Mike Reaume

Husband of @ABee_MD. #Girldad. Cat father. Sports enthusiast. Pulmonary & Critical Care physician.

[Ross Prager @ross_prager]

Longer ventilation in the ICU is independently associated with mortality... so how do we decide how to safely get patients off the vent sooner?

Hint: It isn't the SBT. https://t.co/VJDJZbT2WS

[IMCrit @IM_Crit_]

Non-invasive ventilation in the ICU - Is there any other trick to teach?

This is NOT a randomized controlled trial and I know it confirms my own bedside bias. But for every patient who just doesn’t look ready to breathe comfortably on their own, I keep coming back to the same practice: extubate straight to NIV rather than wait for trouble

This is a recently published post-hoc analysis of two multi-center clinical trials including 829 high-risk patients (i.e., older than 65 y.o. or with underlying cardiac/respiratory disease) without hypercapnia (PaCO2 ≤ 45mmHg) the day of extubation

After extubation, 540 patients (65%) received NIV + HFNC while 289 (35%) received HFNC alone. The re-intubation rate at day 7 was 11.8% with NIV + HFNC versus 17.6% with HFNC alone (difference:, −5.8% [95% CI -11.2 to -0.8%]; p = 0.021)

Conclusion: For high-risk patients, but without hypercapnia on the day of extubation, the use of prophylactic NIV alternating with HFNC after extubation significantly decreases the risk of re-intubation as compared to HFNC alone

#foamed #foamccc @ArielG_RRT

[IMCrit @IM_Crit_]

Atrial fibrillation secret:

When a patient presents to the ED, ICU, or wards with new-onset atrial fibrillation -and we do not know their systolic function- it is worth taking a quick look at the heart before reflexively reaching for diltiazem or metoprolol. We do not always need a formal echo before acting. But if bedside US is available, even a brief POCUS assessment can change the entire plan.

I know this is not always feasible in real time. But every year, I see a few patients who crash -or even arrest- after AV nodal blockers are given, only for POCUS afterward to reveal an ejection fraction of 10-20%.

The point is simple: not every patient with rapid atrial fibrillation has a ventricle that can tolerate negative inotropy.

Let’s try to make the “diltiazem death challenge” a thing of the past.

[Philippe Rola @ThinkingCC]

Hopefully one day clinicians at-large will realize that the IVC is not a fuel gauge and stop treating it as such. The heart works hard to generate the lowest central venous pressure possible…that’s what makes the blood go ‘round.

[Justin Trudeau @JustinTrudeau]

You can’t take our country — and you can’t take our game.

[Mike Reaume @ReaumeM1]

Team Canada!!! 🇨🇦

[Mike Reaume @ReaumeM1]

@pash22 @pash22 FYI I was mistagged in this post

[Mike Reaume @ReaumeM1]

@RapsodoGolf Amazing update!

[IMCrit @IM_Crit_]

ICU Hemodynamic Secrets:

I don't know who has to hear this, but fluids do not always have to come first before starting a pressor... 🤷‍♂️

#FOAMed #FOAMcc #meded #MedTwitter #medstudent #hemodynamics

[NFL Memes @NFLMemes]

All of us at approximately 1:00PM EST today…

[Joshua @reverendofdoubt]

Now that I’m at a place that uses procalcitonin regularly after not having it during residency, I am convinced it is one of the most useless lab tests out there.

[Salim R. Rezaie, MD @srrezaie]

RANT: Stop lowering sedation dosing for unstable hemodynamics during mechanical ventilation

POSSIBLE OPTIONS:
-Start a vasopressor
-Change up sedation/analgesia
-Ensure no other etiologies to low BP
-DO NOT USE SUBTHERAPEUTIC SEDATION

#FOAMed #Sedation

[Steve Carroll DO MEd @embasic]

This is my shocked face

Stop aggressively treating asymptomatic hypertension with IV meds!

[Matt Siuba @msiuba]

If ever the pulse ox or the BP cuff “stops working” please check the condition of the patient before the condition of the device!

[Sam Ghali, M.D. @EM_RESUS]

Resuscitation before intubation must be the way moving forward. This goes for medical and trauma patients alike. It is no longer acceptable in 2023 for patients to code on induction because “ABC”.

[Josh Farkas MD 💊 @PulmCrit]

Nurses save lives.

I see this all the time in the ICU.

It's a curious thing - both obvious, yet also frequently overlooked.

🙏Thank you for everything that you do.

#NursesWeek

[Adi @IDdocAdi]

Papers you “plan to read”

[The Bottom Line @WICSBottomLine]

#TBL 43: CAPE COD - Hydrocortisone in Severe Community Acquired Pneumonia
https://t.co/PHkxvK1bum
Article by @PierreDequin
Review by @hgmwalker89
#ISICEM23 #FOAMed #FOAMcc

[Mike Reaume @ReaumeM1]

@DanielKapadia 🤣💯