Siegfried Reimer 🌸, 🌿/🛸/❤️🫂/🛡️/🔴✨(✸,✸)

[Fluid Academy @Fluid_Academy]

💧 Acid–Base Effects of IV Fluids – Stewart Approach

Beyond bicarbonate: Strong Ion Difference

This chapter introduces the Stewart approach, where pH is determined by strong ion difference, PaCO₂ and weak acids rather than bicarbonate alone. It shows how chloride‑rich fluids reduce the strong ion difference and drive hyperchloremic metabolic acidosis, whereas balanced solutions better preserve acid–base equilibrium.

Clinical Application at the Bedside

Through worked examples, the authors demonstrate how to interpret ABGs after large volumes of saline vs balanced crystalloids. Recognizing fluid‑induced acid–base changes helps clinicians adjust both fluid choice and ventilatory strategy, especially in patients with sepsis, kidney injury or major surgery.

📘 Detailed figures and case discussions in the acid–base chapter: https://t.co/7pvDxZGh4I
🔵 At IFAD 2026, a dedicated session will apply the Stewart approach to real ICU blood gases and fluid decisions.
👉Registration: https://t.co/wATwBWAIge

#AcidBase #StewartApproach #Chloride #ICU

[Dr. Chacón-Lozsán F .'. @franciscojlk]

🫁PEEP in ARDS is no longer just a number. It is a phenotype test.

The last 3 years of PubMed indexed literature show a clear shift in ARDS ventilation: from oxygenation based PEEP tables toward individualized assessment of recruitability, overdistension, transpulmonary pressure, regional ventilation, and mechanical power.

The 2023 ESICM ARDS guideline strongly supports lung protective ventilation and recommends against prolonged recruitment maneuvers, but does not give a universal recommendation for one PEEP titration strategy (Grasselli et al., 2023). The 2024 ATS guideline, however, conditionally suggests higher PEEP without lung recruitment maneuvers in moderate to severe ARDS and strongly recommends against prolonged recruitment maneuvers (Qadir et al., 2024).

This disagreement is clinically important.

Why? Because PEEP can be protective or harmful depending on the lung.

In a recruitable lung, PEEP may reduce cyclic opening and closing, improve homogeneity, lower dynamic strain, and reduce ventilator induced lung injury. In a poorly recruitable lung, the same PEEP may mainly increase overdistension, dead space, right ventricular afterload, and mechanical power.

Recent PubMed indexed evidence supports this personalized approach.

Electrical impedance tomography guided PEEP titration improves compliance, reduces driving pressure, and lowers mechanical power compared with conventional strategies, although larger trials are still needed before routine outcome based recommendations can be made (Songsangvorn et al., 2024).

The recruitment to inflation ratio is attractive because it can be measured at the bedside, but recent CT validated data show important limitations. In a 2025 study, the R/I ratio had poor diagnostic performance for identifying high recruitability, especially in focal ARDS, although very low values may still help identify low recruiters (Richard et al., 2025).

Esophageal pressure remains physiologically elegant because it separates lung stress from chest wall pressure. This is especially relevant in obesity, abdominal hypertension, pleural effusion, and extrapulmonary ARDS. However, it requires technical expertise and should not be treated as a simple number.

The future of PEEP titration will probably not be one method, It will be an integrated bedside phenotype.

The key question is no longer: “What PEEP gives the best PaO₂?”

The better question is:

At this PEEP, is the lung being recruited, protected, or injured?

References📚
*Grasselli, G., Intensive Care Medicine, 49, 727–759. https://t.co/67nFMfpurf
*Qadir, N., American Journal of Respiratory and Critical Care Medicine, 209(1), 24–36. https://t.co/Cf5W5R79KU
*Songsangvorn, N.. Intensive Care Medicine, 50(5), 617–631. https://t.co/BsnCgclUEZ
*Pavlovsky, B., Annals of Intensive Care, 14, 1. https://t.co/p51IFsuMjn
*Richard, J. C., Critical Care, 29, 220. https://t.co/JZp9cxdsKn

[Goku @ProjectGokuu]

Novak Djokovic just said only 5% of your daily life is actually conscious.

Djokovic is the 24-time Grand Slam champion and has spent the last 20 years studying the mental side of high performance.

He says he was shocked when he learned the science behind this number.

