Intensive Care Medicine@yourICM

International peer-reviewed medical journal for all involved in Intensive Care #FOAMed #FOAMcc 🖋 Write bit.ly/ICMguidelines 📨 Submit bit.ly/SubmitToICM

springer.com/journal/134
Joined December 2012
Managing critically ill patients in #ICU, 10 tips on... 🌡️ fever rdcu.be/c89F3 🩸 optimizing vasopressors use rdcu.be/cMGG1 🛏️ severe acute pancreatitis rdcu.be/dfNVA 🫁 acute pulmonary edema rdcu.be/c2hOa Free to read #FOAMcc on @yourICM
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Albumin, 10 myths 1️⃣leaks into interstitium 2️⃣ ⬇️volume expansion vs artificial colloids 3️⃣ ⬇️AKI 4️⃣ sepsis: ⬆️survival 5️⃣ ⬆️diuretics effects 6️⃣RRT: ⬆️ fluid removal 7️⃣cirrhosis: ⬇️mortality 8️⃣TBI: ⬆️mortality 9️⃣correcting hypoalb ⬇️mortality 🔟 ⬆️NaCl 📎 bit.ly/3KkeAwK
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Reflections/lessons from a life in #ICU: 1⃣work with people you like/love 2⃣take sabbaticals to recharge 3⃣prioritize family = those you love most 4⃣live every day as having terminal disease: focus on what most important @JRandallCurtis1 #ICMfromtheInside bit.ly/3D2or7i
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Invasive arterial pressure 🌊monitoring 🌊SBP 🌊DBP 🌊MAP 🌊pulse pressure 🌊arterial waveform Knowledge & application of different signals allow to understand/interpret hemodynamic derangements in #ICU guiding #resuscitation using simple bedside tools. 📎bit.ly/3Ax5HOX
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#ARDS @ESICM guidelines 🫁 definition 🫁 phenotyping 🫁 #HFNO 🫁 CPAP/NIV 🫁 low tidal volume MV 🫁 PEEP & recruitment maneuvers 🫁 prone positioning 🫁 neuromuscular blocking agents 🫁 extracorporeal life support #ECMO #ECLS #ECCO2r #FOAMcc on @yourICM 🖇️ bit.ly/43J1OCe
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Vasopressors in #ICU 1️⃣set MAP/DBP goals 2️⃣individualize 3️⃣may⬇️+ve fluid balance 4️⃣reassess fluid status/CO 5️⃣change mechanism as 2 line 6️⃣high doses?? hydrocortisone 7️⃣vasopressin in RV failure 8️⃣no MAX dose 9️⃣EN can be initiated 🔟can be safe in PVC 🖇 rdcu.be/cMGG1
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◾️In memory of Prof L Gattinoni, towering figure in ICM, profoundly shaping understanding of #ARDS & #ECMO. The “father" of prone position revolutionized MV with a pioneering "baby lung” concept. His legacy will guide/inspire for generations to come. 🔗esicm.org/obituary-luciano-g…
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Fluid administration among most common interventions in #ICU... but high potential for harm! Here everything you need to know about deresuscitation ☔️ Why deresuscitation? ☔️ What is it? ☔️ When to start/stop? ☔️ How to deresuscitate? ☔️ So what's next? 🖇️ rdcu.be/cTb0g
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Source control to eliminate origin of infection, control contamination, restore premorbid anatomy/function in #sepsis & septic shock 🧫 think outside (abdominal) box 🧫 have multidisciplinary approach 🧫 first do NO (additional) harm #FOAMcc on @yourICM 🖇 rdcu.be/cVDIb
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Coagulopathies severe/frequent complication in #ICU: how to manage?? 🩸 hemorrhagic coagulopathies: non‑malignant & malignant 🩸 thrombotic c.: sepsis‑induced & solid cancer‑associated 🩸 managing hemorrhagic c. 🩸(preventing &) managing thrombotic c. 🖇️ rdcu.be/c5TQd
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🏆 Here some of our TOP @altmetric score articles for 2022... #FOAMcc on @yourICM ☔️ Deresuscitation rdcu.be/c2fdO 🥚 Myths on albumin rdcu.be/c2fc4 🩸 Invasive BP monitoring in #ICU, beyond MAP rdcu.be/c2fc1 🍬 Managing DKA rdcu.be/c2feq
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Management of moderate to severe TBI ⏳ first hours: initial #resuscitation targets 🩸💧 in #ICU, ⬇️ secondary insults after trauma: ICP, CPP, hemodynamics 👁 multimodality monitoring targets & management 🫁 extracranial complications 🧠 long‐term outcome rdcu.be/cN2rq
