Last for tweet-ucation in day 3 of #CHEST2021 - "Controversies in Septic Shock: Vasopressors and Corticosteroids"! #CHEST2021 1/
First up is Dr. Angel Coz Yataco will discuss "Adding Vasopressin Early" #CHEST2021 2/
Improved urine output and creatinine clearance with Vasopressin vs Levophed. #CHEST2021 3/
HR decreased and CI stable with Vasopressin compared to NE alone. #CHEST2021 4/
NE doses were reduced in patients who were also on Vasopressin. #CHEST2021 5/
Tachyarrhythmias were much higher with NE alone and skin ischemia was not different with or without Vasopressin. #CHEST2021 6/
This RCT randomized patients with septic shock to either Vasopressin + NE or NE alone. There was no difference in mortality at 28 or 90days. #CHEST2021 7/
The NE group was a little older. Also note that the MAPs at inclusion were in the low 70s, so these patients were actually not hypotensive when enrolled. #CHEST2021 8/
There was a mortality difference in patients with less severe shock and Vasopressin use. #CHEST2021 9/
In this trial more people needed RRT when on NE alone compared to Vasopressin. #CHEST2021 10/
In the VANISH trial there was more need for RRT in the NE alone group than those on Vasopressin. #CHEST2021 11/
In this meta-analysis digital ischemia was way more common in the catecholamine alone group, and there is potentially less mortality in the Vasopressin group. #CHEST2021 12/
This group also shows a possible decreased mortality in the Vasopressin group. #CHEST2021 13/
The early use of short-term high dose steroids was previously found to be ineffective and harmful in septic shock. #CHEST2021 19/
Later studies showed that steroids may reverse the course of shock more quickly. JAMA trial that showed improved survival and reversal of septic shock in patients with relative adrenal insufficiency. The CORTICUS trial showed faster shock reversal. CHEST2021 20/
These guidelines suggest not using steroids in patients with sepsis without shock, but using HC in patients with septic shock that was unresponsive to moderate-to-high dose vasopressor therapy. #CHEST2021 21/
These trials came out in 2018 and studied patients with septic shock given HC (one also with Fludrocortisone). Both showed improved shock reversal with steroids. APROCCHSS also showed a mortality benefit. #CHEST2021 22/
This updated meta-analysis found a reduction in mortality, and shorter ICU/Hospital LOS, but increased risk of hypernatremia, hyperglycemia, and weakness. #CHEST2021 23/
This meta-analysis also supported reduced mortality. #CHEST2021 24/
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/
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
Next up for tweetucation at #SCCM2023 is “The Intersection of Climate Change and Critical Care” with Dr. Srinivas Murthy (@srinmurthy99) and Dr. Gloria Rodriquez-Vega!
We will talk about whether our ICUs are ready and what they can do to help. #SCCM2023
Case presentation - this is a code red for humanity! #SCCM2023
My next session for tweetucation is something I’m VERY passionate about!: “Moral Injury: Don’t Just Stand There, Do Something”! #SCCM2023
First up is “Recognizing the Signs, Symptoms, and Impacts of Moral Injury” with Kimberly Ichrist (@IchristKimberly)! #SCCM2023
The concept of moral injury is from military literature and is “a wound from doing something that violated one’s own ethics, beliefs, or attachments.” #SCCM2023