Andrés Pacheco Reyes

[Critical Care Reviews @CritCareReviews]

Positive end-expiratory pressure titration in acute respiratory distress syndrome–a practical bedside algorithm

CCR Journal Watch
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[Critical Care Reviews @CritCareReviews]

ARISE framework: a temporal, multi‑organ view of perfusion in sepsis

CCR Journal Watch
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[Critical Care Reviews @CritCareReviews]

Today's Paper of the Day is:

Critical illness-related corticosteroid insufficiency (CIRCI) - pathogenesis, clinical presentation and management

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

[CardiovascularCorner @TrackYourHeart]

Beyond CPR: Identifying Reversible Causes of Cardiac Arrest

[CardiovascularCorner @TrackYourHeart]

Pulmonary Embolism Algorithm

[CardiovascularCorner @TrackYourHeart]

The H's & T's of ACLS.

[Critical Care Reviews @CritCareReviews]

Today's Paper of the Day is:

Ventilator-associated pneumonia: pathobiological heterogeneity and diagnostic challenges

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

[Critical Care Reviews @CritCareReviews]

Today's Paper of the Day is:

How I diagnose and treat cardiorespiratory complications of transfusion

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

[Critical Care Reviews @CritCareReviews]

Today's Paper of the Day is:

Iatrogenic air embolism: pathoanatomy, thromboinflammation, endotheliopathy, and therapies

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

[Critical Care Reviews @CritCareReviews]

Balancing lung recruitment and venous congestion in ARDS: rethinking the systemic effects of PEEP

CCR Journal Watch
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[Critical Care Reviews @CritCareReviews]

Severe Metabolic Acidosis in the ICU

CCR Journal Watch
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[CardiovascularCorner @TrackYourHeart]

Normal Cardiac Pressures & Oxygen Saturations.

This diagram is a goldmine for understanding intracardiac hemodynamics, pressure tracings, and oxygen saturation patterns.

- RA: 0–4 mmHg | O₂ sat ~75%
- RV: 25/5 mmHg | O₂ sat ~75%
- PA: 25/10 mmHg | O₂ sat ~75%
-PCW/LA: 7–12 mmHg |O₂ sat ~97%
- LV: 120/10 mmHg | O₂ sat ~95%
-Aorta: 120/80 mmHg |O₂ sat ~95%
Note how pressure tracings correlate with the ECG , vital for timing valve events and understanding pressure gradients.

Clinical uses:
⚪Diagnosing shunts
⚪Evaluating valve disease
⚪Monitoring shock/hemodynamics
⚪Assessing pulmonary hypertension

[CardiovascularCorner @TrackYourHeart]

Grading of diastolic function from normal diastolic function to restrictive filling, based on:
◻️ Pulsed-wave trans-mitral inflow Doppler velocities
◻️ Tissue Doppler myocardial diastolic velocities
◻️ Pulmonary venous flow velocities

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

🫨Acute Agitation in Psychiatry: Are We Still Over-Sedating Patients?

Acute psychomotor agitation is a common emergency in both psychiatric and general hospital settings. While rapid control is often necessary to protect patients and staff, the goal should not be immediate deep sedation. Modern evidence increasingly supports tranquilization rather than oversedation, allowing assessment, communication, and definitive treatment to continue.

What Does the Evidence Show?

This 2025 umbrella review analyzed 20 systematic reviews and meta-analyses involving more than 51,000 patients, evaluating the efficacy and safety of pharmacological interventions for acute agitation.

Key findings include:

💨 Inhaled Loxapine • Rapid onset, often within minutes • 10 mg more effective than 5 mg • Particularly useful in cooperative psychotic patients

💉 Olanzapine • Frequently superior to haloperidol at 60 minutes • Lower incidence of extrapyramidal symptoms (EPS) • Strong evidence supporting IM use

🧠 Aripiprazole • Effective with less sedation than olanzapine • Favorable tolerability profile

⚡ Ziprasidone • Faster onset than haloperidol • Better tolerated • Strong option when rapid calming is required

😌 Lorazepam • Effective with fewer adverse effects than many antipsychotics • Useful alone or in combination • Often preferred when diagnosis is uncertain

🚀 Midazolam • Fastest tranquilization among many studied agents • Higher risk of respiratory depression and oversedation • Requires careful monitoring

🎯 Droperidol • Comparable efficacy to olanzapine • Often produces faster sedation • Evidence supports reconsideration of its role in emergency psychiatry

🤝 Haloperidol + Promethazine • Consistently effective • Lower risk of dystonia than haloperidol alone • Better safety profile than many clinicians may appreciate

A Few Important Clinical Lessons

1️⃣ Haloperidol alone may no longer be the optimal default choice.

Although effective, it is associated with higher rates of extrapyramidal adverse effects and often performs no better than newer agents. Several reviews questioned the routine use of haloperidol monotherapy when safer alternatives are available.

2️⃣ Second-generation antipsychotics have changed the landscape.

Olanzapine, ziprasidone, and aripiprazole generally achieve similar efficacy with improved tolerability compared with first-generation agents.

3️⃣ Speed matters.

Among available treatments:

• IV Droperidol: ~5–10 min
• Inhaled Loxapine: ~10–20 min
• IM Olanzapine: ~15–30 min
• IM Ziprasidone: ~15–30 min
• IM Haloperidol: ~30–60 min

Rapid onset can reduce restraint time, staff injuries, and escalation of violence.

4️⃣ Sedation should be the last goal, not the first.

Reference 📚

Uribe ES, Bravo Rodríguez CA, Navarrete Juárez ME, et al. Pharmacological management of acute agitation in psychiatric patients: an umbrella review. BMC Psychiatry. 2025;25:273. DOI: 10.1186/s12888-024-06426-3.

[CardiovascularCorner @TrackYourHeart]

A simple way to see the 12-lead ECG

Color-coding helps pattern recognition:
🟢 Inferior: II, III, aVF
🟡 Lateral: I, aVL, V5–V6
🔵 Anterior/septal: V1–V4
🔴 Right: aVR (± V1)
Instead of memorizing 12 leads individually, think in territories.
This makes STEMI localization faster, cleaner, and harder to miss.

[Leonardo Santos @Leo_Santo5]

🩸💉Antídotos para la Reversión de Anticoagulantes

🔰📚N Engl J Med 2026

DOI: 10.1056/NEJMra2506021

Enlace a Artículo Completo👇🏻🆓✅
https://t.co/xumUMHaxVK

[Critical Care Reviews @CritCareReviews]

Today's Paper of the Day is:

Magnesium in Neurocritical Care: Clinical Relevance, Status Assessment, and Practical Implications for Outcomes

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

[Critical Care Reviews @CritCareReviews]

Today's Paper of the Day is:

The burden of hepatic encephalopathy and the use of albumin as a potential treatment

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

[Critical Care Reviews @CritCareReviews]

Sodium bicarbonate in critical illness: Correcting acidaemia without changing outcomes?

CCR Journal Watch
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[Critical Care Reviews @CritCareReviews]

Missed any of CCR26?

Want to watch it again?

The unedited recording of the entire conference is now freely available for a few days before being taken down & edited.

Enjoy the best critical care trials in the world!

https://t.co/8n2rryPEja