@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
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!
1/
#VExUS Score at Discharge as a Predictor of Readmission in Patients with Acute Decompensated #HeartFailure: A Cohort Study
๐ https://t.co/kgPFReCGYa
@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
@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
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!"
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 ๐งต all about lactic acid and lactated ringers!
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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 ๐
https://t.co/fq66OIHxw5
@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!
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