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Paul Young Profile
Paul Young

@DogICUma

11,268
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ICU doctor, clinical researcher, kite-surfer, bad wing foiler #FOAMed #TEAMtrial #MegaROX @CritCareUnimelb

Wellington, NZ
Joined May 2013
Don't wanna be here? Send us removal request.
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@DogICUma
Paul Young
6 years
Reviewer #1 , whoever you are, I hope we meet again...
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@DogICUma
Paul Young
5 years
I am an intensive care doctor. I have never felt as scared as I do now. Please stay home. If New Zealand embraces this challenge we will together save tens of 1000s of lives. If you are in NZ, please RT this & tell everyone you know. #Covid_19nz #COVID19nz
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@DogICUma
Paul Young
5 years
In NZ @jacindaardern has just announced: 1. Everyone who comes to NZ (from anywhere) will need to self-isolate for 14 days. 2. Massive restrictions on mass gatherings 3. Expansion of public health measures 4. No cruise ships to NZ. This will save many many lives.
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@DogICUma
Paul Young
4 years
Usually New Zealand has 500 deaths a year due to Influenza. This year, there were only SIX flu isolates in New Zealand all winter as we experienced 'near extinction' of influenza due to lockdown & other #COVID19 public health measures
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@DogICUma
Paul Young
3 years
Vaccination mandates have just been announced for approximately 40% of NZ workers. This is brilliant and will save lots of lives. I think that this is genuine game changer for the #COVID19nz response.
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@DogICUma
Paul Young
3 years
I am shocked that Christopher Luxon has COVID.
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@DogICUma
Paul Young
6 years
Before being too critical of any RCT, try doing one. Even simple things are more complicated than they seem.
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@DogICUma
Paul Young
4 years
In New Zealand we have now done almost quarter of a million #COVID19 tests and have 1153 confirmed cases. Most have now recovered; only 30 known active cases remain. We are on the verge of elimination.
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@DogICUma
Paul Young
3 years
Dear @AndrewLittleMP , I am afraid that your assertion that the number of staffed ICU beds has increased from 234 to 340 in the past 15 months is false. I challenge you to visit any ICU in the country and find one clinician (just one) who can show their newly staffed beds.
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@DogICUma
Paul Young
3 years
I am pleased & proud to see the #PLUStrial published in @NEJM today. It is my 10th @NEJM paper! Hereโ€™s my list of @NEJM papers and what I think they mean for clinical practice
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@DogICUma
Paul Young
4 years
In NZ there has been no community transmission of #COVID19 for 66 days & the last case associated with a cluster recovered 28 days ago. We have had 22 deaths in total. This is remarkable.
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@DogICUma
Paul Young
4 years
Today, I have just passed 150 career publications. Here are the dozen I am most proud of. Nearly all funded by the @HRCNewZealand (funding for which I am most grateful)
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@DogICUma
Paul Young
3 years
Being double vaccinated against delta reduces the chance of needing ICU admission by 97%. Vaccinating over 2% of NZ's population today matters. #SuperSaturday #COVID19nz
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@DogICUma
Paul Young
2 years
2022 has been ridiculous. I have had 3 manuscripts in @nejm , 2 manuscripts in @NEJMEvidence , 2 manuscripts in @JAMANetwork . Ten years ago, if someone had told me that I would publish this many high profile papers in my whole career, I would not have believed them...
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@DogICUma
Paul Young
5 years
Check out New Zealand on this graph! Recovered cases are consistently exceeding new cases. Our country, as a team of 5 million, is working towards an ambitious goal of eliminating #COVID19 from our shores. I think we will.
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@DogICUma
Paul Young
5 years
This is the NZ #covid19nz strategy. Anyone who suggests we should end the lockdown early for economic reasons doesn't get it #COVID ใƒผ19
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@DogICUma
Paul Young
1 year
The @PATCHTrial , led by @RussellGruen , a study of pre-hospital TXA for severe trauma in adults at high risk of acute traumatic coagulopathy treated in advanced trauma systems, has been published today in @NEJM . #CCR23 Hereโ€™s a summary of what we did...
