Romain Barthélémy

Therefore, yes. There is a separate effect in hypoxia with vasodilators: one from impairment of HPV and one from the increase in CO

Haemodynamic impact of positive end-expiratory pressure in SARS-CoV-2 acute respiratory distress syndrome: oxygenation versus oxygen delivery - PubMed Haemodynamic impact of positive end-expiratory pressure in SARS-CoV-2 acute respiratory distress syndrome: oxygenation versus oxygen delivery

If PaO2 increase with PEEP but CO decrease, it’s not alveolar recruitment
We most recently tried to highlight this in this paper

pubmed.ncbi.nlm.nih.gov/33223045/

Depression of cardiac output is a mechanism of shunt reduction in the therapy of acute respiratory failure - PubMed The relationship between changes in cardiac output and intrapulmonary shunt associated with mechanical ventilation was evaluated in 20 patients with the adult respiratory distress syndrome (ARDS). The distribution of ventilation-perfusion (VA/Q) ratios and the level of intrapulmonary shunt was deter …

It is an overlooked effect by which PEEP improves PaO2

pubmed.ncbi.nlm.nih.gov/6988180/

Influence of cardiac output on intrapulmonary shunt - PubMed The effect of changing cardiac output on intrapulmonary shunt was studied in the setting of hemorrhagic pulmonary edema induced by intravenous oleic acid in 17 alpha-chloralose-anesthetized dogs. The dogs were mechanically ventilated and cardiac output was alternately depressed and augmented using e …

There’s an impact of change in CO on Qs/Qt, it has been known for decades and the same magnitude of effect is observed whether CO is manipulated pharmacologically or mechanically

pubmed.ncbi.nlm.nih.gov/422447/

Systemic tolerance of intravenous milrinone administration for cerebral vasospasm secondary to non-traumatic subarachnoid hemorrhage - PubMed Intravenous milrinone for CVS treatment seems associated with significant impact on systemic hemodynamics leading sometimes to treatment discontinuation.

In the case of milrinone used in treatment of cerebral vasospam following SAH, we observed an increase in hypoxemia as well as an increase in CO
pubmed.ncbi.nlm.nih.gov/38579430/

Pure vasodilators might decrease hypoxic pulmonary vasodilation, but in the case of inodilators (milrinone), the increase in CO will lead to an increase in Qs/Qt

Professor Jan Bakker presented the interesting relationship between CVP and prediction of respiratory weaning failure

💦An early increase in CVP >= 5mmHg is highly predicative of weaning failure

#ISICEM25

In Brussel for #ISICEM25 🇧🇪

The 44th International Symposium on Intensive Care & Emergency Medicine

2nd day starts with a great session on subphenotying at #ISICEM25

Why do we bother about subphenotypes?

First talk by @seymoc.bsky.social

@ISICEM.bsky.social

Jan BAKKER at #ISICEM25
Congestion coexisting w/ fluid responsiveness
With some @argaiz.bsky.social inside

#ISICEM25 | Endotypes & Mortality – A key framework for personalizing sepsis management. Understanding distinct biological profiles could shape targeted therapies and improve outcomes with Prof Evangelos Giamarellos–Bourboulis

#ISICEM25 | Over 300 posters showcased in 4 days, highlighting the latest breakthroughs in intensive care and emergency medicine. A deep dive into innovation, research, and future clinical practice! Don’t miss it!

Opening slide regarding Haemodynamic effects of Prone Positioning by Prof X. Monnet

Infographic describing potential outcomes of prone positioning g on the cardiovascular system

Four keys messages on the impact of prone positioning on patient Haemodynamics

Prof Xavier Monnet addresses the HD effects of prone positioning.

Great take homes about the risk of the waterfall effect and the use of Trendelenburg position in the prone patient to predict fluid responsiveness.

Linked paper below

#ISICEM25
#EMIMCC

ccforum.biomedcentral.com/articles/10....

Prof. Julia Wendon finishing her talk on acute on chronic liver failure (ACLF) and encouraging hepatology sustaining behaviours.

The liver IS evil.
Is does needs exercise

The day ends with a phenomenal talk from one of my favourite hepatologists - Prof Julia Wendon.

ACLF… a difficult topic that we all should know more about.

