New 📝 We know RV dysfunction occurs on VV-ECMO in ARDS despite ECMO mitigating many of the traditional RV dysfunction risk factors (hypercapnia etc) We don’t understand RV function dynamically over time on ECMO…

@gurujosh.bsky.social presents the results of the MSSA domain of the SNAP 🫰 trial at #ESCMID2025 fluclox caused more acute kidney injury than cefazolin; early mortality favored cefazolin Absolutely Herculean effort by the entire global trial team and practice changing data #teamcefazolin

Have you ever wondered what it takes before a clinical trial ends up in your timeline? Well… we recently published the DDx-BRO trial ⬇️ Here is a 🧵 of its lifecycle: from 💡to 🏁, well, if the latter actually exists.

Core outcome set of daily monitoring of gastrointestinal function in adult critically ill patients: a modified Delphi consensus process (COSMOGI) Thanks to @criticalcarereviews.com ccforum.biomedcentral.com/articles/10....

#Halo #SwissMountains #Freeride

I got tired of opening a dozen PDFs to find the ECMO pressure/flow curve I need. So I made an app! Choose the cannula/size and you can see the max flow for a given pressure drop. Or compare multiple different cannula. Lmk what ya’ll think. Useful? What’s it need? onepagericu.com/ecmo-calcula...

Let us start 2025 in a positive mood: here are 10 methods things researchers can worry *less* about in 2025

ICYMI #emimcc

This was a fun study leveraging social media to demonstrate the high prevalence in Impella malrotation among cases shared on old Twitter. If it's malrotated, but it works well, without suction alarms or other problems, do you change it? #cccsky #cardiosky #emimcc www.pcronline.com/News/Whats-n...

Fresh off the press: COSMOGI 🗞️🗞️🔥🔥 What variables should we use to daily monitor #gastrointestinal function in #criticalcare? We have developed a core outcome set and have defined 13 variables for daily GI assessment. Published today in Critical Care: ccforum.biomedcentral.com/articles/10....

#MedSky #EMIMCC #IDsky #cardiosky @pulmcrit.bsky.social What is the culture at your hospital for potassium replacement? At most hospitals I'm at it seems to be a culture of replace to K 4.0 and the individual doctor makes the call. This paper confirms my bias... jamanetwork.com/journals/jam...

Results of the #SAHARAtrial released after #CCRdownunder. A lot to discuss… www.nejm.org/doi/full/10.... #neurocriticalcare

Awesome and interesting work by the late Luciano Gattinoni and colleagues. #emimcc

#ADAPTtrial released & the results are interesting… Compared to SOC, Procalcitonin guided antibiotics in sepsis resulted in: - FEWER antibiotic days: 10.7 vs 9.8 (p=0.01) BUT - HIGHER 28 day mortality: 19.4% vs 20.9% (p=0.02) though this did not meet the pre-specified non-inferiority margin 🤔 1/

The #Renovate Trial was just published. Kudos to the authors for this large trial. HFNO was non-inferior to NIPPV in 1776 patients with acute respiratory failure. I have some comments and discussions; feel free to join in. 👇 1/n #emimcc #ccr

It's amazing that Esmolol can show such consistency in effect size that has never been seen in sepsis, while Landiolol has a natural variation across trials. Add to that that the single trials vary more than the larger multicenter trials and one might almost get suspicious... #emimcc

1/ Anemia happens frequently in our aSAH patients. These patients are at risk for delayed cerebral ischemia and other neurologic insults It would seem having adequate oxygen to the brain tissue would be a good thing to prevent such injury. But how much hgb is adequate? A #skytorial on SAHARA

#PCCMSky Update 146 members- only 4 more slots in this starter pack Repost so the noobs know who the cool PCCM kids are Reply if you are not included and should be (make sure your creds are in your bio I am not putting randos on here) go.bsky.app/88wg6oG

jamanetwork.com/journals/jam... ADAPT-SEPSIS just published in JAMA #ccrdownunder

👇ICU strain is measurable & impacts outcomes. “Measuring the Impact of ICU Strain on Mortality, After-Hours Discharge, Discharge Delay, Interhospital Transfer, and Readmission in Australia With the Activity Index.” David Pilcher et al. 🩺Critical Care Medicine. 🔗 journals.lww.com/ccmjournal/f...

Skytorial: pH management in DKA! I've been following debates about this for a *long* time (eg wrote this blog in 2016, which stands up pretty darn well: emcrit.org/pulmcrit/bic...) after years of arguing, lemme break down my take on this 😁

Let‘s go! #brandonsanderson #stormlightarchive #windandtruth

⬆️ ICP means avoiding central catheterization of internal jugular due to ⬇️ venous return, right? Wrong, according to work by my colleagues! @emoryneurocrit.bsky.social "Contrary to classic teaching ... IJ CVC placement was not associated with increased ICP" pubmed.ncbi.nlm.nih.gov/39592540/

Are you interested in #Sustainability in #Anesthesiology and how reusing TIVA lines could help reduce greenhouse gas emissions? Per Werner Moller, originally an expert in #AppliedPhysiology and #VenousReturn, discusses their environmental paper on the #EJA podcast. open.spotify.com/episode/2RCa...

