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6 Dec, 30 tweets, 72 min read
Do we need maintenance fluids at all? What is your preferred maintenance fluid solution?
#IFAD2021 #FOAMed #FOAMcc

REPOSITORY (access 100+ lectures): whova.com/portal/webapp/…

@avkwong - @Manu_Malbrain - @azJanPalfijn - @FOAMecmo - @Wilkinsonjonny - @strachanjamie - @iceman_ex
When do you use starch solutions?

#IFAD2021 #FOAMed #FOAMcc
REPOSITORY (access 100+ lectures): whova.com/portal/webapp/…
@avkwong - @Manu_Malbrain - @azJanPalfijn - @FOAMecmo - @Wilkinsonjonny - @strachanjamie - @iceman_ex - @icmteaching - @Gas_Craic
When do you use (hypotonic) albumin 4% solutions?

#IFAD2021 #FOAMed #FOAMcc
REPOSITORY (access 100+ lectures): whova.com/portal/webapp/…
@avkwong - @Manu_Malbrain - @azJanPalfijn - @FOAMecmo - @Wilkinsonjonny - @strachanjamie - @iceman_ex - @icmteaching - @Gas_Craic
When do you use (hypertonic) albumin 20% solutions?

#IFAD2021 #FOAMed #FOAMcc
REPOSITORY (access 100+ lectures): whova.com/portal/webapp/…
@avkwong - @Manu_Malbrain - @azJanPalfijn - @FOAMecmo - @Wilkinsonjonny - @strachanjamie - @iceman_ex - @icmteaching - @Gas_Craic
There is no place for a liberal blood transfusion strategy

#IFAD2021 #FOAMed #FOAMcc
REPOSITORY (access 100+ lectures): whova.com/portal/webapp/…

@avkwong - @Manu_Malbrain - @azJanPalfijn - @FOAMecmo - @Wilkinsonjonny - @strachanjamie - @iceman_ex - @icmteaching - @Gas_Craic
What is most important regarding fluids in #COVID19?

#IFAD2021 #FOAMed #FOAMcc

REPOSITORY (access 100+ lectures): whova.com/portal/webapp/…

@avkwong - @Manu_Malbrain - @azJanPalfijn - @FOAMecmo - @Wilkinsonjonny - @strachanjamie - @iceman_ex - @icmteaching - @Gas_Craic
What is your preferred monitoring tool?

#IFAD2021 #FOAMed #FOAMcc #POCUS

REPOSITORY (access 100+ lectures): whova.com/portal/webapp/…

@avkwong - @Manu_Malbrain - @azJanPalfijn - @FOAMecmo - @Wilkinsonjonny - @strachanjamie - @iceman_ex - @icmteaching - @Gas_Craic
What monitoring would you like to have in the future?

#IFAD2021 #FOAMed #FOAMcc

REPOSITORY (access 100+ lectures): whova.com/portal/webapp/…

@avkwong - @Manu_Malbrain - @azJanPalfijn - @FOAMecmo - @Wilkinsonjonny - @strachanjamie - @iceman_ex - @icmteaching - @Gas_Craic
What is in your opinion the best #ICU model?

#IFAD2021 #FOAMed #FOAMcc

REPOSITORY (access 100+ lectures): whova.com/portal/webapp/…

@avkwong - @Manu_Malbrain - @azJanPalfijn - @FOAMecmo - @Wilkinsonjonny - @strachanjamie - @iceman_ex - @icmteaching - @Gas_Craic
Fluid balance is an overrated and obsolete concept. Or isn't it? We need your help #EA21 #IFAD2021
#FOAMcc #FOAMed

👉👉What is best way to monitor fluid overload?

@avkwong @Manu_Malbrain @FOAMecmo @Wilkinsonjonny @strachanjamie @iceman_ex
What has #COVID19 taught us about monitoring? We need your help #EA21 #IFAD2021
#FOAMcc #FOAMed

** How to target plateau pressure in lung protective MV?

@avkwong @Manu_Malbrain @FOAMecmo @Wilkinsonjonny @strachanjamie @iceman_ex
What has #COVID19 taught us about monitoring? We need your help #EA21 #IFAD2021
#FOAMcc #FOAMed

** The mean systemic filling pressure is CLINICALLY relevant?

@avkwong @Manu_Malbrain @FOAMecmo @Wilkinsonjonny @strachanjamie @iceman_ex
What has #COVID19 taught us about monitoring? We need your help #EA21 #IFAD2021
#FOAMcc #FOAMed

Use of POCUS + IVCCI has many limitations (RV, IAP, PEEP,...)

