Fresh Blog: Is oseltamivir assassinating ICU patients? ☠️ The REMAP-CAP trial has concluded with >98% certainty that oseltamivir is killing patients. ☠️ This is an extraordinary claim that requires extraordinary evidence. #1/2... #EMIMCC

Important study of real-world use of rapid respiratory diagnostics. Encouragingly, pace INHALE, no signal to harm in the intervention group (indeed signal to benefit in those with panel-detectable organisms on culture).

Counterpoint: Treat fluids like the drugs they are, especially considering Give the right one for the right patient. Hyperkalemia? Avoid NS Hypochloremia? Give NS (Traumatic) brain injury? Give NS Hyperkalemia and fluid overload? Give furosemide Etc.

Take home messages so far from #CCR26 1. Stop routine carbocisteine/HT saline nebs- no benefit & may be harmful 2. Stop prescribing oseltamivir in critically unwell flu- it probably kills patients 3. Don't use bicarb in ❤️ arrest or for 'all comers' with metab acidosis but may be useful in some circs

Fascinating results of SODa-BIC trial at #CCR26 - no difference in primary outcome of MAKE-30. Well done to the triallists- first double blind bicarb trial! Marlies Ostermann doing a great job of putting these results in context with previous and ongoing studies www.nejm.org/doi/full/10....

Yes Just give whatever crystalloid you have in your cupboard. Don’t give colloids.

Interesting results from the FISSH trial at #CCR26 ! No difference in mortality overall but some signal for benefit for balanced crystalloid in patients with AKI, esp those with Stage 2 or 3 AKI Have we now had enough fluid trials comparing NS and balanced crystalloid? 🤔

I will never understand the seeming widespread enthusiasm internationally for giving bicarb in cardiac arrest. I have almost never seen this in UK practice and there's little evidence to support it. Why is this a thing???

Jaw-dropping results from REMAP-CAP- oseltamivir domain today. I believe this is the first randomised evidence for oseltamivir in the critically unwell. No evidence of benefit and 98% probability of harm 🤯🤯🤯 #CCR26

So is it finally dead yet, or do we need precision medicine to identify vitamin C responders? (This is sarcasm)

Wow! MARCH trial results show no significant benefit for hypertonic saline and carbocisteine in ventilated ICU patients, and significant harm associated with both. Very well done to all of the investigators! www.nejm.org/doi/full/10.... #CCR26

Interesting! This is at odds with the ICU ROX subgroup results...

41% of ventilated patients receive a mucoactive agent If you exclude (prescribed) NaCl 0.9%, it’s 27% of all ventilated patients pmc.ncbi.nlm.nih.gov/articles/PMC... MARCH will change practice whichever way it goes

#ccr26 is this week. Sadly can’t attend so will be following the live stream. Anyone got any interesting predictions to make? I’m expecting a surge of interest in bicarbonate… #emimcc #foamcc

💡 JAMA Insights: #POCUS by trained clinicians is a guideline-endorsed alternative to chest #radiography for #pneumonia diagnosis, offering higher sensitivity and specificity, immediate results, and no ionizing radiation. ja.ma/4xbZ9QI

Strong opinion of the day: there seems to be a trend for presenting slideshows online in 'normal view' (I.e. in editing mode) Please stop doing this!🙏🙏🙏 It's just awful

Seems open evidence is no longer available in Europe 😭 Anyone have suggestions for a suitable replacement- reliable and transparently-evidenced medical AI

Only just learned this great fact- the white crust on cheeses like brie and camembert is actually penicillium mold! Only produces trivial amount of penicillin so cross reactive allergies are very rare en.wikipedia.org/wiki/Penicil...

Fresh blog on the HI-PEITHO trial 😁 🔊 ~18 mg alteplase over 7 hrs is safe (no ICH, no difference in bleeding rates) 🔊 Alteplase reduces the risk of cardiopulmonary decompensation and poor functional outcomes #1/2 #EMIMCC

There are lots of ongoing studies The PRECARE study from Sydney suggested malposition 89% of the time pubmed.ncbi.nlm.nih.gov/40090608/m

#TEElovers @drfreeze.bsky.social @thinkingcc.bsky.social @load-dependent.eurosky.social any thoughts ? jamanetwork.com/journals/jam...

