Discover and read the best of Twitter Threads about #sepsis
Most recents (24)
We've just presented and published a multicenter RCT at #CCR23 and in @JAMA_current!
Continuous vs Intermittent Meropenem Administration in Critically Ill Patients with Sepsis: The #MERCYtrial!
🔗 jamanetwork.com/journals/jama/…
This 🧵 will explain the study in detail /11
#FOAMcc
Continuous vs Intermittent Meropenem Administration in Critically Ill Patients with Sepsis: The #MERCYtrial!
🔗 jamanetwork.com/journals/jama/…
This 🧵 will explain the study in detail /11
#FOAMcc
2/
β-lactams (e.g., #meropenem), are typically given intermittently, but continuous administration can provide constant serum levels and may improve outcomes.
In fact, several meta-analyses reported reduced mortality when administered continuously.
β-lactams (e.g., #meropenem), are typically given intermittently, but continuous administration can provide constant serum levels and may improve outcomes.
In fact, several meta-analyses reported reduced mortality when administered continuously.
3/
Therefore, we conducted a multinational, double-blind, randomized controlled trial to test the hypothesis that continuous administration of #meropenem, compared with intermittent administration, would improve clinically relevant outcomes in critically ill pts with #sepsis
Therefore, we conducted a multinational, double-blind, randomized controlled trial to test the hypothesis that continuous administration of #meropenem, compared with intermittent administration, would improve clinically relevant outcomes in critically ill pts with #sepsis
📢 Tweetorial on sepsis -endotoxin- cytokine cascade
👉Pathogen invasion in body
👉Pathogen expresses certain molecular patterns or
endotoxins called pathogen-associated molecular patterns (PAMPs)
👉
PAMPs are recognized by toll-like receptors expressed by
neutrophils
👉Pathogen invasion in body
👉Pathogen expresses certain molecular patterns or
endotoxins called pathogen-associated molecular patterns (PAMPs)
👉
PAMPs are recognized by toll-like receptors expressed by
neutrophils
👉 Activation of innate immunity and leukocytes
👉Release of cytokines - pro +
anti-inflammatory(interleukins 1, 6, 8, 10 &
tumor necrosis factor)
👉 Dysregulated host
response to infection - organ failures
👉 Immunoparalysis, reinfection,
hospital-acquired infections
👉Release of cytokines - pro +
anti-inflammatory(interleukins 1, 6, 8, 10 &
tumor necrosis factor)
👉 Dysregulated host
response to infection - organ failures
👉 Immunoparalysis, reinfection,
hospital-acquired infections
Futher in the thread , extracorporeal therapies targeted at each level of sepsis cascade would be discussed 👇
nejm.org/doi/full/10.10…
ncbi.nlm.nih.gov/pmc/articles/P…
nejm.org/doi/full/10.10…
ncbi.nlm.nih.gov/pmc/articles/P…
1/
🎬 Now on stage Professor @giovannilandoni talking about what we DON'T KNOW about #cardiocirculatory drugs
✅ #Norepineprhine is the most used vasoactive drug in the guidelines for:
🔹 #sepsis
🔹#cardiogenic shock❗(Scandinavian)
BUT...
@Smart_Meeting_M @SRAnesthesiaICU
🎬 Now on stage Professor @giovannilandoni talking about what we DON'T KNOW about #cardiocirculatory drugs
✅ #Norepineprhine is the most used vasoactive drug in the guidelines for:
🔹 #sepsis
🔹#cardiogenic shock❗(Scandinavian)
BUT...
@Smart_Meeting_M @SRAnesthesiaICU
2/
BUT... #Norepineprhine (base) does not exist❗
🚫 base is not soluble, unstable and unable to reach target receptors
💡 Let's make it a salt!
🤔 But which one?
⚠️ Available Norepineprhine salts has different #dilution
⚠️ Sometimes with misleading #labeling
BUT... #Norepineprhine (base) does not exist❗
🚫 base is not soluble, unstable and unable to reach target receptors
💡 Let's make it a salt!
🤔 But which one?
