🔥 HOT topics 🔥#LIVES2023

I’m tired. But I’ll try keep up
As always - read the actual papers please!! First up - out now 👇🏻

#LIVES2023 nejm.org/doi/full/10.10…

I am hanging out here for the next 45mins #LIVES2023
🧵 Of the bat, I’m in the wrong room so racing to the other side of the convention centre 😫 #LIVES2023

Last up we have Hot Topics…. #LIVES2022 First comes @JAMyburgh with #SuDDICU looking at selective decontamination (SDD) of the digestive tract on hospital mortality

(To know- Aim of SDD is to prevent VAP caused by pathogenic gram negatives organisms and overgrown of fungus from upper GI tract)

🧠 Heading here this morning for joint @ERC_resus session ‘How do I predict neurological outcome after cardiac arrest” at #LIVES2022

This is a core part of my day to day and frequent conversation I have with the junior team so interested to listen … So far the audience have been asked four times to move closer to the front. Nobody moves.

It’s 16:40 - I’ve come to palliative care session

I *think* (but cannot be sure) that it won’t mention biomarkers

Impressive turnout for such late session. It’s actually nearly full!

#LIVES2022 First speaker Hartog said she’s surprised by the turnout ☺️

She comments that the WHO definition of palliative care (PC) doesn’t mention death

She directs us to concept that it accompanies curative care - then takes overtakes it - and eventually, no even continues after death

Up next at #LIVES2022

🧠 Optimising Brian perfusion after resuscitation.

This is another debate (read chat, more than debate)

So I’ll try to keep up… It opens by saying we know that 2/3 of unconscious patients in ITU post cardiac arrest die

And most of them die from brain injury

(I’ll use HIE to say hypoxic ischaemic encephalopathy from now)

❓Do we need to improve perfusion to the brain and can it help anyway❓

🫁 🧬 ARDS in Sepsis - Are biomarkers helpful? #LIVES2022

(The answer for me is - minimally…I rarely have access to them at the beside 🛌 but I presume the answer from JM Constantin has meat to it, so I’m here to listen) We start here by asking is ARDS due to sepsis the same as that due to peritonitis or pneumonia?

And he has now changed the title to Are biomarkers helpful in ARDS?

Are biomarkers helpful? #LIVES2022

(That’s the question) Jokes, it isn’t

“Are biomarkers helpful in characterising inflammation V infection?”

One of the useful things about a conference in Europe is the opportunity to understand a breath of socio-cultural perspectives (it’s almost like we’re better together 💁🏻‍♀️🇪🇺)

Anyway, looking forward to this - let’s go
#LIVES2022

https://twitter.com/whistlingdixie4/status/1584806432536264704

This is a joint session from ethics and metabolism & nutrition section. They start with Arabi who highlights the variability - he’s trained in US, works in Saudia Arabia and has relationship with Australia

He starts by pointing to this paper

pubmed.ncbi.nlm.nih.gov/25581712/

Next I’m here for this @ESICM #LIVES2022 chat on ‘diversity’ with amongst others @iceman_ex

My first thought is that this should be in a main theatre The first question is ‘what is’ diversity

@ElieAzoulay5 says it is ‘us…all of us”

(My own thought on that is the sense of ‘us’ is sometimes the issue but I get the intention)

Ellie says there’s a generation gap - need to understand elements of language that we don’t share

🫁 Over the past years we have started using NIV more and more for respiratory fairly …practice changed under pressure

But now we’ve taken a breath

When do we use NIV and more importantly …when do we move on?

Follow along for debate #LIVES2022 Bellani says that any T1RF normally warrants a trial of helmet free flowing CPAP to see if they improve by monitoring with RR and paO2

Jaber says no, just get the FiO2 to >92% and then get them to ICU and see what you need…NIV..HiFlo etc

🫁 Steroids and covid-19 #LIVES2022 with Derek Angus

There is biological rational…
but also we just love giving steroids when we don’t know what to do 💁🏽

Why a need to test them?

Potential side effects:

- impaired host response

- secondary bacterial infections - Metabolic, somatic and neuropsych effects

-And we need to specify:
Dose
Durations
Starting point

- Conflicting evidence from non-Covid ARDS

🫁 Steroids & non-covid ARDS #LIVES2022

We’ve all had or fill of steroids and ARDS but where are we with this now?

Conflicting guidelines …don’t use universally…or need more research

ARDS here is Berlin definition with diffuse alveolar damage as the hallmark (DAD)…mostly DAD we said for years, wasn’t a target for steroids….but have we been misled ?

Future trial needs to be defined based on presence of local and systemic inflammation (not clinical signs)

We need to avoid the 3rd (fibrosis) phase and pick up the earlier proliferative phases

🫁 Up next #LIVES2022…Steroids and severe CAP

There is no doubt that high and persistent SIRS is associated with higher mortality

Made worse again by adrenal insufficiency in some pts

JAMA (2015) when those with high SIRS identified and then given methyl prednisolone… There was less treatment failure* among patients from the methylprednisolone group (8 patients [13%]) compared with the placebo group (18 patients [31%])

pubmed.ncbi.nlm.nih.gov/25688779/

*composite outcome explained in link above

My TAKE HOME from neuro debate with @Menon_Cambridge & Janneke Horn is that PtBO2 may represent impotent opportunity to do *less* in TBI

Although we know silent hypoxia worsens outcomes,we don’t have good evidence that PtBO2 monitoring improved outcomes (?yet)
#LIVES2022 (1/4) But putting it in the healthy parts of brain gives us an opportunity not to harm it…

(maybe preumbra best, but how to find it?)

…e.g through hyperventilation induced hypoxia 😫 (2/4)

Today’s @guardian photo story by @WeeksJonny is a timely reminder that the hope created by the launch of a vaccination programme is still very much partnered with grief. And there is much grief to come

We are doing our best-please do your best too

theguardian.com/society/2020/d… and again from today’s @guardian
a most beautiful tribute to all of these people and those like them
theguardian.com/society/series…

… I know this pandemic has caused great economic & psychological hardship. It’s has disrupted medical treatment for so many.

⭐️Learning points from the @ESICM second webinar on #COVID19 and intensive care, today⭐️
Thanks to Prof Yaseen Arabi for presenting the information and Dr Lennie Derde for leading.

It's a long one!

(thread) In the Chinese cohort, 87% of cases occurred in the 30-79 year age group

<2% were in <19 year olds

Learning points from @ESICM webinar on #COVID19 (based on experience in China)

- 10% of all cases had GI symptoms in the first week

-80% OF CASES WERE MILD

- 5% of all cases were 'critical' and needed ICU (respiratory failure on air, shock or other organ failure)
(thread) - In ICU patients, prolonged steroid course may lead to longer virus shedding time.

- 50% of the ICU pts had high Troponin related to myocardial virulence of #coronovirus. They saw some sudden, resistant cardiogenic collapse