Discover and read the best of Twitter Threads about #ISICEM23
Most recents (7)
#ISICEM23
John J MARINI himself
Intracycle power and strain distribution are heterogenous
Flow rate and patterns are important
John J MARINI himself
Intracycle power and strain distribution are heterogenous
Flow rate and patterns are important
#ISICEM23
Luigi CAMPOROTA
Mechanical Power. Physiological basis. Pronostic tool.
Mechanical Power Ratio (measured/expected) better ?
Luigi CAMPOROTA
Mechanical Power. Physiological basis. Pronostic tool.
Mechanical Power Ratio (measured/expected) better ?
#ISICEM23
Paul MAYO
Safer endotracheal intubation
Praise to Samir Jaber in this field
Importance of processes and reassessments
Preemptive start of vasoopressors. Before hypotension occurs.
Paul MAYO
Safer endotracheal intubation
Praise to Samir Jaber in this field
Importance of processes and reassessments
Preemptive start of vasoopressors. Before hypotension occurs.
#ISICEM23
Pr Sheila MYATRA
Safer endotracheal intubation
Complications are frequent. Mostly hypotension...and propofol used as induction agent ?
CV collapse multifactorial
PREPARE I and II trials : fluid boluses mostly useless
Use capno to detect esophageal intubation +++
Pr Sheila MYATRA
Safer endotracheal intubation
Complications are frequent. Mostly hypotension...and propofol used as induction agent ?
CV collapse multifactorial
PREPARE I and II trials : fluid boluses mostly useless
Use capno to detect esophageal intubation +++
#ISICEM23
Craig JABALEY
The difficult airway
How to prevent periintubation hypoxemia ?
Adaptative approach for proexygenation, according to baseline hypoxemia. Awake intubation in some cases ?
Optimize 1st & VideoL
Craig JABALEY
The difficult airway
How to prevent periintubation hypoxemia ?
Adaptative approach for proexygenation, according to baseline hypoxemia. Awake intubation in some cases ?
Optimize 1st & VideoL
Day 3 of #ISICEM23 begins with
Sepsis: the first steps
There are many things to do in the first few hours of sepsis care, e.g.,
🦠Sampling for pathogens
💉Antibiotics
📝Severity assessment
🫀Resuscitation
This session will address a whole picture of the initial TO DOs!
@ISICEM
Sepsis: the first steps
There are many things to do in the first few hours of sepsis care, e.g.,
🦠Sampling for pathogens
💉Antibiotics
📝Severity assessment
🫀Resuscitation
This session will address a whole picture of the initial TO DOs!
@ISICEM
Sepsis prediction is challenging
🔸Heterogeneity
🔸High AUROC ≠ High utility in clinical context
🔸Poor generalizability to different settings (units, department)
🔸Necessity of prediction??
@ISICEM #ISICEM23
🔸Heterogeneity
🔸High AUROC ≠ High utility in clinical context
🔸Poor generalizability to different settings (units, department)
🔸Necessity of prediction??
@ISICEM #ISICEM23
Septic shock prediction @KhannaAshishCCM
🔸Hypotension increases the risk of death
🔸Patients at risk of shock development are the target population (proactive🟡 rather than reactive🔴)
🔸But continuous monitoring is lacking because they are out of ICU
@ISICEM #ISICEM23
🔸Hypotension increases the risk of death
🔸Patients at risk of shock development are the target population (proactive🟡 rather than reactive🔴)
🔸But continuous monitoring is lacking because they are out of ICU
@ISICEM #ISICEM23
A. Demoule: How to assess respiratory muscles strength? #ISICEM23
❌ EMG and p0.1 - they measure drive!
❌ Clinical Examination? - limb muscles ≠ diaphragm strength
- Patient on MV (Pressure Support):
✅ diaphragm ultrasound (TFdi)
✅ measure Pocc (occlusion pressure)
(1/3)
❌ EMG and p0.1 - they measure drive!
❌ Clinical Examination? - limb muscles ≠ diaphragm strength
- Patient on MV (Pressure Support):
✅ diaphragm ultrasound (TFdi)
✅ measure Pocc (occlusion pressure)
(1/3)
How to perform? #Diaphragm #Ultrasound #ICISEM23
❌ You cannot use if the patient doesn’t trigger the MV
➡️ Intercostal view
➡️ Linear probe
➡️ 8-9 IC space
➡️ Mid axillary line
➡️ 2D then M-Mode
✔️Diaphragm Thickening Fraction: TFdi
✔️ Weaning failure if TFdi < 29%
(2/3)
❌ You cannot use if the patient doesn’t trigger the MV
➡️ Intercostal view
➡️ Linear probe
➡️ 8-9 IC space
➡️ Mid axillary line
➡️ 2D then M-Mode
✔️Diaphragm Thickening Fraction: TFdi
✔️ Weaning failure if TFdi < 29%
(2/3)
❗️A low TFdi or Pocc predicts diaphragm weakness!
