Ben Millette
@benmillette.bsky.social
Consultant in Intensive Care and Anaesthesia. POCUS, Antibiotic stewardship, MedEd and Mexican food
www.fraserhealth.ca/news/2025/No...
V interesting- spinal anaesthesia still seems to work in microgravity! I look forward to the full publication of these results
V interesting- spinal anaesthesia still seems to work in microgravity! I look forward to the full publication of these results
WATCH - From Royal Columbian Hospital to microgravity: testing the role of anesthesia in space
A research team conducted experiments in France that could shape future medical protocols for astronauts and patients on Earth.
www.fraserhealth.ca
November 13, 2025 at 12:30 PM
www.fraserhealth.ca/news/2025/No...
V interesting- spinal anaesthesia still seems to work in microgravity! I look forward to the full publication of these results
V interesting- spinal anaesthesia still seems to work in microgravity! I look forward to the full publication of these results
Reposted by Ben Millette
A short video that started as a bluesky post a few weeks ago. For clarity, I am actually quite optimistic about AI being useful in many areas of medicine. I’m just saying being a “diagnostic machine” really won’t move the modern healthcare needle that much
youtube.com/shorts/hRv5K...
youtube.com/shorts/hRv5K...
What everyone gets wrong about AI in medicine
YouTube video by Medlife Crisis
youtube.com
November 9, 2025 at 9:54 PM
A short video that started as a bluesky post a few weeks ago. For clarity, I am actually quite optimistic about AI being useful in many areas of medicine. I’m just saying being a “diagnostic machine” really won’t move the modern healthcare needle that much
youtube.com/shorts/hRv5K...
youtube.com/shorts/hRv5K...
UK facing long, tough flu season, NHS chiefs warn
www.bbc.com/news/article...
We desperately need more evidence on how best to manage flu. Even the most basic questions- we don't really know if oseltamivir is benefical or if steroids help or harm in severe flu. I think REMAP CAP is looking at this?
www.bbc.com/news/article...
We desperately need more evidence on how best to manage flu. Even the most basic questions- we don't really know if oseltamivir is benefical or if steroids help or harm in severe flu. I think REMAP CAP is looking at this?
UK facing long, tough flu season, NHS chiefs warn
Vulnerable urged to come forward for flu jab quickly as virus has come early this year.
www.bbc.com
November 6, 2025 at 1:38 PM
UK facing long, tough flu season, NHS chiefs warn
www.bbc.com/news/article...
We desperately need more evidence on how best to manage flu. Even the most basic questions- we don't really know if oseltamivir is benefical or if steroids help or harm in severe flu. I think REMAP CAP is looking at this?
www.bbc.com/news/article...
We desperately need more evidence on how best to manage flu. Even the most basic questions- we don't really know if oseltamivir is benefical or if steroids help or harm in severe flu. I think REMAP CAP is looking at this?
Reposted by Ben Millette
MASSIVE RCT from Kenya showing that steroids reduce mortality in CAP
Mortality benefit easier to demonstrate w/ less resources available to salvage pts
Should allay the hype that the negative REMAP-CAP steroid RCT received (despite being woefully underpowered)
www.nejm.org/doi/pdf/10.1... #EMIMCC
Mortality benefit easier to demonstrate w/ less resources available to salvage pts
Should allay the hype that the negative REMAP-CAP steroid RCT received (despite being woefully underpowered)
www.nejm.org/doi/pdf/10.1... #EMIMCC
October 29, 2025 at 3:37 PM
MASSIVE RCT from Kenya showing that steroids reduce mortality in CAP
Mortality benefit easier to demonstrate w/ less resources available to salvage pts
Should allay the hype that the negative REMAP-CAP steroid RCT received (despite being woefully underpowered)
www.nejm.org/doi/pdf/10.1... #EMIMCC
Mortality benefit easier to demonstrate w/ less resources available to salvage pts
Should allay the hype that the negative REMAP-CAP steroid RCT received (despite being woefully underpowered)
www.nejm.org/doi/pdf/10.1... #EMIMCC
Reposted by Ben Millette
Among patients with early #SepticShock, a personalized hemodynamic resuscitation protocol targeting capillary refill time was superior to usual care for the primary composite outcome, driven by a lower duration of vital support.
