Is atropine really required in addition to fentanyl & succinylcholine prior to intubation to prevent severe bradycardia in neonates? We found yes... Severe bradycardia during the whole procedure was signif > in placebo vs atropine group; RR 6.3(95% CI 1.2 - 34.1) t.co/TKJovw24BQ #NeoSky #PedSky

“The review… comments that without core knowledge of the pre-clinical subjects (such as pathology), it is not possible to apply mechanistic reasoning to complex health problems” Agreed Training to be a doctor is necessarily long because, simply put, medicine is complex www.bmj.com/content/390/...

Her biggest lesson for the critical care community? “Look beyond the patient” Think about their support networks, their environment… The things that make their life worth living. #soa25

Fantastic presentation of the #GASTROSAM trial at #CCR25 - IV rehydration strategies for children with severe acute malnutrition & gastroenteritis. Amazing commitment to generating evidence in the hardest of circumstances incl a coup and flooding. Bravo! www.nejm.org/doi/full/10....

Conservative oxygen therapy with a target SpO2 of 90% did not reduce 90-day all-cause mortality compared to usual oxygen therapy in mechanically ventilated adult patients. #CCR25 @criticalcarereviews.com https://ja.ma/4kG5gWK

16,500 patients randomised to #UKROXTrial presented just now at #CCR25 and simultaneously published in @jama.com No difference in 90d mortality between target SpO2 88-92 with reduced exposure to supplemental O2 vs usual care jamanetwork.com/journals/jam...

#CCR25 … here we go! Three days of deep discussion of the top trials in critical care. If you are not in the room, do connect via livestream - see criticalcarereviews.com

Augmenting enteral protein did not improve outcomes for critically ill patients compared with standard protein levels in the intensive care setting. #CCR25 @criticalcarereviews.com https://ja.ma/4kuYRxv

Early Intra-Aortic Balloon Support for Heart Failure-Related Cardiogenic Shock: A Randomized Clinical Trial CCR Journal Watch - tracking the critical care literature daily https://criticalcarereviews.com/latest-evidence/journal-watch

In the Altshock-2 randomized trial, routine early #IABP plus standard care, compared with standard care, did not significantly improve survival or successful bridging to heart replacement therapies in patients with heart failure–cardiogenic shock www.jacc.org/doi/10.1016/...

This is a fantastic paper from @intensiveperson.bsky.social and the team. Ten-year national study of risk factors and complications from arterial puncture/insertion of central lines. Mandatory reading for anyone who inserts CVCs. Really well done.

Right RCP Fellows! Voting for elections is now open. I am running for Clinical VP. My election statement is here: 🧵

I am running for Clinical VP of the RCP. For those who don't know me, here is a potted bio. 🧵

Profound septic shock is usually associated with mithocondrial dysfunction and relatively fixed low VO2 (one of the causes of hyperlactatemia, mithocondria aren’t using enough pyruvate even in presence of sufficient oxygen) while cardiogenic shock is usually a case of normal mithochondrial fnct.

An infographic on Vaccine-preventable diseases. Might as well start familiarizing ourselves with these. Made me feel better to put this together

We can disagree and still love each other unless your disagreement is rooted in my oppression and denial of my humanity and right to exist. — James Baldwin

Reread this banger today. How often does one see an invited commentary that cogently and respectfully destroys the entire conceptual paradigm of the article it's critiquing? jamanetwork.com/journals/jam...

Mobilisation during ECLS - still controversial, depends on patient physiology - spectrum from contra-indicated to arguably essential for sustained recovery - key paper here. #ECMO #MCS #ECLS

🚩 Just out in @thelancet.bsky.social 🚩 African Critical Illness Outcome Study ➡️ Describing the burden of critical care in Africa ➡️ 1 in 8 inpatients are critically ill ➡️ ~70% cared for on general wards ➡️ ~50 don't receive basic critical care interventions doi.org/10.1016/S014...

