In last week’s journal club, we turned our gaze back to neuro critical care, with a paper that revisited the question of blood pressure control in acute intracerebral haemorrhage. It’s a scenario that is familiar to many of us; the systolic blood pressures well into the 200s in a patient with a new bleed in their head. Qureshi and colleagues have tried to revisit the question of what is the best way to respond to this through the ATACH2 trial (Antihypertensive Treatment in Acute Cerebral Haemorrhage II). The paper is available to read through the link below:

The ATACH2 Trial

The scene will be familiar to many of us; our patient is leaving the ICU after their brutal clash with sepsis. They were really, REALLY sick when they came in but you and the team have done an amazing job. Aggressive cardiovascular support, meticulous attention to lung protective ventilation, intensive physiotherapy – you’ve done a cracking job in maximising their chances and they’ve pulled through. They are now stepping down to the ward and it’s all smiles, best wishes and high fives around the room. Job well done team!

But wait, one of your junior trainees has pointed out that their 2 year mortality is actually quite affected by this illness, and they’re not out of the woods yet…

The mood darkens slightly. The party hats are taken off. Killjoy! Can’t we celebrate the little victories?

And yet this is where we are in intensive care medicine much of the time. A spell on the unit is hardly a spa weekend that renews your vigour and health – the acute illness process is just the start. This topic is the focus of the paper from our recent journal club, available open-access through the link below. Specifically, it looks at the impact of sepsis on our patients in the long term.

Prescott H et al. Late mortality after sepsis: propensity matched cohort study. BMJ. 2016. 353. i2375