I finally caught up with my 8-week backlog of @criticalcarereviews.com emails. I'm unsurprised to say that nothing has changed. This is totally not a sub-tweet directed at the Andromeda-Shock-2-stans.

This definitely comes with experience and feeling comfortable interpreting the data by yourself. I always skip the introduction and go straight into the methods, followed by the results, last paragraph of the discussion ± supplement.

Chelsea Parlett@chelseaparlett.bsky.social · 11mo ago

One of the most powerful skills you get with more and more experience is just understanding what you can ignore lol. It’s made reading stats papers much easier 😂

Yes. If you're worried about a lung fungus, mica/eraxis ain't it. People reach for it because it's easy (where as vori/isavu/ampho aren't easy), but it's not useful here. And if you think you found candida because your BAL said so....no you didn't.

josh farkas 💊@pulmcrit.bsky.social · last yr.

I sometimes see folks using echinocandins (micafungin et al) to cover "possible fungal pneumonia" But, I'm not aware of *any* fungal pneumonias that can be treated adequately with echinocandin monotherapy 🤔 (I'm not counting Candida PNA because it has an incidence rate on par with Sasquatch)

What I value most about institutions of higher education is their moral compass, their natural inclination to speak truth to power, and how unflappable they are in the face of changing political winds.

Dexmedetomidine-associated fever happens WAY more often than this, particularly in cardiac surgery patients. Such an easy way to trick yourself into an unnecessary infectious workup and antibiotic course.

@IM_Crit_@imcrit.bsky.social · 2y ago

2. Fever/Hyperthermia: happens probably in 5% of patients & is associated with higher/prolonged infusion rates. Some authors suggest that the opposite, fever control using a2-agonists in the settings of sepsis, may be related to hyperthermia-associated vasodilatation… 🤷‍♂️

The Hypotension-Prediction Index--a convoluted way of predicting hypotension by...checking whether the MAP is low--fails once again. Shocker. "HPI-guided hemodynamic therapy did not reduce the incidence of postoperative AKI or overall complications [vs] standard care."

I'm just here for the DL/VL drama. (this is pretty classic confounding by indication)

Michael Hofkamp, MD, FASA@hofkampmichael.bsky.social · 2y ago

Published TODAY in @tandfonline BUMC Proceedings: Airway management of appendectomies In this retrospective study, we found that most airways (88%) were managed with DL (97% 1st pass success) and that VL was less successful (76%) . VL pts were sicker🧵 #ansky tandfonline.com/doi/full/10.10…

open.substack.com/pub/sensible... #EMIMCC #Cardiosky #Medsky

Is One of the Most Popular Cardiac Drugs Better than its Generic Competitor?

The British Medical Journal has reignited a 14-year debate regarding the antiplatelet drug ticagrelor (Brilianta) and PLATO trial

open.substack.com

Merry Christmas to everyone except for the people being unnecessarily pedantic about hypoxia and hypoxemia.

1) If you're looking for an excuse to deescalate (i.e., procalcitonin), just deescalate 2) I really want to see us move away from magic numbers (5, 7, 10, 14, etc.) but not sure that fixating on a different magic number is the way to go

JAMA@jama.com · 2y ago

Published in JAMA with #CCRdownunder: In critically ill adults with suspected sepsis, antibiotic regimens were safely reduced when guided by measurement of procalcitonin but not by C-reactive protein. @criticalcarereviews.com ja.ma/3BovM5v

“Professional ethics must guide us precisely when we are told that the situation is exceptional. Then there is no such thing as ‘just following orders.’” ~ Timothy Snyder

This is incredibly disturbing.

ProPublica@propublica.org · 2y ago

NEW: “Eat What You Kill” Hailed as a savior upon his arrival in Helena, Dr. Thomas C. Weiner became a favorite of patients and his hospital’s highest earner. As the myth surrounding the high-profile oncologist grew, so did the trail of patient harm and suspicious deaths. @davidmcswane.bsky.social

A patient presented in need of an urgent but relatively minor surgery. Vitally stable. Surgery goes fine, but ICU is called because their “sat is too low to extubate.” No prior pulmonary or cardiac conditions. #emimcc

I'm just waiting for the day when we finally stop teaching people that pressors don’t work in acidotic patients.