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Diabetic ketoacidosis? address 3 main issues 💉insulin to resolve at its root cause (glucagon-to-insulin ratio)!) 💧fluids vs hypovolemia (if present) & TBW 🧂 electrolyte replacement, with attention to life-threatening shifts in K+ & beware its myths! 🖇️ bit.ly/3C85dOz
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The forgotten relevance of CVP (& its change over time) monitoring in #ICU 🫀 measurement & normal values 🫀 impact of high CVP values: how could CVP elevation per se cause organ damage? On @yourICM 🖇️ rebrand.ly/m98xvr3
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🏅 Here some of our most liked (on #SoMe) articles for 2022... #FOAMcc on @yourICM 🩸 Optimizing vasopressors use rdcu.be/cMGG1 🧠 Managing moderate/severe TBI rdcu.be/cN2rq 🩸 CVP rdcu.be/cTv6e 💧 Acute pulmonary edema rdcu.be/c2hOa
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Understanding CNS efficacy of antimicrobials in #ICU 🧠 physiology of CSF 🩸 blood–brain barrier 💉 PK/PD of antimicrobials in CSF & selected examples: β-Lactam agents, fluoroquinolones, amphotericin B 🔮 future developments #FOAMcc on @yourICM 📎 rdcu.be/cSwhO
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📣 Surviving sepsis campaign: international guidelines for management of #sepsis & septic shock 2021 out! ➡️screening & early treatment ➡️infection ➡️hemodynamic management ➡️ventilation ➡️additional therapies #LIVES2021 @ESICM 📣Open #FOAMcc @yourICM 🔗rdcu.be/cyKPO
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Vasopressors in critically ill pts with shock: ➡️summary of evidence & pivotal trials ➡️relevant pathophysiology of vasodilatory shock ➡️when & what vasopressor(s) to administer? agents & receptor/effect(s), dose, additional benefits ➡️monitoring ➡️weaning rdcu.be/cqYDo
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Setting ventilator in acute brain injury 💨 ventilatory settings 🧠 oxygen & carbon dioxide targets 🫁 management of concurrent acute BI & #ARDS Free to read #FOAMcc on @yourICM 🔓rdcu.be/dILp2
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Tracheal intubation in #ICU ➡️ preoxygenation & apneic oxygenation ➡️ devices for ETT positioning & airway management algorithms ➡️ tube position confirmation ➡️ hemodynamic optimization/choice of drugs ➡️ bundle to limit complications #FOAMcc @yourICM 📎 bit.ly/3cgcC58
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Direct oral anticoagulants, 10 things to know 1️⃣ indications 2️⃣ types 3️⃣ half‑life & elimination 4️⃣ organ failure 5️⃣ ⬇️ absorption & enterohepatic recirculation 6️⃣ monitoring 7️⃣ reversal 8️⃣ management of major bleeding 9️⃣ DOACs in #ICU 🔟 resuming DOACs 📎 rdcu.be/cZJ8F
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Aerosolised antibiotics in #ICU 💨 delivery to tracheobronchial tree? easy 💨 delivery to infected lung parenchyma? difficult 💨 clinical delivery of aerosolized ABTS 💨 how to address unmet clinical needs from a research standpoint Free to read #FOAMcc 🖇️ rdcu.be/datQH
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Driving pressure at the bedside: 🛌 how to measure? 🛌 how to control driving pressure in spontaneously breathing patients? 🛌 limitations One single Vt does not fit all: ΔP may help to titrate Vt according to lungs size, potentially improving outcomes. 🖇️ bit.ly/41F4cIs
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Interpretation of CVP? 🫀reflection of RV filling pressure 🫀downstream pressure for organ perfusion As CVLs recommended in shock, would be regrettable not to (also) use them to help assess hemodynamic status... but measure CVP properly! #FOAMcc @yourICM 🖇rdcu.be/cTv6e
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☢️ IV contrast in patients #AKI? NOT associated with either persistent AKI at hospital discharge or initiation of dialysis. Current ACR-NKF consensus recommendations for use of IV CM in pts with stable renal disease may be applied if pre-existing AKI. 📎 bit.ly/3Rp023W
