#echofirst views of the right ventricle.
#POCUS #FOAMcc #Nephpearls
Courtesy: Bulwer, B.E. (2022) doi 10.1007/978-3-030-83864-5_21
#FOAMcc
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influence of #ECLS circuit & components
anticoagulant medications
monitoring & targets
monitoring & replacement of AT, fibrinogen, vWF antifibrinolytic & adjunct hemostatic agents
bleeding & thrombotic complications
priorities for clinical Research
#FOAMcc #FOAMecmo #PedsICU
Summary 
https://bit.ly/3RU7l5c
& special issue https://bit.ly/3XVOqL7
Selective digestive tract decontamination to prevent nosocomial infections in #ICU 
practical guidance
comprehensive implementation strategy 
multidisciplinary team: substantial group effort required!
Pharmacy & microbiology support essential for SDD, to be integrated in hospital Antimicrobial Stewardship Program and Infection Prevention policy. To be effective, meticulous execution of the full SDD protocol + bedside follow up required for every pr
#FOAMcc on @ICM https://rdcu.be/dL87U
Investigating in #sepsis??
tailoring treatment to individual needs
temporal dynamics of intervention
population selection challenges
choose appropriate endpoints
considerations on design
Editorial free to read #FOAMcc on @ICM https://rdcu.be/dL22c
Refers to 
stepped wedge, cluster randomized trial on impact of implementing 1-h bundle in patients with suspected sepsis in ED: not associated with a significant change in in-hospital mortality. https://rdcu.be/dL27N
Critcare.social is shutting down, so I’m back on the med-mastodon.com instance.
And I think I have screwed up the migration back from there
You can follow me if you share interest in #CriticalCare #CritCare #NeuroCritCare #FOAMcc #IntensiveCare #ICU
Gut microbiome?? Organ implicated in both health and disease... What happens in critical illness?
intestinal microbiome in #ICU: dysbiosis as potential therapeutic target?? Early & profound disruption with loss of commensals/overgrowth of potential pathogens may occur! These derangements may be associated with acute/chronic organ dysfunction + adverse outcome
protective/ecological restorative strategies
Free to read #FOAMcc on Intensive Care Medicine https://rdcu.be/dLuHN
Consumptive coagulopathy during #ECLS close monitoring & follow up pivotal during the #ECMO run 
️ giving platelets/clotting factors to fix numbers often worsens underlying process low doses of anticoagulants may protect both circuit (vs thrombotic complications) & patient (vs bleeding & thrombosis)️ bleeding complications should NOT always prompt complete cessation of UFH
Detailed underlying pathophysiological process & physiological rationale free to read #FOAMcc https://rdcu.be/dLmXO
Extended reality in #ICU: ready for take-off?? Here translation of NASA Technology Readiness Levels into clinically applicable scale for XR research + identification of maturity of all recent XR-related critical care studies to determine its applicability.
XR increasingly important tool but small minority of clinically implemented projects identified, highlighting a gap to be bridged to move from testing to structured clinical application.
Free to read #FOAMcc on @ICM https://rdcu.be/dKSPm
Management of dyspnea is a teamwork! Should be the next great goal of #ICU multi-professional team caring for critically ill mechanically ventilated patients. PS distinction between dyspnea & breathlessness essential!
Free to read #FOAMcc on Intensive Care Medicine https://rdcu.be/dKPpy
In reply to https://rdcu.be/dKPp2
All refer to ERS ESICM statement on dyspnea in acutely ill adults on MV https://rdcu.be/dzq9F
June issue of Intensive Care Medicine is now available!!
European Society of Intensive Care Medicine (ESICM) fluid therapy guidelines
critical care in LMICsemergency chemotherapy for hematological patients in #ICU 
#RRT in PedsICU #sepsis & bloodstream infection proning in #ECMO Pes
#ECLS in cardiogenic shock
neuromonitoring
& more! Full texts free to read #FOAMcc if you follow the links we share in our social media posts... enjoy!
https://bit.ly/ICMJun2024
Optimal time to stop continuous renal replacement therapy in children? Decision based on anticipated pathophysiology, underlying diagnoses, fluid balance & recovery of residual renal function (with increasing UO easily available sign, to date). Less CRRT may be more, but right time to cease still open question.https://rdcu.be/dKiC7
Refers to analysis on #CRRT in critically ill children & young adults.
