2007年第36届SCCM的要闻

    The Society of Critical Care Medicine's 36^th Critical Care Congress， February 17-21, 2007， Gaylord Palms Resort and Convention Center， orlando, Florida, USA

    2007年底36届的美国SCCM年会刚刚召开完，会议没有前些年经常出现的重大阳性研究报告的发表，看看著名的Medscape的会议报道系列就知道了，目录如下：

Conference News:
Pulmonary Artery Catheter Appears Unnecessary for ARDS Patients
New FACTT findings favor "dry lung" in acute respiratory distress syndrome.
Medscape Medical News, February 26, 2007 这篇研究文献去年就在《New england journal of medicine》发表了，结论当然是宣告了肺动脉导管和限液治疗的有限性。

Organ Donor Designation on Driver's License Frequently Ignored by Family
One fifth of families do not honor the patient's wishes for organ donation.
Medscape Medical News, February 23, 2007

Death in Severe Trauma May Be Result of Exhausted Cytokine Response
Early cytokine "storm" in trauma suggests a potential treatment approach to improve survival.
Medscape Medical News, February 22, 2007

Hypotension a Risk in Children on High-Dose Inhaled Albuterol
More than half of children who receive high-dose inhaled albuterol (or salbutamol) for respiratory distress develop diastolic hypotension, investigators at the University of Pittsburgh reported here this week.
Reuters Health, February 22, 2007  上述研究的结论让人痛心，为什么即使在发达国家经“科学”治疗之后的并发症也是这样恐怖，注意“大剂量”意味着药厂的收益——想起“沐舒坦”的那个生产厂家一直在宣扬单次应用或单日应用总量可达1000mg(这种药的包装是30mg/支)，按tid

应用也就100mg-300mg/日，简直不能用语言形容药厂的嘴脸了。

Protocol for Factor VIIa Reduces Costs, Increases Off-Label Use
Before the guidelines were implemented, dosing was often inappropriate; after the guidelines were implemented, more patients received fewer doses.
Medscape Medical News, February 21, 2007  诺和诺德公司的重组凝血因子VIIa ，怎么看怎么和lilly公司的活性蛋白C的市场推广一样，其实不能不说药厂和医生、患者应该是一条战线的，但是现在不知道药厂的股票收益/市场表现怎么和人民群众的健康脱节了呢？

Epoetin Alfa Halves Mortality in Critically Ill Patients
Recombinant epoetin alfa reduces mortality in critically ill patients by 48%, according to results from the EPO-3 trial; the reduction in mortality was called "surprising."
Reuters Health, February 21, 2007  又一个放卫星的药物，促红细胞生成素（EPO）。在德国的ICU，我问过他们的医生为什么他们没有考虑应用EPO，他们不知道怎么回答我。2年前我和科里的同事曾经考虑过该药的价值，为什么呢？因为贫血在ICU非常普遍，甚至就和感染/发热一样到了不被重视的地步，但是感染有抗生素，贫血呢，一般并不被临床医生重视，用EPO的几乎没有（实际1999年NEJM曾经发表过EPO增加ICU患者死亡率的报道，这也是我最后放弃研究的主要原因，其次那时候已经准备出国了），其次部分厂家的EPO产生了红细胞再障，因此也限制了临床应用。没有想到，哎，很多时候就是这样，不能把自己看扁了，认准一件事情坚持做下去就好了。

Lipid Diet Reduces Mortality and Risk for organ Failure in ICU
High eicosapentaenoic and linoleic acid content in diet appears to modulate the inflammatory cascade in the critically ill by changing cell membrane, blocking inflammation.
Medscape Medical News, February 20, 2007  含有二十碳五烯酸和亚油酸的饮食看来又是一轮免疫调理营养的开始。

最后，建议大家到http://www.sccm.org/SCCM/Conferences/Annual+Congress/ 下载这次会议的议程，其中 http://www.sccm.org/NR/rdonlyres/9291FC01-8D44-4478-8733-EEEE85E4E520/546/Congress_AdvanceProgram_Designer1.pdf 的文件应该下再看看，

在这个PDF文件中，提供了SCCM选定的全球知名专家组成的委员会名单，（World-Renowned Multiprofessional Faculty），总计约200名专家中，美国专家自然是占绝大多数，其次是加拿大的，再次是来自其他国家的，主要是欧洲的，这也说明欧洲的重症监护水平，令人吃惊的是比利时和以色列的专家竟各有3名！要知道澳大利亚也就2位，亚太地区也就澳大利亚，日本，香港和大陆还没有。以上美国/加拿大之外的专家名单如下，老黄我的Blog经常提到的几位欧洲专家都在，没想到我这里的老板也名列其中：

Lia Fluit MD, CRMG
Onderwijs Instituut
Bezoekadres Geert Grooteplein,
Netherlands

Djillali Annane, MD  激素替代治疗
Raymond Poincaré University Hospital
Garches, France

Daniel De Backer, MD, PhD
Erasme University Hospital
Brussels, Belgium

Greet Van den Berghe, MD, PhD  强化血糖控制
University Hospital Gasthuisberg
University of Leuven
Leuven, Belgium

Jean Chastre, MD
Hôpital Pitié-Salpêtrière
Paris, France

Julian Bion, MD
Queen Elizabeth Hospital
Birmingham, West Midlands,
Great Britain

Richard Bourne, PharmD
Royal Hallamshire Hospital
Sheffield, United Kingdom

Simon Finfer, MD, MBBS, MRCP
Senior Staff Specialist in Intensive Care
Royal North Shore Hospital of Sydney
University of Sydney
Sydney, Australia

Claudia Spies, MD
Charité Universitatmedizin Berlin
Berlin, Germany

Charles Sprung, MD, FCCM   目前也在从事激素替代治疗
Hadassah Medical Center
Jerusalem, Israel

Idit Matot, MD
Hadassah Hebrew
University Medical Center
Jerusalem, Israel

Graham Ramsay, MD, PhD
Maastricht University and Hospital
Maastricht, Netherlands

Marco Ranieri, MD
Universita di Torino Ospedale S.
Giovanni Battista
Torino, Italy

Jorge Neira, MD, FCCM
Sanatorio de la Trinidad
Ciudad de Buenos Aires, Argentina

Fleur Nooteboom, MD
Nederlandse Vereniging
voor Intensive Care
Beesel, Netherlands

Pierre Singer, MD
Rabin Medical Center
Petah Tikva, Israel