IFA Talks

Fluid Matters - The nil by mouth (NPO) debate | TopMedTalk

Nov 28, 2018

This piece is taken from "The Great Fluid Debate", it's about changes in practice that have been implemented both in the UK and at various medical centres in the US. Hear how and why the old 'nil by mouth' or 'NPO' policy has changed in many instances.

From water to carbohydrate drinks, to black coffee, the thinking has changed in many institutions but part of the battle is in educating patients and their well meaning friends and relatives.

These pieces have been released to coincide with IFAD, the 7th International Fluid Academy Day. Make sure you subscribe to TopMedTalk to ensure you hear some of the pieces we recorded there.

Chaired by Professor Monty Mythen and featuring; Dr Tim Miller, anesthsiologist from Duke University Medical Centre; Professor Mike Grocott, Professor of Anaesthesia and Critical Care at the University of Southampton; Professors Paul Wischmeyer and Stuart Grant, from the Department of Anesthesiology, Duke University and featuring questions from the audience.

Join in the debate: [email protected]

Fluid Matters - 'The Great American Fluid Debate' | TopMedTalks

Nov 27, 2018

This is an excerpt from 'The Great American Fluid Debate' which was hosted at Duke University Medical Centre's "Controversies in Perioperative Medicine" conference of this year.

These pieces have been released to coincide with IFAD, the 7th International Fluid Academy Day. Make sure you subscribe to TopMedTalk to ensure you hear some of the pieces we recorded there.

The two pieces Monty mentions in the podcast, featuring Paul Myles, are found here:

"THE RESULTS"

https://www.topmedtalk.com/the-relief-trial-results/

"YOUR ESSENTIAL DEEP DIVE"

https://www.topmedtalk.com/rcoa-11-the-relief-trial-your-essential-deep-dive-into-the-results/

And you can find the other piece here:

"JOURNAL CLUB; BALANCED VERSUS SALINE"

https://www.topmedtalk.com/journal-club-saline-solution/

Presented by Monty Mythen featuring; Mike Grocott, Professor of Anaesthesia and critical care at the University of Southampton; Professor Paul Wischmeyer from the Department of Anesthesiology, Duke University; Professor Stuart Grant, MB ChB, FRCA Director, Medical Student Education, Duke University School of medicine and Tim Miller, anaesthsiologist from Duke University Medical Centre.

Fluid Matters - Total body water and electrolytes | POQI

Nov 24, 2018

These pieces have been released to coincide with IFAD, the 7th International Fluid Academy Day. Make sure you subscribe to TopMedTalk to ensure you hear some of the pieces we recorded there.

Coming from this summer's Peroperative Quality Initiative (POQI) hosted at Washington Duke University in Durham this podcast is presented by Monty Mythen and Henry Howe with their guests Tom Woodcock, an independent consultant in patient safety, medical law and ethics, and Manu Malbrain, Professor at Faculty of Medicine and Pharmacology Vrije University in Brussells.

The website mentioned in this piece is here: https://www.fluidacademy.org/

Fluid Matters - Definite definitions, fluid physiology | POQI

Nov 23, 2018

This conversation was recorded on the morning of the second day of the Perioperative Quality Initiative (POQI) meeting hosted at Washington Duke University in Durham.

These pieces have been released to coincide with IFAD, the 7th International Fluid Academy Day. Make sure you subscribe to TopMedTalk to ensure you hear some of the pieces we recorded there.

Presented by Desiree Chappell with Professor Monty Mythen, Henry Howe and their guest Tim Miller, anaesthsiologist from Duke University Medical Centre and organiser of the POQI meeting.

The growing popularity of new media in medical education | IFAD

Nov 23, 2018

This piece is a chance to reflect upon the importance of new media within the sphere of medical education. As the run away success of TopMedTalk and other podcasts in this area shows people are hungry to use the unique potential of this medium. Also - how has social media, video casting and live streaming altered the way conferences are both organised, executed and received?

Finally, our team of experts tackle the eternal question; where to next?

