Discover and read the best of Twitter Threads about #intensivecare
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🫁 Physics of lung US 🫁
#lungultrasound
#ICU #CriticalCare #IntensiveCare #IntensiveCarecommunity #FOAM #JCardenas_MD #MICU #CICU @JCardenas_MD
#lungultrasound
#ICU #CriticalCare #IntensiveCare #IntensiveCarecommunity #FOAM #JCardenas_MD #MICU #CICU @JCardenas_MD
1️⃣(Left) Ultrasound waves reflected at the pleural line creating A-line reverberation artifacts.🫁
#lungultrasound
#ICU #CriticalCare #IntensiveCare #IntensiveCarecommunity #FOAM #JCardenas_MD #MICU #CICU @JCardenas_MD
#lungultrasound
#ICU #CriticalCare #IntensiveCare #IntensiveCarecommunity #FOAM #JCardenas_MD #MICU #CICU @JCardenas_MD
2️⃣(Center) As the interstitium thickens, the artifact pattern changes, with B-line artifacts obliterating A-lines. B-lines are hyperechoic vertical artifacts arising from the pleural line extending to the bottom of the field of view. 🫁
#lungultrasound
#lungultrasound
🧠 Intracranial pressure (ICP): current perspectives on physiology and monitoring 🧠 #FOAMcc #NeuroCritCare #FOAMed #EMCCM #NeuroICU #NeruroMonitoring #IntensiveCare #CriticalCare #MedEd 📖 Intensive Care Med (2022) 48:1471–1481
📖 doi.org/10.1007/s00134…
📖 doi.org/10.1007/s00134…
✅ ICP monitoring is now viewed as integral to the clinical care of many life-threatening brain insults, such as severe traumatic brain injury, subarachnoid hemorrhage, and malignant stroke.
#FOAMcc #NeurocritCare
#FOAMcc #NeurocritCare
✅ It serves to warn of expanding intracranial mass lesions, to prevent or treat herniation events as well as pressure elevation which impedes nutrient delivery to the brain. #FOAMcc #NeuroCritCare
“Ten tips to optimize #vasopressors use in the critically ill patient with #hypotension.” #IntensiveCare #MedTwitter #CardioTwitter #sepsis #FOAMed #FOAMcc #CriticalCare #EmergencyMedicine #PedsICU #ICU #EMCCM
📚 Intensive Care Med (2022) 48:736–739 rdcu.be/c57Se
📚 Intensive Care Med (2022) 48:736–739 rdcu.be/c57Se
1. Set goals of mean or diastolic blood pressures.
2. Individualize the arterial pressure targets goals.
3. Vasopressors induce an endogenous fluid recruitment and may limit positive fluid balance.
4. Reassess fluid status and cardiac output after initiation of vasopressors
2. Individualize the arterial pressure targets goals.
3. Vasopressors induce an endogenous fluid recruitment and may limit positive fluid balance.
4. Reassess fluid status and cardiac output after initiation of vasopressors
5. Consider agents with a different mechanism of action as a second line agent.
6. Consider adding hydrocortisone in patients on high doses of vasopressors.
7. Vasopressin is an option in patients with right ventricular failure.
8. There is no maximal dose of vasopressors.
6. Consider adding hydrocortisone in patients on high doses of vasopressors.
7. Vasopressin is an option in patients with right ventricular failure.
8. There is no maximal dose of vasopressors.
New to the ICU?
Osler's catalogue of modules is completely free, and you can even print off a certificate of completion for your records!
Here's 10 great modules to get you started
#intensivecare #intensivist #ICU #FOAMed #FOAMcc #medtwitter @CICMANZ @anzics @ANZCA @acemonline
Osler's catalogue of modules is completely free, and you can even print off a certificate of completion for your records!
Here's 10 great modules to get you started
#intensivecare #intensivist #ICU #FOAMed #FOAMcc #medtwitter @CICMANZ @anzics @ANZCA @acemonline
If your're going to do invasive procedures, you need to get the basics right
osler.app.link/CztXIRjyntb
osler.app.link/CztXIRjyntb
If you're new to mechanical ventilation, this will give you the basics
osler.app.link/dnoTmYYRkvb
#mechanicalventilation
osler.app.link/dnoTmYYRkvb
#mechanicalventilation
MAPSE in #IntensiveCare (with examples)🧵#FOAMcc #FOAMed #MedTwitter #Hemodynamic #POCUS #EchoFirst #CriticalCare
Take homes:
1⃣ Redefining "the hyperdynamic heart" with #MAPSE
2⃣ MAPSE is better than EF in the #ICU
3⃣ Linking MAPSE with supply/demand-ischemia
1/n
Take homes:
1⃣ Redefining "the hyperdynamic heart" with #MAPSE
2⃣ MAPSE is better than EF in the #ICU
3⃣ Linking MAPSE with supply/demand-ischemia
1/n
1⃣ Can MAPSE redefine "the hyperdynamic heart?