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Less mechanical ventilation? is more! 🔸FiO2 🔸Tidal Volume 🔸Respiratory Rate 🔸PEEP But aggressive interventions often well justified in #ICU during stabilization... So it's extremely unlikely that lesser is (invariably) more than less #FOAMcc @yourICM rdcu.be/ccJqt
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Managing of status epilepticus in emergency setting & #ICU: 📈 epidemiology, etiologies, diagnosis 💉 treatment: early, established, refractory & super‑refractory SE & etiology‑driven treatment 🧠SE in hypoxic–ischemic encephalopathy 🔮prognosis #FOAMcc 🔓 rdcu.be/dt9Zm
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2021 🏆 #SoMe @yourICM narrative reviews 🧠Post-cardiac arrest BI rdcu.be/cDVD4 🫀ECPR rdcu.be/cDVJL 🧫Septic shock #resus rdcu.be/cDVLu 💧AKI rdcu.be/cDVKC 🫁 Non-invasive support rdcu.be/cDVMr 🌀Delirium rdcu.be/cDVMY
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Renal replacement therapy in ICU 🟡 initiation timing 🟡 modality selection 🟡 modes of solute clearance 🟡 intensity of #RRT 🟡 dialysate/replacement fluid composition 🟡 anticoagulation 🟡 fluid management 🟡 discontinuation 🟡 #PedsICU considerations 📎 bit.ly/3BhuaaN
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Acute pulmonary edema in #ICU: 1⃣what is it? 2⃣pathophysiology 3⃣actors of organ cross talk 4⃣how to recognise 5⃣management goals 6⃣ensure adequate oxygenation 7⃣loop diuretics 8⃣role of vasodilators 9⃣multidisciplinary teams needed? 🔟avoiding readmission bit.ly/3LGkdqL
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Diuretics in #ICU 🫘 what the indications? 🫘 how to monitor? 🫘 continuous infusion more effective vs intermittent dosing? 🫘 combining w albumin to improve effectiveness? 🫘 furosemide stress test 🫘 how to manage diuretic resistance #FOAMcc @yourICM 🔓 rdcu.be/dG6xx
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Guidelines on acute hypoxemic respiratory failure #AHRF/acute respiratory distress syndrome #ARDS presented today at #LIVES2022 @ESICM annual congress! Here the visual summary... soon the full article on @yourICM!
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Cardiogenic shock 🔸5 stages SCAI classification 🔸culprit‑lesion‑only or multivessel percutaneous coronary intervention? 🔸norepinephrine or epinephrine? 🔸non‑pharmalogical interventions 🔸Temporary circulatory support: #IABP #ECMO #Impella... #FOAMcc rdcu.be/cb6nH
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Recent guidelines published 🔓 by @yourICM 🫁 #ARDS: definition, phenotyping, support @ESICM 📖 rdcu.be/djVb7 🫁 Managing severe CAP @EuroRespSoc ESICM @ESCMID @ALATorax 📖rdcu.be/dc5sK 🫁 Managing severe bronchiolitis in #PedsICU 📖 rdcu.be/c2Njf
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Detecting shock? SR aimed to identify value of 10 clinical signs 🫀 tachycardia 🫁 tachypnea 🔵 mottling 👉🏻 capillary refill time 🫘 oliguria 🧠 altered mental state 💦 diaphoresis 🩸 peripheral pulse 🩸 peripheral pulse quality 🧮 shock index #FOAMcc 🔓 rdcu.be/dlVuz
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Prone position in #ARDS ➡️ effects: chest wall/lung mechanics, ventilation, perfusion, gas exchange ➡️ hemodynamics ➡️ whom & when? indications/contraindications ➡️ ventilator settings ➡️ how to perform bedside ➡️ impact on outcomes ➡️ unanswered questions bit.ly/3eHVfXX
in supine position, open, non-dependent lung mass (at 50% of the sternum-vertebra distance) is about 40% of the total mass, while the dependent accounts for the 60%. As collapse is primarily a function of superimposed hydrostatic pressure (including shape/weight of the heart), while prone, more mass opens in the non-dependent zones than collapses in the dependent sternal regions bottom: improvement in RV function after proning session of 18 h