Presented by Joff Lacey with his guests; David Lyness, Doctor in Anaesthetics and Intensive Care Medicine at Belfast Health and Social Care Trust, Segun Olusanyam Specialty Trainee in Intensive Care Medicine, Jamie Strachan, Intensive Care Medicine and Anaesthesia Registrar & Council Member of the Royal College of Anaesthetists and Dr Cian McDermott Consultant in Emergency Medicine at Mater Misericordiae University Hospital.

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Streamed live from the International Fluid Academy Day (IFAD) in Amsterdam on www.topmedtalk.com

You can also join in with IFAD for free online https://www.fluidacademy.org/

Discussing The Paradigm Shift in Fluid Therapy | IFAD

Nov 23, 2018

This podcast is an exclusive discussion regarding the second session at The International Fluid Academy Day (IFAD) in Amsterdam.

This in depth discussion is a reaction to the session at IFAD and contains insights into the following topics; 'Everything you need to know about fluid therapy', results from some of the most recent trials and 'How to set-up a fluid guideline'.

The team also reflect a little more on the first session.

Presented by Joff Lacey with Monty Mythen and Henry Howe.

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Streamed live from the International Fluid Academy Day (IFAD) in Amsterdam on www.topmedtalk.com

You can also join in with IFAD for free online https://www.fluidacademy.org/

TopMedTalk at IFAD | Understanding Fluid Physiology

Download this podcast for an exclusive discussion regarding the first session at The International Fluid Academy Day (IFAD) on Friday morning in Amsterdam.

This in depth discussion is a reaction to the first session at IFAD and contains insights into the following topics; 'Everything you need to know about fluid physiology'; 'From Frank-Starling to Guyton-Hall'; 'Understanding edema formation' and 'Where does the albumin go?'.

Presented by Joff Lacey with Monty Mythen and Henry Howe.

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Streamed live from the International Fluid Academy Day (IFAD) in Amsterdam on www.topmedtalk.com

You can also join in with IFAD for free online https://www.fluidacademy.org/

Have you joined the International Fluid Academy yet?

Nov 23, 2018

Live from the International Fluid Academy Day (IFAD) in Amsterdam; the team explain how you can join in for free online https://www.fluidacademy.org/ and give us a bit of the history of the conference along with some of the discussion points you can expect to hear.

Presented by Joff Lacey with Henry Howe, Monty Mythen and their guest Manu Malbrain, Professor at the Faculty of Medicine and Pharmacology Vrije University in Brussels and organiser of the conference.

Participants and Setting

1. Jonny – Host/moderator, introducing the social media team at the International Fluid Academy (IFA) 2018 in Amsterdam.

2. David – Social Media Chair for the conference.

3. Catherine (Beni) – A new social media team member from Seattle, USA.

4. Cian – Returning social media team member, participated in the previous year's IFA event.

They discuss their roles within the conference's social media coverage, including how they prepare content (infographics, posts, and video segments), their personal journeys in social media, and the various platforms they use.

Main Discussion Points 1. Newcomers to the Social Media Team

• Catherine's Preparations and Travels

  • She traveled 9–13 hours from Seattle to Amsterdam.

  • She was excited to see differences and similarities in how medicine is practiced in Europe compared to the US.

• Creating Infographics

  • Catherine used Canva to design visually appealing and accurate graphics summarizing conference lectures.

  • She prepared templates in advance and read through presentations/papers beforehand.

  • Noted that a significant portion of her time was spent perfecting the infographic's look and content—sometimes losing progress and having to rebuild from screenshots.

2. Value of Visual Content in Education

• High Engagement with Graphics

  • All participants agreed that infographics and visual media get more traction on social media (Twitter, Facebook) than plain text.

  • People frequently save, print, and share these visuals in their departments.

• Online Tools and Analytics

  • They mention using tools like "Pocket" to curate or bookmark interesting content for later reference.

  • Social media metrics help identify which posts resonate most with their audiences.

3. Growth of Social Media in Medicine

• Conference Social Media Teams

  • Cian describes how these roles evolved: reading abstracts in advance, posting content in real time, and engaging with audiences worldwide.

  • The group also references other conferences (e.g., ultrasound/teaching courses in Melbourne, Montreal) that have embraced active social media coverage.