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@DogICUma
Paul Young
4 years
97% recovered. Only 27 active cases of #COVID19 in NZ. Only one new case in the last 7 days.
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@DogICUma
Paul Young
3 years
Neither the case numbers nor the numbers hospitalised are rising as I was expecting they would. I am feeling a tiny glimpse of optimism that vaccination might save us & I won't end up with PTSD after all... #COVID19nz
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@DogICUma
Paul Young
5 years
I have decided I am having a " #COVID19 free Sundays policy" from now on. Tomorrow I will not look at Twitter, read emails, or compulsively browse the Internet. That is my pledge.
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@DogICUma
Paul Young
5 years
Really troubling that @NEJM have published a case series like this. It provides zero basis for drawing causal inferences about the effect of remdesivir on outcomes. It has only been published because it's clickbait.
@NEJM
NEJM
5 years
A cohort of patients with severe Covid-19 received treatment with remdesivir under a compassionate-use protocol. Improvement in oxygen-support status was observed in 68% of patients, and overall mortality was 13% over a median follow-up of 26 days. #COVID19
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@DogICUma
Paul Young
11 months
Having done a bunch of studies in this space, here is all we know about balanced crystalloids vs. saline in critical illness in one tweet: If you have a traumatic brain injury give saline; otherwise give a balanced crystalloid. The end.
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@DogICUma
Paul Young
4 years
The last person has recovered. New Zealand is now #COVID19free
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@DogICUma
Paul Young
4 years
A pre-print version of the #RECOVERYtrial evaluating dexamethasone for #COVID19 is now online. This is clear and well written, and the data are extraordinarily persuasive. Bottom line: dexamethasone 6mg per day for #COVID19 patients who require 02.
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@DogICUma
Paul Young
6 years
Results of the #TARGETtrial , the largest critical care nutrition trial ever undertaken, are now online @NEJM What we did, what we found, and what it means followsโ€ฆ Please RT to help translate this new knowledge.
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@DogICUma
Paul Young
3 years
(1) Therapeutic hypothermia is associated with a higher risk of arrhythmia and does not appear to benefit any patient group. The @TTM2trial data should herald the end of the era of therapeutic hypothermia for adult cardiac arrest.
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@DogICUma
Paul Young
5 years
Hereโ€™s what we did in the #PEPTICtrial , what we found, and what I think it all means. #CCR20 @jama_current
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@DogICUma
Paul Young
3 years
Here is a press release on NZ's current ICU bed capacity from @anzics . The numbers reflect the reality on the ground (we have just over 170 staffed adult ICU beds). These are numbers NZ experts in intensive care medicine agree on @AndrewLittleMP
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@DogICUma
Paul Young
3 years
Over $500 million in new funding for intensive care in New Zealand has been announced today. This will be transformative for the care of people who are critically ill and for our #COVID19nz response.
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@DogICUma
Paul Young
5 years
Testing more New Zealanders is key. @jacindaardern has announced that in NZ we will now test everyone with symptoms irrespective of travel history or contacts. I am so relieved. #COVID19nz
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@DogICUma
Paul Young
5 years
The worst thing you can do is visit the supermarket. Hundreds of people together in a supermarket will spread this disease & the consequences if that happens will be worse than you can imagine.
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@DogICUma
Paul Young
5 years
Only 29 new cases in NZ in the last 24 hours; 35 recovered in the last 24 hours. Extraordinary. Carry on NZ. Soon we will #CrushTheCurve #Covid_19nz
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@DogICUma
Paul Young
5 years
I have been thinking...it's not to late for NZ. We should: 1. close our borders 2. allow NZers to return home in the next few weeks (but require all to be quarantined for 14 days) If we did this...
