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VTA Symposium Profile picture
@VTA_Symposium
May 5 • 6 tweets • 2 min read Twitter logo Read on Twitter
First session after lunch is Dr Rob Wise - on 'Personal vs Precision Medicine - What does it all mean?'
#VTA23
So Personalised Medicine - its about tailoring the medicine/treatment to the specific patient group to get the right treatment. Its essentially about subcategorising patients and trying to give them more nuanced therapy then just following a protocol.
#VTA23
Precision Medicine - very similar, but going down to the molecular/genetic profile of the patient. So for example, by measuring the biomarkers/genetic profile, you could give a specific interleukin blocker in a particular patient with a specific type of immune response. #VTA23
Where are we seeing this already?
Sepsis, AKI, Breast Cancer, ARDS - all have research coming that involve precision medicine principles looking at targeted therapies. #VTA23
Personalised medicine might look at tailoring fluid therapy to the particular septic patient based on measures of fluid responsiveness and responsiveness. Precision medicine might go the extra step, and look at the release of genetic/bio-markers to tailor this further. #VTA23
Protocols, guidelines and formularies are all the starting point, but are not personalised or precise. They are merely a starting point. #VTA23

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More from @VTA_Symposium

VTA Symposium Profile picture
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
VTA Symposium Profile picture
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
VTA Symposium Profile picture
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
VTA Symposium Profile picture
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
VTA Symposium Profile picture
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
VTA Symposium Profile picture
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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