Alex Warren
@alexwarrenicu.bsky.social
ICU doctor and researcher | physiology and data geek | NIHR PhD fellow looking at epidemiology and management of cardiogenic shock | all views my own.
Reposted by Alex Warren
Is atropine really required in addition to fentanyl & succinylcholine prior to intubation to prevent severe bradycardia in neonates?
We found yes...
Severe bradycardia during the whole procedure was signif > in placebo vs atropine group; RR 6.3(95% CI 1.2 - 34.1)
t.co/TKJovw24BQ
#NeoSky #PedSky
We found yes...
Severe bradycardia during the whole procedure was signif > in placebo vs atropine group; RR 6.3(95% CI 1.2 - 34.1)
t.co/TKJovw24BQ
#NeoSky #PedSky
July 18, 2025 at 1:47 PM
Is atropine really required in addition to fentanyl & succinylcholine prior to intubation to prevent severe bradycardia in neonates?
We found yes...
Severe bradycardia during the whole procedure was signif > in placebo vs atropine group; RR 6.3(95% CI 1.2 - 34.1)
t.co/TKJovw24BQ
#NeoSky #PedSky
We found yes...
Severe bradycardia during the whole procedure was signif > in placebo vs atropine group; RR 6.3(95% CI 1.2 - 34.1)
t.co/TKJovw24BQ
#NeoSky #PedSky
Reposted by Alex Warren
“The review… comments that without core knowledge of the pre-clinical subjects (such as pathology), it is not possible to apply mechanistic reasoning to complex health problems”
Agreed
Training to be a doctor is necessarily long because, simply put, medicine is complex
www.bmj.com/content/390/...
Agreed
Training to be a doctor is necessarily long because, simply put, medicine is complex
www.bmj.com/content/390/...
Farewell, associates. Welcome back assistants
On 20 November 2024, Wes Streeting, the UK’s Secretary of State for Health and Social Care, commissioned Gillian Leng to undertake an independent review of physician associates and anaesthesia associa...
www.bmj.com
July 17, 2025 at 4:52 AM
“The review… comments that without core knowledge of the pre-clinical subjects (such as pathology), it is not possible to apply mechanistic reasoning to complex health problems”
Agreed
Training to be a doctor is necessarily long because, simply put, medicine is complex
www.bmj.com/content/390/...
Agreed
Training to be a doctor is necessarily long because, simply put, medicine is complex
www.bmj.com/content/390/...
Reposted by Alex Warren
Her biggest lesson for the critical care community?
“Look beyond the patient”
Think about their support networks, their environment…
The things that make their life worth living.
#soa25
“Look beyond the patient”
Think about their support networks, their environment…
The things that make their life worth living.
#soa25
July 1, 2025 at 10:45 AM
Her biggest lesson for the critical care community?
“Look beyond the patient”
Think about their support networks, their environment…
The things that make their life worth living.
#soa25
“Look beyond the patient”
Think about their support networks, their environment…
The things that make their life worth living.
#soa25
Reposted by Alex Warren
Fantastic presentation of the #GASTROSAM trial at #CCR25 - IV rehydration strategies for children with severe acute malnutrition & gastroenteritis. Amazing commitment to generating evidence in the hardest of circumstances incl a coup and flooding. Bravo! www.nejm.org/doi/full/10....
Intravenous Rehydration for Severe Acute Malnutrition with Gastroenteritis | NEJM
International recommendations advise against the use of intravenous rehydration therapy
in children with severe acute malnutrition because of the concern about fluid overload,
but evidence to suppo...
www.nejm.org
June 13, 2025 at 9:03 AM
Fantastic presentation of the #GASTROSAM trial at #CCR25 - IV rehydration strategies for children with severe acute malnutrition & gastroenteritis. Amazing commitment to generating evidence in the hardest of circumstances incl a coup and flooding. Bravo! www.nejm.org/doi/full/10....
Reposted by Alex Warren
Conservative oxygen therapy with a target SpO2 of 90% did not reduce 90-day all-cause mortality compared to usual oxygen therapy in mechanically ventilated adult patients.
#CCR25 @criticalcarereviews.com
https://ja.ma/4kG5gWK
#CCR25 @criticalcarereviews.com
https://ja.ma/4kG5gWK
June 12, 2025 at 8:15 AM
Conservative oxygen therapy with a target SpO2 of 90% did not reduce 90-day all-cause mortality compared to usual oxygen therapy in mechanically ventilated adult patients.
