Zbigniew Putowski @ZPutowski
MD, PhD, Center for Intensive And Perioperative Care, Jagiellonian University, Poland. Interested in hemodynamics. Dum spiro spero intensywna.pl Kraków, Poland Joined August 2011-
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This awesome paper provides a theoretical rationale for the results of the newly published meta-analysis journals.lww.com/ccmjournal/abs… @DrFDamico @giovannilandoni
This awesome paper provides a theoretical rationale for the results of the newly published meta-analysis journals.lww.com/ccmjournal/abs… @DrFDamico @giovannilandoni
#CritCare #OpenAccess Significance of critical closing pressures (starling resistors) in arterial circulation Read the full article: ccforum.biomedcentral.com/articles/10.11… @jlvincen @ISICEM #FOAMed #FOAMcc
Lecząc pacjenta z obrzękiem płuc i wysokim ciśnieniem tętniczym zawsze zaczynam od wysokich dawek nitrogliceryny - 200-500mcg/min. Dodatkowo HFNC, rzadziej NIV. Diuretyki pętlowe + ew. morfina przy znacznej duszności. W diagnostyce USG przy wjeździe na SOR. Działa świetnie!
Lecząc pacjenta z obrzękiem płuc i wysokim ciśnieniem tętniczym zawsze zaczynam od wysokich dawek nitrogliceryny - 200-500mcg/min. Dodatkowo HFNC, rzadziej NIV. Diuretyki pętlowe + ew. morfina przy znacznej duszności. W diagnostyce USG przy wjeździe na SOR. Działa świetnie!
Zachęcam do zapoznania się z polskim komentarzem do nowo opublikowanej meta-analizy dot. porównania niższych vs. wyższych wartości ciśnień tętniczych w populacjach OIT oraz chirurgicznych! "Kiedy ciśnienie tętnicze nie przekłada się na skuteczną perfuzję?" intensywna.pl/kiedy-cisnieni…
Zachęcam do zapoznania się z polskim komentarzem do nowo opublikowanej meta-analizy dot. porównania niższych vs. wyższych wartości ciśnień tętniczych w populacjach OIT oraz chirurgicznych! "Kiedy ciśnienie tętnicze nie przekłada się na skuteczną perfuzję?" intensywna.pl/kiedy-cisnieni…
❓Which is the correct BP target in critically ill❓ ❌ Probably NOT the most appropriate question‼️ ✅ Is blood flow adequate to ensure organ perfusion? ⚠️Interventions to reach a "comfort zone" BP may lead to higher mortality #protectivehemodynamics 🔗journals.lww.com/ccmjournal/abs…
1/10 🚨Low Versus High Blood Pressure Targets in Critically Ill and Surgical Patients 📊Our meta-analysis will redefine how blood pressure is considered in anesthesia and critical care. This study marks a 'before' and 'after' in our understanding of BP. Key findings follow
@DrFDamico @giovannilandoni Low BP is worse than normal BP. To me, the question is, above a certain point, does pharmacologically increasing BP benefit patients, and if so to what levels, for which indications or comorbidities, and with which drugs.
10/10 ⚠️ Important Clarification: - Lower blood pressure is not better than normal pressure. - Our study does not advocate for actively pursuing lower BP targets. For a thorough understanding of our findings, please read the full paper
1/6🧐 Observational studies have long noted that hypotension is linked to adverse events in perioperative and critical patients, influencing clinical practice and guidelines. 🔗 But is this a true cause-effect relationship, or just bias due to confounding? 🔀 Let’s see what the…
⚡ Breaking new ground in blood pressure management! 🫀 How should we manage blood pressure in critical care and perioperative settings? 📈 Check out our latest meta-analysis, which could redefine how we manage blood pressure in #criticalcare and #perioperative…
🚀 Just published! Our new meta-analysis revolutionizes blood pressure management in critical and perioperative patients. Discover how our findings can change clinical practice. 🔗 journals.lww.com/ccmjournal/abs…
@ZPutowski @DrFDamico @giovannilandoni Great thread! Clearly having a map of 30 is bad and drugs can be life saving. But if you map is ~60 and you're awake and perfusing, I have major doubts that pharmacologically boosting your BP to make an arbitrary 65+ cutoff (often overshooting!) is life saving. Maybe it harms.
@ZPutowski @DrFDamico @giovannilandoni This meta analysis supports a massive rethinking of the pervasive dogma of "set it [map >65] and forget it" medicine and encourages a megaROX scale study of BP targets and comparison of ways to get there.
Katie @snowercita
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Dr. Miguel Ibarra-Est.. @DrMiguelIbarra1
1K Followers 56 Following Clinical Research; Mechanical Ventilation; Septic Shock; Critical Care Ultrasound; Awake Prone Positioning; Sistema Nacional de Investigadores 🇲🇽. LIVEN
Eduardo Kattan @edu_kattan
362 Followers 249 Following Dad, Husband, Intensivist, PhD / Assistant Professor @FacMedicinaUC 🇨🇱/ Collaborative research. LIVEN. Views are my own.