ALT in supine position, open, non-dependent lung mass (at 50% of the sternum-vertebra distance) is about 40% of the total mass, while the dependent accounts for the 60%. As collapse is primarily a function of superimposed hydrostatic pressure (including shape/weight of the heart), while prone, more mass opens in the non-dependent zones than collapses in the dependent sternal regions bottom: improvement in RV function after proning session of 18 h

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Transfusion strategies in bleeding critically ill adults current evidence/research areas from @ESICM clinical practice guideline 🩸massive bleedings 🩸non‑massive bleedings 🩸tranexamic acid in traumatic/non‑traumatic hemorrhages Open #FOAMcc on @yourICM 🖇️bit.ly/3G5KUlM
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Etomidate (0.2–0.3 mg/kg) vs ketamine (1–2 mg/kg) for emergency endotracheal intubation, RCT 💉801 critically ill pts 💉day 7 survival significantly lower with etomidate 💉no significantly different day 28 survival Full results #FOAMcc rdcu.be/cDp0c ⬇️ Visual abstracts
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🎨 2022 @yourICM top visual abstracts 💉 Etomidate vs keta for emergency intubation rdcu.be/cDp0c 💉 Epinephrine vs NE as vasopressor post CA rdcu.be/c2wZl 💉 Vanco + pip-tazo in ICU rdcu.be/cRLAi 💉 EN if vasopressors needed rdcu.be/cHwVf
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Thoracic (lung & pleural) #POCUS in critical care: ➡️technique Evaluating & managing ➡️pneumothorax ➡️pleural effusion ➡️acute dyspnea ➡️pulmonary edema vs #ARDS ➡️pulmonary embolism ➡️interstitial processes ➡️MV support Narrative review #FOAMus #echofirst rdcu.be/cjirz
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Acute‑on‑chronic liver failure 🏥 clinical characteristics 🩺 pathophysiology 🫘🩸 🧠 🫁 management of individual organ dysfunction: liver, coagulation, kidney, brain, lung 🫀 circulation 🏥 #ICU management 🟫 liver transplantation Free to read @yourICM 🔓rdcu.be/diYyq
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How to use face-mask noninvasive ventilation 🫁 set‑up & ventilatory settings 🚦 indications & contraindications 🖥️ monitoring to assess response, adjust settings, identify need to switch to IMV ⚠️ associated constraints associated #FOAMcc on @yourICM 🔓 rdcu.be/dJex8
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Assessing hemodynamics to assess volume status? 💧volume status & fluid therapy, physiological concepts 💧monitoring 💧indications for fluid #resuscitation 💧how to predict fluid responsiveness & perform fluid challenge? 💧strategy for fluid management 🖇️bit.ly/3vQ7dIz
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Bleeding leading preventable cause of death in trauma: understand, detect, treat trauma-induced coagulopathy pivotal to improve outcomes 🩸pathophysiology 🩸diagnosis 🩸management 🩸knowledge gaps/future development DON'T miss supplementary file #FOAMcc 🖇 rdcu.be/cS6bn
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💉 Dexmedetomidine sedation in adults on MV in #ICU, rapid practice guideline: use suggested over other agents, if desirable effects including ⬇️ #delirium valued vs undesirable, including ⬆️ hypotension & bradycardia - weak recommendation (suggestion). 📎 bit.ly/3lo4f8G
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High‑risk pulmonary embolism in #ICU 🩸 understanding high‑risk PE: deadliest presentation of acute PE (case fatality rate 22-65% if CA) 🩸 diagnosing PE in critically ill pt 🩸 (immediate) reperfusion therapy 🩸 hemodynamic support #FOAMcc on @yourICM 🖇️ rdcu.be/c7R6z
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Basic #ultrasound skills in #ICU & NCCU, @ESICM consensus & expert recommendations: ➡️brain ➡️lung ➡️heart ➡️abdomen ➡️vascular #FOAMcc #FOAMus #echofirst #POCUS 🖇️bit.ly/3kNPw7g DO NOT miss supplementary files including additional figures & links to video description!