⚠️ Available Norepineprhine salts has different #dilution
⚠️ Sometimes with misleading #labeling
3/
➡️ Please do not change you're clinical practice for this ⬅️
But consider the possible implications on:
🔹Second line drugs initiation
🔹Co- administration of other vasopressors
❗Comunication of your results!!!
pubmed.ncbi.nlm.nih.gov/36978126/
#FOAMed #FOAMcc
➡️ Please do not change you're clinical practice for this ⬅️
But consider the possible implications on:
🔹Second line drugs initiation
🔹Co- administration of other vasopressors
❗Comunication of your results!!!
pubmed.ncbi.nlm.nih.gov/36978126/
#FOAMed #FOAMcc
Next up: Dr Elizabeth Munroe, when do we add vasopressors in #sepsis ?
#ATS2023 @atscommunity
Early vasopressors will:
- control shock faster
- allow leas fluids
Look up the #CENSER and #CLOVERS trials
#ATS2023 @atscommunity
Early vasopressors will:
- control shock faster
- allow leas fluids
Look up the #CENSER and #CLOVERS trials
In #CLOVERS restrictive fluid groups show no difference in major outcomes compared to liberal group
How do we administer vasopressors?
Do we always need a CVC?
Check out the reviews 👇🏻
Do we always need a CVC?
Check out the reviews 👇🏻
Dr Ivor Douglas discussing pathophysiology of IV fluids and vasopressors in #sepsis
#ATS2023
Follow below for highlights!
@atscommunity
#ATS2023
Follow below for highlights!
@atscommunity
Too much or too little fluids can have consequences.
What is the optimal range for fluids?
What is the optimal range for fluids?
Excess fluid balance (> 5L in 1st day) is associated with increased mortality
Will you be watching ‘Jason & Clara: In Memory of Maudie’ this evening at 9pm on ITV1?
We’ll be live tweeting during the programme using the hashtag #InMemoryofMaudie. Follow along in the thread below
We’ll be live tweeting during the programme using the hashtag #InMemoryofMaudie. Follow along in the thread below
‘Jason & Clara: In Memory of Maudie’ is now showing on ITV1 & ITVX.
UKST CEO @SepsisUK said: “We’re so grateful to our ambassador Jason, & Clara for bravely telling the story of #Maudie to help raise awareness about #sepsis and save lives.”
Find out more: sepsistrust.org/maudie/
UKST CEO @SepsisUK said: “We’re so grateful to our ambassador Jason, & Clara for bravely telling the story of #Maudie to help raise awareness about #sepsis and save lives.”
Find out more: sepsistrust.org/maudie/
@SepsisUK “I know it seems macabre but by sharing it, it somehow maybe it unburdens me a bit or certainly it's sort of saying she existed and was alive, she’s not just wherever she is now.” – @Jason__Watkins
Share your own #sepsis story to help raise awareness: voices@sepsistrust.org
Share your own #sepsis story to help raise awareness: voices@sepsistrust.org
🧵1/Most people don’t know that everyday cuts & infections can lead to life threatening sepsis, amputation or death
New, rapid diagnostic tests are available to get the right treatment early, but docs need to start using them
insider.com/rick-bright-wa… @thisisinsider @Hilarx #AMR
New, rapid diagnostic tests are available to get the right treatment early, but docs need to start using them
insider.com/rick-bright-wa… @thisisinsider @Hilarx #AMR
2/ Failure to accurately diagnose bacteria / fungi early, often leads to delayed / wrong treatment. Every minute of delay increases severity of the infection; it’s spreading in your body
Wrong meds can make the problem worse for you & for the world, increasing drug resistance
Wrong meds can make the problem worse for you & for the world, increasing drug resistance
3/ We are losing the battle against drug resistant bacteria & fungi. Fewer drugs work on every day infections. More people are dying of sepsis. R&D funds for new drugs is shrinking.
It’s truly a silent pandemic that is closing around us.
It’s truly a silent pandemic that is closing around us.