• Twitter, Facebook, and Instagram

  • Twitter is favored for quick updates, "signposting" to deeper resources, and professional networking.

  • Facebook can be better for detailed discussions or case-based sharing (e.g., surgical cases with peer input). It also reaches a large nursing audience.

  • Instagram is increasingly popular, especially among medical students, and may suit visually oriented material like ultrasound clips.

4. Personal Journeys and Networking

• Cian and Catherine both note that Twitter opened doors to collaboration and learning, even without having many publications or lengthy CVs.

• WhatsApp Groups and Personal Learning Networks

  • The team uses group messaging for real-time coordination, workshop planning, and educational exchanges.

  • While beneficial, they joke about 15 notifications first thing in the morning.

• The Challenges of Recognizing People In Person

  • Since many had only interacted online, they used Twitter photos to identify each other in a local bar.

  • The speakers point out that having a recognizable profile picture (rather than an abstract image) helps colleagues connect at conferences.

5. Future Directions for Social Platforms

• Potential Shift Away from Twitter

  • The group acknowledges that social media trends evolve quickly. Younger generations may prefer Instagram for visuals; educators and clinicians must adapt or risk "falling behind."

  • They predict new platforms or versions might emerge with curated discussions or more advanced features.

• Ongoing Experimentation

  • Some foresee ultrasound demonstrations flourishing on Instagram (short video clips).

  • Others see Facebook as underutilized in certain specialties, given how it can host more in-depth discussions and large communities.

Key Takeaways

1. Preparation Yields High-Quality Content

   • Reading presentations ahead of time and designing infographic templates in advance helps the social media team produce polished, accurate, visually appealing posts.

2. Visual Media Drives Engagement

   • Infographics and video clips resonate strongly, making it easier for conference attendees and global followers to digest complex medical information quickly.

3. Platform Choice Matters

   • Twitter excels at real-time coverage and networking.

   • Facebook can offer more room for in-depth discussion (especially appealing to nurses, who represent a large segment of that user base).

   • Instagram is popular among students and well-suited to short, highly visual medical content.

4. Collaborations Transcend Borders

   • Social media allows people with few publications or limited conference access to learn from global experts, join personal learning networks, and build professional communities.

5. Adaptability is Crucial

   • As social media evolves, clinicians and educators need to remain flexible—learning new platforms to continue sharing and accessing the best medical knowledge.

Concluding Note

This conversation highlights how the International Fluid Academy's social media team prepares conference coverage and leverages different platforms (Twitter, Facebook, Instagram) to reach broad audiences. They emphasize that carefully crafted visual content, proactive networking, and an openness to new technology can significantly enhance global medical education.

Participants and Setting

• Speakers:

  1. Dr. Catherine ("Beni") – A surgical resident posing detailed questions about fluid management.

  2. Dr. Johnny Wilkinson – An intensivist and physiology enthusiast, referencing research trials and discussing fluid strategies.

  3. Additional Colleagues (unnamed) – Intensivists, surgeons, or critical care professionals joining the discussion.

They are at the International Fluid Academy 2018 in Amsterdam, where they discuss advanced fluid-management topics and reflect on conference sessions.

Main Discussion Topics 1. The "Three-Day" Ebb and Flow Rule for Capillary Leak

• Traditional Teaching: Clinicians often cite a three-day period during which capillary permeability peaks (capillary leak), followed by a "closure" or "flow" phase. This is especially mentioned in sepsis and major surgical contexts.

• Open Abdomen & Repeated Surgeries:

  • Dr. Benny wonders if this three-day timeline still applies to trauma patients returning multiple times to the operating room.

  • Key Insight: Repeated insults (new surgeries, infections, "second hits") can prolong capillary leak well beyond three days.

• Individualized Response:

  • The group explains that the "three-day rule" is, at best, a rough guide.

  • Ongoing inflammation, sepsis, or major trauma can stretch the leak over weeks or months. The leak closes only when the underlying cause (e.g., infection, open abdomen) is controlled.