The term "hyperdynamic LV" - EF > 55% - is misleading. It has no relation to a hyperdyanmic circulation; SV/CO. Someone bleeding to death has a hyperdynamic heart, but the circulation is life-threatening hypodynamic.
2/n
The term "hyperdynamic LV" - EF > 55% - is misleading. It has no relation to a hyperdyanmic circulation; SV/CO. Someone bleeding to death has a hyperdynamic heart, but the circulation is life-threatening hypodynamic.
2/n
MAPSE is cardiac motion, and defining the hyperDYNAMIC heart as good cardiac motion makes perfect sense. Recent geometrical analysis of cardiac pumping shows that MAPSE is the main determinant of SV. Fig from @mugander: tinyurl.com/mxbfmcyk
Why?
3/n
Why?
3/n
Starting with "Whats *HOT* in data science?" Kirsten COLPAERT
- hype cycle for data science & ML in 2022.
- innovation trigger -> peak of inflated expectations -> trough of disillusionment
#LIVES2022
#datascience #WeAreICU #TogetherICU #IntensiveCare #CriticalCare @ESICM
- hype cycle for data science & ML in 2022.
- innovation trigger -> peak of inflated expectations -> trough of disillusionment
#LIVES2022
#datascience #WeAreICU #TogetherICU #IntensiveCare #CriticalCare @ESICM
Still some time for newer tools. Aiming for path towards productivity.
Potential usage of "Synthetic data" to "preserve privacy" and "augment unbalance/or biased data". This is potentially interesting as it allows more transportability of models from one health care system to others.
FINAL day 2 of 2 : WEANING . Lisanne Roesthuis. Weaning definitions starting with WIND study. #LIVES2022
#ventilation
#weaning #WeAreICU #TogetherICU #IntensiveCare #CriticalCare
@ESICM
#ventilation
#weaning #WeAreICU #TogetherICU #IntensiveCare #CriticalCare
@ESICM
@ESICM pubmed.ncbi.nlm.nih.gov/27626706/ Successful weaning (or successful separation) - extubation without death or reintubation within next 7 days. same for tracheostomy.
Different groups and trajectories
NEXT :: COPD - Oriole Roca.
Evidence : NIV is great for acute COPD. The classic from Laurent Brochard pubmed.ncbi.nlm.nih.gov/7651472/
Evidence : NIV is great for acute COPD. The classic from Laurent Brochard pubmed.ncbi.nlm.nih.gov/7651472/
but if beyond 24 hours. alternative is High flow nasal cannulae.
#LIVES2022
#ventilation
#NIV #COPD @ESICM
#LIVES2022
#ventilation
#NIV #COPD @ESICM
@ESICM NIV failure - intubat the patient, COPD patient intubated, Vol Control, 7ml/kg PBW, I:E = 1:4 , RR 20. Then patient is "hypotensive". why?
Patient failing weaning on trachy?
Just do a bronchoscopy without positive pressure
Just do a bronchoscopy without positive pressure
#LIVES2022 #IntensiveCare #MechanicalVentilation @ESICM
SBT t-tube or PS
No one in the audience use t-tube anymore
SBT t-tube or PS
No one in the audience use t-tube anymore
Little support = little pregnant 😜
Respiratory load and respiratory capacity
What are the possibilities
Different acronym for same mode of ventilation
Can we have universal language for MV ?
Can we have universal language for MV ?
