ʇɟıɥsI̍CͨMͫpɐɹɐd ≆ Dr Justin Kirk-Bayley

UK somnificator, sinistral INTJ #POCUS inamorato, #FOAMed, #FOAMcc & #FOAMus.
Turning ICU upside down one ultrasound scan at a time. @ICS_updates Council member

[Turning the Tide @Turningthe_Tide]

A new meta-analysis reports that balanced crystalloids reduce mortality compared with 0.9% saline in adults with sepsis.

RR 0.92 (95% CI 0.86–0.98).

So have we finally proved that balanced crystalloids save lives?

Not quite.

The 2026 Surviving Sepsis Campaign analysed much of the same underlying evidence and estimated mortality at OR 0.94 (95% CI 0.85–1.04).

Those estimates are remarkably similar.

One crosses the conventional threshold for statistical significance. One doesn't.

That does not mean the physiology suddenly changed.

Balanced crystalloids remain the sensible default for most patients with sepsis: they cause less hyperchloraemia, produce less acid–base disturbance, and the clinical evidence points towards either equivalence or modest benefit compared with saline.

But a meta-analysis cannot create information that wasn't present in the underlying trials, and sepsis subgroup data from broader critical-care trials need careful interpretation.

Perhaps more importantly, debates about which bag can distract from the bigger fluid-safety question.

Giving unnecessary balanced crystalloid is still unnecessary fluid.

Before choosing the fluid, ask:

Does the patient actually need it?

Our take on the new evidence:

https://t.co/BRnOpAdhGg

Sign up for free for access to all the latest evidence on fluids

[ʇɟıɥsI̍CͨMͫpɐɹɐd ≆ Dr Justin Kirk-Bayley @PARADicmSHIFT]

@khaycock2 @IM_Crit_ @ThinkingCC Never let science get in the way of a strong opinion!

[ʇɟıɥsI̍CͨMͫpɐɹɐd ≆ Dr Justin Kirk-Bayley @PARADicmSHIFT]

What’s hot in point of care ultrasound in critical care? Well this to begin with 😁
https://t.co/Yt12VjVahc
Join the FUSIC team for a day of pushing boundaries & healthy discussion about how we can all help treat patients to our best ability with ultrasound.
See you there!

[Ashley Miller @icmteaching]

FUSIC HD was designed to answer the haemodynamic questions clinicians face at the bedside of critically ill patients.

The updated curriculum integrates LV performance, filling pressure, RV function and pulmonary vascular loading into a complete, structured bedside ultrasound assessment of haemodynamics.

Our paper explains what changed and why:

https://t.co/xJzRPZVZu9

[Turning the Tide @Turningthe_Tide]

Australia has recognised IV fluid safety as a national systems problem.

Its new national guidance is built around three simple principles:

Start IV fluids only when there is a clear indication.
Stop them as soon as they are no longer needed.
Switch treatment as the patient’s condition changes.
The important point is that IV fluid harm is not only caused by choosing the wrong bag.
It also occurs when fluids are:

• started without a clear purpose
• prescribed without an intended response or stopping point
• continued without reassessment
• allowed to run because nobody actively decides to stop them
• considered in isolation from drug diluents, nutrition and other hidden fluid sources

The UK already has much of the necessary clinical guidance. What remains inconsistent is the system that turns guidance into everyday practice: leadership, education, prescribing standards, documentation, audit and multidisciplinary review.

Fluids are drugs. Every prescription should answer:
Why is it being given?
What effect are we looking for?
How will we monitor it?
When will we stop?

Our commentary on what the Australian approach means for IV fluid safety in the UK:
https://t.co/BRnOpAdhGg

[ʇɟıɥsI̍CͨMͫpɐɹɐd ≆ Dr Justin Kirk-Bayley @PARADicmSHIFT]

7/7
Respect the bag. 💧
Prescribe fluids with the same care as any other drug — because that’s exactly what they are.
It’s time for 𝗙𝗹𝘂𝗶𝗱 𝗦𝘁𝗲𝘄𝗮𝗿𝗱𝘀𝗵𝗶𝗽.
#FluidStewardship #MedTwitter #FOAMed

In the UK?
Join https://t.co/bg0DCciw2W and help us make IV fluids safer.

[ʇɟıɥsI̍CͨMͫpɐɹɐd ≆ Dr Justin Kirk-Bayley @PARADicmSHIFT]

1/7 🧵
Imagine a doctor prescribes a drug.
They don’t know the right dose.
They haven’t even decided when it should stop.
Sounds unlikely?

This is a call to arms for UK doctors, nurses and pharmacists to join https://t.co/bg0DCciw2W to help us fix this.