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Ventilating obese pts in #ICU? ➡️ NIV to prevent/treat ARF + vs re-intubation ➡️ airways: evaluate, pre-oxygenate, choose devices ➡️ careful RM (case-by-case) ➡️ (moderate to high) PEEP vs collapse ➡️ low Vt (PBW!) in non-ARDS/ARDS ➡️ proning (severe ARDS) bit.ly/3omGsGn
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Ventilator induced lung injury 🫁 mechanical ventilation & VILI 🫁 conceptual and mechanistic evolution of VILI: barotrauma, volutrauma, atelectrauma, biotrauma, ergotrauma 🫁 VILI pathogenesis 🫁 VILI assessment 🫁 clinical approach Free to read #FOAMcc 🔓rdcu.be/dva3V
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Haloperidol vs placebo in acutely admitted, adult #ICU pts with #delirium? With IV haloperidol 2.5 mg × 3 daily & as needed doses up to max 20 mg daily: ➡️ high probabilities of benefits ➡️ low probabilities of harm for primary & most secondary outcomes 🖇️ bit.ly/3lHm2eM
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🫁 Let’s protect lung & its circulation to improve prognosis! Besides limiting VILI/improving oxygenation, proning protects pulmonary circulation, unloads RV, improves hemodynamics, maybe partly explaining its beneficial effect especially if RV failure. 🖇️ bit.ly/3xU3cn3
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Coagulation & perioperative bleeding 🩸fibrinogen source/dose/time 🩸Ca++: just vs citrated blood products? 🩸PCCs/factor concentrates 🩸TXA 🩸plasma: volume or coagulation? 🩸PLTs as primary components 🩸RBCs not just DO2 🩸targeted coagulation support 🖇️ bit.ly/3VWMAGN
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Cardiogenic shock in 2024: 🫀 #extracorporeal life support #ECLS 🫀 left ventricular unloading strategies in #ECMO strategies & evidence from recent trials (& beyond) Free to read #FOAMcc #FOAMecmo on @yourICM 🔓 rdcu.be/dHzLz
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What's new in cardiac #ICU?? 🫀 Valvular procedures in interventional cardiology 🔓 rdcu.be/cd8nG 🫀 Cardiogenic shock 🔓 rdcu.be/cb6nH 🫀 Mechanical support in children with severe cardiac failure #PedsICU 🔓 rdcu.be/dmRNI All free to read #FOAMcc
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How to optimize extubation? ➡️ anticipate cause of failure before extubation ➡️ after extubation: still anticipate to avoid re-intubation ➡️ high risk specific populations: COPD, obesity, brain injury Free to read #FOAMcc on @yourICM 🖇️ rdcu.be/c4BFk
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Intensive Care Medicine joins the condolences for the lost of Jordi Mancebo, who, in addition to being an exceptional intensive care doctor, teacher & researcher, was an excellent Editor and supporter of @yourICM We will continue to honour your legacy in our editorial activities.
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Assessing lung recruitability: does it help with PEEP settings? 🫁 opening pressures 🫁 recruitment maintenance 🫁 interaction between opening pressure & PEEP 🫁 available methods to assess recruitment 🫁 clinical implications #FOAMcc on @yourICM 🔓 rdcu.be/dCJr0
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🫁 Protective Ventilation? Since first recognition that mechanical ventilation can harm lung, our understanding of what constitutes protective MV continued to evolve, and optimal goals continue to be refined as new insights emerge. #FOAMcc on @yourICM 🖇️ bit.ly/3p8qBNa
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Septic shock #resuscitation, from current practice: ➡️clinical targets ➡️initial fluids & fluid responsiveness ➡️vasoactive drugs ... to evolving concepts: ➡️new potential targets ➡️fluid resuscitation ➡️vasopressors ➡️refractory shock Narrative review on bit.ly/3EYZAT1
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Resuscitation fluids, @ESICM guideline 🧵1/2 💦 for volume expansion use crystalloids vs albumin in critically ill pts in general, in #sepsis, ARF & periop + if risk for bleeding 💦 isotonic saline vs albumin in TBI & albumin vs crystalloids if cirrhosis 🔓bit.ly/3wLJTj4
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Management of severe community-acquired pneumonia: @EuroRespSoc @ESICM @ESCMID @ALATorax international guidelines ➡️ evidence-based recommendations for diagnosis, empirical treatment, ABTs ➡️ current knowledge gaps ➡️ recommendations for future research 🖇️ bit.ly/3m4tC3n