@avkwong @Manu_Malbrain @FOAMecmo @Wilkinsonjonny @strachanjamie @iceman_ex
Fluid #Stewardship - measures for success
We need your help #EA21 #IFAD2021
#FOAMcc #FOAMed

Deresuscitation is less important than resuscitation?

@avkwong @Manu_Malbrain @FOAMecmo @Wilkinsonjonny @strachanjamie @iceman_ex
Fluid #Stewardship - measures for success
We need your help #EA21 #IFAD2021
#FOAMcc #FOAMed

Awareness/knowledge on correct fluid prescription by doctors is low?

@avkwong @Manu_Malbrain @FOAMecmo @Wilkinsonjonny @strachanjamie @iceman_ex
Fluid #Stewardship - measures for success
We need your help #EA21 #IFAD2021
#FOAMcc #FOAMed

Who should take the lead in fluid stewardship?

@avkwong @Manu_Malbrain @FOAMecmo @Wilkinsonjonny @strachanjamie @iceman_ex
Fluid #Stewardship - measures for success
We need your help #EA21 #IFAD2021
#FOAMcc #FOAMed

The best KPI (key performance indicator) to measure success of fluid stewardship?

@avkwong @Manu_Malbrain @FOAMecmo @Wilkinsonjonny @strachanjamie @iceman_ex
Personalised medicine should not be an excuse to do whatever you want...
We need your help #EA21 #IFAD2021
#FOAMcc #FOAMed

** The macrocirculation is more important than the microcirculation?

@avkwong @Manu_Malbrain @FOAMecmo @Wilkinsonjonny @strachanjamie @iceman_ex
Personalised medicine should not be an excuse to do whatever you want...
We need your help #EA21 #IFAD2021
#FOAMcc #FOAMed

** Patients with septic shock are hypovolemic?

@avkwong @Manu_Malbrain @FOAMecmo @Wilkinsonjonny @strachanjamie @iceman_ex
Personalised medicine should not be an excuse to do whatever you want...
We need your help #EA21 #IFAD2021
#FOAMcc #FOAMed

** The SEP-1 mandate advocates SSCG with 30ml/kg/1hr

@avkwong @Manu_Malbrain @FOAMecmo @Wilkinsonjonny @strachanjamie @iceman_ex
Personalised medicine should not be an excuse to do whatever you want...
We need your help #EA21 #IFAD2021
#FOAMcc #FOAMed

** Regarding big data and artificial intelligence (AI)?

@avkwong @Manu_Malbrain @FOAMecmo @Wilkinsonjonny @strachanjamie @iceman_ex
Personalised medicine should not be an excuse to do whatever you want...
We need your help #EA21 #IFAD2021
#FOAMcc #FOAMed

** Regarding personalised vs protocolised care?

@avkwong @Manu_Malbrain @FOAMecmo @Wilkinsonjonny @strachanjamie @iceman_ex
At the end, human factors are more important than technical skills...
We need your help #EA21 #IFAD2021
#FOAMcc #FOAMed

** What is most dangerous in times of (#COVID19) crisis?

@avkwong @Manu_Malbrain @FOAMecmo @Wilkinsonjonny @strachanjamie @iceman_ex
At the end, human factors are more important than technical skills (TS)...
We need your help #EA21 #IFAD2021
#FOAMcc #FOAMed
** What is your opinion on human factors (HF) and non-technical skills (NTS)?

@avkwong @Manu_Malbrain @FOAMecmo @Wilkinsonjonny @strachanjamie @iceman_ex
At the end, human factors are more important than technical skills (TS)...
We need your help #EA21 #IFAD2021
#FOAMcc #FOAMed

** What is/was your worst #COVID19 nightmare?

@avkwong @Manu_Malbrain @FOAMecmo @Wilkinsonjonny @strachanjamie @iceman_ex
What is next in fluid research...
We need your help #EA21 #IFAD2021
#FOAMcc #FOAMed

** What future studies do we need?

@avkwong @Manu_Malbrain @FOAMecmo @Wilkinsonjonny @strachanjamie @iceman_ex
What is next in #fluid in #ICU #perioperative #anaesthesia research...
We need your help #EA21 #IFAD2021
#FOAMcc #FOAMed