Prognosis is everything.
#ISICEM25
#EMIMCC

Figure 2. Comparison of Clinician-Observed Administration of Vasopressin With Treatment Recommended by the Reinforcement Learning Rule

The initiation of vasopressin following recommendations by a reinforcement learning model was associated with decreased mortality in patients with septic shock already receiving norepinephrine. https://ja.ma/3FOK2WU #ISICEM25

Visual Abstract. Inhaled Sedation in Acute Respiratory Distress Syndrome

Among patients with moderate to severe ARDS, inhaled sedation with sevoflurane resulted in fewer ventilator-free days at day 28 and lower 90-day survival than sedation with propofol. https://ja.ma/4kxDZGm #ISICEM25

Optimal Vasopressin Initiation in Septic Shock This multicenter study uses reinforcement learning to examine the treatment implications of a vasopressin initiation rule developed to improve short-term and hospital outcomes in critically ill adults...

At #ISICEM

Fodder for the evening run is gathering.

Not least the OVISS study looking at a reinforcement learning tool for the optimal timing of vasopressin introduction.

jamanetwork.com/journals/jam...

Association between cerebral oxygenation and usual parameters of cerebral perfusion in critically ill patients with acute brain injury In patients with acute brain injury (ABI), optimizing cerebral perfusion parameters relies on multimodal monitoring. This include data from systemic monitoring–mean arterial pressure (MAP), arterial c...

A good start to the year with the publication of this work in #JCBFM

pmc.ncbi.nlm.nih.gov/articles/PMC...

#neurocrit

I think it’s underappreciated how often aspiration is the symptom of worsening systemic illness rather then the cause

What do you think about radial vs femoral arterial catheters for blood pressure monitoring in shock? Risks vs benefits ? #emimcc #cccsky

New #neurocriticalcare guidelines from NCS 💡 Guidelines for Seizure Prophylaxis in Patients Hospitalized With Nontraumatics ICH: ow.ly/o7wi50UFCps

I am SO thrilled to share this paper, which has truly been a labour of love on a topic I care about deeply.

"Demystifying Volume Status: An Ultrasound-Guided Physiologic Framework," now published online in @accpchest

Let us know what you think!

#emimcc

journal.chestnet.org/article/S001...

Electrical impedance tomography monitoring in adult ICU patients: state-of-the-art, recommendations for standardized acquisition, processing, and clinical use, and future directions - Critical Care Electrical impedance tomography (EIT) is an emerging technology for the non-invasive monitoring of regional distribution of ventilation and perfusion, offering real-time and continuous data that can g...

read both links plz
.
'Electrical impedance tomography (EIT) is an emerging technology for the non-invasive monitoring of regional distribution of ventilation and perfusion' #p-sili #vili #pulmsky #critcaresky #emimcc #peep #ventilator
ccforum.biomedcentral.com/articles/10....

I think the appropriate outcome is still undefined

I can't believe it doesn't change the prognosis for survivors (which is the only real patient-centered outcome).

Liberal or Restrictive Transfusion Strategy in Aneurysmal Subarachnoid Hemorrhage | NEJM The effect of a liberal red-cell transfusion strategy as compared with a restrictive strategy in patients during the critical care period after an aneurysmal subarachnoid hemorrhage is unclear. We ...

Results of the #SAHARAtrial released after #CCRdownunder. A lot to discuss…

www.nejm.org/doi/full/10....

#neurocriticalcare

Sure, it’s Pinsky’s sense of humour. It’s the negative of the picture: a single value of HR APB CO CVP and presence/absence of peripheral oedema does not describe the hemodynamics of the patient

The VEntriculostomy-Related Infection Score: An Antibiotic... : Neurosurgery antibiotic therapy initiation when VRI is suspected. METHODS: This retrospective, single-center cohort study included patients admitted to the intensive care unit after EVD placement who were suspe...

Nice work from colleagues, confirming risks factors of ventriculatis in our cohort of #NeuroCriticalCare patients and proposing the VERI-score for risk stratification

journals.lww.com/neurosurgery...

It could be added to the Pinsky’s “Hemodynamic Monitoring Truths »

Lactate has the same clinical value as tachycardia: it tells you something is going on, but something may be going on anyway