Patrick Wieruszewski @pwierusz
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Segun Olusanya (He/Hi.. @iceman_ex
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𝙟𝙤𝙨𝙝 𝙛.. @PulmCrit
62K Followers 548 Following zentensivist 😷 FOAMite 🌊 diuresis jedi 💦 leader of the rebel alliance ⚔️ resuscitationist 💉 humanist 😢 writer with aweful speling 😬 no COI 💰
Jan De Waele MD @criticcaredoc
8K Followers 559 Following President-elect @ESICM - intensivist @uzgent - professor @ugent - researcher @fwovlaanderen - foodie 👨🍳, wildlife photographer 📷, cyclist 🚴♀️- Ghent,🇧🇪
Ricardo Castro @RCastro_L
4K Followers 784 Following Physician, Intensivist. Assoc professor @ucatolica, MPH, PhD(c) @Erasmusuni; Christian. Proud husband and father
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Tim Norfolk @norfolk_tim
2K Followers 521 Following Single CCT intensive care trainee. Striving to be humbled with a little less regularity! Have more questions than answers 🥴
Tom Woodcock @thomaswoodcock
2K Followers 1K Following Starling physiology, critical care medical law and ethics. Free Speech. Fly fishing.
Jonny Wilkinson @Wilkinsonjonny
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Cosmo @londonsdrcosmo
4K Followers 843 Following Anaesthesia & prehospital care. Simulation, ultrasound, ski, snowboard, motorbikes. #London #Norway
Ross Prager @ross_prager
7K Followers 622 Following Intensivist ⚕️Creator of https://t.co/S7HBZvwYR6 Follow for ultrasound cases, hemodynamics, and discussions around performing efficient and impactful research 📊
Sara @saravanaszk
16K Followers 967 Following Lekarka, rezydentka pediatrii zainteresowana endokrynologią dziecięcą, entuzjastka pielęgnacji i perfum, zwierzolubka; Opinie prywatne
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466 Followers 531 Following Intensivist & Anesthesiologist. Love research and study. Interested in original questions. Most importantly, a happy father!
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17K Followers 136 Following International Fluid Academy promotes #FOAM education + innovation. Mark #IFAD2024 May 10 @ECCC_DUBAI and August 20 @crit_sa CCSSA Jo-burg, #SMACC affiliated
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Manu Malbrain @Manu_Malbrain
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BarcaInfo @_BarcaInfo
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14K Followers 640 Following Klasyczny radykał | Metapolityk. Książki: "Antykomuniści lewicy" (2014), "Crowdfunding" (2015), "Niepodległość i socjalizm" (2020), "Wieczna lewica" (2023).
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2.0M Followers 220 Following Engineer. Selecting and curating pictures and videos trying to add context, source and explanation to science, tech, art and weather topics
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Bernd Saugel @BerndSaugel
212 Followers 113 Following Professor of Anesthesiology UKE Hamburg, Outcomes Research Consortium @OutcomesRC (Tweets reflect my personal opinion)
Tennis images that pr.. @sadtennis
7K Followers 0 Following tag me in tennis images that proceed unfortunate events
San Raffaele Anesthes.. @SRAnesthesiaICU
3K Followers 190 Following The Department of Anesthesia and Intensive Care of @SanRaffaeleMI in Italy. Our goal is reducing mortality in the ICU/OR, improving quality of life thereafter.
7/9 One size fits all? Not quite. Some people comfortably tolerate MAP levels below 65mmHg. 🌙 Consider this: a third of patients monitored the night before surgery spontaneously dropped below 65mmHg. pubs.asahq.org/anesthesiology…
8/9 And the lower limit of organ autoregulation is subjective: 🧬 Influenced by medications, existing conditions, and likely lower than what's identified in animal studies. kidney-international.org/article/S0085-…
1/9 “Low versus High Blood Pressure Targets in Critically Ill and Surgical Patients” 🧨 The meta-analysis that redefines how we interpret blood pressure ⁉️ What are the reasons behind this paradigm shift from 'higher is better'? pubmed.ncbi.nlm.nih.gov/38656245/
Tradycyjnie mówiąc o trudnych drogach oddechowych myślimy o trudnej anatomii. Jednak w medycynie ratunkowej największe zagrożenie w trakcie procedury RSI powodują współistniejące zaburzenia patofizjologiczne. O fizjologicznie trudnych drogach oddechowych piszemy w „Na ratunek”
Hello #MedTwitter! Just getting started on this community! Super excited to be here! @AndromedaShock @ThinkingCC @ross_prager @DrMiguelIbarra1 @avkwong
3/10 🦣Our meta-analysis is the largest ever on blood pressure management in critically ill and perioperative setting - 28 RCTs -15,672 patients It's the first to include both critically ill and perioperative populations, evaluating each group separately.
