Category Archives: Uncategorized

Social Media Team Interviews

It’s two months since ESICM LIVES 2019 in Berlin, which can only mean one thing: time to release the Social Media Team Interviews!

Of course, the Social Media Team were busy gathering, curating and creating content to capture messages and connect audiences around the world. However, as a new member, I was struck by the industry and ingenuity of my seasoned colleagues. Where did they get this phenomenal energy and drive to work so hard? How do they harness the beast of social media to bring about something actually worthwhile? Most of all, they all seem so up to date – and they seem to know everything about everything in the world of ICU research!

Gratefully, I was able to interview all nine members using my coloured pencils. Here are the results! I asked three questions: who are you? You do so much – where do you get the energy to engage? Navigating the digital world is such a challenge, and somehow you are able to keep up with the cutting edge of ICU research using it – what’s your method, your workflow? I’ll summarise as we go…

Adrian Wong: Eurovision and Destiny 2 Lover, Social Media Team leader/hero. He loves ICU and makes his main goal to work with people he’d like to go to the pub with…and the drinks are on him. Twitter should be treated like a newspaper, with something for everyone. Top tip: save articles to Pocket to read later, and save articles to Evernote into labelled folders. Bonus fact: I’m really grateful to Adrian for inviting me on board.

Jonathan Downham: father of twin boys and rugby fanatic. He loves being a geek, and he loves the excitement of it all. He’s missing a few words from his vocabulary. Twitter is there to signpost us to the really important bits of work. He has his own study with lighting, sound desk, triple screen layout, and a roller blind behind him that acts as a green screen. Top Tip: these are much cheaper when bought from a home decorating shop, but just as effective as a professional cinematic bit of kit. Bonus fact: he uses his teaching blog as a way of learning for himself…

Lars Mølgaard Saxhaug: organiser of the UKA festival in Norway, hosting Jay-Z and Franz Ferdinand. He also has two ovens. His social media adventures all sprung out of sheer curiosity, and now he gets to have conversations with people he never would have met without social media…and to read papers he never would have come across. Top Tip: be deliberate and selective in who you follow on social media.

Renske Wiersema: she doesn’t “do” social media…. her real motivations are… how can we stop people getting sick? How can we do good science that allows us to make progress? Her real motivator is teamwork, with mutual learning, laughter and enthusiasm. Bonus fact: this picture does not look like Renske. At all. Sorry, Renske.

Velia Antonini: the personification of ECMO (extra-corporeal membrane oxygenation). Her life goal is a happiness that is a very specific blend of social media, ECMO and FOAM (free open-access medical education). Top tips: Velia’s specific method of staying up to date is to type her search strategy (ECMO) into PubMed on a daily basis and catch up with the latest articles. From there, she summarises the content for social media to engage and connect others. For the really good stuff, she creates infographics using Adobe Illustrator… or Keynote if she’s at a conference. Bonus fact: she is considered by many to be the hardest working person in FOAM…

Aoife Abbey: author, who doesn’t believe she’s an author because she’s only got one bestseller. Her motivation is the desperate need for community that’s so easily lost in modern medicine… she has a couple of Top Tips: if you save articles to Pocket (freely available App), you can even use it to read you the articles while you’re doing the washing up! Aoife uses the Apple Pencil and the Notability App to create her legendary, chart-topping infographics and sketchnotes. Bonus Fact: this, again, doesn’t look anything like Aoife. So sorry, Aoife.

Jamie Strachan: bridge builder between technology and training. He basically likes everything. He is continually improving his work life balance and finding his why. He started out on twitter with flurries of follows but now he uses structure and focus to make sure he’s effective. Bonus fact: he only sends two thirds of the tweets he composes! Top Tips: check out the ALIEM How I work smarter articles for other top tips….his is to try ordering emails and folders by months and years…

David Lyness: he’s another team builder with the goal to democratise medical education. He loves to create and to dig in – whether it’s finding different views or being cynical. He built his own computer in his self-converted garage. It sounds like some sort of Bat Cave. Top tips: again, be very selective in who you follow. Bonus fact: this sketchnote was created over the phone, so I drew both a man in a tux and an octopus, because I couldn’t quite remember what he looked like.

