Critical Care Canada Forum was held in Toronto Canada from 25

Critical Care Canada Forum was held in Toronto Canada from 25 to 28 October 2009 [1]. pandemic The Critical Care Canada Forum 2009 featured several presentations describing the outcomes of critically ill Linifanib patients with H1N1 virus infection from Australia Mexico and Canada. Dr Jamie Cooper (Melbourne Australia) speaking on behalf of the Australia-New Zealand Intensive Care Influenza Investigators [2] described outcomes of 722 patients with confirmed H1N1 virus infection that were admitted to 187 intensive care units. Of these patients most (92%) were younger than age 65 and large proportions were pregnant (9.1%) or had a body mass index >35 (28.6%). The overall mortality rate (as of September 2009) was 14.3% (95% confidence interval = 11.7 to 16.9%). Nitric oxide inhaled prostacyclin and prone positioning were used frequently to treat refractory hypoxemia. Outcomes of 68 patients from bHLHb39 15 centres who were treated with extracorporeal membrane oxygenation were also described [3]. Illness severity was predictably very high in this group and the overall hospital mortality was 23% with most deaths due to haemorrhage. Dr Anand Kumar (Winnipeg Canada) and Dr Rob Fowler (Toronto Canada) presented data from the Canadian Experience [4]. Severe illness due to H1N1 infection Linifanib (confirmed or probable) occurred in 168 patients during a 4-month period. Similar to the Australian-New Zealand experience the cohort was young (mean age 32 years) and females children and the obese were disproportionally affected by severe illness requiring critical care. The overall mortality at 90 days was 17.3% (95% confidence interval = 12.0 to 24%). Notably one-quarter of cases involved First Nations Canadians Inuit M├ętis or aboriginals. Rescue therapies to treat refractory hypoxemia including nitric oxide and high-frequency oscillation were also commonly required in this group. Dr Guillermo Dominguez (Mexico City Mexico) next presented outcomes of 58 critically ill patients with H1N1 infection in Mexico [5]. This cohort was one of the first to be affected by the pandemic and mortality at 60 days was high (41.4% Linifanib 95 confidence interval = 28.9 to 55.0%). Together these presentations highlighted the potential importance of early treatment with neuraminidase inhibitors. Following the session 240 of the Critical Care Canada Forum delegates received the H1N1 vaccine through a team from the Toronto Public Health Department. Renal replacement therapy Dr Jamie Cooper (Melbourne Australia) also presented the recently published RENAL study (Randomized Evaluation of Normal vs. Augmented Level of renal replacement therapy in ICU) [6] on behalf of the Australian and New Zealand Intensive Care Society Clinical Trials Group and the George Institute for International Health. This study randomized 1 508 patients to receive either lower intensity (25 ml/kg body weight/hour) or higher intensity (40 ml/kg body weight/hour) post-dilution continuous venovenous haemodiafiltration. At 90 days mortality in both groups was the same (44.7%) (odds ratio = 1.00 95 confidence interval = 0.81 to 1 1.23; P = 0.99). Higher rates of hypophosphataemia were observed in the higher intensity group. Dr Cooper concluded that the results of this study and the recently published Veterans Affairs/National Institutes of Health Acute Renal Failure Trial Network study [7] which Linifanib produced similar findings suggest that higher intensity renal replacement therapy does not lead to lower mortality for critically ill patients. Intensive care unit follow-up programmes Dr Brian Cuthbertson (Toronto Canada) presented the PRaCTICaL study a UK multicentre randomized controlled trial of intensive nurse-led intensive care unit follow-up programmes versus standard care [8]. The intervention included clinic visits and a self-directed physical rehabilitation programme. In total 286 patients were included Linifanib and 192 completed 1-year follow-up. There was no evidence of a difference in the main outcome measure – health-related quality of life measured using the Short Form 36 questionnaire at 12 months. During the discussion following the presentation it was suggested that future studies should consider focusing on differently timed or differently structured programmes to improve long-term out comes of patients following intensive care unit discharge..