Joined December 2015
Sandra Peake retweeted
According to a Sussex source Markle found Charles's letter highly amusing and thought it was ridiculous that he made it public without any negotiation with them. Also accordingly she has made a copy and is going to framed it. This also explains their contempt for His Majesty....
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Sandra Peake retweeted
Among adults with septic shock, the use of restricted fluids and early vasopressors did not result in more days alive and out of the hospital through day 90 than the use of liberal fluids and later vasopressors. Full ARISE FLUIDS trial results and Research Summary: nej.md/3PVdwIp
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Sandra Peake retweeted
Original Article: Vasopressors or Fluids in Early Septic Shock (ARISE FLUIDS trial) nej.md/3PVdwIp Editorial: More Than One Way to Save a Life in Septic Shock nej.md/4j1pPio #EmergencyMedicine #CriticalCare
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Sandra Peake retweeted
Well, it depends... who do you want to yell at you? Cardiology or Nephrology? Our latest video in partnership with @DGlaucomflecken summarizes the ARISE FLUIDS trial that examined whether hemodynamic resuscitation with early vasopressors versus more liberal fluids could affect outcomes in patients with septic shock. Read the full study for free: nej.md/DrG47 #emergencymedicine
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ARISE - A neutral trial is not a neutral message The ARISE FLUIDS trial compared two approaches to early septic shock: giving less fluid and starting vasopressors earlier, or giving more fluid before moving to vasopressors. The result was described as neutral. Patients in both groups had the same median number of days alive and out of hospital at 90 days. It would be easy to conclude that the choice between fluid and vasopressors does not matter. That would be the wrong lesson. Read about it here fluids.info/news/arise-a-neu…
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Sandra Peake retweeted
Hugely important post below about an important trial
ARISE-FLUIDS has arrived and it's awesome 🥳 For over a decade, the Surviving Sepsis Guidelines recommended that septic patients get at least 30 cc/kg fluid. In the United States, these guidelines were weaponized into performance metrics, pressuring clinicians to prescribe arbitrary volumes to every patient. Evidence-based clinicians have LONG known that this guideline lacked evidentiary support. For example, I've attached a picture of a blog I wrote about this back in 2017. Despite the lack of evidentiary support and some evidence of harm, the Surviving Sepsis Guidelines INSISTED on perpetually recommending 30 cc/kg fluid resuscitation. We finally have a prospective RCT demonstrating that mandating early administration of 30 cc/kg fluid (as compared to early vasopressors) doesn't help and may actually cause harm. It's important to note that all of the hard endpoints in this trial were neutral (e.g., mortality, days free of organ support). I still think that 30 cc/kg fluid is a pretty reasonable volume of fluid for *most* patients. But the study does suggest that giving too much fluid may promote edema - so we should be *thoughtful* about this intervention rather than mandating it for every septic patient. Based on the subgroup analysis, the fluid-conservative strategy may have helped the subgroup of pneumonia patients the most. This is statistically nonsignificant but aligns with my expectation. ARDSy patients often don't respond well to fluid. (In contrast, I really doubt that a liter of fluids in either direction matters for most urosepsis patients.) This is a great example of the over-reach of guidelines and protocoled medicine. People get all upset about practice variation, so sometimes they try to stomp it out using guidelines and protocols. But these guidelines are highly fallible, so what may occur is that you standardize care in a way that harms everyone equally. 🤦‍♂️
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Presenting the results of the trial today in Belfast at #CCR26 Thank you to all involved @anzicsctg @acemonline @anzicrc @ccrem2
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Sandra Peake retweeted
Presented at #CCR26: Among adults with septic shock, the use of restricted fluids and early vasopressors did not result in more days alive and out of the hospital through day 90 than the use of liberal fluids and later vasopressors. Full ARISE FLUIDS trial results: nej.md/3PVdwIp @CritCareReviews
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➡️ Are we giving too much fluid in early sepsis? ➡️ Should we use vasopressors much sooner? ➡️ Join us in June for the ARISE-FLUIDS trial results! Register now: criticalcarereviews.com/meet…
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On the second day of Christmas, my true love gave to me 🎁 🚑 ARISE FLUIDS in septic shock 💉 Pressors early, fluids less 🏥 And one big trial at CCR26 🎄
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Last night’s terrorist attack on families celebrating the Jewish festival of Hanukkah at Bondi Beach is a tragedy of unimaginable proportions. My heart goes out to the loved ones of all those killed and injured. After yesterday Australia will never be the same. Every Australian has been attacked by this evil and hateful act of violence. It was all too predictable and so many of us said so. The Director General of our national security and intelligence agency ASIO even rang the alarm bell himself warning that the dangerous rise in antisemitism was his ‘number one priority’ in terms of threats to life. Why didn’t our leaders listen and why didn’t they act? The massacre we have seen at one of our nations most inconic landmarks is the culmination of an unprecedented failure of leadership to heed the warning signs that were so obvious to every Australian who opened their eyes. From the disgraceful scenes on the steps of the Opera House just hours after Hamas’s attack on October 7 to the firebombing of synagogues and child care centres, the doxxing of Jewish artists, harassment of jewish students and daily violent protests on our streets, the last two years has seen a tsunami of hate that has left the local jewish community feeling abandoned and alone. In response we got little more than hollow words from our leaders as they stood by and watched the flames of hate burn. The Prime Minister’s public pledge after October 7 that he would not let antisemitism ‘find so much as a foothold here’ in Australia, is now fully exposed for the failure it has been. The fact is Australia is no longer safe for Jews. Everything must now change from here. Everything must be on the table. The law must be enforced. Those who spew hate must no longer be tolerated. We cannot as a country continue as we have done. Our leaders must now finally stand up, accept responsibility for what has happened on their watch and close this shameful chapter in our nation’s history. Every Australian must demand nothing less.
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Sandra Peake retweeted
The September issue of Critical Care and Resuscitation is now online. An entire issue dedicated to the extraordinary legacy of Rinaldo Bellomo: sciencedirect.com/journal/cr…
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Very proud to be here as part of the @ProteinTarget study team and support @LSChapple @MelbourneICU and Matt Summers @sandrapeake01 Augmented Enteral Protein During Critical Illness jamanetwork.com/journals/jam… #CCR25
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Sandra Peake retweeted
Augmenting enteral protein did not improve outcomes for critically ill patients compared with standard protein levels in the intensive care setting. #CCR25 @CritCareReviews ja.ma/45jf3NI
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Big shout out to Ipswich Hospital for enrolling participant number 800. Great work team @anzicrc @anzicsctg @acemonline
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We can’t wait to share the results of the TARGET Protein trial- the largest trial of augment protein in critically ill adults!
#CCRdownunder was superb, but now we turn our attention back to Belfast The first trial result for #CCR25 in @TitanicBelfast in June is @ProteinTarget Augmented administration of enteral protein to critically ill adults Register at criticalcarereviews.com/meet…
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We have recruited 750/1000 participants in the trial. Thanks Port Macquarie Base Hospital. On the home stretch towards completion. Thanks to all our participating sites and investigators @acemonline @anzicsctg @anzicrc
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Chloe Moran is off to her first @Olympics 🇦🇺 #AllezAUS #Paris2024
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Introducing the 1️⃣3️⃣ track cyclists selected for the #Paris2024 Olympic Games! 🚴🏼 #AllezAUS | @AusCycling | @AusCyclingTeam
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