#CCR25 @criticalcarereviews.com
https://ja.ma/4kG5gWK
#CCR25 @criticalcarereviews.com
https://ja.ma/4kG5gWK
16,500 patients randomised to #UKROXTrial presented just now at #CCR25 and simultaneously published in @jama.com
No difference in 90d mortality between target SpO2 88-92 with reduced exposure to supplemental O2 vs usual care
jamanetwork.com/journals/jam...
No difference in 90d mortality between target SpO2 88-92 with reduced exposure to supplemental O2 vs usual care
jamanetwork.com/journals/jam...
Conservative Oxygen Therapy With Mechanical Ventilation
This randomized clinical trial assesses whether reducing supplemental oxygen to a peripheral oxygen saturation target of 90% would reduce mortality among critically ill adults receiving mechanical ven...
jamanetwork.com
June 12, 2025 at 8:48 AM
16,500 patients randomised to #UKROXTrial presented just now at #CCR25 and simultaneously published in @jama.com
No difference in 90d mortality between target SpO2 88-92 with reduced exposure to supplemental O2 vs usual care
jamanetwork.com/journals/jam...
No difference in 90d mortality between target SpO2 88-92 with reduced exposure to supplemental O2 vs usual care
jamanetwork.com/journals/jam...
Reposted by Alex Warren
#CCR25 … here we go! Three days of deep discussion of the top trials in critical care. If you are not in the room, do connect via livestream - see criticalcarereviews.com
June 11, 2025 at 7:47 AM
#CCR25 … here we go! Three days of deep discussion of the top trials in critical care. If you are not in the room, do connect via livestream - see criticalcarereviews.com
Reposted by Alex Warren
Augmenting enteral protein did not improve outcomes for critically ill patients compared with standard protein levels in the intensive care setting.
#CCR25 <a href="https://bsky.app/profile/did:plc:u6ai4u2rvrdb5xjk62y2jpci" class="hover:underline text-blue-600 dark:text-sky-400 no-card-link" target="_blank" rel="noopener" data-link="bsky-mention">@criticalcarereviews.com
https://ja.ma/4kuYRxv
#CCR25 <a href="https://bsky.app/profile/did:plc:u6ai4u2rvrdb5xjk62y2jpci" class="hover:underline text-blue-600 dark:text-sky-400 no-card-link" target="_blank" rel="noopener" data-link="bsky-mention">@criticalcarereviews.com
https://ja.ma/4kuYRxv
June 11, 2025 at 8:15 AM
Augmenting enteral protein did not improve outcomes for critically ill patients compared with standard protein levels in the intensive care setting.
#CCR25 <a href="https://bsky.app/profile/did:plc:u6ai4u2rvrdb5xjk62y2jpci" class="hover:underline text-blue-600 dark:text-sky-400 no-card-link" target="_blank" rel="noopener" data-link="bsky-mention">@criticalcarereviews.com
https://ja.ma/4kuYRxv
#CCR25 <a href="https://bsky.app/profile/did:plc:u6ai4u2rvrdb5xjk62y2jpci" class="hover:underline text-blue-600 dark:text-sky-400 no-card-link" target="_blank" rel="noopener" data-link="bsky-mention">@criticalcarereviews.com
https://ja.ma/4kuYRxv
Reposted by Alex Warren
Early Intra-Aortic Balloon Support for Heart Failure-Related Cardiogenic Shock: A Randomized Clinical Trial
CCR Journal Watch - tracking the critical care literature daily
https://criticalcarereviews.com/latest-evidence/journal-watch
CCR Journal Watch - tracking the critical care literature daily
https://criticalcarereviews.com/latest-evidence/journal-watch
March 31, 2025 at 9:15 AM
Early Intra-Aortic Balloon Support for Heart Failure-Related Cardiogenic Shock: A Randomized Clinical Trial
CCR Journal Watch - tracking the critical care literature daily
https://criticalcarereviews.com/latest-evidence/journal-watch
CCR Journal Watch - tracking the critical care literature daily
https://criticalcarereviews.com/latest-evidence/journal-watch
Reposted by Alex Warren
In the Altshock-2 randomized trial, routine early #IABP plus standard care, compared with standard care, did not significantly improve survival or successful bridging to heart replacement therapies in patients with heart failure–cardiogenic shock www.jacc.org/doi/10.1016/...
Early Intra-Aortic Balloon Support for Heart Failure-Related Cardiogenic Shock: A Randomized Clinical Trial
www.jacc.org
March 31, 2025 at 6:55 AM
In the Altshock-2 randomized trial, routine early #IABP plus standard care, compared with standard care, did not significantly improve survival or successful bridging to heart replacement therapies in patients with heart failure–cardiogenic shock www.jacc.org/doi/10.1016/...