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@DogICUma
Paul Young
4 years
New Zealand is now 1 day away from 100 consecutive days without a locally acquired case of #COVID19
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@DogICUma
Paul Young
5 years
The healthcare system can't save us from #COVID19 but people staying at home can. #StayHomeSaveLives
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@DogICUma
Paul Young
5 years
More patients recovered from #COVID19 in NZ in the last 24 hours than there were new cases & there are only 12 patients hospitalised in the whole country. Encouraging signs...
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@DogICUma
Paul Young
4 years
OMG, I have realised that in the ICU, we only have four plans. We either: 1. wake up, 2. keep stable, 3. make stable, or 4. change the focus to allowing a comfortable & dignified death
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@DogICUma
Paul Young
5 years
Hospitals being completely overwhelmed means that people die of heart attacks, strokes, accidents, etc. They die of everything because the kind of healthcare we take for granted will not be available if our hospitals are full.
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@DogICUma
Paul Young
11 months
Balanced crystalloids versus saline for critically ill patients (BEST-Living): a systematic review and individual patient data meta-analysis - The Lancet Respiratory Medicine
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@DogICUma
Paul Young
3 years
This is the official statement from the organisations representing New Zealand intensive care doctors with respect to our ICU bed numbers. The key message is that getting vaccinated is the best way to avoid needing an ICU bed at all and keeps everyone safer from #COVID19NZ
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@DogICUma
Paul Young
3 years
Thanks to my colleagues in every public hospital in NZ who helped with this just-published study to describe NZ's staffed ICU capacity & surge capacity.
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@DogICUma
Paul Young
3 years
The best time to issue a national directive to our DHBs to employ more ICU nurses was 18 months ago. However, it is not too late to affect what happens in 2022. Please, please do this now. We desperately need more ICU nurses for endemic #COVID19nz .
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@DogICUma
Paul Young
5 years
This is WRONG WRONG WRONG. They try & minimise the risk by saying COVID only poses the same risk of death as one's annual mortality risk. The problem is that this is an ADDITIONAL risk. In other words, it will approximately double the number of deaths.
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@DogICUma
Paul Young
5 years
The #PEPTICtrial database lock is imminent. We compared PPI vs. H2RB for stress ulcer prophylaxis in ICU. I think it is the biggest critical care RCT ever (N=26733). We're on track to present results at @CritCareReviews #CCR20
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@DogICUma
Paul Young
3 years
This is pretty much all I know about oxygen in ICU and anaesthesia.
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@DogICUma
Paul Young
4 years
Two days in a row with zero new cases of #COVID19 in NZ & more than two weeks since we had more than ten new cases in a day. There are now fewer than 200 active cases in NZ.
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@DogICUma
Paul Young
3 years
To keep our staff and patients safe and to prevent spread of #COVID19 , only vaccinated staff are permitted to enter @wellingtonicu #COVID19nz
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@DogICUma
Paul Young
5 years
#PEPTICtrial 1. We enrolled approx 27000 patients from 50 ICUs in 5 countries in 3 yrs 2. Novel methods mean the total cost of the trial was approx USD250k 3. We will establish the comparative effectiveness/risks of 2 drugs that are very commonly prescribed to the critically ill
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@DogICUma
Paul Young
5 years
failed.
@DogICUma
Paul Young
5 years
I have decided I am having a " #COVID19 free Sundays policy" from now on. Tomorrow I will not look at Twitter, read emails, or compulsively browse the Internet. That is my pledge.
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@DogICUma
Paul Young
5 years
Two weeks on sabbatical & I have: 1. Peer-reviewed 5 papers for journals 2. Written an editorial 3. Written a paper 4. Edited 2 papers for junior ...and... 5. Been snorkeling in the lagoon in Tahiti every day after picking up the kids from school.
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@DogICUma
Paul Young
3 years
This thread on the #TTM2 trial has now been viewed >280,000 times. This is more than 10xs more times than the @NEJM paper has been downloaded and more than 100xs as many times as the editorial accompanying the paper has been downloaded.
