Propofology

Should we be giving prolonged abx infusions in ICU? PkPd in the Critically Ill. FULLSCREEN = https://t.co/QHNgBvaOwW https://t.co/d84CHGEWaB (via Twitter http://twitter.com/Gas_Craic/status/1068757242466496512) Should we be giving prolonged abx infusions in ICU? PkPd in the Critically Ill. FULLSCREEN = https://t.co/QHNgBvaOwW https://t.co/d84CHGEWaB

New Systematic Review: The Effect of Peri-Op NSAID's on Post-Op Kidney Function --> ??? https://t.co/bJh1bPRTLw https://t.co/TWYeJtuTBi (via Twitter http://twitter.com/Gas_Craic/status/1068739524157681664) New Systematic Review: The Effect of Peri-Op NSAID's on Post-Op Kidney Function --> ??? https://t.co/bJh1bPRTLw https://t.co/TWYeJtuTBi

Effect of Peri-Op NSAIDs on Post-Op Kidney Function (Cochrane)

NSAIDs & AKI

OPIOID ALTERNATIVES - See the HD version at www.propofology.com/infographs/certa-opioid-alternatives Version 2 2018 Update :)

OPIOID ALTERNATIVES VERSION 2 - The 2018 Update with (PDF & Ref's: https://t.co/SqcEXeVESf) https://t.co/8cIS1IA8wk (via Twitter http://twitter.com/Gas_Craic/status/1067487078441717760) OPIOID ALTERNATIVES VERSION 2 - The 2018 Update with (PDF & Ref's: https://t.co/SqcEXeVESf) https://t.co/8cIS1IA8wk

PARAMEDIC TRIALS 2014-2018 (better graphic & PDF: https://t.co/i32e9hzMwx) https://t.co/JJHOCLAFdp (via Twitter http://twitter.com/Gas_Craic/status/1067016447925329920) PARAMEDIC TRIALS 2014-2018 (better graphic & PDF: https://t.co/i32e9hzMwx) https://t.co/JJHOCLAFdp

A look at AIRWAY systematic reviews 2009-2018 PDF/better images--> https://t.co/11TDoBM8Dn https://t.co/ifSqGuyqYU (via Twitter http://twitter.com/Gas_Craic/status/1066778343557791744) A look at AIRWAY systematic reviews 2009-2018 PDF/better images--> https://t.co/11TDoBM8Dn https://t.co/ifSqGuyqYU

An isotonic maintenance fluid strategy will cause hyperchloremia in most patients.

It is not only the volume, but also (mainly?) the tonicity of your maintenance fluid strategy that is responsible for perioperative fluid overload.

1. A HYPOTONIC maintenance fluid strategy can = hyponatremia, but ?it’s clinical relevance
2. An ISOTONIC maintenance fluid strategy = fluid retention in a surgical population
3. An ISOTONIC maintenance fluid strategy = hyperchloraemia in a surgical population

20% albumin is probably a "slow-release" preparation that expands the plasma volume for more than one whole day.

The intravascular persistence time of 20% albumin is several times longer than 5%.

Fluids are drugs.
Give less if in doubt.
If you must give, consider a fluid challenge
Difference with initial response & sustainability

Fluid Boluses -
Responders? Non-responders?
That's very black and white.
It's likely more complicated than that.

We do a lot of trials - but do we know the physiology of fluid adminstrationn??

The major challenge of our age is translating established physiology into clinically relevant outcomes

In the critically ill patients, most of the time, oedema formation (both in the early and late phase) is associated with a renal sodium-retaining state.

Oedema is ONLY clinically evident from 2.5-3L of insterstitial volume.

Noradrenaline likely works synergistically with fluids....

Fluids in disease = different ballgame. Same with so many things when we clash theoretical physiology with the real world of medicine. What do things like the 'glycocalyx', fluid responsivity and CO monitoring ACTUALLY translate to, in terms of benefit?

Studies revealed fluid responsivity in about 50% of cases...
NOT all patients are fluid responsive.

Why do we give fluids?
Theoretically, to refill the venous tank, the reservoir of blood and increase the mean systemic pressure....

If we infuse 1L of crystalloid in healthy volunteers, about half of it is excreted in about 1h. This is very different DURING anaesthesia - it's slower

Give 2L of balanced crystalloid over 30mins...
IV content of this at 1hr is about 20% of the infused amount

1L OF 5% GLUCOSE CONTAINS 200KCAL.
TYPICAL ADMIN IN HOSPITAL IS 2L
THIS GLUCOSE IS NOT OPTIMALLY UTILISED, PHYSIOLOGICALLY, IN THE SERIOUSLY ILL.

Many small studies show that complications increase when more than 3 L of crystalloid fluid is administered.

Let us all think long and hard about the implications of what went on within the case against Dr & support the review/challenge that this campaign aims to make happen.

Independent Legal Opinion on Dr Bawa-Garba Case We are doctors that have been opposing attempts to argue junior doctors out of statutory whistleblowing protection.

David Lyness on Twitter “Food for thought, from SMACC DUB 2016 ”

David Lyness on Twitter “Never knew this! ”

David Lyness on Twitter “Changing probes in US? How complex is your scanning system? ”

David Lyness on Twitter “Are you too reliant on the media/text/fluff in your presentations? ”

David Lyness on Twitter “MARIK on SEPSIS ”

David Lyness on Twitter “"Albumin- a molecule with powerful properties. However, it has no oncotic value in the septic patient." ”

An infographic tour of with 80 of our graphic-tweets in this slideshow :-) https://buff.ly/2ruDp5R https://buff.ly/2G7niyf

An Infographic Tour of #IFAD2017 The amazing SoMe team at made over 80 infograms on the topics at the conference. Peruse them below. Some of them are tongue-in-cheek and designed to drive discussion - which indeed they...