Really was😂

(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

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

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

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