👇👇 Live Thread for the great topics of #C19marathon, 22/05/2021 - #COVID #ICU @ESICM 👉👉 Watch the conference live here: esicm.org/events/lives-c… 
Today, we'll be using the hashtag: #livesc19 for all content.
#livesc19 We'll kick off by looking at what went well and what we can do better together, accompanied by a global update on #COVID19. A focus on the science used to fight the pandemic and the successes/difficulties we had throughout the world. @DrMCecconi @msh_manu @strachanjamie
Follow @avkwong @iceman_ex @strachanjamie @TrishMcCready @FOAMecmo for the SoMe content throughout the day :-) #livesc19 #FOAMed #FOAMcc #COVID19
facebook.com/intensiveconne… is an alternative Live Video link for anyone getting involved with #livesc19 today :-) #FOAMed #FOAMcc
130,000 healthcare professionals united within @ESICM in a joint approach to #COVID19 across the world. We have enormous challenges ahead. We are better together. #livesc19
"A ventilator is not an ICU bed - an ICU bed is a team of healthcare professionals working together." @DrMCecconi #livesc19
Non-ICU front-line workers can avail of training with the "C19 Space Programme" #FOAMed #FOAMcc esicm.org/covid-19-skill… #livesc19
@WHO expert Dr Ann Lindstrand works in immunisation and updates us on #COVID19 Over 163 million cases worldwide and >3.3 Million Deaths austerely frames the topic... #FOAMed #FOAMcc #livesc19
"The science has been extraordinary" - many very safe vaccines rolled out in their billions.... #livesc19 - we have a lot of work yet to do... #COVID19 - the key is collaboration. The green map below needs to be a homogenous colour! @DrMCecconi
Huge distribution of vaccines across the world #COVID19 but 10 countries have administered 76% of all doses. "We are worried about the vaccine race" - of individual countries - it needs to be a global approach #livesc19
95% of member states (of @WHO) have commenced vaccination programmes - but the inequity is CLEAR - 16.5% of doses administered in countries that represent almost HALF of the world's population #livesc19 #COVID19
20% vaccine coverage in a country is a critical number - only Bhutan/Mongolia (of LMIC/LIC's) have achieved this #livesc19
Vaccine Rollout Challenges in #COVID19 #livesc19 - funding amongst serious problems.... This is COMPLEX work with multiple vaccines. Majority of countries use multiple vaccine types - this adds to coaching, admin and logistical requirements.
'At risk' age shift seen now, in Germany for example. Younger people more at risk of serious #COVID19 complications. Disruption of vaccine rollout is serious. #livesc19
Fascinating insights - general vaccine programmes (measles etc) have slowed down or been POSTPONED due to #COVID19 vaccine prioritisation:
80-90% of research can be considered 'wasteful'.... this is seriously problematic. "Random drugs to small numbers of people outside RCTs etc...." @msh_manu #livesc19
Lockdowns changed the trajectory of the pandemic. The UK learned from Italian lessons. #livesc19 #covid19
We know that there is a clear COVID infective pathway in the body now - it's cytotoxic to the cell and *can* lead to immune dysregulation: @msh_manu #livesc19
There are more asymptomatic and mild infections versus hospital admissions/serious disease. We know the general trajectory now. #livesc19 #covid19
We are trying to explore #COVID19 in the context of insufficient knowledge. We needed to embrace uncertainty and study it. We need to focus on things that assist BEDSIDE management. #livesc19
There is a serious shift in study numbers and participants - representing tremendous effort from all involved #livesc19 #covid19 @msh_manu
We have learned: NO to ivermectin, hydroxychloroquine, antivirals and ?remdesevir. Steroids in certain circumstances. #covid19 #livesc19 @ESICM @DrMCecconi @msh_manu
Clinical sequelae of #covid19 common to sepsis and critical illness. A HUGE opportunity for shared learning here. @msh_manu #livesc19 #foamed #foamcc
3200 submissions (75% increase) to @yourICM journal - we have managed to maintain academic integrity despite this! #covid19 #foamed #foamcc
Prof Nicole Juffermans now chairs our panel on Respiratory Failure! #livesc19
The traditional view of ARDS: #livesc19
But we need to look at the mechanisms of dysregulation and injury in #COVID19: severe endothelial injury, vascular thrombosis and *new vessel growth* - these are multitudes greater than ARDS #livesc19