If patient is fully cooperative, try Maximum Inspiratory Pressure (high value excludes muscle weakness).
(3/3)
#ISICEM23
If patient is fully cooperative, try Maximum Inspiratory Pressure (high value excludes muscle weakness).
(3/3)
#ISICEM23
The #vasopressor session has started with 1️⃣“When is radial artery pressure unreliable?”
Detection
🔸Invasive vs Non-invasive
🔸Brain monitoring
🔸Mitral valve gradient
🔸Artery stenosis
🔸Waveform
👇Possible mechanisms of radial vs femoral differences
@ISICEM #isicem23
Detection
🔸Invasive vs Non-invasive
🔸Brain monitoring
🔸Mitral valve gradient
🔸Artery stenosis
🔸Waveform
👇Possible mechanisms of radial vs femoral differences
@ISICEM #isicem23
2️⃣Peripheral vasopressor use @HalliePrescott
🔸Low rates of complications reported up to 48 h with monitoring protocol
🔸Peripheral administration may avoid central line insertion (& its complications)
🔸Peripheral administration is becoming more common.
@ISICEM #isicem23
🔸Low rates of complications reported up to 48 h with monitoring protocol
🔸Peripheral administration may avoid central line insertion (& its complications)
🔸Peripheral administration is becoming more common.
@ISICEM #isicem23
3️⃣Early #norepinephrine infusion by Prof. JL Teboul.
🔸In 2018, 12% of intensivists used early norepinephrine but experts seemed to like it.
🔸Norepinephrine may increase preload/cardiac contractility
🔸Small RCTs suggest a trend of clinical benefits
@ISICEM #isicem23
🔸In 2018, 12% of intensivists used early norepinephrine but experts seemed to like it.
🔸Norepinephrine may increase preload/cardiac contractility
🔸Small RCTs suggest a trend of clinical benefits
@ISICEM #isicem23
Future sepsis therapies session💉🦠
Disease tolerance by Christopher Seymour @seymoc
🔸Difficulties in measurement
🔸May become a new focus in future clinical trials
@ISICEM #isicem23
Disease tolerance by Christopher Seymour @seymoc
🔸Difficulties in measurement
🔸May become a new focus in future clinical trials
@ISICEM #isicem23
Immune stimulation by Anthony Gordon @agordonICU
🔸Sepsis occurs as a result of dysregulated immune reactions.
🤔What happens when stimulating the immune system in patients with immune suppression?
A large RCT on GM-CSF is ongoing.
europepmc.org/grantfinder/gr…
@ISICEM #isicem23
🔸Sepsis occurs as a result of dysregulated immune reactions.
🤔What happens when stimulating the immune system in patients with immune suppression?
A large RCT on GM-CSF is ongoing.
europepmc.org/grantfinder/gr…
@ISICEM #isicem23
Important results presented during the opening ceremony #ISICEM23!
@ISICEM
✅ Hydrocortisone reduces mortality in sCAP (bit.ly/3ZbqHUc)
✅ Ravulizumab did not improve survival or other key outcomes in patients hospitalised with severe COVID-19 (bit.ly/3JVDdTm)
@ISICEM
✅ Hydrocortisone reduces mortality in sCAP (bit.ly/3ZbqHUc)
✅ Ravulizumab did not improve survival or other key outcomes in patients hospitalised with severe COVID-19 (bit.ly/3JVDdTm)
✅ no benefit in PCC administration in trauma patients at risk of massive transfusion (bit.ly/3Jvu7va)
✅ therapeutic-dose heparin: beneficial in hospitalized C19 patients less severely ill at presentation or lower body mass index (bit.ly/3Jq1uiE)
(2/3)
✅ therapeutic-dose heparin: beneficial in hospitalized C19 patients less severely ill at presentation or lower body mass index (bit.ly/3Jq1uiE)
(2/3)
✅ Low-calorie low-protein feeding (acute phase of critical illness): Faster recovery, fewer complications (bit.ly/3TtMg0X)
✅ In the absence of early parenteral nutrition, tight glucose control did not reduce duration of ICU dependency.
(3/3)
✅ In the absence of early parenteral nutrition, tight glucose control did not reduce duration of ICU dependency.
(3/3)
