Teddy Hla Profile picture
Oct 25 12 tweets 6 min read
NEXT : @AriErcole
Association is not necessarily a causation
RCTs are thought of as "gold standard" for a good reason.
"Randomisation" eliminates influences of confounders.
- allows "causality" inference.
@AriErcole RCTs require relatively little prior knowledge.
But
"DO WE HAVE ASSURANCE OF THIS" ?
we try to "by having a inclusion criteria"
🧐 we can only control what we know

RCTs have limitations - dont really imply causality absolutely.

@ESICM #datascience #ai #ml #icudata #RCT
🗒 Structural Causal Models
- multiple regression models
can make these DAGs arbitrarily complex (many regressions = structural equation modelling)
see pic
Example of DAG
📃 What about "Natural Experiments"
- in a big enough data set, there will be a "digital twin"
- creates a natural experiment if we hav enough data
- can use to address confounding by indication
e.g., Propensity score matching(PSM) and Inverse probability of Treatment Weighting
What do those mean - and here
📃How about "time-series" causality?
- given t-s e.g., HR
- all physiology fluctuates
- causality based on "information flow between signals as it has "DIRECTIONALITY"
-eg fluctuation has meaning
- signal complexity outperforms anything either as early predictors of sick or not.
Example of this.
📃What about "reinforcement learning"?
give computer "policies" and see what is the "best policy". a bit like "propensity score matching"
- ML model
mentions @matkomorowski paper
What about “individualised treatment effects” using @MihaelaVDS clairvoyance models
@MihaelaVDS Summary
- statistical techniques nor RCTs prove causality
- "natural experiments" are another way of assessing causality
- "big data" allows sophisticated processes #datascience #ai #ml #icudata #LIVES2022

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More from @teddyhla

Oct 25
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
Oct 25
Mariangela PELLEGRINI
Uppsala- Sweden
"Do we Need a biological definition of ARDS"

- Berlin definition has NO Diffuse alveolar damage .
- the Berlin defn does not capture well
Frohlich - different definitions specificity of 0.63, 0.42, 0.31 even!
#ventilation #ards #LIVES2022
academic.oup.com/bja/article/11…
The BJA article by Frohlich.
Fibrosis only starts after 7 days
Thille article : atsjournals.org/doi/full/10.11…
In essence, different disease processes are happening to the lung at different times in the "ARDS"
pubmed.ncbi.nlm.nih.gov/24429204/
Read 14 tweets
Oct 25
ARDS - new definition or phenotypes by @GicoBellani refreshing with Kigali definition of ARDS - useful not just low resource but during pandemic in supposedly high income settings and only draw back is no PEEp requirement #ards #ventilation #LIVES2022 @ESICM
@GicoBellani @ESICM Resolved versus confirmed ARDS
- prospectively applying Berlin definition did work but if ya wait 24 hrs and re-measure P/F ratio, you end up stratifying much better.
- Better separation of groups

pubmed.ncbi.nlm.nih.gov/29632996/
#ventilation #LIVES2022
@GicoBellani @ESICM Whichever definition - american european consensus or Berlin or Kigali -- all goes back to Ashbaugh original paper in 1967

thelancet.com/journals/lance…

Why are we so confused when it comes to ARDS definition ?

#ards #ventilation #LIVES2022 @ESICM
Read 11 tweets
Oct 25
Next : Mypinder SEKHON on cardiac arrest in COVID-19 era.

Works in Vancouver
COVID 19 era cardiac arrest ARE a lot less sexy with all the PPE. #als #covid19 #resuscitation #LIVES2022
@ESICM
@ESICM Let's look at epidemiology. Northern Italy, Manhattan - COVID hit hard and has impact on other diseases.

e.g., OHCA in Italy during COVID 19 massive spike.
ImageImageImage
Read 9 tweets
Oct 25
NEXT Speaker : VA ecmo for which patients?
Alain COMBES

Severe cardiogenic shock has different phenotypes
1. medical cardiogenic shock(AMI, end stage dilated CM, myocarditis, septic shock)
2. Post cardiotomy refractory CS (post CABG)
#LIVES2022
@ESICM #ecmo #resuscitation #ALS
@ESICM 2022 what do the guidelines say
- ESC recommends short term MCS should be considred in cardiogenic shock.
IABP may be considered but not routinely recommended in post MI
#LIVES2022
Image
Read 18 tweets
Oct 25
what about in refractory cardiac arrest?
ERC - ESICM guidelines 2021
- timing of CAG if no evidence ofr ST segment evaluation.

which means we will end up treating a lot of patients with stent and anticoagulation
TOMAHAWK trial : delayed or early invasive angiography -- no effec.

#LIVES2022
- immediate catheterisation for non ST elevationrr
Read 4 tweets

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