Casey Albin, MD
@caseyalbin.bsky.social
Neurointensivist @EmoryNeuroCrit | @ContinuumAAN media AE | Co-Author Acute Neurology Survival Guide | Passionate about #FOAMncc & acute neurology
Hmm like beyond ENLS?
March 11, 2025 at 9:34 PM
Hmm like beyond ENLS?
I think this is a reasonable take based on the evidence!
Do I really think the grade 1 SAH with a whisp of blood and low risk of DCI needs a Hgb of 9? No.
But for pt in clear vasospasm (aSAH but also TBI) or other perfusion disturbing physiology I think I will keep 9 as my threshold.
Do I really think the grade 1 SAH with a whisp of blood and low risk of DCI needs a Hgb of 9? No.
But for pt in clear vasospasm (aSAH but also TBI) or other perfusion disturbing physiology I think I will keep 9 as my threshold.
December 10, 2024 at 9:52 PM
I think this is a reasonable take based on the evidence!
Do I really think the grade 1 SAH with a whisp of blood and low risk of DCI needs a Hgb of 9? No.
But for pt in clear vasospasm (aSAH but also TBI) or other perfusion disturbing physiology I think I will keep 9 as my threshold.
Do I really think the grade 1 SAH with a whisp of blood and low risk of DCI needs a Hgb of 9? No.
But for pt in clear vasospasm (aSAH but also TBI) or other perfusion disturbing physiology I think I will keep 9 as my threshold.
18/
Interested in how others are interpreting these results. Again, huge congrats to the authors. and a special shout out to Dr. Ofer Sadan who led the SAHARA effort at
@emoryneurocrit.bsky.social
@ericclawsonmd.bsky.social @pulmcrit.bsky.social @aartisarwal.bsky.social @ajwpharm.bsky.social
Interested in how others are interpreting these results. Again, huge congrats to the authors. and a special shout out to Dr. Ofer Sadan who led the SAHARA effort at
@emoryneurocrit.bsky.social
@ericclawsonmd.bsky.social @pulmcrit.bsky.social @aartisarwal.bsky.social @ajwpharm.bsky.social
December 10, 2024 at 6:30 PM
18/
Interested in how others are interpreting these results. Again, huge congrats to the authors. and a special shout out to Dr. Ofer Sadan who led the SAHARA effort at
@emoryneurocrit.bsky.social
@ericclawsonmd.bsky.social @pulmcrit.bsky.social @aartisarwal.bsky.social @ajwpharm.bsky.social
Interested in how others are interpreting these results. Again, huge congrats to the authors. and a special shout out to Dr. Ofer Sadan who led the SAHARA effort at
@emoryneurocrit.bsky.social
@ericclawsonmd.bsky.social @pulmcrit.bsky.social @aartisarwal.bsky.social @ajwpharm.bsky.social
17
I think there is enough data to suggest that aiming for 9g/dL PARTICULARLY (maybe exclusively) in pts at ⬆️ risk for decreases in cerebral perfusion due to ongoing physiologic changes like vasospasm makes sense given the control population in this trial & the results of TRAIN
I think there is enough data to suggest that aiming for 9g/dL PARTICULARLY (maybe exclusively) in pts at ⬆️ risk for decreases in cerebral perfusion due to ongoing physiologic changes like vasospasm makes sense given the control population in this trial & the results of TRAIN
a showtime ad for billions shows an old man talking to another man
ALT: a showtime ad for billions shows an old man talking to another man
media.tenor.com
December 10, 2024 at 6:30 PM
17
I think there is enough data to suggest that aiming for 9g/dL PARTICULARLY (maybe exclusively) in pts at ⬆️ risk for decreases in cerebral perfusion due to ongoing physiologic changes like vasospasm makes sense given the control population in this trial & the results of TRAIN
I think there is enough data to suggest that aiming for 9g/dL PARTICULARLY (maybe exclusively) in pts at ⬆️ risk for decreases in cerebral perfusion due to ongoing physiologic changes like vasospasm makes sense given the control population in this trial & the results of TRAIN
16/
The way I have put this together, is that I will be more aggressive (than the standard 7 or what we have allowed as 8g/dL) in transfusions for the patients at highest risk for secondary neurologic injury.
The way I have put this together, is that I will be more aggressive (than the standard 7 or what we have allowed as 8g/dL) in transfusions for the patients at highest risk for secondary neurologic injury.
December 10, 2024 at 6:30 PM
16/
The way I have put this together, is that I will be more aggressive (than the standard 7 or what we have allowed as 8g/dL) in transfusions for the patients at highest risk for secondary neurologic injury.
The way I have put this together, is that I will be more aggressive (than the standard 7 or what we have allowed as 8g/dL) in transfusions for the patients at highest risk for secondary neurologic injury.
15/
It seems to me a take away is that 10g/dL is too high to offer benefit, but the lowest acceptable number I think is still up for debate, and TRAIN would suggest 9g/dL might be a more reasonable target.
Indeed, the restrictive group in SAHARA was on average > that threshold
It seems to me a take away is that 10g/dL is too high to offer benefit, but the lowest acceptable number I think is still up for debate, and TRAIN would suggest 9g/dL might be a more reasonable target.