@DogICUma
Paul Young
3 years
The #TTM2trial was published today in the @NEJM Hereโ€™s a summary of what we did, what I think the trial means, and what next. @ttm2trial @nielsen_niklas @CritCareReviews @NEJM
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@DogICUma
Paul Young
4 years
If #COVID19 has taught us anything, it is that New Zealand is the place to be if there is a Zombie Apocalypse.
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@DogICUma
Paul Young
8 years
#smaccDUB #dassmacc We should have original @nejm articles presented for the first time at SMACC. Show Jeff Drazen why with 10,000 RTs.
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@DogICUma
Paul Young
5 years
Breaking the chain of transmission means physical distancing needs to be practised by health professionals too. Stay away from the hospital when you can. Conduct handovers via Zoom or similar. Wash your hands. #COVID19nz
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@DogICUma
Paul Young
6 years
Thanks to #smacc I have 191 new followers in the last week despite having tweeted nothing. The pressure to come up with an original thought is now overwhelming.
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@DogICUma
Paul Young
4 years
New Zealand might be the only country in the world where #COVID19 has reduced mortality rates... Fewer deaths in lockdown than previous year
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@DogICUma
Paul Young
3 years
I agree with this entire commentary ...it's a shame this was not the editorial that accompanied the paper in the @nejm
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@DogICUma
Paul Young
4 years
I saw a Takahe in the wild. This bird was thought to be extinct for 50 years. There are around 400 of them alive now.
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@DogICUma
Paul Young
3 years
My gripe is not with surge capacity. Surges are an emergency that requires extreme measures and compromise. My concern is that we need to prepare now for a new normal where COVID is with us always. We need to recruit specialist ICU nurses for this.
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@DogICUma
Paul Young
3 years
True story: I once resuscitated someone from VF halfway through a four hour plane flight after which the patient (and I) were moved to business class. The only other people in business class were Prince Andrew and his entourage. He was watching Night at the Museum.
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@DogICUma
Paul Young
5 years
Only 18 new cases of #COVID19 in New Zealand in the last 24 hours. The number of people recovering per day is consistently exceeding the number of new cases per day.
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@DogICUma
Paul Young
6 years
My friend & colleague, @WellingtonICU Director @Peter_R_Hicks died suddenly while climbing Mt Cook on Monday. When I started as an ICU Specialist he assigned me no non-clinical duties because he believed that good people fill their time doing good work. I will miss him.
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@DogICUma
Paul Young
7 years
I just went to the Tempodrom. Holy crap. This place is ridiculous. Thanks to #dasSMACC #nerdsget2feellikerockstars
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@DogICUma
Paul Young
3 years
Free access to our @NEJMEvidence paper in which we demonstrated an 89.5% chance that the average effect of using balanced crystalloids instead of saline for ICU fluid therapy is to reduce mortality. If both are available, why would you still choose saline?
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@DogICUma
Paul Young
5 years
My 13 year old has written his timetable for the first day of online learning from home tomorrow. He appears to be planning on rising late and easing into it... @WC_Principal
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@DogICUma
Paul Young
4 years
@PulmCrit An alternative approach is to assume almost no-one in the ICU is hypovolaemic. In the absence of bleeding or fluid loss, if you want to know if fluid is good, then maybe a fluid challenge (not easily undone) should be replaced with a nor-adrenaline challenge (easily undone).
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@DogICUma
Paul Young
5 years
. @jacindaardern @AshBloomfield I hope the next step in the #COVID19nz plan will be large-scale testing in essential workers. Essential workers are now at the greatest risk of contracting & spreading the disease. Even those who are minimally symptomatic need to be tested.
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@DogICUma
Paul Young
3 years
The single most important message for the general public is please, please, please, please, please GET VACCINATED NOW. Do not wait. On this point I am certain @AndrewLittleMP and I agree.
