunday October 4 – Wednesday October 7 2021 – Sunday December 5 – Wednesday December 8 ------------------------- MECHANICAL VENTILATION SYMPOSIUM April 9 – 11, 2019Old Mill Toronto
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