A cautionary tale about highly complex trial designs? Difficult to interpret. Small groups powered into for large effect sizes. Risk of error?

Gosh that other explanation at the end is so much less exciting

Sounds great in theory. Still waiting for some evidence that just giving levophed is the wrong answer in almost all non-pure cardiogenic shock cases

We all underdose NIV

And mortality higher in PCT guided arm! Should this have been designed as a non-inferiority trial with a 5% non-inferior mortality margin? Makes the study conclusions read very strangely #emimccm

important thread 👇

{norepi + vaso} can often induce a state of *normotensive* vasoconstrictive shock

this is why I dislike blind algorithms that start with NE, then pile on vaso on without considering global hemodynamics

for experts, there is no such thing as a “1st/2nd/3rd line” pressor #EMIMCC

I guess we have DRIVE and Prevent VILI to look forward to! Prevent VILI targeting DP if 12 which should create more separation #emimcc

Pressure support, patient effort and tidal volume: a conceptual model for a non linear interaction - Critical Care Pressure support ventilation (PSV) is a form of assisted ventilation which has become frequently used, with the aim of partially unloading the patient’s inspiratory muscles. Both under- and over-assis...

Pressure support ventilation ( #PSV), aim of partially unloading the patient’s inspiratory muscles, over-assistance, under-assistance, patient self-inflicted lung injury ( #P-SILI), #pulmsky #emimcc #critcaresky
ccforum.biomedcentral.com/articles/10....

One of my favorite teachings from @xanderpharmd.bsky.social check out how different receptor binding is for each med—and we tend to use interchangeably!

Ya for sure. Great screening test—especially on off hours

We use these a lot—they can help with the seizure/no seizure decision but an epileptologist is really needed for more complex findings on the ictal spectrum. What do you do about those sharp waves in the right parietal region not meeting 2.5hz

Have we tried bagging the liver in humans

Don’t we have an RCT?

I hear this a lot. Don’t use it a ton but never had major issues with IV hydral. Maybe I’m in the minority but seems to work fine and more or less predictably @xanderpharmd.bsky.social

“Awake” Cannulation of Patients for Venovenous Extracorporeal Membrane Oxygen: An Analysis of the Extracorporeal Life Support Organization Registry “Awake” cannulation for venovenous extracorporeal membrane oxygenation (ECMO), where patients remain spontaneously breathing without invasive mechanical ventilation during the cannulation procedure, m...

Do you cannulate ‘awake’ (non intubated) for VV ECMO? What’s your experience? Our findings using the ELSO registry match what we’ve seen @montefiorecritcare.bsky.social. About half of patients intubated at 24-hours. No mortality difference. Check it out! pmc.ncbi.nlm.nih.gov/articles/PMC... #emimccm

This is great. Ty!

Super interesting!! Why can’t I just increase the density of gas going into any ventilator? What is special about the chamber

#emimcc

Bluesky crowdsource! Patient admitted with CO poisoning (carboxyhemoglobin 32%). Intubated for coma. Whats the benefit of hyperbaric in an intubated patient? How does it work? @nickmark.bsky.social @nickjohnsonmd.bsky.social @pulmcrit.bsky.social @pulmtoilet.bsky.social @avrahamcoopermd.bsky.social

In subgroup no difference between humeral and tibial

No difference in time to placement! Would that be true in our population??

3 brand new trials comparing IV to IO in OHCA. No survival differences. #ReSS24 #emimcc

Poster by Montefiore resident Jack Galfund on CT findings after in-hospital cardiac arrest! Many scans would find something that was not previously known, resulting in a change in management.
#ReSS2024 #emimcc
@almoskow.bsky.social

Quick synthesis of the recent trials on ppx antibiotics to prevent VAP

more evidence to support short-course antibiotic therapy after severe brain injury to prevent pneumonia 😃

small study, but consistent with PROPHY-VAP trial

prior evidence along this vein is reviewed here: emcrit.org/pulmcrit/pro... #EMIMCC

Nice Blue-sky-able chart. Interesting how any improve from CPC 2/3 to CPC 1

Survival! If you survive the first month you’re likely to survive for years!! No difference between treatment groups

Tough to keep up with these patients

What happens to these patients 5-8 YEARS later?

As a reminder these were the original results, better outcomes in 48 hour group but not significant