Keep reading.

[ʇɟıɥsI̍CͨMͫpɐɹɐd ≆ Dr Justin Kirk-Bayley @PARADicmSHIFT]

IV fluids 𝒂𝒓𝒆 medicines.
Every bag deserves:
✅ An indication
✅ A dose
✅ A duration
✅ A daily review — and de-escalation when the job is done

[Ashley Miller @icmteaching]

I spend a lot of time talking about IV fluids because we still cause avoidable harm with them every day.

That is why we created Turning the Tide — a UK charity focused on safer fluid prescribing, better education and practical resources for clinicians. @Turningthe_Tide

Membership is free for UK healthcare professionals and gives access to our members’ area, new articles, resources and future educational content.

Join us at https://t.co/KDz2rD4KIl

[Ashley Miller @icmteaching]

A long time ago, in a laboratory far, far away, a new way of seeing the circulation was born…

Some papers change what we know. A few change how we think.

Arthur Guyton’s 1955 papers did something rarer still: they gave cardiovascular physiology a new way of seeing itself.

Before Guyton, physiologists understood many of the individual components of the cardiovascular system. The heart obeyed the Frank–Starling mechanism: as filling increased, the heart pumped more blood. Blood vessels were elastic structures that stored volume, generated pressure and resisted flow. Cardiac output, blood pressure and vascular resistance could all be measured.

Yet the circulation remained difficult to understand as a complete system.

The problem was deceptively simple: what determines cardiac output?

The obvious answer was the heart. After all, the heart was the pump. But Starling’s mechanism immediately created another question. If the heart pumps what it receives, what determines what it receives?

The circulation was a closed loop. The heart determined flow through the circulation, but the circulation determined the conditions presented back to the heart. Each side influenced the other, making it difficult to identify where cause ended and effect began.

Guyton’s insight was to break that circle conceptually.

He separated the circulation into two interacting systems: a cardiac function describing the relationship between filling and output, and a vascular function describing the relationship between the systemic circulation, flow and right atrial pressure.

Study them separately. Then put them back together. Where those two relationships intersected, the entire circulation found its equilibrium.

Cardiac output and venous return were not competing explanations of flow. They were two views of the same circulation seen from opposite sides of the loop.

It was an extraordinarily powerful idea. In a single diagram, Guyton united Starling’s law, vascular properties and cardiac output into one coherent picture. Physiologists could now visualise how changes in blood volume, vascular tone or cardiac function shifted the operating point of the entire circulation.

Few papers have influenced cardiovascular physiology more profoundly.

But every powerful idea carries a hidden danger. Sometimes the way we draw a diagram changes the way we think, and sometimes the language we use to describe a relationship instead becomes a story about cause and effect.

That is where the venous return wars began....

Continue reading for free on SubStack https://t.co/QZOeGvT6oQ

[ʇɟıɥsI̍CͨMͫpɐɹɐd ≆ Dr Justin Kirk-Bayley @PARADicmSHIFT]

What a landmark day for the future of intensive care in the UK— we have a College!

Time for a new domain name!

https://t.co/ls4js5gEeP

[ReferToPharmacy @ReferToPharmacy]

having a great meeting with like minded Fluid Stewards from @Turningthe_Tide - worth following this group

[ʇɟıɥsI̍CͨMͫpɐɹɐd ≆ Dr Justin Kirk-Bayley @PARADicmSHIFT]

@g__j 39362.6

[ʇɟıɥsI̍CͨMͫpɐɹɐd ≆ Dr Justin Kirk-Bayley @PARADicmSHIFT]

Key topics include:
·     Treating IV fluids as drugs: right composition, right patient, right timing
·     Avoiding fluid creep and managing cumulative exposure
·     Fluid responsiveness versus tolerance
·     Reassessment, de-escalation, and IV-to-enteral transition

[ʇɟıɥsI̍CͨMͫpɐɹɐd ≆ Dr Justin Kirk-Bayley @PARADicmSHIFT]

Join us for a webinar: Breaking the habit: Individualised IV fluid prescribing & stewardship
Delivered by @Turningthe_Tide in collaboration with @Fluid_Academy, & sponsored by @baxter_intl

📅 Monday 6 July
🕔 17:00 CET/16:00 UK/Portugal
Register here:
https://t.co/WucxpN8cBT

[ʇɟıɥsI̍CͨMͫpɐɹɐd ≆ Dr Justin Kirk-Bayley @PARADicmSHIFT]

IV fluids are among the most commonly prescribed therapies in hospitals, yet they require careful, patient-specific decision-making. This webinar will explore practical approaches to rationale-driven prescribing and stewardship.