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Less (antibiotics) is more in #ICU ➡️ use effective short‑course regimens ➡️ de‑escalate if improvement/negative cultures ➡️ optimize according to PK/PD ➡️ targeted/directed ABT: NO combinations if known pathogen/susceptibility ➡️ aggressive source control rdcu.be/b8kG0
Practical bedside recommendations to minimize unnecessary antibiotic exposure in critically ills

ALT Practical bedside recommendations to minimize unnecessary antibiotic exposure in critically ills

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Major haemorrhage in critical care 🩸pathophysiology of hemorrhagic coagulopathies: trauma, postpartum, chronic liver disease, DIC, uremia, anticoagulation 🔍diagnosis & evaluation 📃protocols 🩸management post bleeding & massive transfusion 🤔 & more 🔓bit.ly/3tNpTLt
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Thromboprophylaxis in #ICU 🩸which pharmacological thromboprophylaxis for critically ill patients? LMWH preferred vs UFH unless severe renal insufficiency 🩸contraindications? mechanical thromboprophylaxis 🩸important considerations & pending questions 🖇️ rdcu.be/cUDA8
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Main early papers on #COVID19 & their findings, an overview: ➡️ manifestations of severe disease ➡️ pharmacological therapy ➡️ ventilatory support in pts with #SARSCoV2 related #ARDS ➡️ healthcare organization & healthcare worker stress #FOAMcc #COVIDFOAM rdcu.be/cc1ll
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Acute brain injury-associated changes in renal function and their therapeutic implications: 💧water &🧂sodium handling: hyponatremia (SIADH/CSWS) and hypernatremia 🟨changes in renal glomerular function: glomerular hyperfiltration & AKI #FOAMcc on @yourICM rdcu.be/cC0ez
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Vasopressors? Focus on norepinephrine 💉pharmacological properties 💉current dosing strategies Consensus of definitions needed (ie refractory shock or high-dose vasopressors) as equivalences between drugs (catecholaminergic/non) to facilitate comparisons 🔓rdcu.be/dBHs4
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Hepatopulmonary syndrome & portopulmonary hypertension in end-stage liver disease: ➡️assess lung function in pts listed/considered for #Tx: high-risk of (right) heart/weaning failure! ➡️HPS/PoPH may require unplanned #ICU admission & early/appropriate care rdcu.be/cvTEa
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How I use #ultrasound in cardiac arrest 🫀#POCUS to confirm CA & guide management during cardiopulmonary resuscitation 🚨general assessment immediately after ROSC: hemodynamics & circulatory support + non cardiac 🔮 future perspective #FOAMcc #FOAMus 🔓rdcu.be/dsrQ8 🧵
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The use of high‑flow nasal oxygen: 💨 acute hypoxemic respiratory failure 💨 acute hypercapnic respiratory failure 💨 weaning from mechanical ventilation 💨 special populations: immunocompromised patients & tracheostomised patients 🖇️ bit.ly/40qXd4Y
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Wean/extubate critically ills 1⃣optimize (⬇️) sedation 2⃣diaphragm-protective MV 3⃣daily screen for SBT 4⃣best SBT? 5⃣weaning strategy 6⃣what if SBT fails 7⃣muscle load/efficiency ratio 8⃣weaning/extubation failure 9⃣post-extubation support 🔟 tracheostomy rdcu.be/b9fNP
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Etomidate vs ketamine for emergency endotracheal intubation, RCT 💉801 critically ill pts assigned to receive etomidate (0.2–0.3 mg/kg) or ketamine (1–2 mg/kg) 💉day 7 survival significantly lower with etomidate 💉no significantly different day 28 survival rdcu.be/cDp0c
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Lung #ultrasound based approach for early diagnosis of #COVID19 pneumonia: ➡️20 US/European hospitals ➡️1462 pts Combining #LUS patterns of probability + clinical characteristics allow to rapidly rule in/out #SARSCoV2 pneumonia at bedside w high accuracy! bit.ly/3vHpmqu