#PedsICU #FOAMcc on @ICM https://rdcu.be/dAs4w
What is happening in this 44-year-old man on VA #ECMO??
#ECPR after 30 min of refractory cardiac arrest post-myocardial infarction recovered native cardiac activity but severe postresuscitation vasoplegia leading to important fluid filling to maintain #extracorporeal blood flow
TEE showed right atrial collapse
…. cardiac tamponade?? Collapse reversed within seconds during a transient reduction in EBF
Free to read #FOAMcc #FOAMecmo on @ICM https://rdcu.be/dJW8S
Replicating Spanish donor transplant coordination model led by intensivists to increase OD rates in other regions, including LMICS?? Here implementation in Santa Catarina, a Southern Brazilian 
state, resulting in 48.9 pmp deceased donor rates in 2023 ( = approaching Spanish), even without DCD program: This organization might provide more persons the opportunity of donating their organs after death + increase transplant options for patients in need
#FOAMcc on @ICM https://rdcu.be/dJErS
Outcome of hospital-acquired bloodstream infection?? Not only a matter of bacteria & hosts... several aspects of healthcare organization may have clinical implications! Editorial https://rdcu.be/dJymM
Refers to analysis on data on hospital-acquired BSI from EUROBACT-2 study highlighting that centre/country factors should be targeted to improve management strategies and outcome of HABSI in #ICU. https://rdcu.be/dJyqE
All free to read #FOAMcc on Intensive Care Medicine
Broad use of processed EEG: ready for prime time?? anesthesia & sedation monitoring
future applications
detection of seizure
detection of cerebral hypoperfusion
closed‑loop anesthesia delivery systems
limitations
PEEG monitoring systems widely available, easy to apply (but training required to avoid misinterpretation), relatively inexpensive & increasingly used outside OR, with potential for #ICU use.
Free to read #FOAMcc on @ICM https://rdcu.be/dJpvI
Managing perioperative myocardial injury etiology: ischemic & non-ischemic, cardiac & extra-cardiac causes management: early detect & tailor etiology-driven treatment
PMI? marker of complications! Increased cardiac troponins prognostically important for mortality & adverse cardiovascular outcomes in patients undergoing non-cardiac surgery.
Free to read #FOAMcc on @ICM https://rdcu.be/dJkab
How to use face-mask noninvasive ventilation: set‑up & ventilatory settings
indications & contraindications monitoring to assess response, adjust settings, identify need to transition to IMV constraints associated with delivering NIV through face-mask
Free to read #FOAMcc on @ICM https://rdcu.be/dJex8
Norepinephrine dose reporting? No reason to delay standardization!NE dose has known prognostic implications: dose reporting heterogeneity could bias perception of severity & prognosis, with the risk of triggering early, delayed, inadequate decisions absolute gap of NE base equivalence wide among different saltbased dose preparation/labeling
Free to read #FOAMcc https://rdcu.be/dISUF
In reply to https://rdcu.be/dISSr
All refer to editorial focusing on NE https://rdcu.be/dGazg
Treating necrotizing skin & soft-tissue infections in #ICU early diagnosis & source control imaging techniques microbiological issues empirical antibiotic therapy & adjuvant therapies
multidisciplinary management
Free to read #FOAMcc on @ICM https://rdcu.be/dIcGD
Using #echocardiography to predict fluid-responsiveness & manage need for fluids in #ICU, bedside experience + literature based approach:
when to fill??
️ when NOT to fill?? optional filling... gray zone of #POCUS parameters
PS adequate training pivotal to avoid misinterpretation!!
Free to read #FOAMcc #FOAMus #echofirst #POCUS on @ICM https://rdcu.be/dH6nb