Indeed, the restrictive group in SAHARA was on average > that threshold
December 10, 2024 at 6:30 PM
15/
It seems to me a take away is that 10g/dL is too high to offer benefit, but the lowest acceptable number I think is still up for debate, and TRAIN would suggest 9g/dL might be a more reasonable target.
Indeed, the restrictive group in SAHARA was on average > that threshold
It seems to me a take away is that 10g/dL is too high to offer benefit, but the lowest acceptable number I think is still up for debate, and TRAIN would suggest 9g/dL might be a more reasonable target.
Indeed, the restrictive group in SAHARA was on average > that threshold
14/
In other neurocritically ill pts including SAH (the recently published TRAIN trial), we did reduce unfavorable outcomes when we set the "liberal" threshold of <9g/dl and restrict all the way down to <7g/dl. This looked at 6 month outcome.
In other neurocritically ill pts including SAH (the recently published TRAIN trial), we did reduce unfavorable outcomes when we set the "liberal" threshold of <9g/dl and restrict all the way down to <7g/dl. This looked at 6 month outcome.
December 10, 2024 at 6:30 PM
14/
In other neurocritically ill pts including SAH (the recently published TRAIN trial), we did reduce unfavorable outcomes when we set the "liberal" threshold of <9g/dl and restrict all the way down to <7g/dl. This looked at 6 month outcome.
In other neurocritically ill pts including SAH (the recently published TRAIN trial), we did reduce unfavorable outcomes when we set the "liberal" threshold of <9g/dl and restrict all the way down to <7g/dl. This looked at 6 month outcome.
13/
This trial was very well done and is pragmatic and generalizable.
The threshold of 10 doesn't seem to improve neurologic outcomes.
However, I don't look at this trial and think that we conclude that maintaining a daily hgb of 8g/dl is proven ok.
This trial was very well done and is pragmatic and generalizable.
The threshold of 10 doesn't seem to improve neurologic outcomes.
However, I don't look at this trial and think that we conclude that maintaining a daily hgb of 8g/dl is proven ok.
December 10, 2024 at 6:30 PM
13/
This trial was very well done and is pragmatic and generalizable.
The threshold of 10 doesn't seem to improve neurologic outcomes.
However, I don't look at this trial and think that we conclude that maintaining a daily hgb of 8g/dl is proven ok.
This trial was very well done and is pragmatic and generalizable.
The threshold of 10 doesn't seem to improve neurologic outcomes.
However, I don't look at this trial and think that we conclude that maintaining a daily hgb of 8g/dl is proven ok.
12/
Between these two groups, there was no significant difference in mRS at 12 months and the risk of having a poor outcome.
Between these two groups, there was no significant difference in mRS at 12 months and the risk of having a poor outcome.
December 10, 2024 at 6:30 PM
12/
Between these two groups, there was no significant difference in mRS at 12 months and the risk of having a poor outcome.
Between these two groups, there was no significant difference in mRS at 12 months and the risk of having a poor outcome.
11/
Note also that once the liberal group got transfused they also mostly stay well above even the liberal threshold.
So intervention was transfusion for a low threshold of 8g/dl ... but we're I think ultimately comparing outcomes for avg daily hgb of ~11g/dL to ~9.5 g/dL
Note also that once the liberal group got transfused they also mostly stay well above even the liberal threshold.
So intervention was transfusion for a low threshold of 8g/dl ... but we're I think ultimately comparing outcomes for avg daily hgb of ~11g/dL to ~9.5 g/dL
December 10, 2024 at 6:30 PM
11/
Note also that once the liberal group got transfused they also mostly stay well above even the liberal threshold.
So intervention was transfusion for a low threshold of 8g/dl ... but we're I think ultimately comparing outcomes for avg daily hgb of ~11g/dL to ~9.5 g/dL
Note also that once the liberal group got transfused they also mostly stay well above even the liberal threshold.
So intervention was transfusion for a low threshold of 8g/dl ... but we're I think ultimately comparing outcomes for avg daily hgb of ~11g/dL to ~9.5 g/dL
10/
However, while the two group are clearly different, its important to note... the restrict group was on avg above 9 g/dl.
Said differently the controls were anemic, but did not linger 8g/dL threshold... so, the intervention, if needed, got them well away from the "danger" level
However, while the two group are clearly different, its important to note... the restrict group was on avg above 9 g/dl.
Said differently the controls were anemic, but did not linger 8g/dL threshold... so, the intervention, if needed, got them well away from the "danger" level
December 10, 2024 at 6:30 PM
10/
However, while the two group are clearly different, its important to note... the restrict group was on avg above 9 g/dl.
Said differently the controls were anemic, but did not linger 8g/dL threshold... so, the intervention, if needed, got them well away from the "danger" level
However, while the two group are clearly different, its important to note... the restrict group was on avg above 9 g/dl.
Said differently the controls were anemic, but did not linger 8g/dL threshold... so, the intervention, if needed, got them well away from the "danger" level