OK - so a bit of the background to this. Jonny Wilkinson and I sat down to discuss the state of #FOAMed and our workshop on Social Media at #IFAD2017 - we were then joined, sequentially, by LOADS of different people, purely by accident.
This evolved into a brilliant Podcast between the team, talking about the issues that matter most to each of us. Off-the-cuff and candid.
IFAD2017 kicked off in Antwerp, Belgium from the 22nd to 25th of November. It comprised of a variety of workshops on echo & point of care ultrasound, social media, fluid management strategies, the glycocalyx and many others. A list of upcoming sessions was created and disseminated in advance on social media.
As you will have seen one of my other blog posts - we also focused on creating a graphic social media campaign utilising programmes which added quotes on top of HD pictures to encourage conversation of the quotes and snippets of the conference. Some quotes have been said to be over simplistic in their message, which is often the charge levelled at twitter when it comes to FOAMed. Nevertheless, I would proffer that the same messages were given at the conference and are not that far removed from their original aims - to provoke discussion, and to some degree, controversy. It is often the case on twitter that we skip past 'boring' or 'seasoned' messages and only engage with the controversial material. Whilst, as someone who focuses on basic science material, this erks me to no end (as often age-old concepts such as adrenoreceptors, kidney function etc get overlooked)- it did provide us with targets to go after to engage the online audience. Perhaps in response to those who would say, "over simplistic messages are dangerous" - I would say looking at ANYTHING in medicine in isolation or out of context is dangerous. This is something everyone must learn. And the 'real-time peer review' of the quotes has been excellent, particularly the heated arguments.
One of the most interesting infographs focuses on the fact that sepsis is primarily a vasoplegic disease and not a hypovolaemic state. This was stated by Prof. Paul Marik, whose work on sepsis has spanned many years and is known for his controversial and illuminating theories on vitamin C, steroids and fluid restrictive strategies. Now, it was also discussed at IFAD2017 that, yes, your patients may ALSO be hypovolaemic via poor intake, fever etc but this is a secondary process and as intrinsic to sepsis as dehydration is to any disease that disrupts homeostasis - this includes prolonged fasting in surgery for a broken wrist, or a quincy that prevents swallowing. All in all, it is very likely that your patient will need fluids in sepsis - but the point of the discussion-challenge was to switch the view of sepsis from one that makes you think, reflexively, that the patient is profoundly hypovolaemic by nature rather than assessing the patients for signs of dehydration. My example would be to look at ICU patients day three post-op, who develops sepsis, who has had their fluids managed on the unit. Hopefully, by virtue of being in an ICU, they will NOT be deplete of their daily water intake enough to require what in some areas is an immediate dose of 30ml/kg fluid. It is certainly an interesting shift in thought process and one that requires a lot more discussion online with people more clever than I.
The presentations at the conference pertained to interesting topics in fluid management - more so than I expected! This actually threw up so many issues with our Social Media team about delivery and presentation skills. We discussed, at length, 'Why People Go To Conferences' and there will be more about that coming out soon. Presentations themselves at conferences are done extremely poorly - a mix of speakers reading their slides off to an audience, clip art, spinning text and slides with over 1000 words on them do NOTHING to help knowledge retention. Love or hate the SMACC conference, I remember their talks years later because they delivered a talk rather than a word-soup. I could not even read half the slides of some of the talks which focused on putting as much of their data as humanly possible on indecipherable graphs, pie-charts and tables. Arguably (well, not arguably) your presentation should be devoid of your data - which should be provided to the conference attendees well before the event or AT the event, in the form of a print-out or digital publication so that you can focus on the delivery of your THOUGHTS. Consultant Paediatric Surgeon, Mr Ross Fisher was at the conference giving a workshop on 'How to Talk Like TED' - delivering some of the worst talks known to medicine (on purpose) to illustrate the problems with bombaring the audience with useless information that detracts from your key message. As he quite rightly asserts - "It is your message that matters, not your slide". Spend the time working on your delivery rather than your slides. Ross was a delight to have on Social Media Faculty - and I hope our collaborations do not end here.
The amazing SoMe team at #IFAD2017 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 have.
Also see the amazing blog of the conference by Dr. Jonny Wilkinson here!
Dr. Adrian Wong collated the list below.
