🫁 Safe ventilation in #ARDS ?? Elusive... justifying use of #ECLS . Challenge is to treat lung disease effectively while mitigating injury risks. #FOAMcc Intensive Care Medicine
🔓 rdcu.be/dGq5p
In reply to
🔓rdcu.be/dGq6n
Refer to editorial on VILI
🔓rdcu.be/dGq6G

Fascinating work and makes sense - the dose of raised ICP throughout the 24-hour day impacts on patient outcome...

So happy to see our paper on ICP dose published in Intensive Care Medicine in 2015 (!) being reproduced once again - ICP toxicity is about dose, not about crossing a threshold Fabian Güiza

doi.org/10.1007/s00134…

🧠 ICP dose in neurological critical care: new visualization method to explore relationship between intensity & time burden of ICP exposure and all-cause mortality + to present intuitive approach for interpret & manage intracranial hypertension.
#FOAMcc
🔓 rdcu.be/dGilo

💉 Norepinephrine dose & concentration reporting Homogenizing practice to provide safer/more efficient care
🔓 rdcu.be/dGaxN

💉On comment on NE dose reporting/compounding
🔓 rdcu.be/dGayF

💉Refer to editorial focusing on NE dosing
🔓 rdcu.be/dGazg

#RRT in comatose pts with severe #AKI : harmful consequence of delaying initiation?
🔍 2 initiation strategies
🫘more-delayed vs currently recommended resulted in lower chance of awakening
🫘in selected pts RRT may reduce coma duration
🔓 rdcu.be/dF3qU
⬇️ visual abstract

How to manage emergencies in #LVAD recipients in #transplant centres?? British societies guideline #FOAMcc on Intensive Care Medicine
🇬🇧UK emergency algorithm development
⏱️initial response & initial/secondary responder
⚙️ #troubleshooting
🩸adequacy of circulation
🔓bit.ly/4ae1xus

Intensive Care Medicine 4/🔹Less inappropriate medication: first steps in medication optimization to improve post-intensive care patient recovery 👉rdcu.be/dFBvy
🔹Relationship between the arterial partial pressure of CO2 & outcomes in MV-acute brain injured patients 👉 rdcu.be/dFBuW

1/ Intensive Care Medicine's highlights:

🔹Visualizing ICP “Dose” of neurological critical care patients👉 rdcu.be/dFBuU
🔹Mild hypocapnia and outcomes in mechanically ventilated acute brain-injured patients: another piece in the puzzle 👉 rdcu.be/dFBuV

Prone positioning?? Used since 70s to improve oxygenation in patients with #ARDS . Here concise overview
🫁main pathophysiological findings
🫁supporting evidence & practical considerations for use
🫁awake proning in non-intubated pts
#FOAMcc on Intensive Care Medicine
🔓rdcu.be/dFIdO

Lung ultrasound in #ARDS
🖥️ LUS examination in ARDS
🖥️ diagnosis
🖥️ management
LUS essential to aid in diagnosis & monitoring progression + treatment response & offering potential for subphenotyping. #POCUS #echofirst
🎥 PS check supplementary videos!!
🖇️ bit.ly/49VMTXw

🧠I cannot agree more‼️ 🧐
Systemic inflammation = DELIRIUM
In a study published in Intensive Care Medicine
⬆️ IL-6, IL-8, IL-10, TNF-α, TNFR1 and ⬇️ protein C were associated with ICU delirium. WesElyMD
We have shown this with other markers
pubmed.ncbi.nlm.nih.gov/31684066/
pubmed.ncbi.nlm.nih.gov/31336587/

Systemic inflammation & #delirium in #ICU ?
🔍1000 critically ill pts
🧪higher inflammation markers/lower endogenous anticoagulant activity consistently associated w delirium/coma day following marker measurement + delirium/coma-free days over next week
🔓 rdcu.be/dFtSD

1/ Intensive Care Medicine's latest manuscripts of the topical collection 'ICU Toolbox':

🔹Monitoring esophageal pressure 👉 rdcu.be/dE18u
🔹Management of the brain-dead donor in the intensive care unit 👉 rdcu.be/dE18i

Improved data sharing, #AI model development and learning in #ICU :
💻 federated data access & federated learning #FL
💻 FL & bedside support
💻 advantages of FL
💻 challenges of FL
💻 data‑driven ICU medicine
Free to read #FOAMcc on Intensive Care Medicine
🔓rdcu.be/dFpVu

Mild hypocapnia & outcomes in pts w acute BI on MV
🧩 only after failure of initial interventions, ICP guided: NOT routine pre-hosp practice
🧩 ETCO2/PaCO2 often not directly comparable
🔓rdcu.be/dFkyl

Reply to🔓rdcu.be/dFkyU
Refer to🔓rdcu.be/dFky2

#ICMpn #OpenAccess
📢Have a look at what your peers are reading most.
A selection of most influential papers
rb.gy/wvh2wr

#neonates #criticalcare #Furosemide #kidneyInjury #premature #oxygentherapy #bronchiolitis #sepsis

More contents at rb.gy/ycnkql

Medication optimization to improve #ICU recovery!
🪜 reduce burden, stopping/tapering inappropriate ones
🪜 communicate plans for those required beyond ICU
🪜 review, restart, re-titrate long-term medications for pre-existing illnesses & multimorbidity
🔓 rdcu.be/dFfQU

Serum lactate poorly specific for hypoperfusion, more often associated with impaired tissue O2 use. Levels affected by 
⬆️ increased anaerobic glycolysis & ⬆️ aerobic glycolysis production
⬇️ impaired mitochondrial function
⬇️ reduced hepatic clearance
Potential harm may result…

Guiding resuscitation on serial lactate measurements? Not an accurate biomarker of hypoperfusion. However integration with clinical phenotyping + peripheral perfusion assessment could better individualize strategies
🔓rdcu.be/dFa9Y

Refers to
🔓rdcu.be/dFcL4