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Oct 16 • 6 tweets • 3 min read
Next is Giancamo Bellani, talking on 'Relationships between oxygenations indices & patient outcomes'
#CCSSA2022 #critcare #FOAMcc
Several indices have been proposed as bedside 'markers' for the development of VILI. They are relevant as they allow us to prognosticate patients, and therefore to determine the need for a higher level of intervention (e.g. ECMO).
#CCSSA2022
PF ratio remains a very robust predictor of mortality, and is the crux for the diagnosis of ARDS.
#CCSSA2022
Often PaCO2 is forgotten, but it is also extremely useful as, if minute ventilation is kept constant, changes in PaCO2 reflect changes in dead space (and recruitment overdistension)
doi.org/10.1007/s00134…
There are two 'new' indicators of VILI
- Driving Pressure (see Amato's work)
doi.org/10.1056/NEJMsa…
- Mechanical Power (see Gattinoni's work)
doi.org/10.1007/s00134…

Two crucial papers for any modern intensivist!
#CCSSA2022
A useful review/suggestion of how to setup PEEP with an algorithm, published by the presenter and his fellow in 2019 - doi.org/10.1186/s13054…
#CCSSA2022

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More from @GasBugZa

Bojan Korda Profile picture
Oct 16
Last for this session is Prof Sean Chetty @seanC001 speaking on 'To Sedate or Not to Sedate'. Is this a ?that is the question? scenario...
#CCSSA2022 #critcare #FOAMcc
Sedation is the reduction of irritability or agitation by administration of sedative drugs, generally to facilitate a medical procedure or diagnostic procedure. In modern ICU practice, the modern concept is analgosedation, but this needs to be teased apart a little.
#CCSSA2022
The typical modern ICU patient is older, sicker and more complex than ever before. Pain is generally a root cause of distress for many patients, but there can be others - dyspnea, delirium and sleep deprivation.
#CCSSA2022
Read 7 tweets
Bojan Korda Profile picture
Oct 16
Next up is Prof Joao Batista Borges, speaking on "Individualised lung recruitment to minimise VILI - the 'Teen Lung' Concept"
#CCSSA2022 #critcare #FOAMcc
To understand recruitment manoeuvres, we need to have a clear understanding of regional lung mechanics, and the concepts of collapse and hyper-distension, along with the lung hysteresis curves.
#CCSSA2022
The 'teen lung' concept is the idea of a lung that is stretched and overdistended, where there is inadequate or insufficient lung recruitement. It is 'partial recruitment' and may be worse than no recruitment at all.
doi.org/10.1186/s13054…
#CCSSA2022
Read 5 tweets
Bojan Korda Profile picture
Oct 16
Next up is respiratory therapist Benevides Netto on 'Optimising Patient Ventilatory Interactions'
#CCSSA2022 #critcare #FOAMcc
First speaks to how patient-ventilator dyssynchrony is common, and has been found in all modes of ventilation! It has significant consequences, via a variety of mechanisms - see P-SILI (but not only P-SILI!)
How to monitor asynchrony
- Graphic analysis
- Oesophageal pressure
- Diaphragmatic ultrasound
- Electrical impedence tomography
#CCSSA2022
Read 6 tweets
Bojan Korda Profile picture
Oct 16
Next up is (my office-mate - yes I'm showing off) Dr Susan Murphy @susan_icu talking about 'Preventing Intubation'.
#CCSSA2022 #critcare #FOAMcc
So how can we divide patients in whom we want to prevent intubation
- Those we want to prevent primarily intubating (e.g. a patient with acute hypoxaemic respiratory failure)
- THose who were previously intubated who you want to avoid re-intubating
#CCSSA2022
Often to try prevent intubation, we consider alternative types of respiratory support, which include:
- Simple Oxygen Delivery
- High Flow Humidified Oxygen
- Non-Invasive Ventilation
- Continuous Positive Airway Pressure
#CCSSA2022
Read 10 tweets
Bojan Korda Profile picture
Oct 16
One of two morning sessions (this one themed 'Take a Breath') at CCSSA2022 - starting with a talk by Prof Charles Feldman on 'E-cigarettes, vaping and lung injury'
#CCSSA2022 #critcare #FOAMcc
Prof starts by saying that vaping is not the panacea that it was hoped.
Electronic cigarettes (e-cigarettes or vapes) work by heating a liquid to produce an aerosol that users inhale into their lungs. The liquid can contain nicotine, THC, CBD, flavourants etc...
#CCSSA2022
Interesting that many of the THC-containing preparation contain Vitamin E - which when injected or ingested is safe, but when inhaled as an aerosol may have a deleterious effect
doi.org/10.1016/j.amjm…
#CCSSA2022
Read 10 tweets
Bojan Korda Profile picture
Oct 15
Final paeds session is by Prof Brenda Morrow on 'Sleep - the Final Frontier'
#CCSSA2022 #critcare #FOAMcc
Sleep is critical to normal health, and children need much more sleep than adults. Circadian rhythms are established as early as two months of age.
doi.org/10.1038/497S2a
doi.org/10.2147/NSS.S6…
#CCSSA2022
Sleep deprivation in healthy children has clear deleterious acute and long term effects.
#CCSSA2022
Read 7 tweets

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