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@DogICUma
Paul Young
5 years
I do not think Ashley Bloomfield should be allowed to take a pay cut. #COVID19nz
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@DogICUma
Paul Young
3 years
Exciting @wellingtonicu news. We will be advertising for a trauma fellowship, an echo fellowship, a research fellowship, a simulation/echo fellowship, and a dedicated "ICU exam preparation" position very soon...
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@DogICUma
Paul Young
3 years
You have two choices: saline or a balanced crystalloid. Both are readily available. This is a situation in which requiring certainty about superiority is illogical. Increasingly, it appears probable that for most patients balanced crystalloids are best
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@DogICUma
Paul Young
4 years
Within less than 24 hours of four cases of #COVID19 in one household being identified NZ will be locking down a city of over 1 million people so that we can eliminate #COVID19 again. We will.
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@DogICUma
Paul Young
4 years
New Zealand now only has ONE known active case of #COVID19
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@DogICUma
Paul Young
6 years
Here's a paper that was a real labour of love. I spent lots of time trying to make it easy to understand
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@DogICUma
Paul Young
5 years
Thanks very much to the @HRCNewZealand for funding the #HOTROXtrial feasibility study. We are hoping to learn how much O2 to give to patients having major surgery. Thanks to Dr Cilรฉin Kearns for the great graphic. @ClinResearchNZ
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@DogICUma
Paul Young
5 years
This is so true #CCCF2019 . Finding things that matter to you is the secret to being intrinsically motivated; being intrinsically motivated is the secret to being successful.
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@DogICUma
Paul Young
5 years
I have been looking at the excellent daily WHO situation reports on #coronavirus & I reckon we have past the point of no return. A pandemic is inevitable.
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@DogICUma
Paul Young
3 years
Step 1: eliminate COVID again. Step 2: vaccinate 95%+. Both are a monumental challenge but we need both
@HorsleyCarl
Carl Horsley
3 years
The shape of cautious optimism...
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@DogICUma
Paul Young
3 years
It is not about preparing for a surge (although that is still important). Instead, it is about preparing for a new disease which in the UK at a relatively steady state, and with a high rate of immunity, is using the equivalent of 25% of our normal ICU capacity every day.
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@DogICUma
Paul Young
4 years
This article suggests contrast nephropathy is not a thing. I like it because that has been my suspicion for some time. What do you reckon? Association of Intravenous Radiocontrast With Kidney Function via @JAMAInternalMed part of @JAMANetwork
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@DogICUma
Paul Young
6 years
#ICUROXtrial has finished as of right now. Patient #1000 enrolled at Austin Hospital. #1 recruiter DCCM, Auckland. Thanks very much RCs, PIs, patients, @DianeMackle @ANZICS_CTG
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@DogICUma
Paul Young
3 years
If you are receiving advice that we have 340 staffed ICU beds, you are receiving bad advice.
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@DogICUma
Paul Young
5 years
Here is a critical point: it's not just that #COVID19 will kill people, it's that even the most conservative modelling shows it will overwhelm our healthcare system so that sick people without #COVID19 will die because we cannot provide them the care we usually do.
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@DogICUma
Paul Young
4 years
OMG. I am an author on two of the most read non-COVID19 papers in @JAMA_current this year. Woo hoo I guess. Thanks for reading them.
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@DogICUma
Paul Young
6 years
The #vitaminstrial now has 118 patients (we are well on the way with our RCT comparing hydrocortisone, vit C, & thiamine with hydrocortisone alone)
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@DogICUma
Paul Young
5 years
With 21,002 tests /1M population & 301 cases /1M population NZ now has the lowest #COVID19 test positivity rate of any country in the world (except those with no cases ๐Ÿคช)
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@DogICUma
Paul Young
4 years
It irks me that randomisation in such circumstances is considered "high risk" but patients are allowed to continue to believe their "doctor knows best" when their doctor cannot possibly know at all because their are no data to confirm or refute their beliefs.
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