ICU Circulation Secrets:

The phenomenon of "hemodynamic incoherence" is observed when microcirculatory dysfunction persists despite the restoration of macro-circulatory indices

In this case, MAP was 88 mmHg & cardiac index was 2.8 l/min/m2 on a small dose of norepinephrine

ICU Studies - Return to the Classics:

It’s been ~25 yrs since the ARMA study showed that ventilation of ARDS patients with a lower tidal volume (Vt) results in ⬇️ mortality & ⬆️ the number of days without ventilator use. It’s also common belief that using volume-controlled (VC)

Rapid prediction of acute thrombosis via nanoengineered immunosensors with unsupervised clustering for multiple circulating biomarkers A nanoengineered immunosensor uses machine learning to detect multiple biomarkers for rapid prediction of acute thrombosis.

Predicting clotting events in 49 of 53 people with Covid!
An immunosensor that rapidly detects 4 different protein biomarkers
science.org/doi/10.1126/...

DDAVP 0.3-0.4 mcg/kg IV ↑ VWF & factor VIII release. VWF binds GPIIb-IIIa receptor on platelets, causing aggregation = antiplatelet reversal.

DDAVP ↑ platelet function in patients on antiplatelet like P2Y12i (PMIDs: 18068065,1434725,8330156)

#medsky #EMsky #pharmsky #HMsky

Obituary: Luciano Gattinoni - ESICM In Memory of Professor Luciano Gattinoni

A sad day for critical care - and what a phenomenal legacy he has left us.

RIP Prof Gattinoni, a Giant ⚕️📟

www.esicm.org/obituary-luc...

VExUS: common misconceptions, clinical use and future directions - The Ultrasound Journal There has been a significant interest in venous congestion in recent years, among which the VExUS score has been prominent, both in clinical practice and research efforts. We have noted some recurrent...

'we review the physiological basis of the VExUS assessment as a measure and marker of venous congestion from the organs’ standpoint and its role as part of the emerging concept of fluid tolerance' #pocus #pocusky #emimcc #cardiosky #vexus
theultrasoundjournal.springeropen.com/articles/10....

Critical point

Decoding VExUS: a practical guide for excelling in point-of-care ultrasound assessment of venous congestion

CCR Journal Watch
criticalcarereviews.com/latest-evide...

Get the latest critical care literature every weekend via the CCR Newsletter - subscribe at criticalcarereviews.com/newsletters/...

Rant #1: Salbutamol is poison...

Salbutamol is prescribed freely by trainees and frequently requested by nurses for "wheeze" on ICU and/or as a hangover from initial managment in ED.

It is not a benign drug though and more careful thought is required before prescription

#medsky #ansky #icusky