Adam Glass

🚨One month to go to the Scottish Right Heart Symposium and RV Echo Masterclass🚨 📅6th / 7th November 2024 🗺️Golden Jubilee Conference Hotel 🎫buytickets.at/nhsgoldenjubil…

@_aboyle @snigdhajain89 @ElliottMillerMD @ShashankSinhaMD @RThachilMD @dfmcauley @philipmccall is working on the follow-up study to answer this question

Excellent editorial in a much needed space! What do cardiac biomarkers and RV dysfunction mean in ARDS? We need more studies at the 🫀🫁interaction @ElliottMillerMD @ShashankSinhaMD @RThachilMD Ps: Extra points for the #Jainism reference to plurality of truths 😉

@VirtueOfNothing @BangFoss @philipmccall @GJanaesresearch I agree 100%. It is also clear that they have access to the patient data from the MYRIAD study as they provide an unpublished (and seemingly non-significant) 1 year mortality result that “supports a 10% mortality increase”.

@BangFoss @aglass01 @philipmccall @GJanaesresearch In all honesty, I don’t even know where to start with this. Not to mention the constant doubling down when they get called out. Selective evidence summation at its finest. I really believe a robust SR/MA is urgently required to limit the damage this one does.

@stephenconeill @marcclancy1 @dvdellen @DabareDilan @paulphel @gabriel_oniscu @LornaMarson @UKODTRN @DamianFog @CJCallaghanTx @johnmocallaghan @UMaggiore We're looking for views from nephrologists, transplant surgeons and anaesthetists involved in renal transplantation... redcap.qub.ac.uk/redcap/surveys… @POMCTN @RCoANews @rupert_pearse @yeung_joyce @RonelleMouton @aglass01 @NHSBT @LouiseSavic @NIAAResearch

Interested in peri-op management in renal transplant? Please complete this 5 min survey by @jon_silversides & share: redcap.qub.ac.uk/redcap/surveys… @marcclancy1 @dvdellen @DabareDilan @paulphel @gabriel_oniscu @LornaMarson @UKODTRN @DamianFog @CJCallaghanTx @johnmocallaghan @UMaggiore

@VirtueOfNothing @BangFoss @philipmccall @GJanaesresearch FYI ccforum.biomedcentral.com/articles/10.11…

@VirtueOfNothing @BangFoss @philipmccall @GJanaesresearch No reply as yet

Professor Nick Hill @UofGlasgow @UofGMaths_Stats Simson Chair of Mathematics and Executive Director @SofTMech will provide us with a fascinating insight into the potential that can be gained through: “Computational Modelling of the Heart and Pulmonary Circulation” 🖥️❤️🫁

@philipmccall @Crit_Care @GJanaesresearch As described in the comment it is important to ensure that the result is not influenced by a outlier and all eligible studies are included. We feel that a 5,400 patient study of TIVA vs volatile (written by the corresponding author in this meta-analysis) should have been included

@Crit_Care Finally, this large SR/MA's search strategy somehow managed to miss this eligible study: nejm.org/doi/full/10.10… 5400 patients. In the NEJM. Of which the first author is the corresponding author on the Kotani SR/MA. HT @aglass01 for uncovering this. LTE awaiting publication.

@GJanaesresearch @BJAJournals @philipmccall The timing of the reflected wave may also influence RV function. If the reflection arrives in mid systole then it arrives at an RV at a higher pressure and may lead to RV hypertrophy. See fascinating paper by Fukumitsu et al doi.org/10.1113/JP2824…

@aglass01 @BJAJournals @philipmccall And blood reflected back towards the heart = impedance to flow = afterload

Question 3: How did you address your research question? doi.org/10.1016/j.bja.… @aglass01 @philipmccall #bjachat

@GJanaesresearch @PhilGuerci @BJAJournals @philipmccall Interestingly in our paper the development of wave reflection in the non-operative PA by 2 months was associated with impaired RV free wall strain (r=0.745). Suggesting that if you non-operative can't adapt then RV function deteriorates #BJAchat

@GJanaesresearch @PhilGuerci @BJAJournals @philipmccall @PhilGuerci #BJAchat. That is a very interesting question. The other aspect is we don't know what happens after 2 months. Lung resection patients (or some of them) may adapt over time. 1/2

Question 2: What was the main aim of your study? #bjachat doi.org/10.1016/j.bja.… @aglass01 @philipmccall #bjachat

@GJanaesresearch @BJAJournals @philipmccall Thats the big question. We need to (and hopefully are) tease out how much of the RV insult is due to acute intra-op increase (which we haven't yet measured) or due to the chronic increase in afterload. Additional this is afterload at rest. 1/2 #bjachat

@aglass01 @BJAJournals @philipmccall #bjachat - what sort of therapies do you have in mind? We can't change the fact that lung is resected (that's the point!) - can we manipulate the changes in afterload or the patient response?

Question 5: How will your work improve the practice of anaesthesia and perioperative medicine? doi.org/10.1016/j.bja.… @aglass01 @philipmccall #bjachat

@GJanaesresearch @PhilGuerci @BJAJournals @philipmccall Surgery may not make it any worse (in the extreme) but wave reflection would already be there. For instance, a PE would cause similar wave reflection to a lobectomy if completely occludes the origin of the lobar PA. 2/2 #bjachat

@GJanaesresearch @PhilGuerci @BJAJournals @philipmccall Wave reflections are usually determined by the downstream vasculature, surgical resection is a relatively unique wave reflection model. If there is already impaired perfusion then there may already be wave reflection. 1/2 #bjachat

@BJAJournals @philipmccall This study paves the way for testing of novel therapeutic strategies to aid adaptation to the unique peri-operative physiology seen in patients undergoing thoracic surgery with a view to preventing cardiovascular complications and improving long-term functional capacity #bjachat

@BJAJournals @philipmccall Pulsatile afterload can account for 1/2 the work of the RV and is overlooked by PVR. Reflection may increase further as cardiac output increases (exercise or illness) further impairing the RV. Investigation is required to determine if it impacts patient-centred outcomes #bjachat