Segun Olusanya: man with six names, all of which are beautiful. He also claims to be the longest serving ICM trainee in the UK. He is powered by two AA batteries called Love and Hope. Social media is, indeed, like trying to drink from a fire hose, but our job is to focus and be a librarian not a library. The workflow is: a page of Tolstoy’s calendar of wisdom in the morning, a quick scroll during breaks at work, and using TweetDeck while on his daily commute. Top Tip: tweetdeck allows you to have multiple open columns with key searches: POCUS, FOAMcc, for example. Top Tip 2: try having a special focus for the season…what are you going to learn that’s new this year?

The nurse is the cornerstone of nutrition delivery (Nestle Health Science sponsored session)

Nurse driven metabolic care

(Mette Berger)

Pts with lower cumulative protein and energy deficits are 3x more likely to go home

ICU is a changeful environment – multiple factors preventing pts from being fed to prescribed goals, but the MAIN problem is often getting EN prescribed / re-started

Nurse-driven protocols (e.g. insulin infusion, catheter infection prevention, resuscitation etc) have a track record of working well!

–> Can Nutrition be nurse-driven, independent of doctors?

  • focus on glycaemic control
  • initiation / resumption of feeding
  • tube placement / control
  • monitoring of delivery

Clear protocols listing roles with describing their responsibilities

Metabolism and nutritional needs vary through the phases of critical illness / during rehabilitation

Nutritional Risk Score (NRS) to identify pts at risk of nutrition-related complications

Glycaemic control

  • demonstrable improvement in tight glucose control when transferred to the care of nurses
  • nurse immediately available to assess and respond to BMs

Initiation of Feeding

  • gastric residues may prevent feeding first 48 hrs post-op
  • can check using ultrasound
  • try pro kinetics during this time

Tube placement

  • tube checking protocols

Monitoring delivery

  • ESPEN guidelines suggest progressively increasing feeding; aggressive early feeding risks hurting sick gut

  • do NOT aim to cover prescribed feeding goals in the first week
  • nurse is well-positioned to detect signs of pt tolerating / not tolerating feed
  • Beware absent stools – Encourage emollients and fibres in feed upon initiation of feeding – this should not cause significant diarrhoea


**Metabolic rationale for starting slow:

Endogenous glucose production is stopped by eating (in healthy people) – this mechanism is lost in critical illness, and therefore there is continuous endogenous glucose production of 200-300g glucose / day = 800kcal even if EN is commenced

–> therefore, starting with a full feed will result in overfeeding


A nursing perspective on nutrition

(Beatrice Jenni-Moser, M-M Jeitziner)

Nutrition has a significant impact on a pt’s ability to respond to medical / nursing treatment

Large variation in nursing practices around nutrition (availability of nutritional guidelines, knowledge and leadership)

Nutrition is often prioritised lower than other care needs

** pt’s relatives are often concerned about having ‘enough to eat’

New paradigm of rehabilitation: Start early, not at the end of medical treatment

–> the same should apply to nutrition – need an MDT approach


Quality project

  • Setting: Interdisciplinary ICU / 37 beds
  • Approx 4000pts / year
  • Length of stay: 2.4days (mean); 8% of pts stay 7days or more

Aim: Overview of nutrition, diarrhoea and constipation

Method: Chart reviews

Sample: (Neurological disease 40%)

2018 – 97 pts, mean age 61.4 (16-90)

2017 – 93 pts, mean age 60.2 (21-94)

— Protocol designed around existing guidelines for patients and also potentially difficult pts

  • EN as the standard approach, early EN within 48 hrs
  • Continuous rather than bolus EN
  • Contraindication to oral, EN –> PN should start within 3-7 days
  • Early and progressive PN is better than starvation
  • After 3 days, caloric delivery can be increased up to 80-100%

Nutritional Assessment: In-depth evaluation of objective and subjective data related to an individual’s food and nutrient intake, lifestyle, medical history

Combine with Frailty scale in every pt for a baseline frailty score (not just in the older pts / long stay)

Take home message: ICU nurses are in a unique situation to take an active role in promoting the best nutritional outcomes to the pts

  • interprofessional nutrition education
  • nutritional screening and assessment
  • using standardised guidelines / protocols
  • evaluating nutrition support