Andrew Helt

@Jeff_Mans @SiriusXMFantasy We called it Sohogby (Soccer-Hockey-Rugby). It was soccer with checking while the ball was on the ground, but if the ball was kicked up & caught, it became rugby. Couldn't just pick up the ball, though. Was awesome. Played this from grade 4-7 when the teachers weren't looking.

What are your all-time favorite made up sports games? Can be ABSOLUTELY ANYTHING POST YOURS RIGHT HERE!!👇👇👇

Brilliant work! Congrats Dr. McKenzie and team!

@BVidalPimentel @ThinkingCC @ross_prager @ArgaizR @NephroP @zbriote I have the same experience at times ing evidence of venous congestion when no great view of the IVC could be had. That said, in those circumstances, the RAP wasn't really in question. BUUUUUT One of my favourite tricks is to look at the IVC from the RUQ through the liver.

Is anyone finding VExUS useful when no good window for the IVC? I'm not aware of any study but I had some situations where a quick good portal and hepatic pulsed doppler helped me when not having a good IVC diameter. @ThinkingCC @ross_prager @ArgaizR @NephroP @zbriote @CanEMDoc

COPD - It did HAPPEN @JAMA_current:

@ross_prager To build off this, perhaps the most powerful way this tool will be utilized will be as a dynamic marker. Being able to stop diuresis prior to exacerbating an AKI would be incredibly useful. Maybe we will find it's dynamic enough to use the 'ol passive leg raise to extract info.

(2/x) The patterns of venous congestion varies significantly based on the cause. For example, tricuspid regurgitation associated congestion will have persistently abnormal Hepatic and Intrarenal Veins even with decongestion, however, the portal vein will normalize with treatment. @ArgaizR As we become more sophisticated in our approach to congestion, I think we will look at patterns of congestion (and the thresholds) in a disease specific context as opposed to using a score like #VEXUS applied across many populations

(1/x) As you might know, I research venous congestion in critically ill patients. This is a fascinating field but is changing a TON as new evidence emerges. Here are my top 5 learnings about venous congestion in the past months. A 🧵 Pinging some experts in the field for their tips 👇

Thank you to @CIHR_IRSC ACT competition for funding a Phase 3 trial of inhaled furosemide as supportive therapy for resp. failure 2nd to pulmonary infection. This adaptive international trial in 50 centers will enroll up to 1540 pts and run on the PRACTICAL platform.

after a week on service with lots of refractory shock, I added a section on refractory shock to IBCC. and also a section on hydroxocobalamin. better late than never 😬 any useful bits I left out? emcrit.org/ibcc/shock/

#CCR24 Day 3 Overview: DEFENDER: No benefit with SLG2Is for allcomers in ICU, but safe. REMAPCAP-steroid: Hard to make sense of this one, but no benefit to steroids in CAP. NAVIGATE: Early NIV prevents worsening of resp failure. REVISE: SUP with PPI ⬇️ GIBs @CritCareReviews

For the PO vs IV PPI (and H2 blocker vs PPI for that matter) PEPTIC (which was discussed at CCR in 2020) provides me some reassurance that the options for SUP are all similarly effective.

Presented at #CCR24: In a randomized trial involving patients undergoing invasive ventilation, pantoprazole decreased the risk of upper gastrointestinal bleeding as compared with placebo but did not affect mortality. Read the full REVISE trial results: nej.md/3KD01Xp

This might be the most insightful part of the entire trial. What matters to clinicians may not be what matters to our patients. Transfusion of a single unit, CT angio, and diagnostic endoscopy, all things that really matter to patients. #CCR24 #REVISEtrial

Since @CritCareReviews and #CCR24 have had a couple of win ratio analyses, here’s a little plug for a video I made with @CMichaelGibson a few years back that is meant to be an accessible explainer of how it works. Please excuse my hair. It was a different time.

Amazing time at #CCR24!! Thanks again for making this doable for those of us with young children! First class!

So, there was no RT involvement. TY for the answer & reposting of the slide! My question remains how much, compared to the usual care group, extra attention did the NIV group get from allied health & MDs? Looking forward to seeing the paper!!! #CCR24 #NAVIGATEtrial

2) Were any additional physicians more comminly involved if a patient was on NIV? In one hospital I work in, BiPap can occur in our telemetry unit with IM MRPs, but intensivist is often consulted to see. 2/2 #CCR24 #NAVIGATEtrial @CritCareReviews @GiacomoMonti @giovannilandoni

2 related questions for @giovannilandoni & @GiacomoMonti re their #CCR24 #NAVIGATEtrial: 1) What was the role of RTs in managing the BiPap? Were they followed closely? Feature of the intervention or confounder? Certainly having an RT follow closely could change outcome. 1/2

@stephen_t_webb @precordialthump @_aacw This is exactly my practice.

@precordialthump @_aacw @CanEMDoc What’s intriguing is that we give up on NIV in ICU often as it’s “not tolerated” …this tells us that we can persevere and just allow pts to go on as much as possible with breaks but not stop it and go back to HFNO/FMO…? #ccr24

@precordialthump @_aacw @stephen_t_webb Good physiologic sense.

@_aacw @stephen_t_webb @CanEMDoc I’ll sometimes use intermittent CPAP similar to #navigate trial protocol for patients I think are at risk of atelectasis - but without being sure it is was helpful #ccr24

The #NAVIGATEtrial shows a very impressive decrease in severe resp failure with WARD-BASED NIV. If findings external valid, then this could be BIG! #CCR24 I'm skeptical & still have Qs. Unsure my centre would replicate these results. Regardless, early NIV seems SAFE and SMART.