Now @Manu_Malbrain arguing for the retirement of the surviving Sepsis guidelines #lives2018
The fall in Sepsis mortality hasn’t coincided with the introduction of the guidelines #lives2018 🤔
Is the pro-con debate of the surviving Sepsis guidelines nothing more than a liberal vs restrictive fluid argument? #Lives2018
The guidelines support lactate guided therapy...

However that’s full of holes intensivecarenetwork.com/understanding-… #lives2018
This is my bugbear with the guidelines.

30ml/kg is a lot of fluid.

The effect of a bolus is short lived and may be harmful... #lives2018
Fluid overload has multi-organ effects.

Tailored care, carefully titrate to response, may be better than a “one size fits all” bundle... @Manu_Malbrain #lives2018
A MAP target of 65 may not be the right one- we haven’t done trials to confirm this

(SEPSISPAM had a bunch of interesting secondary outcomes mind. thebottomline.org.uk/summaries/icm/…) #lives2018
The guidelines And bundles are based on a lot of correlative studies (Kumar and antibiotics, Seymour and bundles)

But correlation is not causation.

So you end up with recommendations based on low quality evidence #lives2018
Only 7% of current guideline recommendations are based on strong evidence

And if the bundles are so great, why was there a reversal on the implementation of the 1 hour bundle? #lives2018
Now in the opposing corner, Mitchell Levy #lives2018
He asks the question:

If your relative got sick, would you want them to go to a guideline positive hospital, or a free for all hospital?

Majority chose hospital 1

(Isn’t this a straw man argument @emcrit @avkwong @EMNerd_?) #lives2018
CLASS MOMENT.

Mitchell’s screen suddenly goes blank

Michell: “Manu, is that you?” #lives2018
This is a superb argument.

Our perceived adherence to guidelines isn’t as good as our actual adherence (ping @docpgb) #lives2018
Here is great data (soon to be published in @ATSBlueEditor ) showing an association with bundle compliance and improved Sepsis mortality

And a suggestion of a dose effect too (more compliance= better mortality) #lives2018
Hey @PulmCrit and @emcrit getting a pasting from Mitchell #lives2018

He didn’t appreciate the Darth Vader/Death Star/secret police comparisons 😉 emcrit.org/pulmcrit/ssc-p…
Shots fired at Mervin Singer!!!!

“He doesn’t let antibiotics be started by a resident without them calling him directly”

“WTF?”

-Mitchell Levy #lives2018

🤣
Mitchell accepts that identifying infection can be challenging in some patients jamanetwork.com/journals/jama/… #lives2018

That doesn’t mean we shouldn’t try to help the ones who turn out to be septic...

And giving a single dose of antibiotics doesn’t mean we need to continue it...
Mitchell Kevy clearing up some myths:

You don’t need to COMPLETE the one hour bundle in the first hour

Time zero for the most part now is accepted as time of presentation

#lives2018
Summary from Mitchell #lives2018
Rebuttal from @Manu_Malbrain:

Guidelines should remain guidelines.

They should never replace the mind of an attentive clinician.

Rebuttal from Mitchell Levy:

Local clinicians are the very people engaging with the guidelines.

#lives2018
“If clinicians are not reminded, they will fail to do the right thing” #lives2018
This is amazing- Mervin Singer is in the audience and is shooting down Mitchell Levy!!
U.K. data- NO CHANGE in Sepsis mortality despite the SSC guidelines

-Mervyn Singer #lives2018

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More from @iceman_ex

May 5, 2023
Is #POCUS a waste of time?

I thought I’d convert my recent talk at #accs2023 @CC_Symposium into a Twitter thread.

#foamed #FOAMcc
This is a difficult presentation to do as I have multiple conflicts of interest related to #POCUS - here they are:
Let’s start by actually defining #pocus

The most popular definition at the moment is probably this one from @Jose_Diaz_Gomez et al in NEJM

This sounds pretty good no? https://t.co/80u7xtlimYnejm.org/doi/full/10.10…
Read 27 tweets
Oct 6, 2021
Soon to be published in @yourICM:

A consensus statement on head to toe ultrasound skills in the general and neuro ICU population

Massive piece of work led by @AVBmir @chiara_robba and @avkwong

Building on stuff published here ccforum.biomedcentral.com/articles/10.11…

#lives2021
@yourICM @AVBmir @chiara_robba @avkwong After Delphi a decent consensus was reached- here are some summaries
1. Cranial ultrasound- TCCD guided PI is weakly recommended as a BASIC skill (over ONSD)
2. Lung US- strong recommendations for PTX, Effusion, and consolidation

#LIVES2021
@yourICM @AVBmir @chiara_robba @avkwong Airway ultrasound for intubation is weakly recommended AGAINST
Diaphragmatic excursion is weakly recommended FOR, with no consensus on diaphragmatic thickening
Lots of strong recommendations for LV assessment to be basic (including RWMA) with no consensus on TOE

#lives2021
Read 7 tweets
Oct 5, 2021
Ok. @esicm #lives2021 🔥 HOT TOPIC 🔥

Results of the HYPO-ECMO study- therapeutic hypothermia post cardiogenic shock requiring ECMO

clinicaltrials.gov/ct2/show/NCT02…
Physiological rationale and clinical question
Study design and end points

Primary =30 day mortality

#LIVES2021
Read 6 tweets
Oct 5, 2021
Now watching: @RKleinpell discussing digital strategies in family care

#LIVES2021
@RKleinpell Our changed visitation policies had…consequences #lives2021
@RKleinpell Katerina Iliopoulou on the consequences of restricted visiting… #LIVES2021
Read 5 tweets
Oct 5, 2021
Want to learn how to review a paper?

Check out @HalliePrescott on channel 7

Your first two questions should be:
1. Accept or reject?
2. How do I optimise this paper for acceptance?

Recommended reading: atsjournals.org/doi/10.1513/An…
@HalliePrescott Recommends learning from Jean-Luc Dumont on scientific communication presentationzen.com/presentationze…

#LIVES2021
@HalliePrescott Think about the core of the article:

What
How
Why

#LIVES2021
Read 15 tweets
Oct 4, 2021
So it’s our first HOT TOPIC

The convalescent plasma arm of @remap_cap

Currently on channel 1 at #lives2021
@remap_cap Inclusion criteria below

Intervention: 2u convalescent plasma vs standard care
Read 6 tweets

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