Discover and read the best of Twitter Threads about #VTA23
Most recents (19)
Why do we put tracheostomies in patients though?
The rationale for a trachy in ICU is that there are respiratory mechanical benefit (compare to a tracheal tube and a native airway). There are many patient care benefits - oral care, feeding, etc...
#VTA23
The rationale for a trachy in ICU is that there are respiratory mechanical benefit (compare to a tracheal tube and a native airway). There are many patient care benefits - oral care, feeding, etc...
#VTA23
There are problems, including the potential for real patient harm. Tracheostomy emergencies are a problem. Complications (Immediate, Early and Late) are encountered in 30% of patients. #VTA23
PEEP is important - it improves oxygenation, and is an essential component of lung protective strategies.
But PEEP also has some problems - it can cause hypotension and increased pulmonary vascular resistance.
So how does one get optimal PEEP?
#VTA23
But PEEP also has some problems - it can cause hypotension and increased pulmonary vascular resistance.
So how does one get optimal PEEP?
#VTA23
Optimal PEEP has no clear universal definition.
Maybe we should look for appropriate PEEP - a PEEP value that results in adequate oxygenation with the lowest risk of overdistension.
#VTA23
Maybe we should look for appropriate PEEP - a PEEP value that results in adequate oxygenation with the lowest risk of overdistension.
#VTA23
Prof Anthony Holley is speaking next on 'Respiratory Support in the Trauma Patient' #VTA23 #critcare #FOAMcc
The 'trauma' patient is not a single disease entity, but ultimately a mechanism that is characterised by a shared multitude of pathophysiological patterns (TBI, lung contusion, etc...) and interventions (surgery, transfusion) that lead to some common disease processes. #VTA23
These common disease processes include TRALI, ARDS, TIC and many more.
Of concern, ARDS is not uncommon in trauma patients.
#VTA23
Of concern, ARDS is not uncommon in trauma patients.
#VTA23
Next up are two of the Occupational Therapists from CHBAH - Marche van der Heyden and Tiffany Fairbairn - speaking on 'Sensory Stimulation in Critical Care'.
#VTA23 #critcare #FOAMcc
#VTA23 #critcare #FOAMcc
Sensory stimulation is emerging in critical care as a modality to re-establish normal functioning. Our senses are our connection to the world. There are 8 (not 5!) senses - auditory, olfactory, gustatory, visual, tactile/touch, vestibular, proprioception and interoception. #VTA23
The lesser known of these - vestibular, proprioception and interoception - all are key in self-soothing...
Interoception is the sense how different parts of our 'deep' body are feeling. There are a few activities that include all 8 senses - for example eating.
#VTA23
Interoception is the sense how different parts of our 'deep' body are feeling. There are a few activities that include all 8 senses - for example eating.
#VTA23
Midmorning #VTA23 session starting - lots of short talks so expect quick changes in topic! #critcare #FOAMcc
PARDIE stands for Pediatric ARDS Incidence and Epidemiology study. This study is one of the results of the PALISI Conference Group.
doi.org/10.1016/S2213-…
#VTA23
doi.org/10.1016/S2213-…
#VTA23
Last up for the morning session is John Davies, who is talking about 'Mechanical Ventilation during ECMO: all, some or none'.
#VTA23 #FOAMcc #critcare
#VTA23 #FOAMcc #critcare
Essential to remember the components of lung protective ventilation - tidal volume, plateau pressure, respiratory rate, PEEP, FiO2.
#VTA23
#VTA23
Do the rules of LPV change when the patient is on ECMO.
There is little doubt that (in appropriately selected patients) ECMO has a mortality benefit. Have a look at the CESAR and EOLIA trials:
doi.org/10.1016/S0140-…
doi.org/10.1056/NEJMoa…
#VTA23
There is little doubt that (in appropriately selected patients) ECMO has a mortality benefit. Have a look at the CESAR and EOLIA trials:
doi.org/10.1016/S0140-…
doi.org/10.1056/NEJMoa…
#VTA23
Next is Prof Ronel Roos, who will be speaking on 'Mobilisation Patients with Extracorporeal Circuits' #VTA23 #critcare #FOAMcc
There are different types of mobilisation.
There can be passive mobilisation or active/assisted exercises. Functional exercises can include standing, sitting, walking, or even a bike (in or out of bed). #VTA23
There can be passive mobilisation or active/assisted exercises. Functional exercises can include standing, sitting, walking, or even a bike (in or out of bed). #VTA23
Alot of this is about setup. Femoral vs upper body cannulisation makes a difference - femoral makes it more difficult. Securing the lines safely is essential, the tubing must be monitored and long enough. #VTA23
As soon as blood leaves the body, it comes into contact with foreign substances that initiate the clotting/coagulation process. The high surface area of the CRRT filters are usually where these processes are most likely to occur. #VTA23
Preserving filter life is very important, as the circuits are very expensive and cumbersome to replace. More importantly, time off CRRT reduces the efficacy of the RRT and puts the patient at risk. #VTA23
Prof Gavin Joynt speaking on 'Personalised Antibiotic Prescription in the Critically Ill Patient'
#VTA23 #critcare #FOAMcc
#VTA23 #critcare #FOAMcc
Antibiotics are different from fluids in that, although they are crucial in reducing mortality, their effect is not immediately apparent. The consequences of underdosing or overdosing are quite real though. #VTA23
We often worry about overdosing, but underdosing puts not only the individual patient at risk, but also other patients in (or coming to the unit) who may be exposed to the eventual MDR organisms that arise.
doi.org/10.1128/AAC.02…
#VTA23
doi.org/10.1128/AAC.02…
#VTA23
First session of Saturday's session of #VTA23 - Dr Jacqui Brown on 'Personalised Fluid Management' #critcare #FOAMcc
The first buffered IV fluids were administed during the cholera epidemic in the UK in 1832. However, fluid therapy only entered main stream medical practice around the first world war. #VTA23
However, some time has passed since then. We have entered the era of personalised on individualised fluid management. There are many paradigms that can assist with this - ROSE, 7 D's, etc...
