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May 5 9 tweets 4 min read Twitter logo Read on Twitter
After a short break, Prof Francesca Rubulotta @frubulotta will be speaking about "Gender disparities in critical illness' - an unbelievably disappointing reality in our profession.
#VTA23
So today she wants to flip the conversation, not to talk about gender disparities in critical care practitioners, but rather in how gender disparities in how patients are treated. #VTA23
In the past, most medications have been tested solely on male 'ideal' patients, and female patients of any weight were actively excluded. Although this has changed in the last 10 years, we still live with the consequences of the earlier studies... #VTA23
This has an effect on both women AND men, as men are less likely to get effective treatment if they are unlucky enough to get a 'female-specific' disease such as osteoporosis. #VTA23
doi.org/10.1097/CCM.0b…
Lots of differences in how men and women are treated in critical care. Women are less likely to get antibiotics in a timely manner, but their survival is similar. Lots of differences here...
doi.org/10.1016/j.ccm.…
#VTA23
And what about diversity in the workforce? If equipment is designed for men, the ergonomics of those devices may not suite women. This is similarly a problem if the patient monitors are designed for and tested on men. #VTA23
Women are less likely to be in leading positions in Intensive Care Societies worldwide. doi.org/10.1186/s13054…
#VTA23
What can we do?
Some societies have begun working on this with systematic approaches.
doi.org/10.1007/s00134…
#VTA23
But Francesca also says you can do something - sponsor someone. If you are invited to go to a meeting and you cannot go, don't just decline. Instead, propose someone you know to go in your stead, to improve inclusivity and diversity!
#VTA23

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More from @VTA_Symposium

May 6
Anthony Holley speaking on 'Tracheostomy - When and How?'
#VTA23 #critcare #FOAMcc
Why do we put tracheostomies in patients though?
The rationale for a trachy in ICU is that there are respiratory mechanical benefit (compare to a tracheal tube and a native airway). There are many patient care benefits - oral care, feeding, etc...
#VTA23
There are problems, including the potential for real patient harm. Tracheostomy emergencies are a problem. Complications (Immediate, Early and Late) are encountered in 30% of patients. #VTA23
Read 9 tweets
May 6
Next is Donna Hamel, speaking on 'PEEP Titration and Recruitment'
#VTA23 #critcare #FOAMcc
PEEP is important - it improves oxygenation, and is an essential component of lung protective strategies.
But PEEP also has some problems - it can cause hypotension and increased pulmonary vascular resistance.
So how does one get optimal PEEP?
#VTA23
Optimal PEEP has no clear universal definition.
Maybe we should look for appropriate PEEP - a PEEP value that results in adequate oxygenation with the lowest risk of overdistension.
#VTA23
Read 5 tweets
May 6
Prof Anthony Holley is speaking next on 'Respiratory Support in the Trauma Patient' #VTA23 #critcare #FOAMcc
The 'trauma' patient is not a single disease entity, but ultimately a mechanism that is characterised by a shared multitude of pathophysiological patterns (TBI, lung contusion, etc...) and interventions (surgery, transfusion) that lead to some common disease processes. #VTA23
These common disease processes include TRALI, ARDS, TIC and many more.
Of concern, ARDS is not uncommon in trauma patients.
#VTA23
Read 6 tweets
May 6
Next up are two of the Occupational Therapists from CHBAH - Marche van der Heyden and Tiffany Fairbairn - speaking on 'Sensory Stimulation in Critical Care'.
#VTA23 #critcare #FOAMcc
Sensory stimulation is emerging in critical care as a modality to re-establish normal functioning. Our senses are our connection to the world. There are 8 (not 5!) senses - auditory, olfactory, gustatory, visual, tactile/touch, vestibular, proprioception and interoception. #VTA23
The lesser known of these - vestibular, proprioception and interoception - all are key in self-soothing...
Interoception is the sense how different parts of our 'deep' body are feeling. There are a few activities that include all 8 senses - for example eating.
#VTA23
Read 9 tweets
May 6
Midmorning #VTA23 session starting - lots of short talks so expect quick changes in topic! #critcare #FOAMcc
Michael Gentile - Is PARDIE Changing Our View of Paediatric ARDS?
#VTA23 #FOAMcc #critcare
PARDIE stands for Pediatric ARDS Incidence and Epidemiology study. This study is one of the results of the PALISI Conference Group.
doi.org/10.1016/S2213-…
#VTA23
Read 7 tweets
May 6
Last up for the morning session is John Davies, who is talking about 'Mechanical Ventilation during ECMO: all, some or none'.
#VTA23 #FOAMcc #critcare
Essential to remember the components of lung protective ventilation - tidal volume, plateau pressure, respiratory rate, PEEP, FiO2.
#VTA23
Do the rules of LPV change when the patient is on ECMO.
There is little doubt that (in appropriately selected patients) ECMO has a mortality benefit. Have a look at the CESAR and EOLIA trials:
doi.org/10.1016/S0140-…
doi.org/10.1056/NEJMoa…
#VTA23
Read 7 tweets

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