Random thoughts of an ICU consultant, honorary Professor, CCR diving enthusiast, motorbike rider, whippet slave. Own views. RTs not endorsements
Jan 30, 2021 • 9 tweets • 2 min read
I'm an ICU Consultant, not a vaccine or Public Health expert. Nevertheless, I'm asked about vaccinations all the time. Here are my thoughts on this, paraphrased from @TimBuchmanMDPhD First, vaccine effectiveness is never 100%. The different vaccines showed variable effectiveness
Ranging from 60% to 95% in clinical studies and no one knows how long that effectiveness lasts. Just because one received the vaccine does not mean that one cannot become ill with COVID. We don't know which vaccine IF ANY can prevent getting infected.
Oct 17, 2020 • 9 tweets • 3 min read
I see a lot of half-information and misrepresentation of figures on critical care capacity in Wales.
I was the @WCCTN clinical lead during the first wave so this is first hand info. #thread
In Wales, there are 189 funded and most importantly, staffed critical care beds. Not all can take ventilated patients, but even those can provide other organ support. It’s important as staffing requirements are different for mechanical ventilation and other forms of support.
Jun 19, 2020 • 13 tweets • 5 min read
I was walking the dog&while she was busy outrunning a doberman and a german shepherd puppy I was thinking about value for money and whether we, on the ICU, did some good in the economic sense during the #covid19 surge. I'm going off on a limb, so please feel free to correct me!
My health economics are very rudimentary, so anyone with a bit of knowledge will see the gaping holes. Please educate me :). The calculations are far from exact, mostly illustrative and rounded up or down so I could do maths easily in my head. This is what I came up with:
Jun 17, 2020 • 14 tweets • 5 min read
The #medtwitter in the US has exploded with cynical and sometimes downright malicious voices after the #RECOVERYtrial announcement. I agree (as does the Trial steering committee based on the press release!) that policy change and implementation should only come after publication.
There are very important data omitted from the press release&the scientific community has every right to demand to see those in a peer-reviewed publication, which will certainly be dissected word-by-word. As a researcher leading this and other RCTs in my Health Board I'm biased.
May 10, 2020 • 17 tweets • 6 min read
The first wave of the #covid19 pandemic is subsiding and we are surfacing for a gulp of fresh air, before we dive in again. Some reflections on the ICU/NHS/research (thread)
We coped, just about. There wasn't a lot of wiggle room, but it sort of worked. We have been lucky, that not only the specialty, but also the wider hospital and NHS leadership listened to the warning sounds. Cancelling elective activity and freeing up acute capacity was key.
Apr 11, 2020 • 13 tweets • 4 min read
Let's talk about "rationing" of intensive care in the context of #COVID19 (thread)
First of all, it's not happening in the UK. There are lots of misconceptions, which stem from the fact we are under enormous pressure.
UK critical care has been and continues to be brilliant at making sure admission to critical care is offered to those who might benefit from it. After all, we have one of the smallest number of ICU beds in Western Europe, so we always had to choose.
Mar 21, 2020 • 12 tweets • 4 min read
Some #medtwitter#CritCareControversies musings on #COVID19 after my first week. (Thread) 1. It’s a new disease. Normal ICU routines don’t seem to work. When you think they are ready to wean from the vent, they are not. Desaturation is common and deep.
2. They seem to like high PEEP as reported before. You can’t wean this fast as with a “normal” pneumonia. All this means light sedation doesn’t work and causes asynchrony. AKI is common and if caught early responds well to diuretics combo. Bloods are weirdly normal.