#LIVES2025 @esicm.bsky.social
ja.ma/3L9m7EB
#LIVES2025 @esicm.bsky.social
ja.ma/3L9m7EB
October 29, 2025 at 1:35 PM
Among patients with early #SepticShock, a personalized hemodynamic resuscitation protocol targeting capillary refill time was superior to usual care for the primary composite outcome, driven by a lower duration of vital support.
#LIVES2025 @esicm.bsky.social
ja.ma/3L9m7EB
#LIVES2025 @esicm.bsky.social
ja.ma/3L9m7EB
Reposted by Ben Millette
New blog: Fresh dueling guidelines about post-arrest care from the AHA and ESICM
💔 BP targets
💔 Who needs an emergent cath?
💔 O2 targets
💔 pan-CT scans
💔 temp targets
💔 neuroprognostication
Which guideline do I love? 😍 You'll have to read the post to find out.
emcrit.org/pulmcrit/202... #EMIMCC
💔 BP targets
💔 Who needs an emergent cath?
💔 O2 targets
💔 pan-CT scans
💔 temp targets
💔 neuroprognostication
Which guideline do I love? 😍 You'll have to read the post to find out.
emcrit.org/pulmcrit/202... #EMIMCC
October 26, 2025 at 2:51 PM
New blog: Fresh dueling guidelines about post-arrest care from the AHA and ESICM
💔 BP targets
💔 Who needs an emergent cath?
💔 O2 targets
💔 pan-CT scans
💔 temp targets
💔 neuroprognostication
Which guideline do I love? 😍 You'll have to read the post to find out.
emcrit.org/pulmcrit/202... #EMIMCC
💔 BP targets
💔 Who needs an emergent cath?
💔 O2 targets
💔 pan-CT scans
💔 temp targets
💔 neuroprognostication
Which guideline do I love? 😍 You'll have to read the post to find out.
emcrit.org/pulmcrit/202... #EMIMCC
Reposted by Ben Millette
Updated the IBCC chapter on pancreatitis
Added fresh, new guidelines from the AGA (meh) and International Association of Pancreatology (very good)
Lets talk about some updates… #1/6🧵
(chapter: emcrit.org/ibcc/pancrea...) #EMIMCC
Added fresh, new guidelines from the AGA (meh) and International Association of Pancreatology (very good)
Lets talk about some updates… #1/6🧵
(chapter: emcrit.org/ibcc/pancrea...) #EMIMCC
a woman wearing headphones is talking on a walkie talkie and the caption says any updates
ALT: a woman wearing headphones is talking on a walkie talkie and the caption says any updates
media.tenor.com
October 24, 2025 at 1:28 PM
Updated the IBCC chapter on pancreatitis
Added fresh, new guidelines from the AGA (meh) and International Association of Pancreatology (very good)
Lets talk about some updates… #1/6🧵
(chapter: emcrit.org/ibcc/pancrea...) #EMIMCC
Added fresh, new guidelines from the AGA (meh) and International Association of Pancreatology (very good)
Lets talk about some updates… #1/6🧵
(chapter: emcrit.org/ibcc/pancrea...) #EMIMCC
Reposted by Ben Millette
A simple shift in NHS critical care practice is set to save more lives from #Sepsis.
The @ICS_updates & @BritInfectAssoc now recommend continuous infusion for key antibiotics over intermittent dosing. Evidence shows increased 90-day survival.
We urge all hospitals to adopt this practice immediately
The @ICS_updates & @BritInfectAssoc now recommend continuous infusion for key antibiotics over intermittent dosing. Evidence shows increased 90-day survival.
We urge all hospitals to adopt this practice immediately
Experts recommend a simple change to antibiotic administration that will save lives in sepsis
ics.ac.uk
October 22, 2025 at 8:16 AM
A simple shift in NHS critical care practice is set to save more lives from #Sepsis.
The @ICS_updates & @BritInfectAssoc now recommend continuous infusion for key antibiotics over intermittent dosing. Evidence shows increased 90-day survival.