“Ten tips to optimize #vasopressors use in the critically ill patient with #hypotension.” #IntensiveCare #MedTwitter #CardioTwitter #sepsis #FOAMed #FOAMcc #CriticalCare #EmergencyMedicine #PedsICU #ICU #EMCCM
📚 Intensive Care Med (2022) 48:736–739 rdcu.be/c57Se
📚 Intensive Care Med (2022) 48:736–739 rdcu.be/c57Se
1. Set goals of mean or diastolic blood pressures.
2. Individualize the arterial pressure targets goals.
3. Vasopressors induce an endogenous fluid recruitment and may limit positive fluid balance.
4. Reassess fluid status and cardiac output after initiation of vasopressors
2. Individualize the arterial pressure targets goals.
3. Vasopressors induce an endogenous fluid recruitment and may limit positive fluid balance.
4. Reassess fluid status and cardiac output after initiation of vasopressors
5. Consider agents with a different mechanism of action as a second line agent.
6. Consider adding hydrocortisone in patients on high doses of vasopressors.
7. Vasopressin is an option in patients with right ventricular failure.
8. There is no maximal dose of vasopressors.
6. Consider adding hydrocortisone in patients on high doses of vasopressors.
7. Vasopressin is an option in patients with right ventricular failure.
8. There is no maximal dose of vasopressors.
1/5 "In healthy individuals, normal #body #temperature is variable and has decreased consistently since the 1860s."
atsjournals.org/doi/10.1164/rc…
atsjournals.org/doi/10.1164/rc…
2/5 "The #gut #microbiome is a key modulator of body temperature variation both in #health and critical illness, and is thus a major, understudied target for modulating #physiologic #heterogeneity in #sepsis."
3/5 The Carrington Event was the most intense geomagnetic storm in recorded history, peaking from September 1 to September 2, 1859 during solar cycle 10.
1/ *Re-consult 📞*
You: What did the last consult note say?
Them: I don't know how to interpret it...
*reading the ✍️ yourself*
#Sepsis
- send tick serologies
- start broad-spectrum antibiotics
- we will follow up OSH data
You: 🤦 I feel you... We'll see the patient again.
You: What did the last consult note say?
Them: I don't know how to interpret it...
*reading the ✍️ yourself*
#Sepsis
- send tick serologies
- start broad-spectrum antibiotics
- we will follow up OSH data
You: 🤦 I feel you... We'll see the patient again.
2/ You wonder...
💭 What tick serologies were we referring to?
💭 What antibiotics were we wanting to start?
💭 And which OSH has prior records?
And you're not the only one wondering...
How can we ✍️ more effective notes?
💭 What tick serologies were we referring to?
💭 What antibiotics were we wanting to start?
💭 And which OSH has prior records?
And you're not the only one wondering...
How can we ✍️ more effective notes?
I work in a private nursing healthcare facility,since the elderly had their FIFTH jab 6-8 weeks ago,we have lost 8-10 residents,more having to go into hospital.All supposedly ending with #sepsis - very strange. Keep your ears peeled @FatEmperor @JohnBoweActor
Just to say,no this isn’t a lie,obviously I can’t 100% the cause,but we usually have a more frequent rate of residents passing away Dec/Jan,not Oct/Nov,many ‘found’ dead, not expected.following Jab,frequent chest infections,inc staff.I am only one not jabbed
I also on the day the jabs were administered had an argument with the nurses administering them,as I told every resident it was their choice wether to have it. They said I was fearmongering, I told them exactly what I thought.Made the head nurse think.
NEXT: Who's "high risk" in ICU? Nicolas Bennett - Zurich, Switzerland.
reminds me of NELA score development in UK.
Declaration : he now works for industry (known side effect for medics doing data science )
@ESICM #criticalcare #ai #datascience #LIVES2022
reminds me of NELA score development in UK.
Declaration : he now works for industry (known side effect for medics doing data science )
@ESICM #criticalcare #ai #datascience #LIVES2022
@ESICM Interesting : eventually end up writing R package. cran.r-project.org/web/packages/r…
#sepsis classification using MIMIC-3 - time series data. Time-series classficiation.
#sepsis classification using MIMIC-3 - time series data. Time-series classficiation.
