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Reposted by Aoife Abbey 📟 🩺 ⚕️

Aoife Abbey 📟 🩺 ⚕️ @whistlingdixie.bsky.social · 01/07/2026

Started in the Winter of 2020, from fragments of conversations. Back then, I hadn’t time or space to write like I had been used to. But there were parts of those days that needed to go somewhere, so they became fragments in my notes app.. open.substack.com/pub/aoifeabb...

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Aoife Abbey 📟 🩺 ⚕️ @whistlingdixie.bsky.social · 01/07/2026

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Aoife Abbey 📟 🩺 ⚕️ @whistlingdixie.bsky.social · 25/06/2026

The Things I Didn't Need to Know Earlier - On hindsight, medicine and the illusion of wisdom open.substack.com/pub/aoifeabb...

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Aoife Abbey 📟 🩺 ⚕️ @whistlingdixie.bsky.social · 19/06/2026

New post on substack: open.substack.com/pub/aoifeabb...

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Aoife Abbey 📟 🩺 ⚕️ @whistlingdixie.bsky.social · 29/10/2025

To follow this up, here is the end result: curated list of ‘papers I want to read’ from my attendance at #Lives2025 #criticalcare 📟 😀

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Aoife Abbey 📟 🩺 ⚕️ @whistlingdixie.bsky.social · 29/10/2025

(I mean not sure - and I miss the edit button!)

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Aoife Abbey 📟 🩺 ⚕️ @whistlingdixie.bsky.social · 29/10/2025

I think there is ambiguity over whether people actually got what they were supposed to in each group ….also the difference in resus fluid was 250ml and >twice as many in the intervention got dobutamine…. I’m just now sure I believe 250ml fluid in the very early stages matters than much

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Aoife Abbey 📟 🩺 ⚕️ @whistlingdixie.bsky.social · 29/10/2025

Core elements of both differing mortality and knowledge gaps laid out here: #Lives2025 #criticalcare

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Aoife Abbey 📟 🩺 ⚕️ @whistlingdixie.bsky.social · 29/10/2025

There’s a nice editorial here www.nejm.org/doi/full/10.... #Lives2025

nejm.org

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Aoife Abbey 📟 🩺 ⚕️ @whistlingdixie.bsky.social · 29/10/2025

Mortality at 30 days was 22.6% in the glucocorticoid group and 284 patients and 26.0% in the standard-care group (p= 0.02) #Lives2025 #criticalcare

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Aoife Abbey 📟 🩺 ⚕️ @whistlingdixie.bsky.social · 29/10/2025

Paper is free here. www.nejm.org/doi/full/10.... I’m sitting at a boarding gate on the livestream, but the **rapturous applause** in the room for Lucinde and her team has been really quite striking. #Lives2025 #criticalcare

nejm.org

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Aoife Abbey 📟 🩺 ⚕️ @whistlingdixie.bsky.social · 29/10/2025

Next up is SONIA - a trial of low dose steroids for pneumonia, which sheds needed light on care of pts with pneumonia in resource limited settings. Worth appreaciting differing baseline mortality associated with CAP and hitherto underrepresentation of pts in these settings in research #Lives2025

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Aoife Abbey 📟 🩺 ⚕️ @whistlingdixie.bsky.social · 29/10/2025

Clearly I need to read it properly - but I also need to make my way to a boarding gate in Munich Airport, so this is to be continued! #Lives2025 #criticalcare

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Aoife Abbey 📟 🩺 ⚕️ @whistlingdixie.bsky.social · 29/10/2025

The trial is reported as +ve but I am not overwhelmed by the outcome: There were 131 131 wins (48.9%) in the CRT-PHR group vs 112 787 (42.1%) in the usual care group for the hierarchical composite primary outcome, with a win ratio of 1.16 (95% CI, 1.02-1.33; P = .04). #Lives2025 #criticalcare

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Aoife Abbey 📟 🩺 ⚕️ @whistlingdixie.bsky.social · 29/10/2025

Flow charts also included information on pulse pressure, diastolic pressure (Tier 1) and MAP, cardiac dysfunction (echo) and dobutamine test (Tier 2) at various points #Lives2025 #criticalcare

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Aoife Abbey 📟 🩺 ⚕️ @whistlingdixie.bsky.social · 29/10/2025

It’s using a composite outcome (all-cause mortality, duration of vital support, and length of hospital stay at 28 days as an overall ‘win ratio’) Patients were Sepsis 3.0 defined with shock <4 hours and every intervention was aimed at normalising CRT (normal CRT halted intervention). #Lives2025

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Aoife Abbey 📟 🩺 ⚕️ @whistlingdixie.bsky.social · 29/10/2025

ANDROMEDA-SHOCK-2 is up next…. this looks at personalised phenotype-based, capillary refill time (CRT) targeted resuscitation in early septic shock, comparing to standard resuscitation. It is large (86 centres, 19 countries). Read it free from JAMA: tinyurl.com/mjcj8s5w #Lives2025 #criticalcare

tinyurl.com

Hemodynamic Resuscitation Targeting Capillary Refill Time in Early Septic Shock

This randomized clinical trial examines whether a personalized hemodynamic resuscitation protocol targeting capillary refill time was more effective than usual care in patients with early septic shock...

