Get ready for some tweet-ucation with "Critical Care Year in Review 1"! #CHEST2021 1/
First up is Dr. Robert Hyzy(@bhyzy) with "Update in ARDS". #CHEST2021 2/
We are seeing an increase in ARF and higher mortality in black, non-urban, and older patients. #CHEST2021 3/ Image
This is the Berlin definition for ARDS. Note at the bottom that they specify these requirements can be met with NIV. #CHEST2021 4/ Image
The Berlin definition may need to be modified to include HHFNC. #CHEST2021 5/ Image
This study showed that awake proning in COVID-19 decreases intubation rates. #CHEST2021 6/ ImageImage
Low TiV with proning was better than low TiV with high PEEP, so consider proning early. #CHEST2021 7/ Image
Low tidal volumes have the most benefit when there is low compliance. #CHEST2021 8/ Image
Both driving pressure and mechanical power correlate with mortality when you re-analyze the data from old studies. #CHEST2021 9/ Image
The change in driving pressure has more of an association with mortality than an increased PaO2/FiO2 ratio. #CHEST2021 10/ Image
Driving pressure is at least 4 times as important as the RR in how much damage the vent inflicted. #CHEST2021 11/ Image
Summary slide! #CHEST2021 12/ Image
Next up is Dr. David Bowton (@David Bowton) with "Neuro Critical Care in Review". #CHEST2021 13/
This study analyzed thrombectomy >6 hours later for CVA and found improvements in mRS. #CHEST2021 14/ ImageImageImageImage
Thrombectomy up to 24 hours after last known normal can be effective in improving patient outcomes. #CHEST2021 15/ Image
There are numerous studies comparing alteplase and teneteplace. #CHEST2021 16/ Image
Why should you care? Tenecteplace is cheaper and easier to administer. #CHEST2021 17/ Image
This meta-analysis has some potentially misleading conclusions in the article.35% of the patients >60yo in this study came from a trial that was withdrawn from publication. #CHEST2021 18/ ImageImageImageImage
This review looked at goal BP in ICH. No benefit to SBP goal <130. Optimal BP targets and timing remain somewhat uncertain. #CHEST2021 19/ ImageImage
The Divani article found that big BP changes were associated with worse outcomes. #CHEST2021 20/ ImageImage
This study looked at temperature management post-CPR for non-shockable rhythms. Targeting normothermia appears equivalent to cooling to 33 degrees C. #CHEST2021 21/ ImageImageImage
This study also agrees with the above conclusion. #CHEST2021 22/ Image
TTM and expert assessment prior to consideration of withdrawal of life support leads to higher survival. #CHEST2021 23/ Image
Last up is Dr. Steven Simpson (@sqsimp) with "Sepsis 2021" #CHEST2021 24/
The surviving sepsis campaign published 2021 guidelines. #CHEST2021 25/ Image
These are the updates in the new surviving sepsis guidelines. #CHEST2021 26/ ImageImage
Infection Updates #CHEST2021 27/ ImageImageImage
Summary Chart #CHEST2021 28/ Image
Updates in hemodynamic management. For septic shock resuscitation they suggest (weak recommendation) using balanced crystalloids instead of NS. #CHEST2021 29/ ImageImage
Updates in ventilation. #CHEST2021 30/ Image
Updates in additional therapies. #CHEST2021 31/ Image
New section on long-term outcomes and goals of care! #CHEST2021 32/ Image
This study on SEP-1 found that there was an improvement in mortality if you did receive the bundle, regardless of the likelihood for compliance. #CHEST2021 33/ ImageImage
Thanks for joining us for this great review! #CHEST2021 34/34

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More from @gretchemaben

Oct 2
Today I took a Freedom Trail tour in Boston and learned a lot. Read on to brush up on some history!
William Blackstone signed up for an expedition to come from England to North America in the mid-1620s. He sets up a farm in what is now Boston.
The king of England and the church were not getting along in 1630, so people came over because they wanted a more strict church (puritans) and landed in Charleston, which is marshland.
Read 64 tweets
Sep 9
Here’s something I don’t understand. If I had $10 million invested with a 4% return, I would have $400,000 in interest every year. Even with my mortgage and taxes and a new car every year, I could still buy all the books, take incredible care of my pets, and travel the world. 1/
This amount would also be more than enough to completely retire and open my animal sanctuary which would be self-sustaining (I have it all planned out). And of course this would be without even touching the principal balance. 2/
Don’t get me wrong, I have absolutely no intent of ever having this kind of money. But here’s what I don’t understand - why in the world are we giving all these tax breaks to people with millions and millions of dollars. There are 759 BILLIONAIRES in the U.S. alone! 3/
Read 9 tweets
Mar 21
Travel Tips Thread!

Many of you have reached out, asking me what company I used to plan my trips. I actually plan the vast majority entirely myself. So since so many of you seem curious, here’s how I do it: 1/
Disclaimer 1: For certain polar locations I have booked cruises through Quark Expeditions. These include my trip to Antarctica, as well as upcoming trips to Greenland and Svalbard. I particularly like this company due to their focus on environmental protection and education. 2/
Disclaimer 2: I did use a travel agency for my most recent trip to Africa, because it is very difficult to book, safari and transfers there without someone with expert knowledge of the area. 3/
Read 32 tweets
Jan 22, 2023
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
Read 121 tweets
Jan 21, 2023
Patient enrollment #SCCM2023
Patient characteristics #SCCM2023
These slides show that they did indeed have a difference in therapies given. #SCCM2023
Read 56 tweets
Jan 21, 2023
My next #SCCM2023 tweetucation session is “Late-Breaking Studies That Will Change Your Practice”!
First we have Dr. Ivor Douglas (@com543) with “Restrictive vs Liberal Fluid Management for Sepsis-Induced Hypotension”! #SCCM2023
So what is the optimal fluid resuscitation strategy in shock? #SCCM2023
Read 10 tweets

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