It is World Sepsis Day.
Guess what❓ #Sepsis kills 11 million people each year, many of which are young children & other vulnerable populations in low-income countries.
Learn more 👉bit.ly/3bIsUiE
Guess what❓ #Sepsis kills 11 million people each year, many of which are young children & other vulnerable populations in low-income countries.
Learn more 👉bit.ly/3bIsUiE
Anyone with an infection can develop #sepsis. But some people are more at risk. These are:
🔸Pregnant women
🔸Newborns
🔸The elderly
🔸The immunosuppressed People with chronic diseases
🔸Hospitalized patients
🔸Pregnant women
🔸Newborns
🔸The elderly
🔸The immunosuppressed People with chronic diseases
🔸Hospitalized patients
The symptoms of #sepsis include:
🔸Fever or shivering
🔸Confusion
🔸Shortness of breath
🔸Rash that does not fade when pressed
🔸Extreme discomfort
🔸Sweaty skin
Seek medical care as soon as possible when an infection is not getting better.
🔸Fever or shivering
🔸Confusion
🔸Shortness of breath
🔸Rash that does not fade when pressed
🔸Extreme discomfort
🔸Sweaty skin
Seek medical care as soon as possible when an infection is not getting better.
Racial bias in temporal (forehead) thermometers🌡
Out @JAMA_current @JAMANetwork
ja.ma/3cLF53j
23% relative reduction in fevers detected in Black patients w/ temporal compared to oral thermometers
Another medical device that could be failing our patients
(1)
Out @JAMA_current @JAMANetwork
ja.ma/3cLF53j
23% relative reduction in fevers detected in Black patients w/ temporal compared to oral thermometers
Another medical device that could be failing our patients
(1)
Cohort: All patients w/suspected infection🦠from 4 hospitals
Paired oral & temporal temperatures within 1 hour of each other🌡️
Eval of association between fever (>38°C) & route of measurement adjusting for age hospital & comorbidities in Black patients & White patients
(2)
Paired oral & temporal temperatures within 1 hour of each other🌡️
Eval of association between fever (>38°C) & route of measurement adjusting for age hospital & comorbidities in Black patients & White patients
(2)
Figure shows odds of fever w/ temporal thermometers (oral = reference) in Black & White patients
Horizontal line at 1.0 = no difference in fevers w/ temporal vs oral
@ varying fever cutoffs Black patients had⬇️odds of having fever detected w/ temporal thermometers
(3)
Horizontal line at 1.0 = no difference in fevers w/ temporal vs oral
@ varying fever cutoffs Black patients had⬇️odds of having fever detected w/ temporal thermometers
(3)
New WHO-@UNICEF report reveals 50% of healthcare facilities around the world 🌏🌍🌎 lack basic hygiene services with water & soap or alcohol-based hand rub.
Read more 👉bit.ly/3CJoLL2
Read more 👉bit.ly/3CJoLL2
Without access to basic hygiene services, more than 3.8 billion people face greater risk of infection while using these facilities.
Read more 👉bit.ly/3CJoLL2
Read more 👉bit.ly/3CJoLL2
Hygiene in healthcare facilities is key to pandemic recovery, prevention and readiness. The basics include:
🚰 safe water
🚽 clean toilets
🚮 safely managed waste
Read more 👉bit.ly/3CJoLL2
🚰 safe water
🚽 clean toilets
🚮 safely managed waste
Read more 👉bit.ly/3CJoLL2
#Sepsis tötet - und wir schauen zu.
Ein Thread mit anschaulichem Beispiel.
Eine der gefährlichsten #Diagnosen in der (#Notfall-)Medizin ist die "Verschlechterung des Allgemeinzustandes" (AZ-Verschlechterung). Und das aus 2 Gründen:
Ein Thread mit anschaulichem Beispiel.
Eine der gefährlichsten #Diagnosen in der (#Notfall-)Medizin ist die "Verschlechterung des Allgemeinzustandes" (AZ-Verschlechterung). Und das aus 2 Gründen:
1. es scheint keine konkrete Ursache für den aktuell schlechten Gesundheitszustand benannt werden zu können & es kann "alles" dahinterstecken.