"How in the world are we then able to live how we want to live where we are actually on autopilot most of the time?"

The 95% on autopilot is your subconscious mind reacting to whatever you have already uploaded into it. It's why you can drive and text and eat without thinking.

Djokovic says most people lose their lives to a subconscious they never bothered to program.

He reprograms his daily through prayer, visualization, and breath work.

The crowd chanting his opponent's name doesn't shake him because his subconscious has already been told what to hear.

— Novak Djokavic (@DjokerNole) on Jay Shetty's (@jayshetty) podcast

PS: B2C health apps, SaaS, brand or info founders:

We'll turn 𝕏 into your #1 organic acquisition channel in the next 90 days without you writing a single tweet.

In just 55 days, this account grew to 10.1K followers and 37.3M impressions.

Book a 30-minute call: https://t.co/E69ENMQoPE

[Critical Care Reviews @CritCareReviews]

Today's Paper of the Day is:

The medical management of acute respiratory distress syndrome

https://t.co/JKgcYjlUQ5

Join us to read 1 paper per day and stay up-to-date as we cover the spectrum of critical care across 2026

[Nav Toor @heynavtoor]

Claude can now meal prep your entire week and hit your exact nutrition goals like a $200/hour registered dietitian from the Mayo Clinic. For free.

Here are 12 prompts that plan meals, calculate macros, and save you $500/month on groceries:

(Save this before it disappears)

[Allen Braden @allen_explains]

This 2-hour Stanford lecture breaks down how models like ChatGPT and Claude are actually built, clearer than what many people in top AI roles ever get exposed to.

Save this and set aside two hours today. It might end up being the most valuable thing you learn all week.

[Roman Sheremeta 🇺🇸🇺🇦 @rshereme]

Gary Kasparov at the NATO Public Forum:

The liberation of Russia from Putin’s fascism will not start until the Ukrainian flag is raised over Sevastopol. Period. Anything else is wishful thinking.

You have to kill the idea of empire in the minds of Russians. They have to understand the war is lost. Ukraine must win. Ukrainian victory includes three things: liberation, reparation, and justice.”

The big debate is whether it’s Russia’s war or Putin’s war. Unfortunately, it’s Russia’s war. Every Russian, myself included, has a responsibility for the crimes committed in Ukraine.

People who want to leave from Putin’s ‘North Korea’ to our, let’s say, virtual ‘South Korea’ have to say three things in five seconds without stuttering: The war is criminal; The regime is illegitimate; Crimea is Ukraine.

[Jürgen Nauditt 🇩🇪🇺🇦 @jurgen_nauditt]

This video is very shocking.

Russians have almost completely destroyed Konstantinovka in Ukraine with cluster bombs, drones, artillery, and rockets.

Only a few hundred people are experiencing a Sunday evening there.

But very differently than you.

[Anesthesiology Journals @_Anesthesiology]

Revisit the February 2026 Image in #Anesthesiology - Choosing Nerve Blocks by Hip Fracture Subtype 📷 https://t.co/xoaXhGKE4Q

[Intensive Care Medicine @yourICM]

JUST RELEASED!
The 2026 Update of the Surviving #Sepsis Campaign Guidlines is now online!
Permanent Free Access
Adult: https://t.co/Noup1PiXmZ
Children: https://t.co/zN6pifl8FT

[Dr. Filippo Cademartiri @FCademartiri]

🫀🏃‍♂️ Exercise Physiology: Why Fitness Is a Vital Sign

Cardiorespiratory fitness (CRF) isn’t just about performance — it’s one of the strongest predictors of cardiovascular and all-cause mortality. In fact, the American Heart Association recommends treating CRF as a clinical vital sign.

At the center of CRF is VO₂ max — the gold standard measure of maximal oxygen uptake. It reflects the integrated function of:

❤️ Heart (cardiac output)
🫁 Lungs (ventilation & gas exchange)
🩸 Blood (oxygen delivery)
💪 Muscle (mitochondrial extraction & utilization)

Using the Fick equation, oxygen consumption = cardiac output × arteriovenous O₂ difference. In simple terms: how much blood the heart pumps × how much oxygen muscles extract.

📉 Without training, VO₂ max declines ~1% per year with aging — but this decline is attenuated by sustained physical activity.