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Post-cardiac arrest brain injury, narrative review: 🧠pathophysiology: primary (ischemic) & secondary (reperfusion) 🧠treatment options 🧠outcomes 🧠neuroprognostication 🧠@ERC_resus @ESICM 2021 algorithm for prognostication Open #FOAMcc #FOAMres @yourICM bit.ly/3nB09ur
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Ventilation in #COPD & asthma ➡️ respiratory mechanics/gas exchange ➡️ heart–lung interactions ➡️ HFNO & NIV ➡️ managing invasive MV from intubation to (early) weaning limiting hyperinflation ➡️ long‑term outcome & role of tracheostomy ➡️ future strategies bit.ly/3lrmGYk
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Hepatorenal syndrome in the #ICU 🫘 diagnostic criteria for #AKI & hepatorenal syndrome ⚙️ specifc management of HRS–AKI 🧪 role of biomarkers in AKI phenotyping Free to read #FOAMcc on @yourICM 🔓 rdcu.be/dGQHz
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Invasive mechanical ventilation 💨 ARDS 💨 lung protective MV 💨 supportive care #ARDS? highly heterogeneous: interventions to improve outcomes need to be tailored to specific subgroups to provide optimal support mitigating risk of additional harm. 🖇️ bit.ly/40Knw6E
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Critical care #ultrasound goal-directed vs EGDT in septic shock 🩸improved 6h lactate clearance 💧reduced 12 & 24h cumulative fluids CCUGDT effective to guide hemodynamic management, optimizing organ perfusion/avoiding excess fluid resuscitation #FOAMus 📖 rdcu.be/czegb
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Lung recruitment maneuver in #ARDS, SR/MA: 💨14 RCTs/3185 pts 💨 no significant improvement in 28-day mortality (systematic use) 💨 positive effects: ⬆️ oxygenation, ⬇️ dP, ⬇️ rescue therapy use 💨adverse events: barotrauma, hemodynamic compromise #FOAMcc rdcu.be/co6Y8
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HFNC as respiratory support, guideline synthesizing best-evidence in 4 recommendations ➡️ hypoxemic resp failure: STRONG ➡️ peri-intubation: NO ➡️ post-extubation: CONDITIONAL ➡️ postop (cardiac or thoracic surgery): CONDITIONAL in high risk &/or obese pts bit.ly/2UzU0kd
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Respiratory muscles, much more than diaphragm! Expiratory muscles in #ICU: 🫁 physiology & pathophysiology 🫁 undesirable effects of recruitment 🫁 expiratory muscle strength (& weakness) + strategies to maintain/improve 🫁 quantification of effort #FOAMcc rdcu.be/cwnnv
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#AKI in #ICU: any new (targeted) pharmacological intervention to prevent, treat or enhance recovery? Let's focus on ➡️ hemodynamics & DO2 ➡️ inflammation ➡️ cellular metabolism & oxidative stress ➡️ apoptosis ➡️ cellular repair/fibrosis #FOAMcc @yourICM 📖 rdcu.be/cUiVP
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#HFNO found a role in every aspect of hypoxemic respiratory failure: ➡️ first-line support ➡️ preoxygenation ➡️ post-extubation Closely monitor, not to delay intubation if needed. Open challenges: improving comfort, potential for even higher flows, weaning rdcu.be/b6Xpi
1 -> Physiologic effects of HFNO & possible impact of the flow. Increase in airway pressure and FiO2 improve oxygenation by different mechanisms and may be optimal at higher flows. Most of dead-space wash-out-related efects (increased CO2 clearance, decrease respiratory drive, respiratory rate and effort to breathe) may be obtained for lower flows. All these physiological effects probably explain the improved comfort in patients with respiratory failure and possibly the outcomes. 2->S uggested algorithm for deciding how to preoxygenate a patient with AHRF who requires tracheal intubation.

ALT 1 -> Physiologic effects of HFNO & possible impact of the flow. Increase in airway pressure and FiO2 improve oxygenation by different mechanisms and may be optimal at higher flows. Most of dead-space wash-out-related efects (increased CO2 clearance, decrease respiratory drive, respiratory rate and effort to breathe) may be obtained for lower flows. All these physiological effects probably explain the improved comfort in patients with respiratory failure and possibly the outcomes. 2->S uggested algorithm for deciding how to preoxygenate a patient with AHRF who requires tracheal intubation.