#VTA23
#VTA23
Final session of the day - Prof Dean Gopalan - who is speaking about 'The Human Touch in Digital Healthcare'. #VTA23
Telemedicine has been around for a while, and more recently telerounding. In 2019, a doctor in California appeared via video link to tell a patient he was dying. This (probably predictably) caused an uproar, but also debate? #VTA23
Is digital healthcare making us lose the personal touch? Making us disconnect from the patient? Or are we just behind the technological curve? #VTA23
Finally for the first afternoon session is Dr Michael Pienaar, who is speaking on 'Machine Learning to Tailor Management Strategies'. #VTA23
Central to this are the definitions of Artificial Intelligence, Machine Learning and Deep Learning.
#VTA23
#VTA23
Statistics --> Machine Learning --> Soft AI --> Hard AI --> General AI
These exist on several spectra
Human Operator --> Self-operated
Seen rules --> Unseen rules
etc...
#VTA23
These exist on several spectra
Human Operator --> Self-operated
Seen rules --> Unseen rules
etc...
#VTA23
Next is Dr Christel Arnold-Day - the first (to my knowledge) neurosurgeon to become an intensivist in South Africa. She is talking about 'Personalised TBI Management' #VTA23
The protocols - Brain Trauma Foundation 4th Edition goals are quite old and outdated. However, for the first time there is interest in age specific cerebral perfusion pressures. #VTA23
What monitors can you use for the TBI patient:
ICP, PtO2, IBP and CVP - this will give you information about how the brain is perfusing - usually measured by the cerebral perfusion pressure.
There is little consensus in South Africa neurosurgeons about whether to do these. #VTA23
ICP, PtO2, IBP and CVP - this will give you information about how the brain is perfusing - usually measured by the cerebral perfusion pressure.
There is little consensus in South Africa neurosurgeons about whether to do these. #VTA23
Next is Prof Fathima Paruk - 'Sub-phenotyping in ICU' #VTA23
At the bedside, we are increasingly responding to the unique profile of the patient in front of us. ARDS and Sepsis, for example, are both widely recognised syndromes that represent a hugely heterogenous patient population. #VTA23
ARDS is a phenotype, characterised by the Berlin Criteria. A further subcategorisation might be a hyperinflammatory vs hypoinflammatory. How deep do you go though? Endotypes look at the mechanisms that produce the subphenotype. #VTA23
First session after lunch is Dr Rob Wise - on 'Personal vs Precision Medicine - What does it all mean?'
#VTA23
#VTA23
So Personalised Medicine - its about tailoring the medicine/treatment to the specific patient group to get the right treatment. Its essentially about subcategorising patients and trying to give them more nuanced therapy then just following a protocol.
#VTA23
#VTA23
Precision Medicine - very similar, but going down to the molecular/genetic profile of the patient. So for example, by measuring the biomarkers/genetic profile, you could give a specific interleukin blocker in a particular patient with a specific type of immune response. #VTA23
After a short break, Prof Francesca Rubulotta @frubulotta will be speaking about "Gender disparities in critical illness' - an unbelievably disappointing reality in our profession.
#VTA23
#VTA23
So today she wants to flip the conversation, not to talk about gender disparities in critical care practitioners, but rather in how gender disparities in how patients are treated. #VTA23
In the past, most medications have been tested solely on male 'ideal' patients, and female patients of any weight were actively excluded. Although this has changed in the last 10 years, we still live with the consequences of the earlier studies... #VTA23
Next up in Prof Guy Richards @ProfGuyRichards who will be talking about Ventilatory Lessons Learnt from COVID. #VTA23
In SA, large numbers of patients who would normally be admitted to ICU for ventilation were instead given support through CPAP and HFNC in wards (and sometimes parking lots...) because of resource limitations. #VTA23
An SA study (n=293) with patients with a mean PF ratio of 68 who were given HFNC, had 47% of patients who survived to weaning. If HFNC failed, you had a risk of mortality of 92%! Predictors of success included a ROX-6 score of >4.4. #VTA23
First talk of the day - Dr Hilary Klonin, a paediatric intensivist from Hull University Teaching Hospital Trust - on 'Less is more, except when it isn't'. Talking about paediatric BP targets in critical care. #VTA23
Up to 50% of paediatric ICU survivors suffer from some sort of impairment. Could this be because the BP targets in paediatric ICU are unclear and too high a target is used? #VTA23
In 2008, a review at their hospital challenged the BP target of the 50th centile for age, and wanted to compare it to a permissive BP target. This was to be done only in critically ill patients, but started from the ED or ward, until critical illness resolved. #VTA23
First weekend lenary session at CCSSA 2022, chaired by @BranniganLliam and Prof M Mer. Starting with a talk by Dr Francesca Rubulotta @frubulotta on 'Knowledge Transfer Across the World' - appropriately a recorded talk made half way around the world! #CCSSA2022 #critcare #FOAMcc
Incidentally I met Dr Rubulotta a few years ago at a different congress - the amazing ventilation congress Ventilation Through the Ages - what a wonderful, passionate intensivist. I'm gonna plug the next one here, which will be next year!
#CCSSA2022 #VTA23
#CCSSA2022 #VTA23
Dr Rubulotta starts by explaining 'Knowledge Transfer' as a mechanism to close the know-do gap. It is the synthesis, exchange and application of knowledge by relevant stakeholders in order to accelerate the benefits of global and local innovation. #CCSSA2022