Frailty and multimorbidity are infrequently considered in ICU RCTs. Subgroup analysis by age is more common but cutoffs vary, & effect modification is rare. Bottom line: We need more critical care RCTs focused on the older, frail and comorbid patient!! pubmed.ncbi.nlm.nih.gov/38661459/
4/10 💥Lower BP targets led to reduced mortality compared to higher targets 13.3% vs 14.4% RR 0.93, 95% CI, 0.87–0.99 p=0.03 This suggests a significant benefit of lower targets.
@DrFDamico Exactly. With what we have available, we should no longer be targeting MAP alone. MAP with a reasonable VTI, CRT and not much CVP should be the goal. Perfusion without congestion. We need work to be done in precision medicine, not one-size fits all🙂
#CritCare #OpenAccess Significance of critical closing pressures (starling resistors) in arterial circulation Read the full article: ccforum.biomedcentral.com/articles/10.11… @jlvincen @ISICEM #FOAMed #FOAMcc
Lecząc pacjenta z obrzękiem płuc i wysokim ciśnieniem tętniczym zawsze zaczynam od wysokich dawek nitrogliceryny - 200-500mcg/min. Dodatkowo HFNC, rzadziej NIV. Diuretyki pętlowe + ew. morfina przy znacznej duszności. W diagnostyce USG przy wjeździe na SOR. Działa świetnie!
High-Dose NTG for SCAPE. youtube.com/shorts/CbtpPnn… High-dose NTG in SCAPE patients results in earlier symptom resolution compared to conventional low-dose NTG without significant adverse effects.
Fascinating 🤔🤔🤔
1/9 ❗️❗️❗️ @CritCareMed just published a meta-analysis of RCTs on critically-ill and perioperative blood pressure (BP) targets! What is more beneficial for survival: targeting Higher or Lower BP? 🧵🧵🧵journals.lww.com/ccmjournal/abs…
Pressure ≠ Flow 🔹In healthy volunteers increasing MAP 20% with norad ⬇️ CO (5.9 -> 5.0L/min) & CBF (772 -> 705ml/min) 🔹Lowering MAP 20% with labetalol ⬆️ CO (5.9 -> 6.4L/min) If you care about flow you need to measure it. MAP alone doesn’t suffice pubs.asahq.org/anesthesiology…
重症患者や手術患者において，低めの血圧管理は，高めの管理と比して，死亡リスクを7%減少させ，心房細動や輸血も減少させた．本メタ解析結果は従来の知見や推奨と一致せず，今後のガイドラインや研究の参考になり得る．28報15,672例メタ解析（Crit Care Med 2024 Apr24）
It’s on my reading list. #LessIsMore can be beneficial in many ways.
1/10 🚨Low Versus High Blood Pressure Targets in Critically Ill and Surgical Patients 📊Our meta-analysis will redefine how blood pressure is considered in anesthesia and critical care. This study marks a 'before' and 'after' in our understanding of BP. Key findings follow
BP (within reason) ain’t nothing but a number 🧵 Reposted as part of my ongoing series entitled, “Could you please stop hanging phenylephrine and think?”
1/9 ❗️❗️❗️ @CritCareMed just published a meta-analysis of RCTs on critically-ill and perioperative blood pressure (BP) targets! What is more beneficial for survival: targeting Higher or Lower BP? 🧵🧵🧵journals.lww.com/ccmjournal/abs…
Low Versus High Blood Pressure Targets in Critically Ill... : Critical Care Medicine journals.lww.com/ccmjournal/abs… Congrats @giovannilandoni and the group. #Lessismore #Lower #Better @SFAR_ORG @SFARJeunes
🚨 NEW POD ALERT 🚨 Trial of the Week: SEPSISPAM Ft. Katherine Spezzano @KatSpazPharmD @UKCritCarePharm BP autoregulation 🧠 SEPSISPAM v SEPSISMAP 🏆 Personalized medicine and higher MAP goals 🩸 AKI prevention v. Longer ICU LOS 🫘 Same effect with different vasopressors? 🤔 &…
❓Which is the correct BP target in critically ill❓ ❌ Probably NOT the most appropriate question‼️ ✅ Is blood flow adequate to ensure organ perfusion? ⚠️Interventions to reach a "comfort zone" BP may lead to higher mortality #protectivehemodynamics 🔗journals.lww.com/ccmjournal/abs…
@DrFDamico @giovannilandoni Low BP is worse than normal BP. To me, the question is, above a certain point, does pharmacologically increasing BP benefit patients, and if so to what levels, for which indications or comorbidities, and with which drugs.
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