Severe lung perfusion abnormalities in #COVID19 predict (to a degree) an increased risk of ICU and IMV. #livesc19 #foamed #foamcc
PEEP doesn't come without a cost - we need to consider the atelectotrauma and volutrauma etc #livesc19
Look at the bottom here - the transition of #COVID19 patients is very different vs standard ARDS #livesc19
A traditional approach to escalating interventions in ARDS: #livesc19
Dr Piquilloud kicks off a session on COVID ventilation - she highlights what our considerations should be: #livesc19 #foamed #foamcc
ARDS IS HETEROGENEOUS! Individualisation of settings is important. Focal v non-focal aspects (many misclassified) on CT/CXR can dictate treatments/strategies? #covid19 #livesc19
Aforementioned Type L patients might suit PEEP 8-10cmH20 and Type H might suit higher PEEPs? This still needs tested prospectively. #foamed #foamcc #livesc19
How were patients ventilated in 2020 (with #COVID19?) - 14075 patients over 26 studies:
What about ARDS rescue therapies in #COVID19? "Proning" appears to work and is safe. It improves oxygenation. #livesc19
In real life - proning was used a lot, followed by pulmonary vasodilators and then ECMO in a smaller amount... #livesc19 #foamcc #foamed
Some serious discussions around CPAP/NIV in deteriorating #COVID19 patients! Best practice is still suggested to perform such NIV in an HDU/ICU setting - but resources may dictate otherwise... *discuss!* #LIVESC19
A potential blindspot is that a lot of our very sick are cared for (expertly) outside an ICU setting, utilising CPAP/NIV - and this is often outside the data capture of ICM trials (and ICNARC in the UK) that frame this into useful information. @iceman_ex @avkwong @Wilkinsonjonny
@susannaprice "no kneejerk reactions without the evidence" - WRT IVIG, aspirin etc in #COVID19 patients.
How does the heart respond to #COVID19?
Loss of radial function and VA uncoupling seen in the right heart in #COVID19 - this is unlike the 'ARDS right heart' @susannaprice
Fascinating - 141 countries, 6 countries, 80% reported a reduction of STEMI presentations during pandemic - and many presenting after the optimal treatment window. Reasons: degree of lockdown, levels of COVID admitted to hospital, restructure of cardiology units. #livesc19
Are the components of #COVID19 within ICU that much different from more traditional critical illnesses? @ElieAzoulay5 #livesc19
Dr. Herridge delves into the post-COVID19 conditions. #LIVESC19
High ICU mortality (55%) in Brazil and high admissions (39%) - "COVID is a different disease in different healthcare and social constructs" #livesc19
In intubated patients post-COVID, they have (obviously - but some surprising) different outcomes versus non-intubated patients.... #livesc19 MANY people are re-hospitalised. "Return to normal" is challenging +++ (medical, psychological, financial)
This study made me think about how we deal with things that matter to the survivor patients - from hair loss to sleep difficulties. #livesc19
ENORMOUS impacts on delirium, and one might hypothesise, long-term cognitive function. The battle within polypharmacy is very real.
*Unknown* long term trajectories in COVID19 - a multi-system and complex problem. #livesc19 - can we learn lessons from our ARDS patients? Yes.
"It is very difficult to distinguish covid pneumonia from other pneumonia" We need excellent antimicrobial stewardship. #LIVESC19 Two "ifs and whens" to start abx -->
Co-infection with bacteria at ICU admission stage is VERY difficult to ascertain. But... 28% (limited data) COVID patients had co-existing infection. Look at the % of patients on broad spectrum abx with COVID-19! #livesc19 90% of ICU patients and 72% of hospital pts.
A ook at ICU acquired infections #livesc19
Final thoughts of abx use are common throughout ICU presentations - but some data considerations here - high risk of VA-LRTI after 1 week ICU stay as well as low rate of co-infections at ICU admission. #LIVESC19
Prof. Garyphalia Poulakou is taking us through living reviews and metanalysis of bacterial infections in COVID-19 patients. She highlights the overlapping clinical features of COVID-19 and bacterial pneumonia.
Great insights into how we can predict superinfections in #COVID19 patients. We can all reflect on these issues in ICU #livesc19 #foamed #foamcc
How to investigate the COVID-19 patient with suspected co-infection --> #livesc19
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