LEKHOUA TAHAR

[David Marco @david_marco45]

🚨 BREAKING: NotebookLM can now act like a personal research assistant for free.

Upload any article, PDF, video, or document and use these 10 prompts to extract everything that matters in minutes:

[Dr Amit Pawa💉🎙️ @amit_pawa]

Delighted that our latest paper on #RegionalAnaesthesia #RegionalAnesthesia for Breast surgery is out today in @Anaes_Journal

Many thanks to @olitolsondoc & @hasyourregtried

Free Link https://t.co/mxcpj8Rouk

[Benlazar S M A @smbenlazar]

New Book From Sringer : Clinical Hematology and Hemato-Oncology , first edition ( July 2026)

[LEKHOUA TAHAR @TaharLekhoua]

@heyadam_ai Drive

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

🧠 Hypertonic Saline or Mannitol for Cerebral Edema?

Cerebral edema and intracranial hypertension remain among the most common life-threatening problems in neurocritical care. The Neurocritical Care Society guideline provides several practical bedside recommendations.

🔹 Hypertonic saline (HTS) is generally preferred over mannitol for acute ICP control in TBI and intracerebral hemorrhage due to more reliable and sustained ICP reduction.

🔹 Both HTS and mannitol effectively reduce ICP, but neither has consistently demonstrated improved long-term neurological outcomes.

🔹 In subarachnoid hemorrhage, symptom-triggered HTS boluses are favored over targeting a specific serum sodium concentration.

🔹 In acute ischemic stroke, either HTS or mannitol may be used, but routine prophylactic mannitol administration is discouraged.

🔹 Corticosteroids should not be used for intracerebral hemorrhage, as evidence suggests no benefit and potential harm.

🔹 The major exception is bacterial meningitis, where dexamethasone reduces neurological sequelae and should be administered before or with the first antibiotic dose.

⚠️ Safety matters. Severe hypernatremia (>155–160 mEq/L) and hyperchloremia (>110–115 mEq/L) are associated with increased risk of acute kidney injury and require close monitoring.

Take-home message: Hyperosmolar therapy remains a cornerstone of cerebral edema management, but treatment should be individualized according to the underlying neurological pathology rather than pursuing arbitrary sodium targets.

#NeurocriticalCare #ICU #CriticalCare #TBI #Stroke #SAH #ICH #CerebralEdema #HypertonicSaline #Mannitol #NeuroICU

Reference 📚

Cook AM, Jones GM, Hawryluk GWJ, et al. Guidelines for the Acute Treatment of Cerebral Edema in Neurocritical Care Patients. Neurocrit Care. 2020;32:647-666. DOI: 10.1007/s12028-020-00959-7.

[Critical Care Reviews @CritCareReviews]

Today's Paper of the Day is:

Protective nutrition strategy in the acute phase of critical illness: why, what and how to protect

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

[LEKHOUA TAHAR @TaharLekhoua]

@SaadShathry The best!!

[LEKHOUA TAHAR @TaharLekhoua]

@AsudaniMarish Nutrition

[LEKHOUA TAHAR @TaharLekhoua]

@lddcmumbai @Banitoto Thank you , we need more

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

🤓🫀We keep asking: “What’s the cardiac output?”
But maybe the better question is:
“How efficiently is the heart working?”

In septic shock, we often focus on:

Preload
Cardiac output
MAP

But we forget something fundamental:

👉 The heart doesn’t work alone.
👉 It works against the arterial system.