I don’t have strong opinions about the result, but this study is grossly underpowered. I would not draw any definitive inferences from it.

Journal of Trauma and Acute Care Surgery@jtraumacutesurg.bsky.social · 2y ago

❇️ Best of Surgical Critical Care❇️ A study was done to determine if adding ketamine to multi-modal analgesics improved pain control in adult blunt trauma patients with rib fractures. Ketamine infusion didn't decrease opiate use & its routine use is not recommended. journals.lww.com/jtrauma/full...

I add a couple of people every day but there are many more of you who work with critically ill patients. Drop a comment here and I'll add you! But check to see if you're already on it first 😁 go.bsky.app/NC7iD2K

Renal: "We must keep the correction rate below 12 mEq/day, but to avoid overcorrection/this is a high risk patient, we're going to recommend 8 mEq/day." Primary team: "Wait—ODS is (really) bad, so we'll do 6 mEq/day." Maybe this is will be the impetus for some high-quality prospective studies.

Joel Topf@kidneyboy.bsky.social · 2y ago

Honey, stop what you're doing, new hyponatremia research just dropped! What's it say? It looks like slow correction is associated with worse outcomes, like death and length of stay! Was it just a small study? No, it was a meta-analysis of almost 12,000 patients! jamanetwork.com/journals/jam...

Spiciest opinion of the day! Can we still use negative binomial if we don't know how to spell poission though?

Noah Greifer@noahgreifer.bsky.social · 2y ago

Given the #Rstats base vs tidy wars have been reignited, I want to create a new front for #statsky: poisson vs. negative binomial regression. I firmly believe you should almost never use NB. My reasoning: stats.stackexchange.com/a/653731/116... And always use a robust/bootstrap SE with poisson!

One of the most amusing things in medicine is seeing how people dismiss high-quality evidence when it challenges their preferred practices (e.g., robotic surgery, regional anesthesia, TAVRs, TTM, etc.).

This common belief isn't entirely accurate. In acute blood loss, fluid shifts happen quickly—hemoglobin decreases in < 30 minutes, even without IV fluids. The levels won't reflect the magnitude of the blood loss, but someone who lost 40% TBV will not have a normal hemoglobin. https://t.co/59...

Without exaggeration, the font change on PubMed Central by @NCBI is probably the worst thing to have ever happened to science in the history of science.

Here's your friendly reminder that Plasmalyte is NOT affected by the IV Fluid Shortage, just in case you needed another reason to switch.

Looks like we’re still trying to make REBOA happen. 🙃 Regardless, this graph is a bit misleading. Neither B nor C survived to discharge, but not mentioned in the graph. https://twitter.com/JAMASurgery/status/1838518771805233592

At least it’s not Xuebijing again. https://twitter.com/giovannilandoni/status/1837176108585996518

It's #WorldSepsisDay. Did you remember to order your 30mL/kg normal saline boluses?

If you wait long enough, everyone dies. (p < 0.001) https://twitter.com/DFCapodanno/status/1830265384546545770

Time to update the Epic dot phrases, I guess https://twitter.com/drahmedmohsen85/status/1829593512914133229

Waiting for the randomized controlled trial so we can agree to use LR and move on with our lives. https://twitter.com/PharmacoJournal/status/1823345767420944565

I am convinced people don't understand delirium and instead use it for any behavioral disturbance they don't understand. Textbook delirium is often missed, while something that is clearly not delirium gets labeled as such.

I remain befuddled by the amount of Plavix prescribed without CYP2C19 testing. We keep burying our heads in the sand, ignoring the fact that 30% of patients will not respond to the drug. It's baffling.