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For? Ok, good evening and welcome to this evening's SI CS education update. Um We are delighted to be joined by our first three Peter presenter um which is great. We're we're welcoming back um Doctor Docking for a third consecutive year, which is amazing. Um I know that many of you on the call will be familiar with SI CS as an organization. But for those of you who are new SI CS um is uh an organization that aims to improve the care delivered to critically ill patients within Scotland. We do that really through three main ways through research, through audit and through education. Um There are a variety of different um uh memberships available on the SI CS website depending on what kind of healthcare professional you are. And we've got healthcare memberships to suit all kinds of different healthcare professionals. The main benefits of membership include reduced uh meeting rates um for our annual scientific meeting, um access to education and travel bursaries. There'll be a new Bursary this year that is aimed at teens looking after recovering patients from critical illness. And then finally, there's comprehensive transfer insurance included. And so have a look at the SI CS website. If you're interested. Also, there's information there about our annual scientific meeting which will be held on the 1st and 2nd of May. We've got a new location this year at Reef Hydro and um a really exciting and engaging um program developing for that. So, again, early bird meets, I think are available for the meeting. So please have a look at the website. So moving on to our speaker, many of you will heard Dr Dockings speak before this session that he does is always one of our best reviewed evening education updates. So we're delighted to welcome him for a third year. He grew up in Newcastle, but has been naturalized to Glasgow by work, his wife and his kids. He is an intensivist and anesthetist at the Queen Elizabeth in Glasgow and is pretty much a full time intensivist with occasional forays into urological anesthesia. He's the faculty teacher and has an interest in medical education, ventilation, and most importantly, Liverpool football club. Um So I'm going to hand over to him and we're going to hear about the top trials of the last year. Thank you very much, Jelly and er, welcome to everybody. Um Thank you for having me back. Um So as, as Jelly says, er, uh I am here to talk about the trials and review from 2024 ish. So, um I very unfortunately I had to, to cancel my December slot um due to a life events. Er, so we bumped it forward by two months. So I think we have one trial that sneaked in into, into 2025 um, via, which will go down as Liverpool football club's 20th, um, a championship win, which is good to know anyway. Right. Let's go forward. So, as always, we've got some caveats and provisos and one conflict of interest. So these are edited, highlights. This is not all the trials that I've read in the last year. Um, everyone has a radar for trials and it's very personal. Um, you, whichever way that you find trials that are out there, um, it will be focused into, into what you're interested in and you will have, I definitely miss stuff that is out with my, my personal biases. Um, you tend to read stuff that fits into your case makes, uh, stuff that fits into your preexisting interests. Um, if there's stuff that doesn't fit into theirs, sometimes you can think it's a bit boring. You put it aside, but that means that you lose loads of, of, of useful information, which is why it is useful to hear other people give their end of year reviews of, of what's going on in the last year. I think I've some become somewhat disengaged with, with social media and trial social media especially. Um, it did seem for a while that it was great. You could interact directly with, uh, key authors, er, with research groups, you could ask them questions about the trials. You could try and pick apart nitty gritty, really interesting stuff that I've, I've gleaned over the last wee while, but slightly disengaged with it. And that's the kind of 22 handed thing of, uh, most social media companies being owned by, um, terrible, terrible, terrible human beings. Uh, and also the fact that also trial, social media leads to social media itis of, of trying to sell your trial as being AAA game changer as a life changer. Um, a practice changer with every single trial you do, which can't be true. Um, and probably trivializes an awful lot of stuff that goes on. So I have disengaged a little bit with that. Um, er, I am a dropping intensivist, I'm not by any means, er, of imagination, a AAA research expert. So, if there are any particular ton to interpretations there, I apologize for that. Um, I have strayed away from any Bayesian analysis this year. I think we talked about some stuff last year. Um, er, there were one or two trials but I had some interesting Bayesian methodology but I've decided to leave them out mainly. So I don't look daft when I try to describe them and my only conflict of interest is that MSD in the past have sponsored some talks that I've given, but they've not asked me back. So I think that probably means I've been, get to divulge myself about co I in due course. So what did I think in the last year? So I don't think there is a game changer here in these trials. And so you, if that makes you turn off your slide straight away, that's, that's absolutely fine. I won't take it too personally. Um, but I don't think there's a trial here that will change what I do probably. Um, they all however address important questions. Um, I think it's great that we are asking those important questions and trying to pick apart what we do, um, in modern it. Um, I have done my usual, er, as in previous years and given my take on how I'm gonna change my practice or how I might change my practice, but that isn't the same for everybody. So, uh your case makes, may vary massively, your current practice may vary massively from what, what I do. Um, it may just not apply to the patients that you see, er, it may not apply to your outlook on, on, er, life in critical care. So just cos I say, I think this is a really good thing to do, doesn't mean that you should go out and, and, and do it. Uh, and as ever, I'd say dive into these trials, um, the quality of trial writing I think has, you know, massively massively improved over the last 1015 years in terms of the information that you get the granularity of data. Um, the ability to dive into supplementary tables and see actually what's going on. Um, what you do have to do is take this stuff apart. And if you think that any of these, these papers are interesting, dig them out, um, dig them out, go and look at them. Er, one very important thing is to interrogate the control group because I think it's very easy to look at interventions and say, well, that's an intervention that seems relatively easy to do. And they've shown a 20% relative risk and reduction of whatever your primary outcome is. Well, maybe I should start doing that. You interrogate the control group and a couple of papers will, will high like that here and the control group is nothing like what you would currently do in your, in your current practice. So you can't say that that intervention is gonna change what happens to your patients if that's not what you do as your standard of care in the first place. So we should always divert these things. We should always not take away exactly what trialists say about what they did. Uh And, and what they showed would be my, my er caution when it comes to looking at trials. So first trial pre oxy. So mid 2024 in the New England journal er by Gibbs et al asking this question does pre ay with N IV in the crystal reduce hypoxemia compared to conventional auction mask therapy. So very important ICU question. So you could see that intubation and ventilation has historically been the kind of syno on, of, of what we do in ICU is how ICU started off. Um, er, ventilating patients, er, postoperatively or, or with acute medical illnesses may not feel like it. If you walk through a modern ICU, it looks like a kind of wrestle for the geriatric and dilapidated. But that is where ICU S started off and it's something we still do commonly is put people off to sleep, put breathing tube down and ventilate them. What do we know about it? Well, we know quite a lot about, about intubation practice. Um and there's some really interesting er case series out there, observational data of, of, of what people are doing. And so we have a lot of info on what can go wrong and what happens when things go wrong. So, hypoxemia during intubation is very common in the critically ill. And we know that there's a marker for things going bad, especially we know that hypoxemia during intubation is very strongly associated with cardiac arrest, which you would argue is probably the worst outcome of an intubation. A. So this was a Multicenter Pragmatic RCT carried out in the United States of America. And last year, I talked a lot about Pragmatic RCT S and I think I said for most of the papers, this is a pragmatic paper. Um this is a pragmatic paper that carries with it problems. Er, so if you are too pragmatic, what happens is you introduced an awful lot of biases that may have actually influenced your, your, er, measured outcomes because you have allowed people to do too many things differently. Um.