2. Durch die Bezeichnung AZ-Verschlechterung werden teilweise lebensbedrohliche Erkrankungsbilder im Alltag verharmlost.
2. Durch die Bezeichnung AZ-Verschlechterung werden teilweise lebensbedrohliche Erkrankungsbilder im Alltag verharmlost.
This work was done in partnership with Dr. Vinnie Liu of @KPDOR, with funding from @AHRQNews, support from @vahsrd, and led by our awesome teams @VA_CCMR & @KPDOR. I can't say thank you enough for the support and to the awesome teams behind this work.
#Sepsis Guidelines, QI programs, and performance evaluation all recommend and/or incentivize prompt antimicrobial treatment for sepsis because earlier time-to-treatment is associated with improved outcomes.
Und da ist es mir passiert: Ein Patient mit Unterarmphlegmone, bestehendem Drogenabusus und ungepflegtem Zustand steht zur OP im Dienst an. Eine kurze Fallbeschreibung als Reminder💡
Er kam fahrig, unruhig und tachykard in den OP.
🧵(1/4)
Er kam fahrig, unruhig und tachykard in den OP.
🧵(1/4)
Schublade: entzügiger Drogi, na toll 🙄
Narkose gut überstanden, im AWR weiter tachykard und unruhig, RR nach Volumenstubstitution normwertig aber weiter tachykard und kaltschweissig. Na toll: Entzug geht richtig los. Methadon von Station besorgt und…
(2/4)
Narkose gut überstanden, im AWR weiter tachykard und unruhig, RR nach Volumenstubstitution normwertig aber weiter tachykard und kaltschweissig. Na toll: Entzug geht richtig los. Methadon von Station besorgt und…
(2/4)
Clonidin - Patient jetzt etwas entspannter: ab auf Station, ist ja jetzt auch schon spät. 🥱🕐
Stunde später Anruf von der Dienstärztin von Station: Patient weiter tachykard, jetzt hypoton und BZ schlecht ➡️ Übernahme auf ICU. Labor mit akutem Nierenversagen, PCT hoch, …
(3/4)
Stunde später Anruf von der Dienstärztin von Station: Patient weiter tachykard, jetzt hypoton und BZ schlecht ➡️ Übernahme auf ICU. Labor mit akutem Nierenversagen, PCT hoch, …
(3/4)
Al parecer Emmanuel Rivers tenía conflicto de interés en su estudio de EGDT, en 1997 había mandado a la oficina de patentes de 🇺🇸 un dispositivo para medir SvO2 continua (🧵 1/4) #FOAM #FOAMcc #sepsis #Emergency
Sus metas tempranas como sabemos consistían entre otras en mantener una SvO2>70 (con monitoreo continuo🧐) ya sea con líquidos inotrópicos o hemoderivados, excluyeron 27 pac 13 del grupo EGDT y 14 del grupo control porque “no completaron 6 hrs” (2/4)
Sus resultados fueron biológicamente improbables, el perfil hemodinámico de SvO2⬇️ con TAM⬆️ en sus datos basales es atípico para sepsis, casi todos los sépticos tienen SvO2 ⬆️ (3/4)
#Sepsis hat keine Lobby. Ist das ein Problem? Klar!
#Sepsis tötet! Und das gar nicht selten. Die Sepsis gehört zu den häufigsten Todesursachen in D.
Die gute Nachricht: d. Verlauf einer Sepsis kann durch frühes Erkennen & rasches Behandeln positiv beeinflusst werden.
Thread 1/23
#Sepsis tötet! Und das gar nicht selten. Die Sepsis gehört zu den häufigsten Todesursachen in D.
Die gute Nachricht: d. Verlauf einer Sepsis kann durch frühes Erkennen & rasches Behandeln positiv beeinflusst werden.
Thread 1/23
Deshalb ist es wichtig, dass alle mal was davon gehört haben und zumindest grob wissen, worum es hierbei geht.
