Thread by @gretchemaben

My final #SCCM2023 tweetucation session for today is “Late-Breaking Studies Affecting Patient Outcomes”!

First we have “Continued Enteral Nutrition Until Extubation Compared to Fasting Prior to Extubation in the Intensive Care Unit: A Clustered Randomized Trial” with Stephan Ehrmann (@stephanehrmann)! #SCCM2023

Nearly all ICUs impose some form of fasting before extubation, but this time seems to be decreasing. #SCCM2023

The fasting is done due to concern for aspiration risk during extubation. #SCCM2023

This study found that dysphasia was very common after extubation. #SCCM2023

Does the dysphasia matter clinically? Yes! #SCCM2023

But does fasting actually prevent aspiration? Maybe not! #SCCM2023

Fasting does have side effects! #SCCM2023

Background #SCCM2023

Study enrollment #SCCM2023

Intervention #SCCM2023

Randomization #SCCM2023

Primary outcome #SCCM2023

Results #SCCM2023

Patient characteristics #SCCM2023

Non-inferiority criteria were met. #SCCM2023

Secondary outcomes #SCCM2023

Extubation failure rates according to cluster #SCCM2023

Sensitivity analyses #SCCM2023

Conclusions #SCCM2023

Next we have “Weaning from Mechanical Ventilation in Intensive Care Units Across 50 Countries: The WEAN SAFE Prospective Observational Study” with Dr. TÃ i Pham. #SCCM2023

There is no unanimous definition of weaning. #SCCM2023

There is a lot of heterogeneity in weaning practices. #SCCM2023

Definitions #SCCM2023

Sedation scale #SCCM2023

Goals and questions #SCCM2023

Flow chart #SCCM2023

In the multi state analysis 65% were weaned #SCCM2023

Weaning groups #SCCM2023

Factors associated with delayed weaning Next steps #SCCM2023

Factors associated with failed weaning #SCCM2023

Next we have “Mortality as a Measure of Treatment Effect in Clinical Trials Recruiting Critically Ill Patients” with Jan Friedrich! #SCCM2023

Time and location-based mortality measures #SCCM2023

Nature of deaths may vary by time point. #SCCM2023

Issues in choosing mortality measures #SCCM2023

Objectives #SCCM2023

Methods #SCCM2023

Results #SCCM2023

Risk of bias #SCCM2023

Number of trials and duration of follow-up increased over time #SCCM2023

Mortality increased rapidly #SCCM2023

Incremental mortalities #SCCM2023

Limited clinical impact #SCCM2023

Summary #SCCM2023

Limitations #SCCM2023

Conclusions #SCCM2023

Next up is “Overt and Occult Hypoxemia in Patients Hospitalized with Novel COVID-19” with Shrirang Gadrey. #SCCM2023

Overt hypoxemia #SCCM2023

Solution #SCCM2023

Example of how the S/F ratio can catch a deterioration  - ePFR is better! #SCCM2023

Occult hypoxemia #SCCM2023

People want to do research on occult hypoxemia, but how can we do this research non-invasively? #SCCM2023

Study details #SCCM2023

Study design #SCCM2023

Cohort characteristics #SCCM2023

Overt hypoxemia analysis #SCCM2023

Overt hypoxemia: predictive validity for adverse outcomes #SCCM2023

Occult hypoxemia analysis #SCCM2023

Occult hypoxemia is not clearly revealed by SpO2 #SCCM2023

Study implications #SCCM2023

Next is “The Impact of Restrictive Transfusion Practices on Hemodynamically Stable Critically Ill Children Without Heart Disease: A Secondary Analysis of the ABC-PICU Trial” with Dr. Katherine Steffen! #SCCM2023

Risk of RBC transfusions may outweigh benefits #SCCM2023

Liberal transfusion persists despite evidence #SCCM2023

ABC-PICU secondary analysis #SCCM2023

Study groups and outcomes #SCCM2023

Propensity weighted regression to reduce confounding #SCCM2023

Cost analysis #SCCM2023

Results flow chart #SCCM2023

Study population characteristics #SCCM2023

The propensity-weighted cohort found no difference in the groups for the primary outcome #SCCM2023

Costs of care were lower in the compliant group #SCCM2023

Discussion #SCCM2023

Study limitations #SCCM2023

Conclusions #SCCM2023

Now we have “180-Day Outcomes in Critically Ill Patients with COVID-19 in the REMAP-CAP Randomized Clinical Trial” with Alisa Higgins! #SCCM2023

REMAP-CAP Study #SCCM2023

Enrollment protocol #SCCM2023

REMAP-CAP has 6 closed and reported domains #SCCM2023

Primary outcomes is a composite of in-hospital mortality and duration of organ failure support. #SCCM2023

Results #SCCM2023

Background and Aim #SCCM2023

Inclusion and exclusion criteria #SCCM2023

Methods #SCCM2023

Outcomes #SCCM2023

Statistical analysis #SCCM2023

Results #SCCM2023

Day 180 mortality was 36.9%. #SCCM2023

Patient characteristics #SCCM2023

IL-6 antagonists and antiplatelets were associated with better outcomes. Antiviral combination therapy and Hydroxychloroquine were associated with harm. #SCCM2023

There is a strong association between short-term and long-term outcomes #SCCM2023

Quality of life results were hard to obtain. #SCCM2023

Study limitations #SCCM2023

Conclusions #SCCM2023

Next is “Stepped Wedge Cluster Randomized Trial of Small-Volume Blood Collection Tubes to Reduce RBC Transfusion in the ICU” with Dr. Deborah Siegal (@DebSiegal)! #SCCM2023

Both anemia and transfusions lead to adverse outcomes. #SCCM2023

Lab testing does lead to significant blood loss. #SCCM2023

Small volume blood collection tubes may have a benefit! #SCCM2023

Rationale for a randomized trial #SCCM2023

Hypothesis #SCCM2023

Study design and population #SCCM2023

The intervention was a transition to small-volume tubes #SCCM2023

Outcomes #SCCM2023

Analysis #SCCM2023

Results #SCCM2023

Baseline characteristics #SCCM2023

Primary outcome of RBC transfusion was significant in all patients. #SCCM2023

Specimens with insufficient quantity were not higher with small-volume tubes. #SCCM2023

Change in hemoglobin - There was a smaller decrease with small-volume tubes. #SCCM2023

Conclusions #SCCM2023

Discussion #SCCM2023

Last we have “Development of Moral Injury in ICU Professionals During the COVID-19 Pandemic: A Prospective Serial Interview Study” with Niek Kok. #SCCM2023

What is moral injury? #SCCM2023

Moral injury vs moral distress #SCCM2023

What is already known?#SCCM2023

Causes of moral distress, moral injury, and burnout. #SCCM2023

Study methods #SCCM2023

What did we ask? #SCCM2023

Respondents #SCCM2023

Six themes were identified #SCCM2023

Results by timeline #SCCM2023

Conclusions #SCCM2023