Discover and read the best of Twitter Threads about #intensivecare

Most recents (24)

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
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
Read 4 tweets
🧠 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… ImageImageImageImage
✅ 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
✅ 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
Read 5 tweets
“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
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
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.
Read 4 tweets
New to the ICU?

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#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

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If you're new to mechanical ventilation, this will give you the basics

osler.app.link/dnoTmYYRkvb

#mechanicalventilation
Read 12 tweets
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
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
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
Read 17 tweets
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
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.
Read 11 tweets
FINAL day 2 of 2 : WEANING . Lisanne Roesthuis. Weaning definitions starting with WIND study. #LIVES2022
#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
Read 18 tweets
NEXT :: COPD - Oriole Roca.
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
@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?
Read 20 tweets
Patient failing weaning on trachy?
Just do a bronchoscopy without positive pressure
Read 20 tweets
#LIVES2022 #IntensiveCare #MechanicalVentilation @ESICM

SBT t-tube or PS

No one in the audience use t-tube anymore
Little support = little pregnant 😜
Respiratory load and respiratory capacity
Read 8 tweets
#LIVES2022 #IntensiveCare #MechanicalVentilation @ESICM
The future of ARDS ventilation
What are the possibilities
Different acronym for same mode of ventilation
Can we have universal language for MV ?
Read 17 tweets
40 years of ECMO
What have change is understanding of MV
🫁 Focus on protection
Read 20 tweets
#LIVES2022 #IntensiveCare #MechanicalVentilation @ESICM

Prone position
Dr Lise Piquilloud
Why we should use prone position
PROSEVA huge impact on mortality
Read 15 tweets
#LIVES2022 #IntensiveCare #MechanicalVentilation @ESICM

impact of MV on 🫘

Dr Antoine Schneider
Association is not causation
Read 13 tweets
#LIVES2022 #IntensiveCare #MechanicalVentilation @ESICM

Impact of mechanical ventilation on 🧠
Prof. Jean-Daniel Chiche
The crosstalk
Read 9 tweets
#LIVES2022 #IntensiveCare #MechanicalVentilation @ESICM

63% develops diaphragm dysfunction just after 3 days of mechanical ventilation 🤯
Pathophysiology of diaphragm dysfunction
Proof of concept
Diaphragm protective ventilation
Read 4 tweets
#LIVES2022 #IntensiveCare #MechanicalVentilation @ESICM
Prof. Giacomo Grasselli on asses respiratory mechanics during assist mechanical ventilation Image
Image
Image
Read 10 tweets
#LIVES2022 #IntensiveCare #MechanicalVentilation @ESICM

Next Professore Massimo Antonelli on helmet ventilation Image
First RCT
Mask NIV vs Helmet Image
Better recruitment with helmet Image
Read 11 tweets
#LIVES2022 #IntensiveCare #MechanicalVentilation @ESICM

Start with NIV in acute hypoxemic failure Image
Image
Standard Oxygen, NIV, HFNC, CPAP ?
Read 17 tweets
🧵 #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.
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
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.
Read 19 tweets
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)
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.
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.
Read 15 tweets
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/
Read 6 tweets

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