We urge all hospitals to adopt this practice immediately
The @ICS_updates & @BritInfectAssoc now recommend continuous infusion for key antibiotics over intermittent dosing. Evidence shows increased 90-day survival.
We urge all hospitals to adopt this practice immediately
Reposted by Ben Millette
Trials coming up at #esicm #lives2025
I am by far most interested in #andromedashock2.
The usual yearly sweepstakes apply ping @avkwong.bsky.social @redneeraj.bsky.social
I think all of those trials will be “positive”.
Your thoughts?
I am by far most interested in #andromedashock2.
The usual yearly sweepstakes apply ping @avkwong.bsky.social @redneeraj.bsky.social
I think all of those trials will be “positive”.
Your thoughts?
October 19, 2025 at 9:20 PM
Trials coming up at #esicm #lives2025
I am by far most interested in #andromedashock2.
The usual yearly sweepstakes apply ping @avkwong.bsky.social @redneeraj.bsky.social
I think all of those trials will be “positive”.
Your thoughts?
I am by far most interested in #andromedashock2.
The usual yearly sweepstakes apply ping @avkwong.bsky.social @redneeraj.bsky.social
I think all of those trials will be “positive”.
Your thoughts?
Reposted by Ben Millette
New post just out:
"On the edge"
On my unexpected week in hospital and five things I learnt about the state of the NHS.
(Free to read)
open.substack.com/pub/samf/p/o...
"On the edge"
On my unexpected week in hospital and five things I learnt about the state of the NHS.
(Free to read)
open.substack.com/pub/samf/p/o...
On the edge
My week in the NHS
open.substack.com
October 19, 2025 at 8:14 AM
New post just out:
"On the edge"
On my unexpected week in hospital and five things I learnt about the state of the NHS.
(Free to read)
open.substack.com/pub/samf/p/o...
"On the edge"
On my unexpected week in hospital and five things I learnt about the state of the NHS.
(Free to read)
open.substack.com/pub/samf/p/o...
ICU diagnostic conundrums (conundra?) are great to exercise the brain cells but they comprise maybe 5% of all our cases? The greater bulk of medicine is routine management of common disease
This is something I say a lot too. People (not the author) seem to think the only thing doctors do is diagnose. In reality, that's a tiny part of a modern doctor's job in the real world. A fancy AI offering diagnostic powers would help me only quite occasionally. Real life is not like House.
October 16, 2025 at 10:26 PM
ICU diagnostic conundrums (conundra?) are great to exercise the brain cells but they comprise maybe 5% of all our cases? The greater bulk of medicine is routine management of common disease
Reposted by Ben Millette
This is something I say a lot too. People (not the author) seem to think the only thing doctors do is diagnose. In reality, that's a tiny part of a modern doctor's job in the real world. A fancy AI offering diagnostic powers would help me only quite occasionally. Real life is not like House.
October 16, 2025 at 7:26 PM
This is something I say a lot too. People (not the author) seem to think the only thing doctors do is diagnose. In reality, that's a tiny part of a modern doctor's job in the real world. A fancy AI offering diagnostic powers would help me only quite occasionally. Real life is not like House.
Reposted by Ben Millette
In 2016 Geoffrey Hinton said “we should stop training radiologists now" since AI would soon be better at their jobs.
He was right: models have outperformed radiologists on benchmarks for ~a decade.
Yet radiology jobs are at record highs, with an average salary of $520k.
Why?
He was right: models have outperformed radiologists on benchmarks for ~a decade.
Yet radiology jobs are at record highs, with an average salary of $520k.
Why?
September 25, 2025 at 1:53 PM
In 2016 Geoffrey Hinton said “we should stop training radiologists now" since AI would soon be better at their jobs.
He was right: models have outperformed radiologists on benchmarks for ~a decade.
Yet radiology jobs are at record highs, with an average salary of $520k.
Why?
He was right: models have outperformed radiologists on benchmarks for ~a decade.
Yet radiology jobs are at record highs, with an average salary of $520k.
Why?