40 years of ECMO
What have change is understanding of MV
🫁 Focus on protection
🫁 Focus on protection
Why we should use prone position
PROSEVA huge impact on mortality
Association is not causation
#LIVES2022 #IntensiveCare #MechanicalVentilation @ESICM
Impact of mechanical ventilation on 🧠
Prof. Jean-Daniel Chiche
Impact of mechanical ventilation on 🧠
Prof. Jean-Daniel Chiche
The crosstalk
#LIVES2022 #IntensiveCare #MechanicalVentilation @ESICM
63% develops diaphragm dysfunction just after 3 days of mechanical ventilation 🤯
63% develops diaphragm dysfunction just after 3 days of mechanical ventilation 🤯
Pathophysiology of diaphragm dysfunction
Proof of concept
Diaphragm protective ventilation
Diaphragm protective ventilation
#LIVES2022 #IntensiveCare #MechanicalVentilation @ESICM
Prof. Giacomo Grasselli on asses respiratory mechanics during assist mechanical ventilation
Prof. Giacomo Grasselli on asses respiratory mechanics during assist mechanical ventilation
#LIVES2022 #IntensiveCare #MechanicalVentilation @ESICM
@DrLeoHeunks on invasive ventilation in asthma / COPD
@DrLeoHeunks on invasive ventilation in asthma / COPD
#LIVES2022 #IntensiveCare #MechanicalVentilation @ESICM
Next Professore Massimo Antonelli on helmet ventilation
Next Professore Massimo Antonelli on helmet ventilation
First RCT
Mask NIV vs Helmet
Mask NIV vs Helmet
Better recruitment with helmet
Standard Oxygen, NIV, HFNC, CPAP ?
🧵 #LivingLongCovid
Some maybe already know me probably% and maybe my story.
I am a #HealthCareWorker and since before and at the beginning of #COVID19 I have worked in the #ICU saving lives and learning about #IntensiveCare
I've had #COVID19 3 times so far this pandemic.
Some maybe already know me probably% and maybe my story.
I am a #HealthCareWorker and since before and at the beginning of #COVID19 I have worked in the #ICU saving lives and learning about #IntensiveCare
I've had #COVID19 3 times so far this pandemic.
I developed #LongCovid from my 2nd contagion that was serious at the time, I required hospitalization in #ICU and oxygen therapy.
Since Dec 2020 I have lived with #LongCovid since then and when I understood the Multi-organic gravity of #LongCovid
Since Dec 2020 I have lived with #LongCovid since then and when I understood the Multi-organic gravity of #LongCovid
I SURVIVED!
And I still do it daily.
A few days ago I had a 2nd #InfarctionSilent a year ago I had a multiorgan failure accompanied by #infarctionSilente
We know that #COVID19 can cause #myocarditis and that is possibly the case, I don't know yet.
I tell you now.
And I still do it daily.
A few days ago I had a 2nd #InfarctionSilent a year ago I had a multiorgan failure accompanied by #infarctionSilente
We know that #COVID19 can cause #myocarditis and that is possibly the case, I don't know yet.
I tell you now.
1 Welcome to #researchmethodologies with @DrAoifeBee
Kaplan-Meier (KM) curves are a wonderfully informative way of presenting survival outcomes over time. But how do we interpret them? Survival analysis determines the probability of a binary outcome (aka an event or a failure)
Kaplan-Meier (KM) curves are a wonderfully informative way of presenting survival outcomes over time. But how do we interpret them? Survival analysis determines the probability of a binary outcome (aka an event or a failure)
2/15
Survival means the event being studied has not occurred yet - the patient is still alive if you’re analysing mortality, the baby has not been delivered if analysing births, the patient has not yet met whatever criteria you have decided constitutes an event in your study.
Survival means the event being studied has not occurred yet - the patient is still alive if you’re analysing mortality, the baby has not been delivered if analysing births, the patient has not yet met whatever criteria you have decided constitutes an event in your study.
3/15
In medical research, the binary outcome of interest is commonly survival vs death though other outcomes/events can be used. KM curves are a visual way of showing the fraction of patients living over time after a treatment, or lack of treatment if in a control group.
In medical research, the binary outcome of interest is commonly survival vs death though other outcomes/events can be used. KM curves are a visual way of showing the fraction of patients living over time after a treatment, or lack of treatment if in a control group.
At the end of a run of 5 busy, long, exhausting days and I'm so, so proud to be able to turn up each day to work alongside such an amazing, empathetic, wonderful team of people. To those who have welcomed us into their home in theatre, those who have stood up and joined 1/
our team when it's scary and overwhelming, those who have welcomed and supported them, those who have been caring for the sickest of patients and their families, and those who have sat with patients at the end, holding their hand, talking to them and making sure noone is alone 2/
Nurses, healthcares, physios, consultants, domestics, pharmacists, doctors, paramedics, porters, managers all piling in...
We have moved half an intensive care unit, set up a whole new one, developed and adapted hour by hour all the while looking after more patients than 3/
We have moved half an intensive care unit, set up a whole new one, developed and adapted hour by hour all the while looking after more patients than 3/