I had the pleasure of teaching lung #pocus at a “train the trainers” course, with the ever excellent @avkwong.bsky.social and Cian McDermott as faculty Some reflections from the day: (1/n)

Very interesting piece. The data is eye-opening, even if it does reflect what’s noticeable day to day.

It's a horrendous flu season. It's killing kids, it's killing adults. It's killing people who were perfectly healthy before and people who, like most Americans, have chronic illness. It costs NOTHING to keep existing resources available. Our government is spending money to make Americans sicker.

ICU Pulmonary Embolism Review: Kudos to the authors for reviewing PE management strategies:

Delighted to share the Barts echo team’s latest article “Examining the Relationship Between Pulmonary Artery Acceleration Time and Pulmonary Artery Pressures in Patients with Ischemic Cardiogenic Shock” Free to read for 50 days on the following link www.sciencedirect.com/science/auth...

In light of the recent air crash in the US (and some somewhat startling proposed causes), it seems like time to roll out this classic from the late, great Dr. Richard Cook: How Complex System Fail how.complexsystems.fail

Great group talk by one of UCL CHIMERA's PhD students this morning - she's using maths to model mucus layers in the lung to understand the impact of critical illness and mechanical ventilation on lung function. Such an interesting project! www.ucl.ac.uk/chimera

Diagnosis and management of immune checkpoint inhibitor (ICI)-induced myocarditis. #AnSky #MedSky #OncSky https://buff.ly/40ATqW9

95% of my confidence interval interpretations include the correct interpretation for confidence intervals

This is a really useful resource for anyone who still needs convincing that immigration is not the reason they can't get a training number. An IMG applying to CT1 in my specialty has a 1 in 45 chance of receiving an offer, compared to roughly 1 in 3 for UK grads. medical.hee.nhs.uk/medical-trai...

I can truthfully say I have been brought to tears this winter I see these pts in my sleep; it means I’m not sleeping much at the moment I’m not in a management position anymore, but the feeling of helplessness is just as acute

Diuretic Potentiation Strategies in Acute Heart Failure #CardioSky #MedSky #JACCHF www.jacc.org/doi/10.1016/... @jaccjournals.bsky.social @robmentz.bsky.social @sjgreene-md.bsky.social @vietheartpa.bsky.social @load-dependent.bsky.social @jimjanuzzi.bsky.social @dranulala.bsky.social

Afterload reduction in the right patient is one of the most satisfying medical interventions imo. Potentially life saving and often staves off intubation. Furosemide often *is* the answer, though 😉

All heart failure is NOT the same; and diuretics are NOT always the answer ‼️ In the very wise words of Dr. Frederik Verbrugge - "Elevated cardiac filling pressures and fluid overload are both important, yet grossly different features of acute decompensated heart failure." #emimcc

Swedish study showed short-term exposures to lower air temp & cold spells are associated with increased risk of hospitalization for MI at lag 2 to 6 days #CardioSky #JACC www.jacc.org/doi/10.1016/... @jaccjournals.bsky.social @load-dependent.bsky.social @vietheartpa.bsky.social

Notable difference from moving from a NHS ambulance service (struggles to retain experience) to New Zealand (keeps very experienced staff) in terms of productivity, decision making and overall patient care!

New publication co-led with Griffin Bullock! 📊 Wide variability in IV diuretic dosing for acute HF, even within a single institution. ⏱️ Delays in 1st, 2nd, & max doses = longer hospital stays. #CardioSky #PharmSKy www.sciencedirect.com/science/arti...

I wrote a quick post about the latest UKHSA data on the current flu wave. christinapagel.substack.com/p/its-defini... TLDR: we are in a very big flu wave, but Covid levels are low & RSV decreasing. But we should consider extending eligibilty for annual flu (and RSV, Covid) vaccines.

New platform, re-sharing our recent sex differences in cardiogenic shock SRMA: -Women are ⬆️ likely to die than men (35% unadjusted, 10% adjusted for comorbidities) -Women ⬇️ less likely to recieve mechanical support Urgent need to understand these differences & enroll more women in CS RCTs!