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Wendy Chang
2.8K posts
Wendy Chang
@EM_NCC
Emergency physician 🚑🚁 & Neuro #zentensivist 🧠👩🏻⚕️ #NeuroResuscitation #IPE #MedSim #WomenInMedicine Views ≠ employer’s ≠ advice
Baltimore, MD Katılım Eylül 2012
616 Takip Edilen1.2K Takipçiler
@neurocritical Agree likely many factors as mentioned. As well as indication for sedation/IMV, choice behind agents, confounding toxic-metabolic encephalopathy, etc.
#NCSVJC
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#NCSVJC Q1: Given that there were no statistically significant differences in IMV duration between sedation strategies after adjustment, how should clinicians interpret these findings in light of prior studies suggesting potential benefits of propofol? Could the lack of difference reflect appropriate titration in neurocritical care settings or limitations in the dataset’s granularity (e.g., sedation depth, dosing protocols)? rdcu.be/efSic
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🧠 Do you care for patients with acute brain injuries?
🫁 What is your sedation strategy with mechanical ventilation in these patients?
Join the #NCSVJC discussion to learn more about practice variations worldwide and impact on outcomes!
Neurocritical Care Society@neurocritical
#NCSVJC is about to begin! Follow us for questions posted started shortly and hourly and discuss in the replies with colleagues. Learn more about how to participate and read the article: bit.ly/4cbgleW
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Katherine Sherwood relearned to paint after an ICH with resultant hemiparesis. Facility of Speech incorporated medieval seals of Solomon to promote healing and her own cerebral angiogram.
pmc.ncbi.nlm.nih.gov/articles/PMC33…
@MCASD #NCS2024
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Standing room only at #NCS2024 session on @brain_trauma penetrating #TBI guidelines.
Long awaited with useful algorithms including tool for assessing futility. Most importantly, advocates for aggressive surgical treatment and acknowledges challenges with prognostication.
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Wendy Chang retweetledi
Curious what concentration mannitol those who voted yes use? Mannitol 20% & 25% both higher osmolarity versus 3% NaCl 🤔
Neurocritical Care Society@neurocritical
#NCSTJC Q3: Do you choose mannitol over hypertonic saline due to access issues? ow.ly/lCpZ50RzV3O @drdangayach
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Exploring Phoenix and learning about sex, gender and diversity through #SAEM24 @AWAEM @SAEM_ADIEM #SGEM scavenger hunt
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⭐️ Super psyched to announce that our very own Anna Lin, PGY-2, just won the 2024 American Headache Society Runnin’ for Research Advocacy Award ⭐️
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Wendy Chang retweetledi
#NCSTJC Q6: The authors also found that prophylactic ceftriaxone did not affect the incidence of late VAP in patients with acute brain injury. Does this finding change your clinical practice? ow.ly/YZf150QFoZU @EM_NCC
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Wendy Chang retweetledi
#NCSTJC Q5: The PROPHY-VAP trial found a single dose of ceftriaxone decreased the incidence of early VAP in patients with acute brain injury. Does this finding change your clinical practice? ow.ly/YZf150QFoZU @EM_NCC
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Wendy Chang retweetledi
#NCSTJC Q4: Do you routinely screen for antibiotic-resistant organisms in your ICU patients? If so, which organisms and in what type of patients? ow.ly/YZf150QFoZU @EM_NCC
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@neurocritical 4 of 9 PROPHY-VAP ICUs routinely screened for ESBL-producing bacteria on admission and discharge #NCSTJC
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@neurocritical Do you differentiate between ventilator-associated pneumonia vs tracheobronchitis? 🤔
#NCSTJC
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#NCSTJC Q3: What criteria do you use to diagnose ventilator-associated pneumonia (VAP)? ow.ly/YZf150QFoZU @EM_NCC
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@neurocritical The PROPHY-VAP ICUs implemented preventive measures including:
🔹HOB elevation
🔹Monitoring tracheal cuff pressure
🔹Oral care
🔹Changing filters/circuits only when necessary
🔹Early enteral feeding
🔹Stress ulcer prophylaxis
None of the sites used SOD/SDD #NCSTJC
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#NCSTJC Q1: Do you use selective oropharyngeal (SOD) and digestive tract decontamination (SDD) to prevent ventilator-associated pneumonia (VAP)? ow.ly/mwog50QFkxS
@EM_NCC
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Wendy Chang retweetledi
Other resources used around the 🌏 apart from @IDSAInfo guidelines to diagnose #VAP? Join the #NCSTJC conversation 👇#IDtwitter #NeuroTwitter #TwitteRx
Neurocritical Care Society@neurocritical
#NCSTJC Q3: What criteria do you use to diagnose ventilator-associated pneumonia (VAP)? ow.ly/YZf150QFoZU @EM_NCC
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Do you prefer noninvasive vs invasive sampling? 🫁
Utilize biomarkers such as procalcitonin? 🩸
Use clinical decision tools like the Clinical Pulmonary Infection Score (CPIS)? 📋
#NCSTJC
Neurocritical Care Society@neurocritical
#NCSTJC Q3: What criteria do you use to diagnose ventilator-associated pneumonia (VAP)? ow.ly/YZf150QFoZU @EM_NCC
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Wendy Chang retweetledi
#NCSTJC Q2: Do you use prolonged IV antibiotics to prevent ventilator-associated pneumonia (VAP)? ow.ly/mwog50QFkxS @EM_NCC
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@KeatonSmetana @neurocritical We also use chlorhexidine as part of our VAP prevention bundle #NCSTJC
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@neurocritical @EM_NCC Chlorhexidine for reducing VAP was previously a standard in our order sets. Literature in most scenarios supports moving away from that practice to just 🪥🦷
Link: cambridge.org/core/journals/…
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