I believe that Dr Imelda Müller may be the first anaesthetist to become an astronaut?
ts2.tech/en/nasas-new...
ts2.tech/en/nasas-new...
NASA’s New Astronaut Class of 2025 Makes History with “All-American” Recruits Poised for Moon and Mars
NASA’s New Astronaut Class of 2025 Makes History with “All-American” Recruits Poised for Moon and Mars - Tech Space 2.0
ts2.tech
September 24, 2025 at 6:53 PM
I believe that Dr Imelda Müller may be the first anaesthetist to become an astronaut?
ts2.tech/en/nasas-new...
ts2.tech/en/nasas-new...
Reposted by Ben Millette
Some thoughts on this study on using vena cava to guide in-patient treatment of deconpensated heart failure and why it will not change the way I diurese (I use vena cava wisely). #emimcc #cardiosky
La veine cave inférieure n'est pas un bon examen pour décider de remplir un malade ? En toute logique, elle n'est pas meilleure pour guider la vidange...
www.jacc.org/doi/10.1016/...
www.jacc.org/doi/10.1016/...
Inferior Vena Cava Ultrasound to Guide Decongestion in Acute Decompensated Heart Failure: A Randomized Controlled Trial
www.jacc.org
September 16, 2025 at 1:48 PM
Some thoughts on this study on using vena cava to guide in-patient treatment of deconpensated heart failure and why it will not change the way I diurese (I use vena cava wisely). #emimcc #cardiosky
Reposted by Ben Millette
I am delighted to announce CACTUS has launched its cardiac #ultrasound module for accreditation, following the successful launch of Lung #POCUS
Suitable for anyone caring for sick kids
#PedsICU @ics-updates.bsky.social @pccsociety.bsky.social @rcpch.bsky.social
👇
ics.ac.uk/learning/cac...
Suitable for anyone caring for sick kids
#PedsICU @ics-updates.bsky.social @pccsociety.bsky.social @rcpch.bsky.social
👇
ics.ac.uk/learning/cac...
ics.ac.uk
August 4, 2025 at 10:31 AM
I am delighted to announce CACTUS has launched its cardiac #ultrasound module for accreditation, following the successful launch of Lung #POCUS
Suitable for anyone caring for sick kids
#PedsICU @ics-updates.bsky.social @pccsociety.bsky.social @rcpch.bsky.social
👇
ics.ac.uk/learning/cac...
Suitable for anyone caring for sick kids
#PedsICU @ics-updates.bsky.social @pccsociety.bsky.social @rcpch.bsky.social
👇
ics.ac.uk/learning/cac...
Underappreciated medical occupational perk: the lid from many brands of antibiotic ampoule unlocks most supermarket/airport trolleys across Europe
August 16, 2025 at 12:27 PM
Underappreciated medical occupational perk: the lid from many brands of antibiotic ampoule unlocks most supermarket/airport trolleys across Europe
"Thank you for calling the ICU cardiology hotline. Your patient has had a type 2 MI. Please perform serial ECGs, check a troponin and request an inpatient echocardiogram. Goodbye!" *click*
August 14, 2025 at 8:33 AM
"Thank you for calling the ICU cardiology hotline. Your patient has had a type 2 MI. Please perform serial ECGs, check a troponin and request an inpatient echocardiogram. Goodbye!" *click*
What diagnosis should immediately spring to mind when you see this CXR?
July 28, 2025 at 1:57 PM
What diagnosis should immediately spring to mind when you see this CXR?
What do you think of this ECG and how would you treat it? BP is normal
July 28, 2025 at 1:21 PM
What do you think of this ECG and how would you treat it? BP is normal
Reposted by Ben Millette
Average consultant NHS salary is £160k ?!!!!
Can someone please tell me what I’m doing wrong if this is the ‘average’ ? 😆😆😆
Can someone please tell me what I’m doing wrong if this is the ‘average’ ? 😆😆😆
We've updated our explainer on doctors' pay in England 👨⚕️
It includes this analysis of real-terms changes to resident doctors' pay since 2010/11.
We also explore longer-term trends in doctors' pay, and how it compares with the wider economy and UK countries.