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Aoife Abbey 📟 🩺 ⚕️ @whistlingdixie.bsky.social · 29/10/2025

There is a question on stages about the end of the Swan Ganz era and the implication that ‘God help you if you need one now’ ….. could this be the same? Trialest is clear the trial is about a-line as indicated for MAP only…. #Lives2025 #Criticalcare

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Aoife Abbey 📟 🩺 ⚕️ @whistlingdixie.bsky.social · 29/10/2025

After much wind and rain - we did have one blue sky day in #Munich - The best part of which was when a stranger asked me to mind her dog for five minutes and he was a very good boy #criticalcare #Lives2025

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Aoife Abbey 📟 🩺 ⚕️ @whistlingdixie.bsky.social · 29/10/2025

Hoping to catch some ‘hot topics’ session from airport, off now to get back in good time for for work tomorrow. Have had a wonderful congress catching up with colleagues from all over the world, attending @intenscaremed.bsky.social board and reaffirming my 🩵 for intensive care! #Lives2025

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Aoife Abbey 📟 🩺 ⚕️ @whistlingdixie.bsky.social · 28/10/2025

Oh, and the passionate pair behind me didn’t ask a question. #Lives2025

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Aoife Abbey 📟 🩺 ⚕️ @whistlingdixie.bsky.social · 28/10/2025

Core messaging - The issue isn’t just atrophy (so fixing atrophy can prevent it all) - Rational for pacing where it is disuse, is reversing atrophy - this may help - There is hope from Rescue-3 - There is role for inspiratory muscle training in the right patients #Lives2025

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Aoife Abbey 📟 🩺 ⚕️ @whistlingdixie.bsky.social · 28/10/2025

I’m not sure the question was fully answered and there was a bid for a follow up Q, but we are running out of time and there are others waiting. #Lives2025

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Aoife Abbey 📟 🩺 ⚕️ @whistlingdixie.bsky.social · 28/10/2025

There is a question from someone who works in a weaning centre who talks about the lack of clarity of what evidence there is in those patient he sees (months of ventilation, difficult wean) - does the principle of training and reversing atrophy hold…. #Lives2025

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Aoife Abbey 📟 🩺 ⚕️ @whistlingdixie.bsky.social · 28/10/2025

Is heart failure a contraindication? - acutely….maybe yes, but there is evidence of benefit in chronic HF we are told. Pneumothorax also no a definite contra-indication , but is a consideration. #Lives2025

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Aoife Abbey 📟 🩺 ⚕️ @whistlingdixie.bsky.social · 28/10/2025

The panel talk about inspiratory muscle training now indicating it isn’t for everyone or for acute phase - the physiotherapist speaking indicates that you need to exclude the right patients (primary cardiac failure for example, the patient needs to be to able to follow commands). #Lives2025

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Aoife Abbey 📟 🩺 ⚕️ @whistlingdixie.bsky.social · 28/10/2025

I will add that there are two people behind me with really very animated and passionate chat about what the panel are discussing (so much so that i have moved seat) but they haven’t yet directed anything to the panel. I hope they do…. #Lives2025

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Aoife Abbey 📟 🩺 ⚕️ @whistlingdixie.bsky.social · 28/10/2025

Leo is asking how in a trial like Rescue-3, when there are just 120 stimulations a day….compared to thousands of breaths, how can we hope to have benefit? Marine explains this by talking about only needing to create a ‘training effect’. #Lives2025

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Aoife Abbey 📟 🩺 ⚕️ @whistlingdixie.bsky.social · 28/10/2025

The main rational for pacing is to improve strength and there is more to say with respect to weaning phase, rather than earlier preventative phase. The ‘subtle’ effect of Rescue-3, which uses transvenous pacing, has been mentioned - pubmed.ncbi.nlm.nih.gov/40498082/ #Lives2025

pubmed.ncbi.nlm.nih.gov

Temporary Transvenous Diaphragm Neurostimulation for Weaning from Mechanical Ventilation (RESCUE-3) - PubMed

gov, ID: NCT03783884.

