Wow I am an intern and the aggressive diuresis and avoiding IV antihypertensives are def things I am going to try to implement, looks like really good stuff. Thank you for the video.
Pretty much the sources I used here! I’ve been using NEJM journal watch which sends weekly emails. And just discovered the SHM updates in HM lecture which is a great resource if you are a SHM member or become one in the future!
Definitely would agree anecdotally that early diuresis works well. I do worry however about generalizing that 1) better outcomes in those who diuresed VERY well implies that 2) heavier diuresis early will lead to similar positive QoL and admission outcomes for all. Also anecdotally, those who respond very well to diuresis tended to have either poorly managed severe diffuse volume overload or were previously well patients with newly onset severe symptoms (think takotsubo, etc). This impression may be wrong, of course. Statistically, it may be tempting to assume that the randomization accounts for these phenotypic differences, but this only applies when looking at the intervention and non-intervention groups overall. The post-hoc nature means that the subgroup of very good responders may still be phenotypically different than the subgroup of poor responders. Overall still a supporter due to the increased speed of symptom relief.
Totally agree with that take! The patients in the first quartile who did not diurese very well may have had some patient characteristics that made them more ill or more refractory to diuresis at baseline compared to the patients in the other quartiles - this definitely could have skewed the results. Still I think it is reassuring that there wasn't any clear signal for any worsened outcomes with more aggressive diuresis at least in this particular study
Agreed! Not really sure what I would do based on that information. Seems like it still be best to just assess the patient clinically for signs of volume overload or see if they start having new chest pain
I think IN CVICU the benefit is establishing a baseline BNP/Trop and then using as a proxy to monitor cardiac function postoperatively. A trend down in BNP especially after cardiac procedure may be a way to predict prognosis?
Was the question “is aspirin as effective as LMWH in prevention of VTE for THA and TKA?” your question or the researchers question? Just curious because that wasn’t technically aligned with the methods of looking at fractures. I assume the results are just being extrapolated to arthroplasty patients was your point?
True that the question wasn’t totally aligned with the study design! I think I accidentally left that question slide from when the lecture was focused on the prior CRISTAL trial which was done in THA and TKA patients
@ConanLiuMD It just won't be the same. I feel lucky to have experienced the competition on iccup. You can't say anything slightly offensive or negative to the kids these days. I feel it's the player base and culture that makes the game. The game will probably be a disappointment to many as bw is difficult to replace.
Best medicine TH-camr 🙌🏻
this is absolutely brilliant, keep these coming, thank you so much
Thanks!
Wow I am an intern and the aggressive diuresis and avoiding IV antihypertensives are def things I am going to try to implement, looks like really good stuff. Thank you for the video.
Definitely do more of these
Love this series
good stuff Conan. Keep up the good work!
Amazing video thank you!
Uptodate and the ACP should hire you to write articles and, of course do tons of videos.
What would you suggest as a good resource to stay up to date on new guidelines/practices?
Pretty much the sources I used here! I’ve been using NEJM journal watch which sends weekly emails. And just discovered the SHM updates in HM lecture which is a great resource if you are a SHM member or become one in the future!
Awesome review!
Awesome lecture :)
Definitely would agree anecdotally that early diuresis works well. I do worry however about generalizing that 1) better outcomes in those who diuresed VERY well implies that 2) heavier diuresis early will lead to similar positive QoL and admission outcomes for all. Also anecdotally, those who respond very well to diuresis tended to have either poorly managed severe diffuse volume overload or were previously well patients with newly onset severe symptoms (think takotsubo, etc). This impression may be wrong, of course. Statistically, it may be tempting to assume that the randomization accounts for these phenotypic differences, but this only applies when looking at the intervention and non-intervention groups overall. The post-hoc nature means that the subgroup of very good responders may still be phenotypically different than the subgroup of poor responders. Overall still a supporter due to the increased speed of symptom relief.
Totally agree with that take! The patients in the first quartile who did not diurese very well may have had some patient characteristics that made them more ill or more refractory to diuresis at baseline compared to the patients in the other quartiles - this definitely could have skewed the results. Still I think it is reassuring that there wasn't any clear signal for any worsened outcomes with more aggressive diuresis at least in this particular study
amazing video!
nice video , keep going !
Thank you!!!!
Still can’t imagine a benefit of trending perioperative BNP/tropnin…
Agreed! Not really sure what I would do based on that information. Seems like it still be best to just assess the patient clinically for signs of volume overload or see if they start having new chest pain
I think IN CVICU the benefit is establishing a baseline BNP/Trop and then using as a proxy to monitor cardiac function postoperatively. A trend down in BNP especially after cardiac procedure may be a way to predict prognosis?
Was the question “is aspirin as effective as LMWH in prevention of VTE for THA and TKA?” your question or the researchers question? Just curious because that wasn’t technically aligned with the methods of looking at fractures. I assume the results are just being extrapolated to arthroplasty patients was your point?
True that the question wasn’t totally aligned with the study design! I think I accidentally left that question slide from when the lecture was focused on the prior CRISTAL trial which was done in THA and TKA patients
@ConanLiuMD ah totally makes sense. Great video and thanks for the clarification!
Not going to lie. Everytime i check the channel. Deep down i hope Superiorwolf would make a comeback and talk shit while cannon rush some noobs.
ZeroSpace 2025? 😜
@ConanLiuMD It just won't be the same. I feel lucky to have experienced the competition on iccup. You can't say anything slightly offensive or negative to the kids these days. I feel it's the player base and culture that makes the game. The game will probably be a disappointment to many as bw is difficult to replace.
Nephro be like... 😮😢
This is amazing! Any possibility you can send me the slides? I emailed you :)