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Alex Warren

@alexwarrenicu.bsky.social
388 followers 740 following 5 posts

ICU doctor and researcher | physiology and data geek | NIHR PhD fellow looking at epidemiology and management of cardiogenic shock | all views my own.

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Reposted by Alex Warren
Dr. Michael Narvey Neonatologist MD @nicumusings.bsky.social · 18/07/2025
Is atropine really required in addition to fentanyl & succinylcholine prior to intubation to prevent severe bradycardia in neonates? We found yes... Severe bradycardia during the whole procedure was signif > in placebo vs atropine group; RR 6.3(95% CI 1.2 - 34.1) t.co/TKJovw24BQ #NeoSky #PedSky
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Stefan Marciniak @profmarciniak.bsky.social · 17/07/2025
“The review… comments that without core knowledge of the pre-clinical subjects (such as pathology), it is not possible to apply mechanistic reasoning to complex health problems” Agreed Training to be a doctor is necessarily long because, simply put, medicine is complex www.bmj.com/content/390/...
bmj.com
Farewell, associates. Welcome back assistants
On 20 November 2024, Wes Streeting, the UK’s Secretary of State for Health and Social Care, commissioned Gillian Leng to undertake an independent review of physician associates and anaesthesia associa...
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Segun Olusanya (He/Him) @drfreeze.bsky.social · 01/07/2025
Her biggest lesson for the critical care community? “Look beyond the patient” Think about their support networks, their environment… The things that make their life worth living. #soa25
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Marion Campbell @marionkcampbell.bsky.social · 13/06/2025
Fantastic presentation of the #GASTROSAM trial at #CCR25 - IV rehydration strategies for children with severe acute malnutrition & gastroenteritis. Amazing commitment to generating evidence in the hardest of circumstances incl a coup and flooding. Bravo! www.nejm.org/doi/full/10....
nejm.org
Intravenous Rehydration for Severe Acute Malnutrition with Gastroenteritis | NEJM
International recommendations advise against the use of intravenous rehydration therapy in children with severe acute malnutrition because of the concern about fluid overload, but evidence to suppo...
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JAMA @jama.com · 12/06/2025
Conservative oxygen therapy with a target SpO2 of 90% did not reduce 90-day all-cause mortality compared to usual oxygen therapy in mechanically ventilated adult patients. #CCR25 @criticalcarereviews.com ja.ma/4kG5gWK
Figure 2. Oxygen Exposure and Arterial Oxygenation by Treatment Group in Patients With Enhanced Data Collection
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Alex Warren @alexwarrenicu.bsky.social · 12/06/2025
16,500 patients randomised to #UKROXTrial presented just now at #CCR25 and simultaneously published in @jama.com No difference in 90d mortality between target SpO2 88-92 with reduced exposure to supplemental O2 vs usual care jamanetwork.com/journals/jam...
jamanetwork.com
Conservative Oxygen Therapy With Mechanical Ventilation
This randomized clinical trial assesses whether reducing supplemental oxygen to a peripheral oxygen saturation target of 90% would reduce mortality among critically ill adults receiving mechanical ven...
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Marion Campbell @marionkcampbell.bsky.social · 11/06/2025
#CCR25 … here we go! Three days of deep discussion of the top trials in critical care. If you are not in the room, do connect via livestream - see criticalcarereviews.com
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JAMA @jama.com · 11/06/2025
Augmenting enteral protein did not improve outcomes for critically ill patients compared with standard protein levels in the intensive care setting. #CCR25 @criticalcarereviews.com ja.ma/4kuYRxv
Figure 2. Total Protein and Calories
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Critical Care Reviews @criticalcarereviews.com · 31/03/2025
Early Intra-Aortic Balloon Support for Heart Failure-Related Cardiogenic Shock: A Randomized Clinical Trial CCR Journal Watch - tracking the critical care literature daily criticalcarereviews.com/latest-evid…
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Giuseppe Biondi-Zoccai @gbiondizoccai.bsky.social · 31/03/2025
In the Altshock-2 randomized trial, routine early #IABP plus standard care, compared with standard care, did not significantly improve survival or successful bridging to heart replacement therapies in patients with heart failure–cardiogenic shock www.jacc.org/doi/10.1016/...
jacc.org
Early Intra-Aortic Balloon Support for Heart Failure-Related Cardiogenic Shock: A Randomized Clinical Trial
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Alex Warren @alexwarrenicu.bsky.social · 25/03/2025
This is a fantastic paper from @intensiveperson.bsky.social and the team. Ten-year national study of risk factors and complications from arterial puncture/insertion of central lines. Mandatory reading for anyone who inserts CVCs. Really well done.
