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ATS Crit Care Profile picture
@ATSCritCare
May 23 • 6 tweets • 3 min read Twitter logo Read on Twitter
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Dr Ivor Douglas discussing pathophysiology of IV fluids and vasopressors in #sepsis

#ATS2023

Follow below for highlights!

@atscommunity Image
Too much or too little fluids can have consequences.

What is the optimal range for fluids? Image
Excess fluid balance (> 5L in 1st day) is associated with increased mortality Image
What about vasopressors?

⛔️ Caution of microcirculatory complications

⛔️ vasopressors can have immunomodulating effects when titrated up Image
We always try to optimize macrocirculation in sepsis but more focus needed to assess microcirculation

👇🏻 effects of sepsis resuscitation on microcirculation Image
Extravasation rate with low dose vasopressors via PIV is low in #CLOVERS trial Image

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More from @ATSCritCare

ATS Crit Care Profile picture
May 23
C4: Making it Personal: Individualizing Resuscitation Targets - Pavan Bhatraju #ATS2023
Image
Can molecular phenotypes guide resuscitation? Image
Read 4 tweets
ATS Crit Care Profile picture
May 23
Next up: Dr Elizabeth Munroe, when do we add vasopressors in #sepsis ?

#ATS2023 @atscommunity

Early vasopressors will:
- control shock faster
- allow leas fluids

Look up the #CENSER and #CLOVERS trials
In #CLOVERS restrictive fluid groups show no difference in major outcomes compared to liberal group
How do we administer vasopressors?

Do we always need a CVC?

Check out the reviews 👇🏻 Image
Read 5 tweets
ATS Crit Care Profile picture
May 22
Here we go #ATS2023

Let’s talk about next generation trials.

First up is Mattew Semler discussing the ABCs of future trials.

@atscommunity Image
The equilibrium is being disrupted and new evolving trial designs are emerging

#ATS2023 @atscommunity Image
@MichelleNgGong discussing advantages of platform trials compared to traditional trials which be costly and ineffective

Frequent analyses, multiple interventions can be studied and ability to add additional arms are advantages of platform trials

#ATS2023 @atscommunity ImageImage
Read 6 tweets
ATS Crit Care Profile picture
May 21
Next: This is your brain on (ICU) Drugs - Image
First up - Tackling delirium - an educational tool to improve nursing-level identification with Dr. Balaban
Nursing level education improvement with educational modules may improve detection of delirium in ICU ImageImage
Next up - Dr. Anderson presents standardized metrics for sedation and delirium assessment -
🗣️ Educational, time interval assessment and performance feedback resulted in greater fidelity to guideline recommendations. ImageImage
Read 8 tweets
ATS Crit Care Profile picture
May 21
Next: ⁦@MichelleNgGong⁩ and Ivor Douglas ⁦@com543⁩ presenting the CLOVERS trial - early or liberal fluid management for sepsis induced hypotension nejm.org/doi/full/10.10…
CLOVERS visual abstract Image
Complex protocols for both Fluid Liberal and Fluid Conservative arms.

Options in each arm to allow for "Rescue" for fluids or vasopressors based on pre-specified criteria
Read 12 tweets
ATS Crit Care Profile picture
May 21
Up next: @erinkkross presenting on investigation of methods to improve goals of card (GOC) communication for critically ill patients
jamanetwork.com/journals/jama/…
Study first author is the late and very missed @JRandallCurtis1.

mednews.uw.edu/news/curtis/in…
Rationale: clinicians don't discuss GOC communications, but pragmatic *and* efficient strategies to increase and improve these critical interactions are lacking

jamanetwork.com/journals/jamai…
Read 19 tweets

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