Read the explainer: buff.ly/sFnmx8x
It includes this analysis of real-terms changes to resident doctors' pay since 2010/11.
We also explore longer-term trends in doctors' pay, and how it compares with the wider economy and UK countries.
Read the explainer: buff.ly/sFnmx8x
July 23, 2025 at 10:29 AM
Average consultant NHS salary is £160k ?!!!!
Can someone please tell me what I’m doing wrong if this is the ‘average’ ? 😆😆😆
Can someone please tell me what I’m doing wrong if this is the ‘average’ ? 😆😆😆
Reposted by Ben Millette
the distinction between “bactericidal” vs “bacterostatic” antibiotics is some irrelevant BS.
this is fantastic, because there are plenty of other complex considerations when it comes to selecting an antibiotic. #EMIMCC
this is fantastic, because there are plenty of other complex considerations when it comes to selecting an antibiotic. #EMIMCC
We implore authors, peer reviewers,and journal editors to stop perpetuating the concept of static and cidal antibiotics, given the aforementioned evidence demonstrating it is a myth. In a clinical context, these terms are not complex. Rather,they are simply incorrect
journals.asm.org/doi/10.1128/...
journals.asm.org/doi/10.1128/...
Static vs. cidal: it’s not complex; it’s simply incorrect | Antimicrobial Agents and Chemotherapy
In the first sentence of their recent study (1), Gil-Gil and Berryhill cite a 2018 review article (2) to support the statement, “The clinical outcomes of antibiotic treatments involving
the administra...
journals.asm.org
July 22, 2025 at 1:23 AM
the distinction between “bactericidal” vs “bacterostatic” antibiotics is some irrelevant BS.
this is fantastic, because there are plenty of other complex considerations when it comes to selecting an antibiotic. #EMIMCC
this is fantastic, because there are plenty of other complex considerations when it comes to selecting an antibiotic. #EMIMCC
For a practice that is fairly ubiquitous, adding an aminoglycoside to a beta lactam for sepsis has surprisingly little evidence to back it up
www.cochranelibrary.com/cdsr/doi/10....
#emimcc
www.cochranelibrary.com/cdsr/doi/10....
#emimcc
www.cochranelibrary.com
July 8, 2025 at 10:36 AM
For a practice that is fairly ubiquitous, adding an aminoglycoside to a beta lactam for sepsis has surprisingly little evidence to back it up
www.cochranelibrary.com/cdsr/doi/10....
#emimcc
www.cochranelibrary.com/cdsr/doi/10....
#emimcc
Reposted by Ben Millette
Mervyn Singer reflects on 40 years of ICU
Including 40 years of ICU trials
His thoughts are interesting…ping @redneeraj.bsky.social
#soa25
Including 40 years of ICU trials
His thoughts are interesting…ping @redneeraj.bsky.social
#soa25
July 1, 2025 at 9:04 AM
Mervyn Singer reflects on 40 years of ICU
Including 40 years of ICU trials
His thoughts are interesting…ping @redneeraj.bsky.social
#soa25
Including 40 years of ICU trials
His thoughts are interesting…ping @redneeraj.bsky.social
#soa25
Reposted by Ben Millette
To a Gen X'er like me, this is an A-ha moment.
But to the rest of the world, "Aha moments are sudden flashes of insight; instances of "Eureka" where, abruptly, the solution to a problem presents itself. A new study suggests we can actually game the system... here's how:
🧵
But to the rest of the world, "Aha moments are sudden flashes of insight; instances of "Eureka" where, abruptly, the solution to a problem presents itself. A new study suggests we can actually game the system... here's how:
🧵
June 26, 2025 at 7:35 PM
To a Gen X'er like me, this is an A-ha moment.
But to the rest of the world, "Aha moments are sudden flashes of insight; instances of "Eureka" where, abruptly, the solution to a problem presents itself. A new study suggests we can actually game the system... here's how:
🧵
But to the rest of the world, "Aha moments are sudden flashes of insight; instances of "Eureka" where, abruptly, the solution to a problem presents itself. A new study suggests we can actually game the system... here's how:
🧵