2. Phenotypes and Personalized Therapy

• Emerging Research:

  • Recent studies identify multiple inflammatory phenotypes within conditions like sepsis (some cite five distinct subgroups). Each phenotype could respond differently to fluids, vasopressors, or adjunctive therapies (vitamin C, corticosteroids, albumin, etc.).

• Why Some Trials "Fail":

  • Large RCTs often lump together heterogeneous patient groups, diluting possible benefits of certain treatments for specific phenotypes.

  • Personalized (or "precision") medicine may be needed to target each subtype optimally.

3. Revisiting CVP (Central Venous Pressure)

• CVP Never Disappeared:

  • Although many experts moved away from using CVP as a strict "target" (e.g., 8–12 cmH2O), surveys indicate a majority of ICUs still track it, at least as a data point.

• Utility vs. Pitfalls:

  • CVP can offer trend information: a sudden jump from 8 to 40 likely indicates significant fluid accumulation or cardiac dysfunction.

  • However, a single absolute CVP value is rarely instructive (e.g., "CVP 15 means fluid overload!"). It must be interpreted in context (cardiac function, vascular tone, changes over time, etc.).

• IVC Ultrasound Comparison:

  • Measuring the IVC (inferior vena cava) via ultrasound is akin to looking at "CVP upside down," as both tools ultimately reflect central venous system pressures.

  • The group lightly jokes that heated debates over CVP vs. IVC often obscure their shared physiologic underpinnings.

4. Albumin Use and Oncotic Pressure

• Persistent Controversies:

  • Some clinicians routinely use albumin; others avoid it, citing cost, infection risk, or inconclusive evidence for mortality benefit.

  • Trials and meta-analyses sometimes suggest fluid-sparing effects (i.e., patients may require less total fluid), but whether that translates into improved outcomes remains uncertain.

• Oncotic Pressure & Glycocalyx:

  • The group mentions the glycocalyx and evolving views on how fluids distribute within the body. Traditional concepts of "oncotic pressure" have been challenged, as measuring it is difficult and the capillary barrier is more complex than once thought.

  • They caution that lab-based findings on glycocalyx or oncotic pressure don't easily translate into everyday bedside decision-making.

5. Conference Highlights and Personal Takeaways

• Evolving Understanding:

  • Dr. Beni appreciates learning that her own confusion reflects the field's genuine complexity; there is no universal formula for fluid management.

  • The conversation reaffirms the value of building a "personal learning network" to share insights and questions with peers.

• Heated Debates:

  • The group enjoys spirited disagreements among conference presenters (e.g., conflating ICU and elective surgery data).

  • They praise the event for turning a "dry topic" like fluid therapy into dynamic, engaging discussions.

Key Takeaways

1. No Strict "Three-Day" Timeline

   • The notion that capillary leak automatically resolves by day three is too simplistic—many variables, like persistent inflammation, repeated surgical interventions, and individual phenotypes, can prolong or alter this process.

2. Precision Medicine in Fluid Therapy

   • Different inflammatory phenotypes and patient contexts (e.g., sepsis vs. trauma) might require tailored therapies. This explains why broad clinical trials often produce mixed or inconclusive results.

3. CVP: Still Relevant, but Context Matters

   • Monitoring and trending CVP can offer valuable clues, yet it should not be used in isolation. It's best interpreted alongside clinical assessment, point-of-care ultrasound, and other hemodynamic data.

4. Albumin Use is Nuanced

   • Research is mixed about when albumin confers an advantage over crystalloids. Many clinicians do use it—often for fluid-sparing reasons—yet conclusive evidence for mortality or strong outcome benefits remains elusive.

   • Cost, supply considerations, and possible infection risk also factor into decisions.

5. Benefit of Open Debate

   • The group appreciates conference sessions that stimulate robust arguments, recognizing it advances the conversation and highlights the complexity of fluid management.

Concluding Note

This transcript offers a window into current fluid-management debates, including capillary leak timelines, CVP's evolving role, and the uncertain but ongoing place of albumin in critical care. Above all, it underscores that individual patient factors—from genetic phenotypes to clinical context—drive decisions more reliably than any single guideline or laboratory concept.