Teddy Hla Profile picture
Oct 24, 2022 8 tweets 3 min read Read on X
Next :: Claude Guerin. Covid v non covid and NIV. #LIVES2022 #ventilation #NIV @ESICM summarising risk factors for NIV failure - old age, multi organ failure etc. then diving straight into “Happy Hypoxemia”.
Re-visiting H and L phenotypes. Silent or happy hypoxemia. So best to proceed by undertaking in depth literature search
But the evidence tends to suggest covid has higher mortality and is also v heterogeneous.
Contrasting with another classic lung safe study. Left graph non covid and right is covid. NIV group annotated. In comparison mortality is comparable at 40% and higher than with invasive.
Let’s look at “intubation”. NIV is tested here with high flow. No effect of NIV versus hfnc n covid and non covid to prevent intubation. NOTE. Significant heterogeneity. BUT. NIV better than SOR to prevent intubation
Just to note on mortality here .
But the new evidence not included in the meta analysis is HELMET NIV. In summary : rate of intubation is v similar between cov and non cov. NIC both cov or non covid prevented intubation without significant effect in mortality. So effectively :: NIV is NIV whatever the aetiology

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More from @teddyhla

Oct 26, 2023
Deep learning lung uss from France and Portugal - proof of concept

#LIVES2023 Image
Predicting ICH using deep learning
Nice waveform analysis - from Nijmegen

#LIVES2023 Image
Periop outcomes using CPET and ML

#LIVES2023 Image
Read 26 tweets
Oct 24, 2023
I'm following the session earlier by Prof Xavier Monnet: 'Venous RETURN' & its monitoring.

Venous return
👉 is NOT cardiac preload
👉 is a flow
👉 measured in litres / min.
should be renamed to reflect that ideally.
Of course VR is linked to cardiac preload.
@ESICM #LIVES2023
1st FACT: VR = Cardiac Output AT equilibrium. LV can only eject what it gets frm R side.

Like any flow, VR determined by Delta P & resistance.

Now what is Delta P here? it's difference betn
👉 Mean Systemic Pressure (upstream)
👉 Right Atrial P(downstream)

@ESICM #LIVES2023
Now, MSP is not 'REAL' : is hypothetical.
by defn - it must be higher than RA to generate VR/flow.

👉not accurate but can visualise as space betn capillary & vein
👉 when heart stops, arterial pressure drops & CVP rises to equilibrate at Mean circulatory P
@ESICM #LIVES2023
Read 16 tweets
Jun 19, 2023
Dr Nicholas Barrett, president of @EuroELSO discussing Research in this area, especially clinical data registries @iceman_ex @MLSCourse @tamishtah #UKECPR23
Image
But what #kind of #registries ? - Patient, Specialty, Device ? e.g., Abiomed Imeplla registry data. Regulatory process is different - FDA normally requires RCT. Abiomed registry data was compelling , resulting in +++ impella uptake in USA. #UKECPR23
Read 16 tweets
Jun 19, 2023
Next up Dr Stuart Gilon
discussing with detailed evidence. #UKECPR23 @tamishtah @iceman_ex @MLSCourse
@tscquizzato great work
onlinelibrary.wiley.com/doi/full/10.11…
Initial #shockable rhythm is better. ARREST trial remains key. Gotta talk about this when chatting the #ECPR thelancet.com/article/S0140-…
Bear in mind - ARREST trial selects shockable rhythm patient. But BLS is key. Looking at old study in Amsterdam pubmed.ncbi.nlm.nih.gov/12104106/
Read 10 tweets
Jun 19, 2023
Session 1 : Starting with recapping #latest evidence in #ECPR with Drs James Raitt, Stuart Gilon, and Dr Nick Barrett with @doctorbrijpatel #UKECPR23 @Novicelearner9 @djlowcock @tamish @DineshCallum @MLSCourse
Dr James Raitt - Cons in EM and PHEM at Thames Valley Air Ambulance - cardiac arrest ; where are we now? #UKECPR23
Read 15 tweets
Oct 25, 2022
Carolyn Calfee Clinical and Biological phenotypes of ARDS
- what do they have in common?

ARDS : subgrouping since the begining
- sepsis vs. non sepsis
- hyper vs. hypoinflamm
- reactive vs uninflamed
#ventilation #ards #phenotypes #LIVES2022
Are clinical phenotypes biologically distinct?
looking at Trauma vs. Non trauma

ICAM-1 , SP-D, vWF, sTNFr-1 are different.
What about in "Direct" vs. "indirect"
or "Diffuse" vs "focal" -- sRAGE comes up again.

pubmed.ncbi.nlm.nih.gov/17944012/
#ventilation #ARDS #LIVES2022
Image
Read 13 tweets

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