A whiter shade of pale: the ongoing challenge of haemorrhagic shock. Muckart DJJ, Malbrain MLNG. Anaesthesiol Intensive Ther. 2017 Nov 18. doi: 10.5603/AIT.a2017.0060. [Epub ahead of print] No abstract available. PMID: 29150998 – FOAM Free Article
The future of evidence-based medicine: is the frog still boiling? Muckart DJJ, Malbrain MLNG. Anaesthesiol Intensive Ther. 2017 Nov 18. doi: 10.5603/AIT.a2017.0059. [Epub ahead of print] No abstract available. PMID: 29150997 – FOAM Free Article
The SEP-1 quality mandate may be harmful: How to drown a patient with 30 mL per kg fluid! Marik PE, Malbrain MLNG. Anaesthesiol Intensive Ther. 2017 Nov 18. doi: 10.5603/AIT.a2017.0056. [Epub ahead of print] No abstract available. PMID: 29150996 – FOAM Free Article
The saga continues: How to set best PEEP in intra-abdominal hypertension? Malbrain MLNG. J Crit Care. 2017 Nov 8. pii: S0883-9441(17)31629-5. doi: 10.1016/j.jcrc.2017.11.013. [Epub ahead of print] No abstract available. PMID: 29146063
Focus on focus: lack of coherence between systemic and microvascular indices of edema formation. Ten Tusscher B, Gudden C, van Vliet S, Smit B, Ince C, Boerma EC, de Grooth HS, Elbers PWG. Anaesthesiol Intensive Ther. 2017 Nov 18. doi: 10.5603/AIT.a2017.0062. [Epub ahead of print] PMID: 29150999 – FOAM Free Article
Re-operative abdominal predictive score: a prognostic model combining Acute Re-intervention Predictive Index and intra-abdominal pressure. Soler-Morejón CD, Lombardo-Vaillant TA, Tamargo-Barbeito TO, Wise R, Malbrain MLNG. Anaesthesiol Intensive Ther. 2017 Nov 22. doi: 10.5603/AIT.a2017.0069. [Epub ahead of print] PMID: 29165775 – FOAM Free Article
Implementing clinical practice changes in critical care: lessons learned in a national collaborative of over 60 ICU teams. Kleinpell R, Zimmerman JJ. Anaesthesiol Intensive Ther. 2017 Nov 18. doi: 10.5603/AIT.a2017.0057. [Epub ahead of print] PMID: 29151000 – FOAM Free Article
Introducing TOPMAST, the first double-blind randomized clinical trial specifically dedicated to perioperative maintenance fluid therapy in adults. Hendrickx S, Van Vlimmeren K, Baar I, Verbrugghe W, Dams K, Van Cromphaut S, Roelant E, Embrecht B, Wittock A, Mertens P, Hendriks JM, Lauwers P, Van Schil PE, Van Craenenbroeck AH, Van den Wyngaert T, Jorens P, Van Regenmortel N. Anaesthesiol Intensive Ther. 2017 Nov 24. doi: 10.5603/AIT.a2017.0070. [Epub ahead of print] PMID: 29170998
Adverse effects of crystalloid and colloid fluids. Hahn RG. Anaesthesiol Intensive Ther. 2017;49(4):303-308. doi: 10.5603/AIT.a2017.0045. Epub 2017 Sep 27. PMID: 28953310
Model-driven gas exchange monitoring in the critically ill. Balan CI, Wong AV. Anaesthesiol Intensive Ther. 2017 Nov 22. doi: 10.5603/AIT.a2017.0066. [Epub ahead of print] PMID: 29165776 – FOAM Free Article
Modern imaging techniques in intra-abdominal hypertension and abdominal compartment syndrome: a bench to bedside overview. Sugrue G, Malbrain MLNG, Pereira B, Wise R, Sugrue M. Anaesthesiol Intensive Ther. 2017 Nov 24. doi: 10.5603/AIT.a2017.0076. [Epub ahead of print] PMID: 29171001
Cardiac ultrasound: a true haemodynamic monitor? Poelaert J, Malbrain MLNG. Anaesthesiol Intensive Ther. 2017 Nov 22. doi: 10.5603/AIT.a2017.0068. [Epub ahead of print] PMID: 29165778 – FOAM Free Article
The use of crystalloids in traumatic brain injury. Dąbrowski W, Woodcock T, Rzecki Z, Malbrain MLNG. Anaesthesiol Intensive Ther. 2017 Nov 22. doi: 10.5603/AIT.a2017.0067. [Epub ahead of print] PMID: 29165777 – FOAM Free Article
The black box revelation: monitoring gastrointestinal function. Moonen PJ, Reintam Blaser A, Starkopf J, Oudemans-van Straaten HM, Van der Mullen J, Vermeulen G, Malbrain MLNG. Anaesthesiol Intensive Ther. 2017 Nov 20. doi: 10.5603/AIT.a2017.0065. [Epub ahead of print] PMID: 29152710 – FOAM Free Article
Perioperative gastrointestinal problems in the ICU. Reintam Blaser A, Starkopf J, Moonen PJ, Malbrain MLNG, Oudemans-van Straaten HM. Anaesthesiol Intensive Ther. 2017 Nov 20. doi: 10.5603/AIT.a2017.0064. [Epub ahead of print] PMID: 29152709 – FOAM Free Article
Lung ultrasound in the critically ill (LUCI): A translational discipline. Lichtenstein DA, Malbrain MLNG. Anaesthesiol Intensive Ther. 2017 Nov 18. doi: 10.5603/AIT.a2017.0063. [Epub ahead of print] PMID: 29151003 – FOAM Free Article
Intravenous fluid therapy for hospitalized and critically ill children: rationale, available drugs and possible side effects. Langer T, Limuti R, Tommasino C, van Regenmortel N, Duval ELIM, Caironi P, Malbrain MLNG, Pesenti A. Anaesthesiol Intensive Ther. 2017 Nov 18. doi: 10.5603/AIT.a2017.0058. [Epub ahead of print] PMID: 29151001 – FOAM Free Article
The Baby Boom and later life: is critical care fit for the future? Pugh R, Subbe CP, Thorpe C, Szakmany T. Anaesthesiol Intensive Ther. 2017 Nov 24. doi: 10.5603/AIT.a2017.0078. [Epub ahead of print] PMID: 29170999
Management of arrhythmia in sepsis and septic shock. Balik M, Matousek V, Maly M, Brozek T. Anaesthesiol Intensive Ther. 2017 Nov 18. doi: 10.5603/AIT.a2017.0061. [Epub ahead of print] PMID: 29151002 – FOAM Free Article
Applying pharmacokinetic/pharmacodynamic principles for optimizing antimicrobial therapy during continuous renal replacement therapy. Honore PM, Jacobs R, De Waele E, Spapen HD. Anaesthesiol Intensive Ther. 2017 Nov 24. doi: 10.5603/AIT.a2017.0071. [Epub ahead of print] PMID: 29171000
You can find all the PODCAST Material below on Propology.com, hosted by the Fluid Academy team.
This content would not have been possible had it not been for Dr. Jonny Wilkinson at www.CriticalCareNorthampton.com - for more info on the Podcasts, check out the website!
We have a LOT of PODCAST content on its way - here are some to start.