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Dr Louella Vaughan @drlkvaughan.bsky.social · 17/03/2025
Right RCP Fellows! Voting for elections is now open. I am running for Clinical VP. My election statement is here: 🧵
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Dr Louella Vaughan @drlkvaughan.bsky.social · 17/03/2025
I am running for Clinical VP of the RCP. For those who don't know me, here is a potted bio. 🧵
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Lars Mølgaard Saxhaug @load-dependent.eurosky.social · 16/03/2025
Profound septic shock is usually associated with mithocondrial dysfunction and relatively fixed low VO2 (one of the causes of hyperlactatemia, mithocondria aren’t using enough pyruvate even in presence of sufficient oxygen) while cardiogenic shock is usually a case of normal mithochondrial fnct.
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Chris Carroll, MD @chriscarrollmd.com · 13/02/2025
An infographic on Vaccine-preventable diseases. Might as well start familiarizing ourselves with these. Made me feel better to put this together
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Karim Wafa-Al Hussaini @karimwafa.bsky.social · 13/03/2025
We can disagree and still love each other unless your disagreement is rooted in my oppression and denial of my humanity and right to exist. — James Baldwin
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Emily Moin @emilymoin.com · 07/03/2025
Reread this banger today. How often does one see an invited commentary that cogently and respectfully destroys the entire conceptual paradigm of the article it's critiquing? jamanetwork.com/journals/jam...
jamanetwork.com
Futile Treatments in Intensive Care Units
The provision of treatments that are perceived to be futile is a major problem in the intensive care unit (ICU), leading to burdens for patients and families, as well as moral distress for caregivers....
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Alex Warren @alexwarrenicu.bsky.social · 03/03/2025
Mobilisation during ECLS - still controversial, depends on patient physiology - spectrum from contra-indicated to arguably essential for sustained recovery - key paper here. #ECMO #MCS #ECLS
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Critical Care Reviews @criticalcarereviews.com · 28/02/2025
🚩 Just out in @thelancet.bsky.social 🚩 African Critical Illness Outcome Study ➡️ Describing the burden of critical care in Africa ➡️ 1 in 8 inpatients are critically ill ➡️ ~70% cared for on general wards ➡️ ~50 don't receive basic critical care interventions doi.org/10.1016/S014...
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Segun Olusanya (He/Him) @drfreeze.bsky.social · 27/02/2025
I had the pleasure of teaching lung #pocus at a “train the trainers” course, with the ever excellent @avkwong.bsky.social and Cian McDermott as faculty Some reflections from the day: (1/n)
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Sam Goodhand @samgoodhand.bsky.social · 22/02/2025
Very interesting piece. The data is eye-opening, even if it does reflect what’s noticeable day to day.
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Emily Moin @emilymoin.com · 16/02/2025
It's a horrendous flu season. It's killing kids, it's killing adults. It's killing people who were perfectly healthy before and people who, like most Americans, have chronic illness. It costs NOTHING to keep existing resources available. Our government is spending money to make Americans sicker.
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@IM_Crit_ @imcrit.bsky.social · 12/02/2025
ICU Pulmonary Embolism Review: Kudos to the authors for reviewing PE management strategies:
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Segun Olusanya (He/Him) @drfreeze.bsky.social · 08/02/2025
Delighted to share the Barts echo team’s latest article “Examining the Relationship Between Pulmonary Artery Acceleration Time and Pulmonary Artery Pressures in Patients with Ischemic Cardiogenic Shock” Free to read for 50 days on the following link www.sciencedirect.com/science/auth...
