Ben Millette

Consultant in Intensive Care and Anaesthesia, Trust POCUS lead, Sportsman, Cinephile, Mexican food aficionado

[Ben Millette @ben_millette]

@cliffreid Nice thread. I think it's worth mentioning that the optimal rate of failed ICU extubation is not zero. If it is then you're not pulling enough tubes!
There needs to be a balance between the attributable harm of a failed extubation and the harm of continued unnecessary intubation

[Nick Mark MD @nickmmark]

New favorite physiology paper: Central Venous Pressure in Space.

So much space & cardio physiology to unpack here including:
- effects of posture, 3g shuttle launch, & microgravity on CVP
- change in the relationship between filling pressure (CVP) & LV size
- Guyton curves!
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[Ben Millette @ben_millette]

@hazlehurst_j @JessicaMABlair Happy birthday Jess!

[Ben Millette @ben_millette]

@nickmmark Now don't go full Marik on us Nick 😉

[NephroPOCUS @NephroP]

#VExUS Score at Discharge as a Predictor of Readmission in Patients with Acute Decompensated #HeartFailure: A Cohort Study
🔗 https://t.co/kgPFReCGYa

[Ben Millette @ben_millette]

@DrKerryMac @DrSimonAshworth @DrTobyGilbert @DrLindaDykes Severe HLH, diagnosed and managed swiftly. If diagnosis had been delayed it would likely have been fatal. Can't say much more as it would be identifiable

[Ben Millette @ben_millette]

@DrSimonAshworth @DrTobyGilbert @DrLindaDykes Second this. We've had a young patient recently who pretty much had his life saved because somebody (not me) thought to check a ferritin

[Ben Millette @ben_millette]

@Cmdr_Hadfield @maritimelaunch Think it is now Vandenberg Space Force Base?

[Ben Millette @ben_millette]

@stephen_t_webb Stopping NG feed prior to extubation
https://t.co/ESEYpZXh7B

[Ben Millette @ben_millette]

@rbarbosa91 The wire is a coil wrapped around a core and by stretching the coil you exert pressure down its length that straightens the tip

[Ben Millette @ben_millette]

Great thread! Reminds me of an old talk by Merv Singer about the misinterpretations of lactate where he said "lactate gets a bad rap but it's a good guy!"

[Nick Mark MD @nickmmark]

You've probably heard "don't give lactated ringers because it raises lactate"

This statement is ~98% false, but there's one crucial practice-changing fact that you need to know.

A 🧵 all about lactic acid and lactated ringers!
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[Ben Millette @ben_millette]

Well done to the whole #CCR24 team for organising an excellent meeting! Enough research to keep our journal club busy for months yet
@CritCareReviews

[Resident Doctors @BMAResidents]

We're aware that many doctors are being told their training is being automatically extended due to exceeding TOOT thresholds. This should NOT happen.
@gmcuk and @NHSEngland confirm there should be no automatic extensions.

See our guidance on TOOT 👇
https://t.co/fq66OIHxw5

[Ben Millette @ben_millette]

@f_g_zampieri : we should revisit the ICU mantra of stopping all the patients home medications when critically unwell
#CCR24

[Ben Millette @ben_millette]

@bryan_reidy My brief read of this: basically a way of making a composite endpoint more clinically relevant but also potentially making it murkier to interpret.
A cynic might say it's another way of torturing the data until it confesses!

[Ben Millette @ben_millette]

@bryan_reidy Agreed. Also my knee jerk response of discontinuing SGLT2i in the critically unwell perhaps needs reevaluating!

[Ben Millette @ben_millette]

A lot to unpack in DEFENDER trial results. Need to get my head around the concept of win ratio! Perhaps not surprising that there was no benefit in a generally critically ill population. Most interesting thing for me is zero euglycaemic DKA cases!
#CCR24
https://t.co/TCEMYgr5Ju

[Ben Millette @ben_millette]

@TPP_MD The phrase "game changer" was thrown around a lot today.
This is a classic example of 'nerf the control group to show an effect'

[Ben Millette @ben_millette]

@iceman_ex @bryan_reidy For shame!