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May 5 8 tweets 3 min read Twitter logo Read on Twitter
Next is Prof Fathima Paruk - 'Sub-phenotyping in ICU' #VTA23
At the bedside, we are increasingly responding to the unique profile of the patient in front of us. ARDS and Sepsis, for example, are both widely recognised syndromes that represent a hugely heterogenous patient population. #VTA23
ARDS is a phenotype, characterised by the Berlin Criteria. A further subcategorisation might be a hyperinflammatory vs hypoinflammatory. How deep do you go though? Endotypes look at the mechanisms that produce the subphenotype. #VTA23
This can lead us to identify treatable traits that produce novel therapies, hence the drive to subphenotype these large population groups.
#VTA23
An example of early subphenotypes has already been mentioned - Hypoinflammatory (P1) vs Hyperinflammatory (P2) ARDS. P1 ARDS is characterised by fewer inflammatory markers, and lower PEEP strategies and liberal fluid strategies produce better outcomes compared to P2. #VTA23
There are also cardiovascular subphenotypes in ARDS - Normal CVS function, Mild RV Dysfunciton, RV Failure and High CO Failure. This can lead to specific therapies to each type of cardiovascular profile. doi.org/10.1097/CCM.00…
#VTA23
In Sepsis, a type of subphenotyping currently being explored is trajectory. This can tell us much about those at higher risk of further hits, and may identify a subgroup in whom there will need to be a more heavy investment of resources. #VTA23
On the other hand, there is a risk of 'over' subphenotyping patients. We need real time rapid detection to be able to implement this - these is no point in subphenotyping if you get a profile 3 days after an intervention might have made a difference. #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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