Really was😂

To follow this up, here is the end result: curated list of ‘papers I want to read’ from my attendance at #Lives2025 #criticalcare 📟 😀

(I mean not sure - and I miss the edit button!)

I think there is ambiguity over whether people actually got what they were supposed to in each group ….also the difference in resus fluid was 250ml and >twice as many in the intervention got dobutamine…. I’m just now sure I believe 250ml fluid in the very early stages matters than much

Core elements of both differing mortality and knowledge gaps laid out here: #Lives2025 #criticalcare

There’s a nice editorial here www.nejm.org/doi/full/10.... #Lives2025

Mortality at 30 days was 22.6% in the glucocorticoid group and 284 patients and 26.0% in the standard-care group (p= 0.02) #Lives2025 #criticalcare

Paper is free here.
www.nejm.org/doi/full/10....

I’m sitting at a boarding gate on the livestream, but the **rapturous applause** in the room for Lucinde and her team has been really quite striking.
#Lives2025 #criticalcare

Next up is SONIA - a trial of low dose steroids for pneumonia, which sheds needed light on care of pts with pneumonia in resource limited settings. Worth appreaciting differing baseline mortality associated with CAP and hitherto underrepresentation of pts in these settings in research #Lives2025

Clearly I need to read it properly - but I also need to make my way to a boarding gate in Munich Airport, so this is to be continued!
#Lives2025 #criticalcare

The trial is reported as +ve but I am not overwhelmed by the outcome: There were 131 131 wins (48.9%) in the CRT-PHR group vs 112 787 (42.1%) in the usual care group for the hierarchical composite primary outcome, with a win ratio of 1.16 (95% CI, 1.02-1.33; P = .04). #Lives2025 #criticalcare

Flow charts also included information on pulse pressure, diastolic pressure (Tier 1) and MAP, cardiac dysfunction (echo) and dobutamine test (Tier 2) at various points #Lives2025 #criticalcare

It’s using a composite outcome (all-cause mortality, duration of vital support, and length of hospital stay at 28 days as an overall ‘win ratio’)

Patients were Sepsis 3.0 defined with shock <4 hours and every intervention was aimed at normalising CRT (normal CRT halted intervention). #Lives2025

Hemodynamic Resuscitation Targeting Capillary Refill Time in Early Septic Shock This randomized clinical trial examines whether a personalized hemodynamic resuscitation protocol targeting capillary refill time was more effective than usual care in patients with early septic shock...

ANDROMEDA-SHOCK-2 is up next…. this looks at personalised phenotype-based, capillary refill time (CRT) targeted resuscitation in early septic shock, comparing to standard resuscitation. It is large (86 centres, 19 countries).

Read it free from JAMA: tinyurl.com/mjcj8s5w
#Lives2025 #criticalcare

There is a question on stages about the end of the Swan Ganz era and the implication that ‘God help you if you need one now’ ….. could this be the same? Trialest is clear the trial is about a-line as indicated for MAP only….
#Lives2025 #Criticalcare

Deferring Arterial Catheterization in Critically Ill Patients with Shock | NEJM In patients with shock, whether noninvasive blood-pressure monitoring is an effective alternative to the recommended use of an arterial catheter is uncertain. In this multicenter, open-label, nonin...

EVERDAC is hot off press @esicm.bsky.social #Lives2025 in @nejm.org open access currently:
www.nejm.org/doi/full/10....
Reports that in (non-blinded trial) patients with shock, management *without* early a-line insertion was noninferior to early catheter insertion…. #Lives2025 #criticalcare

After much wind and rain - we did have one blue sky day in #Munich - The best part of which was when a stranger asked me to mind her dog for five minutes and he was a very good boy #criticalcare #Lives2025

Hoping to catch some ‘hot topics’ session from airport, off now to get back in good time for for work tomorrow. Have had a wonderful congress catching up with colleagues from all over the world, attending @intenscaremed.bsky.social board and reaffirming my 🩵 for intensive care! #Lives2025

Oh, and the passionate pair behind me didn’t ask a question. #Lives2025

Core messaging
- The issue isn’t just atrophy (so fixing atrophy can prevent it all)
- Rational for pacing where it is disuse, is reversing atrophy - this may help
- There is hope from Rescue-3
- There is role for inspiratory muscle training in the right patients #Lives2025

I’m not sure the question was fully answered and there was a bid for a follow up Q, but we are running out of time and there are others waiting. #Lives2025

There is a question from someone who works in a weaning centre who talks about the lack of clarity of what evidence there is in those patient he sees (months of ventilation, difficult wean) - does the principle of training and reversing atrophy hold…. #Lives2025

Is heart failure a contraindication? - acutely….maybe yes, but there is evidence of benefit in chronic HF we are told. Pneumothorax also no a definite contra-indication , but is a consideration. #Lives2025

The panel talk about inspiratory muscle training now indicating it isn’t for everyone or for acute phase - the physiotherapist speaking indicates that you need to exclude the right patients (primary cardiac failure for example, the patient needs to be to able to follow commands). #Lives2025

I will add that there are two people behind me with really very animated and passionate chat about what the panel are discussing (so much so that i have moved seat) but they haven’t yet directed anything to the panel. I hope they do…. #Lives2025

Leo is asking how in a trial like Rescue-3, when there are just 120 stimulations a day….compared to thousands of breaths, how can we hope to have benefit? Marine explains this by talking about only needing to create a ‘training effect’. #Lives2025

Temporary Transvenous Diaphragm Neurostimulation for Weaning from Mechanical Ventilation (RESCUE-3) - PubMed gov, ID: NCT03783884.

The main rational for pacing is to improve strength and there is more to say with respect to weaning phase, rather than earlier preventative phase. The ‘subtle’ effect of Rescue-3, which uses transvenous pacing, has been mentioned - pubmed.ncbi.nlm.nih.gov/40498082/ #Lives2025

Speaking about phrenic nerve stimulation there is a lot of ‘may’ improve…..‘may help’ - there is an audience member who uses Quadricep stimulation in practice….with knock-on for weaning….but when asked, nobody in room willing to state they’re using phrenic nerve stimulation in practice. #Lives2025

I’m closing my day with (you guessed it) - another debate. This time, diaphragmatic pacing and ventilator weaning

Diaphragmatic weakness is multi-factorial but lack of contraction on IMV is obviously a big one …..

#Lives2025 #criticalcare

I am back to do some poster moderation again for the late afternoon. It’s so wonderful hearing what people around the world and doing an contributing to our speciality #Lives2025 @esicm.bsky.social