This is a fantastic paper from @intensiveperson.bsky.social and the team. Ten-year national study of risk factors and complications from arterial puncture/insertion of central lines.
Mandatory reading for anyone who inserts CVCs.
Really well done.
Mandatory reading for anyone who inserts CVCs.
Really well done.
Full text at tiny.cc/hartcvc
March 25, 2025 at 9:47 AM
This is a fantastic paper from @intensiveperson.bsky.social and the team. Ten-year national study of risk factors and complications from arterial puncture/insertion of central lines.
Mandatory reading for anyone who inserts CVCs.
Really well done.
Mandatory reading for anyone who inserts CVCs.
Really well done.
Reposted by Alex Warren
Right RCP Fellows! Voting for elections is now open. I am running for Clinical VP.
My election statement is here:
🧵
My election statement is here:
🧵
March 17, 2025 at 11:28 AM
Right RCP Fellows! Voting for elections is now open. I am running for Clinical VP.
My election statement is here:
🧵
My election statement is here:
🧵
Reposted by Alex Warren
I am running for Clinical VP of the RCP.
For those who don't know me, here is a potted bio.
🧵
For those who don't know me, here is a potted bio.
🧵
Right RCP Fellows! Voting for elections is now open. I am running for Clinical VP.
My election statement is here:
🧵
My election statement is here:
🧵
March 17, 2025 at 11:41 AM
I am running for Clinical VP of the RCP.
For those who don't know me, here is a potted bio.
🧵
For those who don't know me, here is a potted bio.
🧵
Reposted by Alex Warren
Profound septic shock is usually associated with mithocondrial dysfunction and relatively fixed low VO2 (one of the causes of hyperlactatemia, mithocondria aren’t using enough pyruvate even in presence of sufficient oxygen) while cardiogenic shock is usually a case of normal mithochondrial fnct.
March 16, 2025 at 7:03 PM
Profound septic shock is usually associated with mithocondrial dysfunction and relatively fixed low VO2 (one of the causes of hyperlactatemia, mithocondria aren’t using enough pyruvate even in presence of sufficient oxygen) while cardiogenic shock is usually a case of normal mithochondrial fnct.
Reposted by Alex Warren
An infographic on Vaccine-preventable diseases. Might as well start familiarizing ourselves with these. Made me feel better to put this together
February 13, 2025 at 6:57 PM
An infographic on Vaccine-preventable diseases. Might as well start familiarizing ourselves with these. Made me feel better to put this together
Reposted by Alex Warren
We can disagree and still love each other unless your disagreement is rooted in my oppression and denial of my humanity and right to exist.
— James Baldwin
— James Baldwin
March 13, 2025 at 5:24 AM
We can disagree and still love each other unless your disagreement is rooted in my oppression and denial of my humanity and right to exist.
— James Baldwin
— James Baldwin
Reposted by Alex Warren
Reread this banger today. How often does one see an invited commentary that cogently and respectfully destroys the entire conceptual paradigm of the article it's critiquing? jamanetwork.com/journals/jam...
Futile Treatments in Intensive Care Units
The provision of treatments that are perceived to be futile is a major problem in the intensive care unit (ICU), leading to burdens for patients and families, as well as moral distress for caregivers....
jamanetwork.com
March 7, 2025 at 7:38 PM
Reread this banger today. How often does one see an invited commentary that cogently and respectfully destroys the entire conceptual paradigm of the article it's critiquing? jamanetwork.com/journals/jam...
Mobilisation during ECLS - still controversial, depends on patient physiology - spectrum from contra-indicated to arguably essential for sustained recovery - key paper here.
#ECMO #MCS #ECLS
#ECMO #MCS #ECLS
Extracorporeal Life Support Organization 2024 Guideline for Early Rehabilitation or Mobilization of Adult Patients on Extracorporeal Membrane Oxygenation
CCR Journal Watch - tracking the critical care literature daily
https://criticalcarereviews.com/latest-evidence/journal-watch
CCR Journal Watch - tracking the critical care literature daily
https://criticalcarereviews.com/latest-evidence/journal-watch
March 3, 2025 at 6:08 PM
Reposted by Alex Warren
🚩 Just out in @thelancet.bsky.social 🚩
African Critical Illness Outcome Study
➡️ Describing the burden of critical care in Africa
➡️ 1 in 8 inpatients are critically ill
➡️ ~70% cared for on general wards
➡️ ~50 don't receive basic critical care interventions
doi.org/10.1016/S014...