Also gibt es jetzt und hier für Laien und medizinisch Interessierte diesen kleinen Thread zum Thema #Sepsis. #einfachMedizin
2/x
Also gibt es jetzt und hier für Laien und medizinisch Interessierte diesen kleinen Thread zum Thema #Sepsis. #einfachMedizin
2/x
#Sepsis wird auch als Blutvergiftung bezeichnet. Sie kann durch jede Infektion ausgelöst werden; also z.B. Lungenentzündung, Entzündungen im Bauch, den Harnwegen od. auch Infektionen, die entstanden sind, weil man sich verletzt hat & Erreger in d. Körper eingedrungen sind.
3/x
3/x
#Pneumonia is the #1 infectious killer of kids – killing > 40,000 in #Somalia, #Guinea, #SouthSudan & #Chad in 2019
Introducing #PCV 💉would dramatically save lives - 92,000 by 2030!
What must be done: bit.ly/3ggUA1g
#EveryBreathCounts #VaccinesWork #AUSummit
🧵 1/
Introducing #PCV 💉would dramatically save lives - 92,000 by 2030!
What must be done: bit.ly/3ggUA1g
#EveryBreathCounts #VaccinesWork #AUSummit
🧵 1/
More than half of child #pneumonia deaths are in countries with < 60% #PCV coverage. These kids are paying with their lives!
These govts👇must introduce & protect >90% children with #PCV by 2025
More 👉 bit.ly/3ggUA1g
#EveryBreathCounts #VaccinesWork #AUSummit
2/
These govts👇must introduce & protect >90% children with #PCV by 2025
More 👉 bit.ly/3ggUA1g
#EveryBreathCounts #VaccinesWork #AUSummit
2/
Introducing the #PCV 💉in #Somalia could avert 32,600 child deaths from #pneumonia, #meningitis & #sepsis
Prevention is key where just 23% of kids with pneumonia symptoms are taken for care. bit.ly/3ggUA1g
#EveryBreathCounts #VaccinesWork #AUSummit @MoH_Somalia
3/
Prevention is key where just 23% of kids with pneumonia symptoms are taken for care. bit.ly/3ggUA1g
#EveryBreathCounts #VaccinesWork #AUSummit @MoH_Somalia
3/
Do you know all of these nuances of #pleuraldisease? Why is an #empyema distinct from a complicated #parapneumoniceffusion? What is #contarinisyndrome #explosivepleuritis #chyliform #pseudochylous? Are all #chylothorax milky? #pccm #pulmcrit #pulmonary
#pleuraldisease is fascinating and nuanced. First step is #lightscriteria which give favor to finding #exudates which tend to be more urgent. You only need one criterion, which maximizes #sensitivity. Meaningless statement: "It's an exudate only by protein." One criterion=exudate
(Like on Tinder, the more criteria you require, the more you narrow your pool, compromising sensitivity for specificity.) Transudates I will skip over. Most common #exudate is #parapneumoniceffusion #PPE. If there is or is likely to be #pneumonia, it's PPE. Next task is to...
Review the Executive Summary to see how the updated guidelines were developed and how they differ from the 2016 guidelines: bit.ly/3wuDOmw
#SurvivingSepsis
#SurvivingSepsis
As #MedTwitter regulars, you may have already heard that the #SurvivingSepsis Campaign has released the updated 2021 version of the International #Guidelines for Management of #Sepsis and #SepticShock!
But have you gone thru the updates yet?
A #Tweetorial (1/x):
But have you gone thru the updates yet?
A #Tweetorial (1/x):
There are 93 #recommendations made in the new publication. I don’t have time to write (or read) that kind of #Tweetorial and neither do you. That’s what the publication is for -> journals.lww.com/ccmjournal/Cit… !
But let’s hit the ✨highlights✨ starring Table 1: (2/x)
But let’s hit the ✨highlights✨ starring Table 1: (2/x)
Why we care (and we care so much!): Sepsis and septic shock affect millions of people globally each year, and kills somewhere between 1/6 and 1/3 of those diagnosed with the #syndrome. 1/3!!! 😳😢 (3/x)