Sadly, one of the great minds of intensive care medicine, Luciano Gattinoni, has passed away. His work is beyond impressive and has shaped many concepts that remain a hallmark of critical care. www.esicm.org/obituary-luc...

Since we’re entering the last month of 2024, here is a non-systematic review of #pulmcrit trials published this year that I found particularly noteworthy. Not comprehensive, so please include any that I may have missed! (🧵1/11) #emimcc #critcare #pulmsky #medsky

This is a not uncolmon scenario in the ICU. I have seen this in long term neuro ICU patients on valproat with sepsis during their ICU stay and mero being because of suspected multiresistant bacteria.

A thread 🧵 on trials I think have changed or will change ICU practice (at least my own). #emimcc

Really pleased with this one. Does what it says on tin. First ever risk assessment tool for pulmonary endarterectomy and open source/free to use pubmed.ncbi.nlm.nih.gov/39603669/

#POCUSky The M-Mode of Olympic Timekeeping: the same prinicple applies by sampling a line at multiple timepoints rather than sampling multiple lines (i.e. 2D image) at one timepoint. youtube.com/shorts/7SkiL...

high-flow for preox is so 2023… all the cool kids are using bilevel now PREOXI trial: https://emcrit.org/pulmcrit/bsi/ #EMIMCC

Definitely worth a read if you‘re interested in venous return physiology and how it relates to Vexus.

Skytorial: Piptazo vs Cefepime 😁 Recently this JAMA-IM paper correlating piptazo with mortality has gained a weird amount of attention (It's been out for months so it's not really new) This one of the most methodologically horrific papers I've ever seen Lets talk real quick about the paper...

State the obvious! 🏥ℹ️ High turnover of nurses and doctors suggests a potential risk for patients. Therefore, retention of healthcare staff should be a priority to improve continuity and quality of care for patients. #medsky doi.org/10.1136/bmj....

Feels right that my 1st post here should be to share this incredible RCT, led by my PhD supervisor Nick Daneman: www.nejm.org/doi/full/10.... Main takeaway: 7-days of abx should be the standard of care for patients with uncomplicated non-S. aureus BSI. A deep dive 🧵: #IDsky

This was a PA/PAOP tracing of a patient with severe mitral regurgitation. In mitral regurgitation, there can be a high V wave when the PAC is in Wedge/PAOP position. If not recognised properly, this can easily be missed. Check out rdcu.be/d05K0 for more insights into estimating LAP.

Just saw 2 ICU hyperNa cases, so here's a #medsky #nephsky🧵 on why... 🤨 Out: Solute-free H2O clearance 😎 In: Electrolyte-free H2O clearance 🫘 1st was recovering from AKI -->⬆️ filtered urea load as the BUN ⬇️ 🥩 2nd was receiving very high protein tube feeds -->⬆️ filtered urea load with stable BUN

#PCCMSky Update Up to 95 members Repost so those new to this place can populate their following list with good PCCM people Reply if you are not on this list and should be go.bsky.app/88wg6oG

How do you define parenteral nutrition? What seems intuitive for clinical practice, is not well defined in research. Read our latest correspondence here: ccforum.biomedcentral.com/articles/10.... We need a global consensus on a detailed definition of PN. #FREM #emimcc #CriticalCare #Nutrition

www.bjanaesthesia.org/article/S000... An important piece of work that I think everyone in Academia (or close to it) should read! #MedSky Misconduct is a serious issie we all should be aware of and should be talking about. Congrats to the authors for writing and publishing this!

So what‘s going on here? Any ideas? #emimcc #cardiosky #criticalcare #MedSky

#PCCMSky starter pack update 66 of us We could use more Reply if you are not on it and I will remedy Use it to find good folks to follow And feel free to REPOST so others see it (there is not algorithm here so liking stuff doesn't make it get seen anymore than not)

Bringing one of our recent pubs to this platform for those interested in #ThePeoplesVentricle emimcc doi.org/10.1002/pul2...

First chapter to launch: PAC-based cardiac output measurements authored by Eugene Yuriditsky, MD #emimcc shockwaves.icu/app/page/1uw...

So here goes my first "#skytorial" on one of our studies. Looking forward to your feedback and the discussions (1/n): Interested in how the RV adapts to preload and afterload changes? rdcu.be/d0AT7

For those unfamiliar with the geometric concepts of ventricular strain, here's a cheatsheet for quick reference

Post a picture you took (no description) to bring some Zen into the timeline.

#BlueSky we just hit 18M. I hope the servers can handle the amount of traffic; Cool to see so many are transitioning and that journals are picking up on this too. Looking forward putting my #bluesky handle on the next publication we do… :) #MedSky

My old boss wrote an awesome publication on this: Low shunt (top left): SpO2 stays high despite poor cardiac output. High shunt (bottom right): SpO2 plummets unless cardiac output is very high. Figure reproduced from Takala, ICM 2007 using #MatLab link.springer.com/article/10.1...