The thing about trauma, is that when something happens that reminds you of your trauma (a similar event, or a similar smell, or taste, or some other stimuli). It triggers a trauma response in you. This manifests in different ways for different people.

The #RELAx trial has been published today in @JAMA. It was coordinated by Anna Algera. This thread is to explain the rationale, what we did, the findings and the meaning.
The rationale of #RELAx is based on the following

First, there is NO adequate evidence on the level of PEEP in non-ARDS patients. Most of the studies are old, conducted in post-surgical patients (short-term ventilation), and were not powered to detect differences in patient-centered

Second, despite the absence of evidence, the levels of PEEP used in non-ARDS patients increased over years, from 5 to 7/8 cmH2O, probably as a reflection of studies and practice in ARDS

Third, one IPDM showed that higher levels of PEEP could benefit more severe ARDS patients. However, opposite trends (higher mortality and longer ventilation) were found in mild ARDS with higher PEEP (despite not powered to be statistically

Fourth, most of the weaning protocols include PEEP ≤ 5 cmH2O as a criterion for readiness to wean. Theoretically, a standardized liberal strategy of higher PEEP could delay weaning in some

1/23 We haven't had a lot to celebrate during this pandemic. But achieving the milestone of offering vaccine to the over 70s, health and care workers and the most clinically vulnerable just before target date is a huge cause for celebration, given the scale of the achievement.

2/23 When Margaret Keenan got her first jab in Coventry on December 8th last year, who’d have thought that, by Valentine’s Day, we’d have vaccinated over fourteen million people across the UK in just ten short weeks? Amazing, extraordinary and truly, really, world class!

3/23 I’ve been struck by how much joy and relief has been brought to those doing the vaccinations and those receiving them. A GP told me yesterday that nothing had given him greater pleasure in his long career. And that the patient's relief was sometimes overwhelming.

4/23 It's vital to recognise the extraordinary contribution of the staff and volunteers who have made this happen. One of my close family had their jab yesterday and was in awe of the volunteer standing outside in the freezing cold for a four hour shift meeting and greeting.

5/23 What I wanted to share in this thread was the slightly untold story of some of the extraordinary challenges the NHS has had to overcome to deliver this target. Requiring superhuman effort from NHS leaders and staff, way beyond the call of duty. Five challenges set out below.

Many of us who have been health activists have been crying hoarse for years about the need to strengthen our health system, focus on public health
Last summer brought policy and public focus to this dire need. One thought lessons were learnt.
Clearly not.

There is INCREDIBLE stress on the health system right now in many parts of the country. Health professionals over worked, burning out, turning positive with families in droves. And sometimes cannot find beds for themselves or their family in the hospitals they are working in.

I have never seen this kind of a situation before. Lots of people reaching out for help. To provide care, advice, help patients and those in medical need is what health providers are trained for. It is what this is unique about health as a profession.

Imagine not being able to help because there is no capacity, no bed, because there are multiple claimants for that one bed all with medical need. Where the only way a bed might be available is a patient discharge or sadly, a patient death

Ambulances lined up outside hospitals waiting to be able to transfer the patient to the facility, and at times to ferry out those who could not make it.