Is atropine really required in addition to fentanyl & succinylcholine prior to intubation to prevent severe bradycardia in neonates?
We found yes...
Severe bradycardia during the whole procedure was signif > in placebo vs atropine group; RR 6.3(95% CI 1.2 - 34.1)
t.co/TKJovw24BQ
#NeoSky #PedSky
“The review… comments that without core knowledge of the pre-clinical subjects (such as pathology), it is not possible to apply mechanistic reasoning to complex health problems”
Agreed
Training to be a doctor is necessarily long because, simply put, medicine is complex
www.bmj.com/content/390/...
Her biggest lesson for the critical care community?
“Look beyond the patient”
Think about their support networks, their environment…
The things that make their life worth living.
#soa25
Fantastic presentation of the #GASTROSAM trial at #CCR25 - IV rehydration strategies for children with severe acute malnutrition & gastroenteritis. Amazing commitment to generating evidence in the hardest of circumstances incl a coup and flooding. Bravo! www.nejm.org/doi/full/10....
Figure 2. Oxygen Exposure and Arterial Oxygenation by Treatment Group in Patients With Enhanced Data Collection
Conservative oxygen therapy with a target SpO2 of 90% did not reduce 90-day all-cause mortality compared to usual oxygen therapy in mechanically ventilated adult patients.
#CCR25 @criticalcarereviews.com
https://ja.ma/4kG5gWK
16,500 patients randomised to #UKROXTrial presented just now at #CCR25 and simultaneously published in @jama.com
No difference in 90d mortality between target SpO2 88-92 with reduced exposure to supplemental O2 vs usual care
jamanetwork.com/journals/jam...
#CCR25 … here we go! Three days of deep discussion of the top trials in critical care. If you are not in the room, do connect via livestream - see criticalcarereviews.com
Figure 2. Total Protein and Calories
Augmenting enteral protein did not improve outcomes for critically ill patients compared with standard protein levels in the intensive care setting.
#CCR25 @criticalcarereviews.com
https://ja.ma/4kuYRxv
Early Intra-Aortic Balloon Support for Heart Failure-Related Cardiogenic Shock: A Randomized Clinical Trial
CCR Journal Watch - tracking the critical care literature daily
https://criticalcarereviews.com/latest-evidence/journal-watch
In the Altshock-2 randomized trial, routine early #IABP plus standard care, compared with standard care, did not significantly improve survival or successful bridging to heart replacement therapies in patients with heart failure–cardiogenic shock www.jacc.org/doi/10.1016/...
This is a fantastic paper from @intensiveperson.bsky.social and the team. Ten-year national study of risk factors and complications from arterial puncture/insertion of central lines.
Mandatory reading for anyone who inserts CVCs.
Really well done.
Right RCP Fellows! Voting for elections is now open. I am running for Clinical VP.
My election statement is here:
🧵
I am running for Clinical VP of the RCP.
For those who don't know me, here is a potted bio.
🧵
Profound septic shock is usually associated with mithocondrial dysfunction and relatively fixed low VO2 (one of the causes of hyperlactatemia, mithocondria aren’t using enough pyruvate even in presence of sufficient oxygen) while cardiogenic shock is usually a case of normal mithochondrial fnct.
An infographic on Vaccine-preventable diseases. Might as well start familiarizing ourselves with these. Made me feel better to put this together
We can disagree and still love each other unless your disagreement is rooted in my oppression and denial of my humanity and right to exist.
— James Baldwin
Reread this banger today. How often does one see an invited commentary that cogently and respectfully destroys the entire conceptual paradigm of the article it's critiquing? jamanetwork.com/journals/jam...
Mobilisation during ECLS - still controversial, depends on patient physiology - spectrum from contra-indicated to arguably essential for sustained recovery - key paper here.
#ECMO #MCS #ECLS
🚩 Just out in @thelancet.bsky.social 🚩
African Critical Illness Outcome Study
➡️ Describing the burden of critical care in Africa
➡️ 1 in 8 inpatients are critically ill
➡️ ~70% cared for on general wards
➡️ ~50 don't receive basic critical care interventions
doi.org/10.1016/S014...
I had the pleasure of teaching lung #pocus at a “train the trainers” course, with the ever excellent @avkwong.bsky.social and Cian McDermott as faculty
Some reflections from the day:
(1/n)
Very interesting piece. The data is eye-opening, even if it does reflect what’s noticeable day to day.
It's a horrendous flu season. It's killing kids, it's killing adults. It's killing people who were perfectly healthy before and people who, like most Americans, have chronic illness. It costs NOTHING to keep existing resources available. Our government is spending money to make Americans sicker.
ICU Pulmonary Embolism Review:
Kudos to the authors for reviewing PE management strategies:
Delighted to share the Barts echo team’s latest article
“Examining the Relationship Between Pulmonary Artery Acceleration Time and Pulmonary Artery Pressures in Patients with Ischemic Cardiogenic Shock”
Free to read for 50 days on the following link
www.sciencedirect.com/science/auth...
In light of the recent air crash in the US (and some somewhat startling proposed causes), it seems like time to roll out this classic from the late, great Dr. Richard Cook:
How Complex System Fail
how.complexsystems.fail
Love me a spritzer. 0.1mg adrenaline (1mL of an ALS mini jet) diluted into a 20mL syringe. Works for big people as well as little ones…
Great group talk by one of UCL CHIMERA's PhD students this morning - she's using maths to model mucus layers in the lung to understand the impact of critical illness and mechanical ventilation on lung function.
Such an interesting project!
www.ucl.ac.uk/chimera
Diagnosis and management of immune checkpoint inhibitor (ICI)-induced myocarditis.
#AnSky #MedSky #OncSky
https://buff.ly/40ATqW9
95% of my confidence interval interpretations include the correct interpretation for confidence intervals
