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

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

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

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

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

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

Next is Prof Ronel Roos, who will be speaking on 'Mobilisation Patients with Extracorporeal Circuits' #VTA23 #critcare #FOAMcc There are different types of mobilisation.
There can be passive mobilisation or active/assisted exercises. Functional exercises can include standing, sitting, walking, or even a bike (in or out of bed). #VTA23

Dr Shabir Alekar is speaking next on 'Prolonging CRRT Circuit Life' #VTA23 #FOAMcc #critcare As soon as blood leaves the body, it comes into contact with foreign substances that initiate the clotting/coagulation process. The high surface area of the CRRT filters are usually where these processes are most likely to occur. #VTA23

Prof Gavin Joynt speaking on 'Personalised Antibiotic Prescription in the Critically Ill Patient'
#VTA23 #critcare #FOAMcc Antibiotics are different from fluids in that, although they are crucial in reducing mortality, their effect is not immediately apparent. The consequences of underdosing or overdosing are quite real though. #VTA23

First session of Saturday's session of #VTA23 - Dr Jacqui Brown on 'Personalised Fluid Management' #critcare #FOAMcc The first buffered IV fluids were administed during the cholera epidemic in the UK in 1832. However, fluid therapy only entered main stream medical practice around the first world war. #VTA23

Final session of the day - Prof Dean Gopalan - who is speaking about 'The Human Touch in Digital Healthcare'. #VTA23 Telemedicine has been around for a while, and more recently telerounding. In 2019, a doctor in California appeared via video link to tell a patient he was dying. This (probably predictably) caused an uproar, but also debate? #VTA23

Finally for the first afternoon session is Dr Michael Pienaar, who is speaking on 'Machine Learning to Tailor Management Strategies'. #VTA23 Central to this are the definitions of Artificial Intelligence, Machine Learning and Deep Learning.
#VTA23

Next is Dr Christel Arnold-Day - the first (to my knowledge) neurosurgeon to become an intensivist in South Africa. She is talking about 'Personalised TBI Management' #VTA23 The protocols - Brain Trauma Foundation 4th Edition goals are quite old and outdated. However, for the first time there is interest in age specific cerebral perfusion pressures. #VTA23

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

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

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

Next up in Prof Guy Richards @ProfGuyRichards who will be talking about Ventilatory Lessons Learnt from COVID. #VTA23 In SA, large numbers of patients who would normally be admitted to ICU for ventilation were instead given support through CPAP and HFNC in wards (and sometimes parking lots...) because of resource limitations. #VTA23

First talk of the day - Dr Hilary Klonin, a paediatric intensivist from Hull University Teaching Hospital Trust - on 'Less is more, except when it isn't'. Talking about paediatric BP targets in critical care. #VTA23 Up to 50% of paediatric ICU survivors suffer from some sort of impairment. Could this be because the BP targets in paediatric ICU are unclear and too high a target is used? #VTA23