Ben Millette

CCR Down Under 2025 Original Article | Dec. 9, 2025 | NEJM.org Ketamine or Etomidate for Tracheal Intubation of Critically Ill Adults Figure 1. In-Hospital Death, According to Trial Group. The NEJM identity sits at the bottom.

In a randomized trial involving critically ill patients undergoing intubation in EDs or ICUs, the use of ketamine for the induction of anesthesia did not lead to significantly lower in-hospital mortality than etomidate. Full trial results: nej.md/44EOlxB

@criticalcarereviews.com

Bear hugging a friend who I hadn't seen in ages, both of us in full PPE in the middle of a covid ICU

Trimethoprim-sulfamethoxazole carries a very low (but real) risk of causing ARDS.

Duration of therapy is a risk factor (>7 days).

Could likely be minimized by avoiding unnecessarily long courses.

TMP-SMX is usually well tolerated, but can wreak havok (SJS, ARDS, drug-induced meningitis). #EMIMCC

www.fraserhealth.ca/news/2025/No...
V interesting- spinal anaesthesia still seems to work in microgravity! I look forward to the full publication of these results

YouTube video by Medlife Crisis What everyone gets wrong about AI in medicine

A short video that started as a bluesky post a few weeks ago. For clarity, I am actually quite optimistic about AI being useful in many areas of medicine. I’m just saying being a “diagnostic machine” really won’t move the modern healthcare needle that much

youtube.com/shorts/hRv5K...

UK facing long, tough flu season, NHS chiefs warn Vulnerable urged to come forward for flu jab quickly as virus has come early this year.

UK facing long, tough flu season, NHS chiefs warn
www.bbc.com/news/article...
We desperately need more evidence on how best to manage flu. Even the most basic questions- we don't really know if oseltamivir is benefical or if steroids help or harm in severe flu. I think REMAP CAP is looking at this?

MASSIVE RCT from Kenya showing that steroids reduce mortality in CAP

Mortality benefit easier to demonstrate w/ less resources available to salvage pts

Should allay the hype that the negative REMAP-CAP steroid RCT received (despite being woefully underpowered)

www.nejm.org/doi/pdf/10.1... #EMIMCC

Yes this paper gave me flashbacks to Rivers for several reasons!

JAMA infographic: Study concludes personalized hemodynamic resuscitation protocol targeting capillary refill time (CRT-PHR) was superior to usual care for early septic shock patients. CRT-PHR wins: 131,131 (48.9%) vs Usual care: 112,787 (42.1%).

Among patients with early #SepticShock, a personalized hemodynamic resuscitation protocol targeting capillary refill time was superior to usual care for the primary composite outcome, driven by a lower duration of vital support.

#LIVES2025 @esicm.bsky.social

ja.ma/3L9m7EB

New blog: Fresh dueling guidelines about post-arrest care from the AHA and ESICM

💔 BP targets
💔 Who needs an emergent cath?
💔 O2 targets
💔 pan-CT scans
💔 temp targets
💔 neuroprognostication

Which guideline do I love? 😍 You'll have to read the post to find out.

emcrit.org/pulmcrit/202... #EMIMCC

a woman wearing headphones is talking on a walkie talkie and the caption says any updates ALT: a woman wearing headphones is talking on a walkie talkie and the caption says any updates

Updated the IBCC chapter on pancreatitis

Added fresh, new guidelines from the AGA (meh) and International Association of Pancreatology (very good)

Lets talk about some updates… #1/6🧵

(chapter: emcrit.org/ibcc/pancrea...) #EMIMCC

a man with a beard and long blonde hair is smiling . ALT: a man with a beard and long blonde hair is smiling .

Congrats!

Experts recommend a simple change to antibiotic administration that will save lives in sepsis

A simple shift in NHS critical care practice is set to save more lives from #Sepsis.
The @ICS_updates & @BritInfectAssoc now recommend continuous infusion for key antibiotics over intermittent dosing. Evidence shows increased 90-day survival.
We urge all hospitals to adopt this practice immediately

a man in a blue shirt with a star trek logo on his chest ALT: a man in a blue shirt with a star trek logo on his chest

Either way or turns out, BICARICU2 will be v interesting!

Trials coming up at #esicm #lives2025

I am by far most interested in #andromedashock2.

The usual yearly sweepstakes apply ping @avkwong.bsky.social @redneeraj.bsky.social

I think all of those trials will be “positive”.

Your thoughts?

but also caused some second order effects on workflows within the hospital. If a task is not being done by one person it has to be handed over and taken on by someone else, and that person is frequently the on call doctor who is quite busy already!

of the job. The 2016 junior doctors contract enshrined the principle of pay for all work done and introduced penalties for departments that made their juniors work longer than contracted hours alongside other safeguards. This has led to a reduction in juniors (now residents) working unpaid overtime,

Older staff are generally more likely to work more unpaid hours (presumably because they're more experienced so there's more pressure on their time).

Thanks for this very interesting perspective Sam. On the point I've highlighted here, what you write is true to some extent but differences in doctors working unpaid overtime are more about broad cultural changes in medicine. Prior to 2016 working unpaid overtime was the norm and was considered part

On the edge My week in the NHS

New post just out:

"On the edge"

On my unexpected week in hospital and five things I learnt about the state of the NHS.

(Free to read)

open.substack.com/pub/samf/p/o...

ICU diagnostic conundrums (conundra?) are great to exercise the brain cells but they comprise maybe 5% of all our cases? The greater bulk of medicine is routine management of common disease

This is something I say a lot too. People (not the author) seem to think the only thing doctors do is diagnose. In reality, that's a tiny part of a modern doctor's job in the real world. A fancy AI offering diagnostic powers would help me only quite occasionally. Real life is not like House.

Many betting on even shorter time horizons than this. The 100 trillion dollar question is whether you get an AI agent that is reliable enough to be monetisable on a large scale before the bubble bursts

In US healthcare (as in the UK) you are more likely to be treated by an immigrant than you are to be behind one in the queue to get care

1st panel Elon musk 2015 "self driving cars in 2 years" 2nd panel Geoffrey Hinton 2016 "radiologists obsolete in 5 years" last panel 2024 radiologists in regular cars driving to work

In 2016 Geoffrey Hinton said “we should stop training radiologists now" since AI would soon be better at their jobs.

He was right: models have outperformed radiologists on benchmarks for ~a decade.

Yet radiology jobs are at record highs, with an average salary of $520k.

Why?

NASA’s New Astronaut Class of 2025 Makes History with “All-American” Recruits Poised for Moon and Mars NASA’s New Astronaut Class of 2025 Makes History with “All-American” Recruits Poised for Moon and Mars - Tech Space 2.0

I believe that Dr Imelda Müller may be the first anaesthetist to become an astronaut?
ts2.tech/en/nasas-new...

Some thoughts on this study on using vena cava to guide in-patient treatment of deconpensated heart failure and why it will not change the way I diurese (I use vena cava wisely). #emimcc #cardiosky

I am delighted to announce CACTUS has launched its cardiac #ultrasound module for accreditation, following the successful launch of Lung #POCUS

Suitable for anyone caring for sick kids

#PedsICU @ics-updates.bsky.social @pccsociety.bsky.social @rcpch.bsky.social

👇

ics.ac.uk/learning/cac...

Alex Baldwin's character in Glengarry Glen Ross pointing to a blackboard which has been altered to say "Always be Extubating"

Underappreciated medical occupational perk: the lid from many brands of antibiotic ampoule unlocks most supermarket/airport trolleys across Europe