sciencedirect.com
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Carl Horsley @carlhorsley.bsky.social · 31/01/2025
In light of the recent air crash in the US (and some somewhat startling proposed causes), it seems like time to roll out this classic from the late, great Dr. Richard Cook: How Complex System Fail how.complexsystems.fail
how.complexsystems.fail
How Complex Systems Fail
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Prof Christina Pagel @chrischirp.bsky.social · 17/01/2025
Great group talk by one of UCL CHIMERA's PhD students this morning - she's using maths to model mucus layers in the lung to understand the impact of critical illness and mechanical ventilation on lung function. Such an interesting project! www.ucl.ac.uk/chimera
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Anaesthesia @anaesjournal.bsky.social · 17/01/2025
Diagnosis and management of immune checkpoint inhibitor (ICI)-induced myocarditis. #AnSky #MedSky #OncSky buff.ly/40ATqW9
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Malcolm 朝精 Barrett @malcolmbarrett.malco.io · 14/01/2025
95% of my confidence interval interpretations include the correct interpretation for confidence intervals
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Rob Fleming @robjimfleming.bsky.social · 12/01/2025
This is a really useful resource for anyone who still needs convincing that immigration is not the reason they can't get a training number. An IMG applying to CT1 in my specialty has a 1 in 45 chance of receiving an offer, compared to roughly 1 in 3 for UK grads. medical.hee.nhs.uk/medical-trai...
medical.hee.nhs.uk
Country of qualification 2023 recruitment data | Workforce, training and education | NHS England
Review the country of qualification recruitment data from the 2023 recruitment rounds
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Nysuri @nysuri.bsky.social · 12/01/2025
I can truthfully say I have been brought to tears this winter I see these pts in my sleep; it means I’m not sleeping much at the moment I’m not in a management position anymore, but the feeling of helplessness is just as acute
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Parham Eshtehardi MD @cardioobdoc.bsky.social · 12/01/2025
Diuretic Potentiation Strategies in Acute Heart Failure #CardioSky #MedSky #JACCHF www.jacc.org/doi/10.1016/... @jaccjournals.bsky.social @robmentz.bsky.social @sjgreene-md.bsky.social @vietheartpa.bsky.social @load-dependent.bsky.social @jimjanuzzi.bsky.social @dranulala.bsky.social
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Alex Warren @alexwarrenicu.bsky.social · 09/01/2025
Afterload reduction in the right patient is one of the most satisfying medical interventions imo. Potentially life saving and often staves off intubation. Furosemide often *is* the answer, though 😉
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Katie Wiskar @katiewiskar.bsky.social · 08/01/2025
All heart failure is NOT the same; and diuretics are NOT always the answer ‼️ In the very wise words of Dr. Frederik Verbrugge - "Elevated cardiac filling pressures and fluid overload are both important, yet grossly different features of acute decompensated heart failure." #emimcc
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Parham Eshtehardi MD @cardioobdoc.bsky.social · 06/01/2025
Swedish study showed short-term exposures to lower air temp & cold spells are associated with increased risk of hospitalization for MI at lag 2 to 6 days #CardioSky #JACC www.jacc.org/doi/10.1016/... @jaccjournals.bsky.social @load-dependent.bsky.social @vietheartpa.bsky.social
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Marcus McDonagh 🇮🇪 @marcusmcdonagh.bsky.social · 04/01/2025
Notable difference from moving from a NHS ambulance service (struggles to retain experience) to New Zealand (keeps very experienced staff) in terms of productivity, decision making and overall patient care!
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Prof Christina Pagel @chrischirp.bsky.social · 03/01/2025
I wrote a quick post about the latest UKHSA data on the current flu wave. christinapagel.substack.com/p/its-defini... TLDR: we are in a very big flu wave, but Covid levels are low & RSV decreasing. But we should consider extending eligibilty for annual flu (and RSV, Covid) vaccines.
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Tom Fisher @tomfisher.bsky.social · 13/11/2024
New platform, re-sharing our recent sex differences in cardiogenic shock SRMA: -Women are ⬆️ likely to die than men (35% unadjusted, 10% adjusted for comorbidities) -Women ⬇️ less likely to recieve mechanical support Urgent need to understand these differences & enroll more women in CS RCTs!
ccforum.biomedcentral.com
Sex differences in treatments and outcomes of patients with cardiogenic shock: a systematic review and epidemiological meta-analysis - Critical Care
Background Women are at higher risk of mortality from many acute cardiovascular conditions, but studies have demonstrated differing findings regarding the mortality of cardiogenic shock in women and m...
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