The plot thickens @pulmcrit.bsky.social

Any consultants who find their sympathy for resident doctors waning in the wake of the newly announced strike action would do well to read the conditions of their current student loan repayments. If you don't find it monstrously unjust, you don't understand it.

I wonder if it means that when PCT tells us the high NEWS2 is not sepsis, we think a bit harder. The need for more study into the outcome won’t identify this unless we have sufficient granularity (of clinical reason). “When the PCT is ⬇️, we find ⬆️ time is spent with the patient, with more DDxs”

This study is a real headscratcher. None of the other studies of PCT in ED have shown any benefit so my priors lean towards not believing it. But even so... www.thelancet.com/journals/lan...

Presented at #ISICEM: In a multicenter trial involving patients with acute hypoxemic respiratory failure, 28-day mortality with high-flow oxygen was not significantly different from that with standard oxygen. Full SOHO trial results: www.nejm.org/doi/full/10.... @isicem.bsky.social

commentary by @zentensivist.bsky.social in @jamanetworkopen.com on the safety of peripheral pressors: "PIV administration of vasopressors likely can be accomplished safely, with perhaps less discomfort and harm, compared with conventional CVC-based approaches in some critically ill patients."

Paediatric and adult Neuro POCUS: The UK Accreditation Pathway New article demonstrating the latest addition to #FUSIC in the UK journals.sagepub.com/doi/10.1177/... #POCUS #medsky

Found on the other place Terrifyingly accurate davetriska.substack.com/p/the-long-s...

Link to fresh blog below The trial surely has limitations, but it's been increasingly clear that catheter-directed thrombolysis is silly for over a decade now TBH, this is a wild story about device manufacturers using sponsored RCTs to torture EBM emcrit.org/pulmcrit/cdt/

The enormous unfairness in the current system is demonstrated by the modeling done by the IFS here. Many medical students have loans of £70-100k and won't actually start paying down their loans for many years ifs.org.uk/articles/how...

It may well remain the most realistic medical TV show….

⚠️ Despite all the hype, chatbots still make terrible doctors. Out today is the largest user study of language models for medical self-diagnosis. We found that chatbots provide inaccurate and inconsistent answers, and that people are better off using online searches or their own judgment.

There are few absolute rules in medicine but «never treat sinus tachycardia, treat the cause» has extremely few exceptions. #emimcc #cardiosky #medsky

Refractory septic shock: our pragmatic approach AKA the “Tommy’s Tonic” Now updated for 2026 link.springer.com/content/pdf/... Thoughts welcome @damienbarraudmd.bsky.social @redneeraj.bsky.social

Great discussion here that reminds me of the old medtwitter

This year's scoring matrix for ICM ST3 applications contains 3 references to POCUS. Looks like we think this is important for the practice of ICM and maybe should be on the curriculum? 🤔

Fantastic to see this published at last An objective assessment of the efficacy of home pulse oximeters on different skin tones Ping @iwashyna.bsky.social Open to comments from all #foamed #medsky www.bmj.com/content/392/...

I mean we are absolutely in a place now where the only solution to this information disorder is for everyone to constantly evaluate the source of information. Never trust a chatbot, but also don't believe a video unless you know and trust where it comes from. Unfortunately... that's a lot of work.

I used to think lung was quite widespread Then I looked at NEAT-ECHO again and did the math Remember that with FUSIC heart any cardiac physiologist can be a supervisor- this hugely increases the pool…

Am I alone in being surprised by how dominant Heart is over all the other FUSIC modules? I feel like Lung is the low hanging fruit, accessible to a wider range of professionals esp AHPs. Is there better provision of Heart mentors or is it just sexier? #pocus #emimcc

It really is remarkable how much better flow through the hospital is on strike days. Maybe having a few more senior decision makers around on normal days will pass a cost benefit analysis?

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

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

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 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

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