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Aoife Abbey 📟 🩺 ⚕️ @whistlingdixie.bsky.social · 28/10/2025

Speaking about phrenic nerve stimulation there is a lot of ‘may’ improve…..‘may help’ - there is an audience member who uses Quadricep stimulation in practice….with knock-on for weaning….but when asked, nobody in room willing to state they’re using phrenic nerve stimulation in practice. #Lives2025

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Aoife Abbey 📟 🩺 ⚕️ @whistlingdixie.bsky.social · 28/10/2025

I’m closing my day with (you guessed it) - another debate. This time, diaphragmatic pacing and ventilator weaning Diaphragmatic weakness is multi-factorial but lack of contraction on IMV is obviously a big one ….. #Lives2025 #criticalcare

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Aoife Abbey 📟 🩺 ⚕️ @whistlingdixie.bsky.social · 28/10/2025

I am back to do some poster moderation again for the late afternoon. It’s so wonderful hearing what people around the world and doing an contributing to our speciality #Lives2025 @esicm.bsky.social

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Aoife Abbey 📟 🩺 ⚕️ @whistlingdixie.bsky.social · 28/10/2025

Spending my time immediately post-lunch attending Ethics section meeting of @esicm.bsky.social at #Lives2025 - it will be my first time actually attending the section I picked. Photo to illustrate that the flow of free coffee from industry is not disappointing #criticalcare

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Aoife Abbey 📟 🩺 ⚕️ @whistlingdixie.bsky.social · 28/10/2025

The panel receive extra points from me for not saying ‘we don’t have a crystal ball’ or ‘we don’t have a magic wand’ #Lives2025 #criticalcare

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Aoife Abbey 📟 🩺 ⚕️ @whistlingdixie.bsky.social · 28/10/2025

Ultimately, We don’t look at patients perceptions of recovery well enough - and often those with severe disability perceive their recovery more positively than we expect… the disability paradox (this is really important) #Lives2025 #criticalcare

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Aoife Abbey 📟 🩺 ⚕️ @whistlingdixie.bsky.social · 28/10/2025

….when the other extreme - a lack of desire to tolerate any impairment - is also a reality (but there is possibility for clinicians to induce bias either way, both pessimism and optimism) #Lives2025

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Aoife Abbey 📟 🩺 ⚕️ @whistlingdixie.bsky.social · 28/10/2025

There is a question about individual ‘resilience’ from the audience - and what we only know in retrospect about what is possible for a patient. Panel indicate that we can’t use the possibility of resilience in acceptance of disability to expose everyone to prolonged prognostication ….. #Lives2025

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Aoife Abbey 📟 🩺 ⚕️ @whistlingdixie.bsky.social · 28/10/2025

Interesting that show of hands suggests <33% of the room indicate access to SSEP and NEPs for patients in critical care. #Lives2025 #Criticalcare

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Aoife Abbey 📟 🩺 ⚕️ @whistlingdixie.bsky.social · 28/10/2025

Biomarkers - most of evidence is in hyperacute phase (ie first 24 hours) but no clear thresholds… There is a nice review touching on this and some other relevant things from @intenscaremed.bsky.social here —> icm-experimental.springeropen.com/counter/pdf/... #Lives2025 #criticalcare

icm-experimental.springeropen.com

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Aoife Abbey 📟 🩺 ⚕️ @whistlingdixie.bsky.social · 28/10/2025

Humility is important - how often do we try and convince ourselves there is more certainty than there is? #Lives2025

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Aoife Abbey 📟 🩺 ⚕️ @whistlingdixie.bsky.social · 28/10/2025

where a family are given space to indicate the values that apply to that patient’s life and then are allowed and given contact time with you to understand what uncertainty there is - they’re unlikely to attempt to force you into a ‘black and white’ prognosis. #Lives2025 #criticalcare

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Aoife Abbey 📟 🩺 ⚕️ @whistlingdixie.bsky.social · 28/10/2025

Much of what is being said then is what I know - that nobody should be making judgement calls based on single labels or tests. Personally I think that …… #Lives2025 #criticalcare

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Aoife Abbey 📟 🩺 ⚕️ @whistlingdixie.bsky.social · 28/10/2025

Victoria points out origin of words prognosis and prognosticate (Greek, like Victoria) and how they are different - that we must be clear with those that support the patients that when asked early, we can only prognosticate and that inevitable in this is uncertainty. #Lives2025 #criticalcare

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Aoife Abbey 📟 🩺 ⚕️ @whistlingdixie.bsky.social · 28/10/2025

Read this during the session and fairly sure the panel thought i was Lol-ing at their content

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Aoife Abbey 📟 🩺 ⚕️ @whistlingdixie.bsky.social · 28/10/2025

Debate 3 of my day - Can we predict prognosis of comatose patients with acute brain injury? This is something that touches a significant proportion of my caseload. #Lives2025 #crticalcare @esicm.bsky.social

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