🔥 Fuel dynamics matter:
At low intensity → fat predominates
At higher intensity → carbohydrates take over
The “crossover” reflects neurohormonal and metabolic shifts.

🧠 Thresholds define performance:
• Ventilatory threshold = sustainable steady-state intensity
• Lactate threshold ≠ “fatigue toxin” — lactate is a metabolic shuttle, not waste
• VE/VCO₂ slope = powerful prognostic marker in heart failure

💓 During exercise, cardiac output can increase ≥5-fold. Stroke volume adaptation — not heart rate — is the primary training-driven cardiac improvement.

🫁 In healthy individuals, lungs rarely limit maximal exercise — it’s usually the heart and peripheral extraction.

🔎 Bottom line:
Exercise is not a single-organ phenomenon. It is a fully integrated systems test of human physiology — and one of the most powerful tools in prevention medicine.

Fitness is not optional biology. It’s measurable resilience.

[SREEVATSA NADIG DM FSCAI FESC @nadig_cardio]

5 Must-Read Non-Textbook Books for Every Medical Professional (IMO 🙃)

• Complications – Atul Gawande
• The Emperor of All Maladies – Siddhartha Mukherjee
• The Youngest Science – Lewis Thomas
• When Breath Becomes Air – Paul Kalanithi
• How Doctors Think – Jerome Groopman

books remind us that medicine is not just science , but uncertainty, humanity, reflection, and most importantly humility😊

Which is your favourite non-fiction medical book?
#MedTwitter #MedX #BookTwitter

[Rafa Nadal @RafaelNadal]

🎿⛷️😃

After 26 years… what an incredible feeling to ski again!

[Siegfried Reimer 🌸, 🌿/🛸/❤️🫂/🛡️/🔴✨(✸,✸) @SiegfriedReimer]

Toxic bumta getting humbled https://t.co/dHeonjNXbm via @YouTube

[Volodymyr Zelenskyy / Володимир Зеленський @ZelenskyyUa]

This is a big mistake to allow the aggressor to take something. It was a big mistake at the very beginning, starting with 2014. And even before that, during the attack and occupation of parts of Georgia. And even before that, when Chechnya was occupied, with total destruction and one million casualties – both killed and wounded.

Many mistakes were made. That's why now I don't want to be the President who will repeat the mistakes made by my predecessors or other people. I'm not just speaking about Ukraine. I'm speaking about the leaders of different countries that allowed an aggressive country like Russia to come onto their territory.

Because you can't stop Putin with your kisses or flowers. I never did it and that's why I don’t feel that it's the right way. My advice to everybody – don’t do that with Putin.

Otherwise, there will be a first step, then in five years, he will rebuild his military, increase the number of soldiers, his army will be well trained. Because he has lost a lot of well-trained people. He is losing 30–35 thousand people per month now.

Can you imagine this in the 21st century? Can you imagine – he’s losing 35,000 each month? I'm not sure that he knows about it.

[ESRA | European Society of Regional Anaesthesia @ESRA_Society]

🫁 PROSPECT recommendations for open thoracotomy

Postoperative pain after open thoracotomy is complex and getting it right matters.

🔎 Full recommendations & infographic: https://t.co/4L48V1gM0y

[Vladyslav Heraskevych OLY @heraskevych]

I want to thank everyone for all the support we’re receiving. There really is an incredible amount of it.

For me, the sacrifice of the people depicted on the helmet means more than any medal ever could - because they gave the most precious thing they had.
And simple respect toward them is exactly what I want to give.

[ChrisO_wiki @ChrisO_wiki]

Magnificent! And still very relevant today.

[The Tennis Letter @TheTennisLetter]

Novak Djokovic on Stan Wawrinka playing his last Australian Open match, ‘When he’s gone, tennis is going to lose a great player & a great person’

“Proud to call him a friend and a rival. Someone who definitely has inspired me, no doubt, with his longevity, with his commitment to the game. He’s so passionate about it. Seeing him battle it out almost 4 hours in the last match that he played in the 2nd round, the way he turned it around.. it’s a testament to his career and what he brought to the court. His legacy will definitely stay and live with many different younger generations that look up to him. He’s a great champion on and off the court, very likable guy. He did everything the right way. He deserved every applause he had this tournament. I think it’s been a great farewell Australian Open for him. When he’s gone, tennis is going to lose a great player & a great person.”

(via Australian Open)