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We are the 24-bed tertiary Intensive Care Unit in Wellington. We provide critical care to over a million people in the middle of New Zealand.
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May 28, 2019 24 tweets 4 min read
This week's @WellingtonICU #Twitterjournalclub was prepared by @oweepower and is on the #ROSEtrial
nejm.org/doi/full/10.10… Multicenter, unblinded, randomized trial of patients with moderate to
severe ARDS
May 3, 2019 19 tweets 4 min read
This week's @WellingtonICU #Twitterjournal club was prepared by Eamonn Deverall
bmjopenrespres.bmj.com/content/6/1/e0… This small pilot RCT looked at the feasibility of running a wider RCT randomising ventilated patients to in-bed cycling and physio vs. routine physio
Apr 25, 2019 9 tweets 3 min read
This week's #Twitterjournalclub was prepared by @alexlin0528
It's the #HelpICUtrial (the hospital-based evaluation of laxative prophylaxis in ICU) which was published in the Journal of Critical Care 52 (2019) 86-91 doi.org/10.1016/j.jcrc… 570 adult mechanically ventilated and enterally fed patients were enrolled
Single ICU: cluster-crossover trial. Three pods in a single ICU each randomized to one of 3 regimens for 4 months with rolling crossover.
Apr 12, 2019 13 tweets 2 min read
This week's journal club is a SR/MA on APRV during acute hypoxaemic respiratory failure
ncbi.nlm.nih.gov/pubmed/30949778 Aim: A systematic review and meta-analysis to verify whether adult patients with hypoxemic respiratory failure had more ventilator-free days at day 28 when ventilated in APRV compared to conventional ventilation strategies.
Mar 27, 2019 21 tweets 4 min read
Here is this week's @WellingtonICU #Twitterjournalclub prepared by Rosanna Rahman. We are so committed, we don't even stop for #SMACC
thelancet.com/journals/lanre… Patients with acute hypoxemic respiratory failure (PaO2:FiO2 ratio ≤300mmHg) frequently require intubation in the intensive care unit.
Mar 20, 2019 17 tweets 3 min read
This week's @wellingtonICU #twitterjournal club is on the #ABATE infection trial in @TheLancet sciencedirect.com/science/articl… The ABATE Infection trial was a cluster randomised trial of 53 hospitals comparing routine bathing to decolonisation with universal chlorhexidine and targeted nasal mupirocin in 194 non-critical care units.
Mar 10, 2019 17 tweets 3 min read
This week's #ICUtwitterjournalclub on a trial evaluating calf compression devices for venous thrombophylaxis was prepared by @RobynLester12
nejm.org/doi/full/10.10… Prevention of DVT is an important part of caring for the critically ill. This study examines whether the addition of pneumatic compression devices to pharmacologic thromboprophylaxis will lower DVT incidence
Feb 28, 2019 23 tweets 4 min read
A great dogma-challenging paper
nejm.org/doi/full/10.10… Hypoxaemia is a potential contributing factor in peri-procedural cardiac arrest and death. RSIs involve delay of 45-90 secs between administration of drugs and laryngoscopy, during which time patient becomes apnoeic.
Feb 22, 2019 26 tweets 6 min read
The ANDROMEDA- SHOCK Randomised Clinical Trial
Thoughts by @z_cepillo
jamanetwork.com/journals/jama/… Multicentre (28) open label RCT to determine if peripheral perfusion targeted resuscitation during early septic shock in adults is more effective than a lactate-targeted resuscitation for reducing mortality.
Feb 14, 2019 18 tweets 4 min read
This week's Tweetorial is by @doctorsinfuga & is on the #CENSER study published by @ATSBlueEditor last week showing early noradrenaline is associated with increased shock control by 6 hours:
#atsjournals #sepsis #vasopressors CENSER was a phase II, randomized, double-blind, placebo-controlled clinical single center trial conducted in Bangkok during the October 2013 to March 2017
Feb 7, 2019 18 tweets 3 min read
Another @wellingtonICU journal club. Nasal high-flow preoxygenation for endotracheal intubation in the critically ill patient: a randomized clinical trial
link.springer.com/article/10.100… Aim: to compare preoxygenation with high-flow nasal cannulae (HFNC) and standard bag-mask oxygenation (SMO) in non-severely hypoxaemic patients during rapid-sequence intubation (RSI) in ICU
Feb 6, 2019 13 tweets 3 min read
Chest physiotherapy is a mainstay in routine care and management of ventilated patients with particular roles in respiratory weaning from mechanical ventilation and clearing of secretions. This includes deep breathing exercises, gravity-assisted drainage, chest wall percussion or vibrations, bagging (manual hyperinflation), suctioning, rib springing, intra-pulmonary percussive ventilation, aerosol therapy (to name a few)
Jan 23, 2019 17 tweets 4 min read
This week's journal club #Tweetorial is written by @oweepower. Its a meta-analysis of bowel regimens in the critically ill by Hay et al, published in JCC this month. Paper here:
sciencedirect.com/science/articl… Constipation is frequent in critically ill patients with potential serious sequelae. Prophylactic laxative regimens have been long administered as a way to prevent this in enterally-fed critically ill patients.
Jan 17, 2019 20 tweets 5 min read
Our weekly #tweetorial returns. This week’s paper is from last month’s NEJM - Haloperidol & Ziprasidone for Treatment of Delirium in Critical Illness
Prepared by @Taffydoc1 ICU delirium remains a huge challenge, affecting 50-75% of our ventilated patients. The implications on patients and healthcare include a higher mortality, longer hospital LOS and periods on mechanical ventilation and long-term effects on cognitive function.
Jan 10, 2019 18 tweets 3 min read
The first @wellingtonicu journal club of 2019 is a single centre pilot trial
investigating the use of ICU diaries and psychoeduction in prevention of PTSD
insights.ovid.com/pubmed?pmid=30… ICU patients are particularly susceptible to PTSD due to things like:
1. the severity of their illnesses
2. loss of circadian rhythm
3. pain
4. sedation
5. paralysis
6. delirium
7. Requirements for unpleasant interventions.
Dec 17, 2018 24 tweets 5 min read
This week's Journal Twitter thread will be on a novel therapy
sciencedirect.com/science/articl… This Tweetorial was prepared by @jwri7170 and focuses on inhaled tranexamic acid for haemoptysis
Dec 12, 2018 36 tweets 7 min read
Our first @WellingtonICU Twitter journal club was prepared by @ETDETDETDETD & looks at SUP-ICU, a multicentre RCT examining the impact on mortality of
pantoprazole vs placebo for ulcer prophylaxis: nejm.org/doi/full/10.10… PPIs are a common feature on ICU drug charts for ulcer prophylaxis. The authors point out that Pantoprazole isn’t licensed for prophylaxis by the FDA. Medsafe has approved it for prevention of NSAID-induced ulcers in NZ