African Critical Illness Outcome Study
➡️ Describing the burden of critical care in Africa
➡️ 1 in 8 inpatients are critically ill
➡️ ~70% cared for on general wards
➡️ ~50 don't receive basic critical care interventions
doi.org/10.1016/S014...
February 28, 2025 at 9:22 AM
🚩 Just out in @thelancet.bsky.social 🚩
African Critical Illness Outcome Study
➡️ Describing the burden of critical care in Africa
➡️ 1 in 8 inpatients are critically ill
➡️ ~70% cared for on general wards
➡️ ~50 don't receive basic critical care interventions
doi.org/10.1016/S014...
African Critical Illness Outcome Study
➡️ Describing the burden of critical care in Africa
➡️ 1 in 8 inpatients are critically ill
➡️ ~70% cared for on general wards
➡️ ~50 don't receive basic critical care interventions
doi.org/10.1016/S014...
Reposted by Alex Warren
I had the pleasure of teaching lung #pocus at a “train the trainers” course, with the ever excellent @avkwong.bsky.social and Cian McDermott as faculty
Some reflections from the day:
(1/n)
Some reflections from the day:
(1/n)
February 27, 2025 at 9:45 AM
I had the pleasure of teaching lung #pocus at a “train the trainers” course, with the ever excellent @avkwong.bsky.social and Cian McDermott as faculty
Some reflections from the day:
(1/n)
Some reflections from the day:
(1/n)
Reposted by Alex Warren
Very interesting piece. The data is eye-opening, even if it does reflect what’s noticeable day to day.
We need to face uncomfortable truths about diversity in our medical workforce - my thoughts for @bmj.com www.bmj.com/content/388/...
We need to face uncomfortable truths about diversity in our medical workforce
Stark inequalities exist in the number and distribution of ethnic minority doctors in specialty roles, writes Sethina Watson
In my region, including me, I know of only three black anaesthetists who ...
www.bmj.com
February 22, 2025 at 7:43 AM
Very interesting piece. The data is eye-opening, even if it does reflect what’s noticeable day to day.
Reposted by Alex Warren
It's a horrendous flu season. It's killing kids, it's killing adults. It's killing people who were perfectly healthy before and people who, like most Americans, have chronic illness. It costs NOTHING to keep existing resources available. Our government is spending money to make Americans sicker.
On Friday night, HHS ordered CDC to take down all flu vaccine campaign materials from its website. Materials are starting to come down.
For example, a campaign explaining that flu shot can reduce flu severity from "wild to mild" is now offline. Left image is from Friday, right is now
Meanwhile...
For example, a campaign explaining that flu shot can reduce flu severity from "wild to mild" is now offline. Left image is from Friday, right is now
Meanwhile...
February 16, 2025 at 6:32 PM
It's a horrendous flu season. It's killing kids, it's killing adults. It's killing people who were perfectly healthy before and people who, like most Americans, have chronic illness. It costs NOTHING to keep existing resources available. Our government is spending money to make Americans sicker.
Reposted by Alex Warren
ICU Pulmonary Embolism Review:
Kudos to the authors for reviewing PE management strategies:
Kudos to the authors for reviewing PE management strategies:
February 12, 2025 at 11:49 PM
ICU Pulmonary Embolism Review:
Kudos to the authors for reviewing PE management strategies:
Kudos to the authors for reviewing PE management strategies:
Reposted by Alex Warren
Delighted to share the Barts echo team’s latest article
“Examining the Relationship Between Pulmonary Artery Acceleration Time and Pulmonary Artery Pressures in Patients with Ischemic Cardiogenic Shock”
Free to read for 50 days on the following link
www.sciencedirect.com/science/auth...
“Examining the Relationship Between Pulmonary Artery Acceleration Time and Pulmonary Artery Pressures in Patients with Ischemic Cardiogenic Shock”
Free to read for 50 days on the following link
www.sciencedirect.com/science/auth...
www.sciencedirect.com
February 8, 2025 at 2:16 PM
Delighted to share the Barts echo team’s latest article
“Examining the Relationship Between Pulmonary Artery Acceleration Time and Pulmonary Artery Pressures in Patients with Ischemic Cardiogenic Shock”
Free to read for 50 days on the following link
www.sciencedirect.com/science/auth...
“Examining the Relationship Between Pulmonary Artery Acceleration Time and Pulmonary Artery Pressures in Patients with Ischemic Cardiogenic Shock”
Free to read for 50 days on the following link
www.sciencedirect.com/science/auth...