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Early prone position: may reduce mortality in #COVID19 induced severe hypoxia? in this study, vs non proned pts significant difference in SpO2/ROX at 10' & SpO2/RR/ROX at 30' (some) improved CT 56.5 vs 24.3% survival at 90 days #FOAMcc #COVIDFOAM @yourICM rdcu.be/b5NET
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The @yourICM special issue on MV in #ICU is online! 🔹#ARDS 🔹pulmonary infections 🔹#SARSCoV2 & #COVID19 🔹HFNC 🔹fluids in #ARDS 🔹pharmacological therapies in #ARDS 🔹diaphragm 🔹lung mechanics & monitoring 🔹#ECMO 🔹special populations & more!! #FOAMcc bit.ly/ICMspecialMV
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Monitoring cerebral oxygenation to understand brain dysfunction after #ABI & individualize management 🧠 pathophysiology of cerebral oxygenation ⚙️ technology of cerebral oxygen measurement 📖 evidence/clinical applications #FOAMcc @yourICM @chiara_robba 📎rdcu.be/cRh2O
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Dexamethasone in #COVID19 & severe hypoxaemia: with 12 vs 6 mg 💉high probabilities of benefit on all outcomes, including days alive without life support/mortality 💉relatively low probabilities of important harm COVID STEROID 2 trial bayesian analysis bit.ly/3kqnOgp
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Pathophysiology of anaphylactic shock captured on CT! 💉post contrast lost of consciousness/cardiac arrest ☢️ early vs late-phase images comparison revealed marked/extensive intestinal edema, IVC collapse, volume-reduced spleen (autotransfusion) #FOAMcc 🖇️rdcu.be/dnTpJ
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#COVID19 induced #AKI in critically ills with #SARSCoV2 #Coronavirus infection: several mechanisms possibly involved, prevalent, associated with poor outcomes/high mortality rates in #ICU &, to date, no specific treatment. Open access #FOAMcc #COVIDFOAM rdcu.be/b4SWR
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As announced, the "Surviving Sepsis Campaign: Guidelines on the Management of Critically Ill Adults with Coronavirus Disease 2019 (COVID-19)" are now online. Thanks for all the efforts to the authors, @ESICM, @SCCM and @yourICM and @CritCareMed staff. esicm.org/wp-content/uploads…
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#ICU delirium 🏥 well described short-term effects: ⬆️ hospital mortality, MV duration, ICU/hospital LoS 📚 more recent findings related to long-term outcomes (≥ 6 months post-ICU) How to mitigate this serious acute BI & its long-term burden? #FOAMcc 🖇️ rdcu.be/c8q69
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Monitoring pain in #ICU ➡️ self‐assessment tools in pts able to self‐report ➡️ observational behavioural scales in pts unable to self‐report ➡️ physiologic parameters in pts unable to self‐report nor express behaviours (deep sedaution, NMBAs) #FOAMcc 🖇 rdcu.be/cSGcB
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Breathing effort on ventilator 🫁 monitoring inspiratory effort w Pes 🫁 monitoring respiratory drive & effort w/o Pes Validated non-invasive tools, allowing bedside detection/quantification of effort are now available: time to start monitoring! #FOAMcc 🔓 bit.ly/3P4q64l
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Fluid de-escalation ☔️ should I withdraw fluids? ☔️ is it right time to attempt fluid withdrawal? Tissue perfusion = adequate + pts must not be preload responsive ☔️ how to proceed? ☔️ when to stop? ☔️ how to react when hemodynamic instability occurs? 🖇️ bit.ly/43CeVnQ
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Predicting fluid responsiveness in #ICU to avoid administration to patients who do not need & give when needed, allowing for truly personalized treatment 💧fluids could be harmful 💧fluids could be inconstantly effective #FOAMcc free to read on @yourICM 🖇️ rdcu.be/cYS0J
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10 things we learned about #COVID19 1 #SARSCoV2 #Coronavirus 2 The infection 3 Immunity 4 Inflammation 5 Thrombosis 6 Diagnostic tests 7 Clinical aspects 8 Therapy 9 Anti #SARSCoV2 vaccines 10 Preparedness & further research Open access #FOAMcc #COVIDFOAM rdcu.be/b4F1D
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Finally online:#COVID19 pneumonia: different respiratory treatments for different phenotypes? on @yourICM by @gattinon FREE READ doi.org/10.1007/s00134-020-0……
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Understanding pathophysiology of hemostasis disorders in critically ill patients with COVID-19. Free read at rdcu.be/b4dFv @yourICM @Dr_Cit @ClinMedJournals @ESICM
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Intubation in critical adults with physiologically difficult airway, consensus & expert statements @SOCCA_CritCare ➡️location + factors ⬆️complications ➡️team preparation + human factors ➡️pt preparation & optimization ➡️procedure ➡️post‑intubation care 🖇️ bit.ly/3AFcasZ
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Norepinephrine? understanding effective dose critical! 💉original investigations 💉pooled estimates in MA 💉trials for drug approvals 💉application of findings at bedside 🖇️ rdcu.be/dbyVG Refers to reply on NE dosage in SSCG 🖇️ rdcu.be/cJuvz #FOAMcc @yourICM
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