** What future studies do we need?

@avkwong @Manu_Malbrain @FOAMecmo @Wilkinsonjonny @strachanjamie @iceman_ex
What is next in #fluid in #ICU #perioperative #anaesthesia research...
We need your help #EA21 #IFAD2021
#FOAMcc #FOAMed

** What future studies do we need?

@avkwong @Manu_Malbrain @FOAMecmo @Wilkinsonjonny @strachanjamie @iceman_ex
What is next in #fluid in #ICU #perioperative #anaesthesia research...
We need your help #EA21 #IFAD2021
#FOAMcc #FOAMed

** What future studies do we need?

@avkwong @Manu_Malbrain @FOAMecmo @Wilkinsonjonny @strachanjamie @iceman_ex
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More from @Fluid_Academy

Fluid Academy Profile picture
19 Mar 20
Must read for every-one guidance from China on #COVID19 #COVID19BE diagnosis management and treatment from Prof. Tingbo LIANG Editor-in-Chief : how to screen for suspected COVID ImageImage
Must read for every-one guidance from China on #COVID19 #COVID19BE diagnosis management and treatment from Prof. Tingbo LIANG Editor-in-Chief : Protection Image
Must read for every-one guidance from China on #COVID19 #COVID19BE diagnosis management and treatment from Prof. Tingbo LIANG Editor-in-Chief : Donning of PPE Image
Read 8 tweets
Fluid Academy Profile picture
10 Mar 20
@jasonvanschoor Dear Jason. Thank you for this excellent thread. We are preparing ourselves @UZBrussel I would like to add some treatment recommendations on #COVID19 #COVID19BE from #paolo_pelosi in the following tweets:
@jasonvanschoor @UZBrussel 1/ Don’t use HFOV or NIV too much
2/ if saturation less than 95 or paO2/FiO2 less than 200 with/without RR higher than 25-30 breaths/min at FiO2 60% with CPAP by NIV (helmet preferred) after 15-30 min - intubate immediately
@jasonvanschoor @UZBrussel 3/ low tidal volume 4-6 ml/kg PBW with minimal RR to achieve pH above 7.2
4/ PEEP relatively high 13-15 cmh2O;
Read 8 tweets
Fluid Academy Profile picture
3 Apr 19
Evaluating volume status and fluid responsiveness - what is new in 2019? by @PrXaMonnet #ISICEM19

fluid challenge
mini-fluid challenge
SVV, PPV
IVCCI
EEO
recruitment maneuver
passive leg raise => less reliable during abdominal hypertension
Excellent talk by @PrXaMonnet #ISICEM19 Detection of fluid responsiveness
Advantages and drawbacks of fluid challenge and mini-fluid challenge @PrXaMonnet #ISICEM19
Read 4 tweets
Fluid Academy Profile picture
22 Mar 19
The question is: How to achieve the right balance
not too much
not too little
just enough
excellent talk by #NateShapiro
#ISICEM19
How do we currently assess therapeutic response to fluids
#ISICEM19
interesting mortality prediction model presented by #NateShapiro looking at a fluid propensity model predicting when we need to give more or less fluids
Bottom line: mortality increases with too little or too much fluids
#ISICEM19
Read 5 tweets
Fluid Academy Profile picture
16 Mar 19
Assessment of Fluid Overload and Hypervolemia (1/8)

Clinical assessment and signs for #FO are aspecific and unreliable:
-pitting edema
-ascites
-positive fluid balance
-orthopnea
-hepatojugular reflux
-...

Preparing for #smacc #ISICEM19 #IFAD2019 #WCACS2019
Assessment of Fluid Overload and Hypervolemia (2/8)

Biochemical Assessment for #FO is aspecific and unreliable:
-Hypoalbuminemia
-Hypoproteinemia
-low COP
-low osmolality
-...

Preparing for #smacc #ISICEM19 #IFAD2019 #WCACS2019
Assessment of Fluid Overload (FO) and Hypervolemia (3/8)

Radiological and #POCUS imaging and signs for #FO are aspecific and unreliable:
- Absence of #IVCC
- Kerley-B lines
- Lung ultrasound B-lines
- Pleural effusions

Preparing for #smacc #ISICEM19 #IFAD2019 #WCACS2019
Read 7 tweets

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