1. The missing concept: Ventriculo–arterial coupling (LVAC)

LVAC = interaction between:

Ees → contractility

Ea → arterial load

👉 Expressed as Ea / Ees

This ratio reflects:

How efficiently the heart converts energy into forward flow

2. What is “normal”?

LVAC ≈ 0.5 → optimal efficiency

LVAC ≈ 1 → maximal stroke work

LVAC > 1 → uncoupling (inefficient system)

But here’s the twist:

👉 In septic shock, LVAC is often >1
👉 Not just due to vasodilation—but also myocardial dysfunction

3. Why this matters clinically

Two patients can have:

Same MAP

Same CO

But completely different physiology:

✔ One → efficient coupling
❌ One → energy wasted, poor flow generation

4. The key insight

Septic shock is NOT just:

❌ “low preload”
❌ “vasodilation”

It is:

👉 A mismatch between heart and arterial system

5. Therapy changes the balance

Fluids → may improve coupling (↓ LVAC)

Norepinephrine → can improve OR worsen coupling

Inotropes → target Ees

Important:

👉 Increasing MAP ≠ improving flow
👉 Increasing pressure can worsen afterload

6. The most interesting part

From the data:

LVAC >1 can predict response to norepinephrine

But improving LVAC ≠ guaranteed tissue perfusion and outcomes follow a U-shaped curve

👉 Both too high AND too low LVAC can be harmful

7. The limitation we must respect

Even if you “optimize” LVAC:

👉 Microcirculation may still be impaired
👉 Lactate may still rise
👉 Shock may persist

Because: Macro ≠ micro

🤓Final message

We need to move from:

❌ “Fix the blood pressure”

To:

✅ “Optimize the interaction between heart and vessels”

LVAC doesn’t replace hemodynamics.
It completes it.

📃Reference
Caicedo Ruiz JD et al. Journal of Critical Care, 2026. https://t.co/1ZNMHqwBl4

[Sultan @Sultan__Shehri]

High yield and compact lecture for neuroanatomic localization. Highly recommend for junior residents and interns interested in neurology

https://t.co/Es1csYUgan

[Regional Anesthesia & Pain Medicine @RAPMOnline]

🥊 TAP vs QL? Who wins this battle?

🥊 QL blocks outperformed TAP blocks in anesthetic spread after laparoscopic surgery, but pain & opioid use were similar at 24 hrs.

👉 Read more here: https://t.co/AS6ZNmsImd

@RenukaGeorge
@SylviaHWilson
@MUSC_Anesthesia
@CUSOMAnesthesia

[LEKHOUA TAHAR @TaharLekhoua]

@claralexlobo Congratulations!!

[Science News @SciencNews]

🎯The anatomy of brainwashing
@ScienceMagazine #MedEd #MedX

Glymphatic-lymphatic brain cleansing may reveal new therapeutic strategies

Read more
https://t.co/QdJFzcsNXH

[Eddy J. Gutierrez, MD @eddyjoemd]

At one point, fluid responsiveness was the best we had for “Goldilocks” resuscitation. Yet again, we continue to improve. 🎩 tip to @edu_kattan @AndromedaShock @ThinkingCC @RCastro_L @curromir for bringing the concept of fluid tolerance to the masses.

https://t.co/4Ise540F2X

[LEKHOUA TAHAR @TaharLekhoua]

@NoraWel31450998 Thank you!!

[CNEAR Anesthésie Réanimation @cnear_fr]

Futur.e.s internes d’#ARMPO le @cnear sort sa mise à jour du livret Tour de France 🇫🇷 des villes !

🏙️ Villes
✍️ Maquette
👩‍🏫 Pédagogie
🪖FST
🍼 Option pédiatrie

Retrouvez toutes les infos utiles sur le site du @cnear_fr ⬇️⬇️⬇️

[SFAR Anesthésie Réanimation @SFAR_ORG]

📆 Jeudi à 17h30, ne manquez pas le #webinar "QUAND et COMMENT intuber un traumatisé grave ?" des comités @SFARJeunes & ACUTE !

📹 En #live sur notre chaîne YouTube ➡️ https://t.co/smk66twa6D

@AJARFrance @SNJeunesAR @SNPHARE @SyndicatSnarf @ThomasClavierMD @vroniqueRAMOND1

[Eddy J. Gutierrez, MD @eddyjoemd]

Manage severe acute pancreatitis like a pro! The days of just arbitrarily flooding patients with fluids and not feeding our patients are behind us. 🎩 tip to the authors.

https://t.co/4Ise540F2X