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Hashtag
#chest2013
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@IUPCCM Amazing all the research, case reports, and abstract winners at #chest2013 from @iumedschool! http://bit.ly/17WLiAP
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Terrific piece for @BossletMD purchased @thesilverroom while in Chicago for #CHEST2013. Highly recommend that place.
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On the @megabus heading back after #CHEST2013- terrific meeting. Can't wait for #CHEST2014 #DILCHEST2013
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#CHEST2013 terrific talk on dynamic hyperinflation by Kenneth Berger from NYU.
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#CHEST2013 #sepsis Hospitals gaming the system in NQF measures isn't helping anyone- but screening is established locally.
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#CHEST2013 #sepsis Jim O'Brien from @SepsisAlliance to give to con against NQF performance measures
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#CHEST2013 #sepsis EEO downside: requires an arterial line
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#CHEST2013 #sepsis EEO test: end-expiratory hold x 15 seconds, look for change in pulse pressure of >5% during the last 3 minutes.
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#CHEST2013 #sepsis End-expiratory occlusion test can predict volume responsiveness
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#CHEST2013 #sepsis Replacement for CVP monitoring: data lacking to say it is ultrasound modalities
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#CHEST2013 #sepsis CVP should not be used. Period.
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#CHEST2013 #sepsis Lots of "beliefs" about CVP without any data to back it up. But it makes sense!!
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#CHEST2013 #sepsis Why use CVP? Because it makes sense, and because we can.
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#CHEST2013 #sepsis Many papers that show sepsis improvement don't use Svo2 measurements!! Hours to antibiotics is the most important!
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#CHEST2013 #sepsis passive leg raise response to blood pressure is a good measure of fluid responsiveness
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#chest2013 #sepsis Pulsus paradoxes can predict fluid responsiveness
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#CHEST2013 #sepsis There is a relationship between cardiac VOLUME and output, but not pressure and output.
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#chest2013 #sepsis No relationship between CVP and stroke volume index!!! Study after study demonstrate this
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#CHEST2013 #sepsis 1L fluid causes 10-15% change in viscosity, decreasing after load.
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#CHEST2013 #sepsis CVP Dogma: 1967 data CVP v. blood volume- weak correlation at best.
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#CHEST2013 #sepsis Central question of fluid therapy: Is my patient normovolemic?
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#CHEST2013 #sepsis Now on to pro/con re: central venous pressure monitoring
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#CHEST2013 #sepsis good evidence that early abx and targeted resuscitation saves lives. What resuscitation goals are the best is unclear.
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#CHEST2013 #sepsis Current sepsis trials: proCess trial (1400 pts), ARISE trial (1600 pts), ProMise (1260 pts)
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#CHEST2013 #sepsis Lactate clearance is not inferior to following Scvo2.
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#CHEST2013 #sepsis disadvantages to Scvo2 monitoring: time spent placing catheter, trials are small, many sepsis pts with nl scvo2
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#CHEST2013 #sepsis Nothing at this point has been shown to be better than following ScvO2
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#CHEST2013 Even small changes in process measures for sepsis leads to mortality benefit #sepsis
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#CHEST2013 #sepsis Consensus guidelines pointless unless they improve patient care.
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