The Berlin definition of ARDS has been endorsed by the European Society of Intensive Care Medicine, the American Thoracic Society and the Society of Critical Care Medicine. It was first aired at the 24th Annual ESICM Conference in October 2011 (Watch Marco Ranieri discuss it here.) and we outlined it in December.

The new definition has been published in JAMA and is freely available here.

PulmCCM.org has provided a concise review of the key elements here.

Honour and integrity has prevailed! The PROWESS-SHOCK trial of Drotrecogin Alpha (activated) in septic shock has been published in this week's NEJM. It is a significant negative trial and fair play for not burying it (See ICN Reviews - The PROWESS of Xigris gets SHOCKed).

PROWESS was a MC-DB-PC-RCT published in 2001 and demonstrated a 6% absolute reduction in 28-day all-cause mortality in patients with severe sepsis (infection + SIRS + MOF). The greatest benefit was seen in the sickest patients, with an APACHE-II > 24. But almost immediately there were concerns.

• Results not replicated in less severe sepsis populations (APACHE-II < 24)
• Results not replicated in children with sepsis
• Concern over a change in the batch of cells used to produce the drug mid-way through the trial
• Concerns about the increased incidence of serious bleeding (3.5 percent vs. 2.0 percent, P=0.06)

So Marco Ranieri and his group set about evaluating the role of Drotrecogin Alpha in the sickest PROWESS population, which is the PROWESS-SHOCK trial.

For those of us with a secure job, this might come as good news. For those of us still flailing about in the temporary market, we might be a little worried.

The delicate issue of 24 hour in-house staffing by fully qualified intensivists has steadily lifted from a quiet back corridor whisper to a genuine topic of conversation. It has been part of the "jobs for post Fellowship intensivists" concerns at the last two New Fellow's Conferences, held in conjunction with the CICM Annual Scientific Meeting, and comes up at various CICM committee meetings. The major themes of clinical benefit to patients and the need to create positions for newly qualified intensivists appears to be pushing us inevitably towards a 24/7 model.