José de Jesús Román Sandoval

Médico y orgullosamente de Torreón, Coahuila 🌵Medicina Interna-Medicina Crítica/Terapia Intensiva en México 🫀🫁🧠🇲🇽

[Josh Farkas MD 💊 @PulmCrit]

SOHO trial in NEJM:

🏙️ Multicenter RCT comparing high-flow nasal cannula vs. low-flow oxygen among patients with acute hypoxemic respiratory failure (mostly pneumonia)
🏙️ Inclusion criteria required a respiratory rate >25 and substantial hypoxemia (P/F <200)
🏙️ No difference in the primary endpoint of mortality (not surprising, the mortality endpoint is nearly always neutral in modern RCTs evaluating the nuances of supportive care).
🏙️ HFNC reduced the rate of intubation and increased the number of ventilator-free days.
🏙️ No significant signals of harm from HFNC.

This is similar to the FLORALI trial (by the same group of investigators). However, FLORALI showed *improvement* in mortality, whereas the current study didn't.

Why do these studies disagree about mortality?

The FLORALI trial found no mortality difference between HFNC versus conventional oxygen among ALL PATIENTS. However, it DID find a mortality difference in the *subgroup* of patients with P/F <200.

So this is a classic tale in critical care - a subgroup analysis from one trial subsequently fails to replicate. (At least, in terms of the mortality benefit.)

But chasing mortality in these trials is a fool's errand. Overall, the SOHO trial still supports the use of HFNC in acute hypoxemic respiratory failure (in terms of reduced intubation and improved ventilator-free days).

Using HFNC for sick pneumonia patients is already standard care, so I don't see this changing practice very much. Keep calm and HFNC on. 🌬️

[NEJM @NEJM]

Original Article: Daraxonrasib or Chemotherapy in Previously Treated Metastatic Pancreatic Cancer (phase 3 RASolute 302 trial) https://t.co/y4G27hfORg

#ASCO26 | @ASCO

[Dr. Eddie Ramirez @EddieRDMD]

NEJM: New research reveals a massive concentration in medical malpractice: just 1% of all physicians account for 32% of all paid claims🩺⚖️

It seems risk isn't random—it's highly concentrated among a small group of practitioners.

Full study: https://t.co/4tcx4F5VWF @EricTopol

[Gustavo Cortes-Puentes, M.D. @DrivingPressure]

Fresh of the press! Enjoy the collection of articles!!! Editorial: The Pulmonary and extra-pulmonary effects of mechanical ventilation in critically-ill patients https://t.co/m97ecBhPpH @BusanaMattia @simonegattarell @DrivingPressure @MayoPCCM @MayoVentilation @MayoAnesthesia

[José de Jesús Román Sandoval @drChuyRoman]

@roeckler @cbonnichsen @MayoClinicCV @MayoClinicCVS @MayoAnesthesia Great lectures and experience to be there! Tnks

[Dr Joshua Walinjom @walinjom]

#Semaglutide improves heart failure-related symptoms and physical function and results in greater weight loss compared with placebo in patients with #HFpEF and #obesity

#STEP-HFpEF trial

[Dr. FEVI🫀🩺 @javier20ch]

#ESCCongress 💯👌 #nejm
✨️ECLS-SHOCK trial 🧐⤵️

⤵️📚Referencia:
https://t.co/wym6uuvj0z
⤵️⚡️Descarga:
https://t.co/UjrQVeV1FX

[Dr. FEVI🫀🩺 @javier20ch]

Soporte vital extracorporeo en choque🫀 por IAM.💥
✨️ECLS-SHOCK trial📈 @NEJM
🟢209👥️Tto médico+ECLS 🆚️ 209👥️Tto médico
⛔️Sin diferencias en outcome1️⃣:☠️🫀RR 0.98
🚫ECLS se asoció con más complicaciones, ⤴️hemorragias (RR 2.44) y eventos vasculares periféricos (RR: 2.86).

[Mayo Clinic Mechanical Ventilation Conference @MayoVentilation]

#VV-ECMO and +pressure #mechanicalventilation ❤️ 🫁 physiology

[Mayo Clinic Mechanical Ventilation Conference @MayoVentilation]

Try to avoid converting to #VA-ECMO from #VV-ECMO for primary respiratory failure with appropriate lung protective ventilation and respecting RV function
@MayoPCCM @MayoAnesthesia @EricaWittwer

[Mayo Clinic Mechanical Ventilation Conference @MayoVentilation]

@MayoPCCM @MayoAnesthesia @EricaWittwer How does inotrope/vasopressor use effect the “mixing cloud” ☁️ with peripheral #VA-ECMO? @EricaWittwer @DrivingPressure

[Mayo Clinic Mechanical Ventilation Conference @MayoVentilation]

@MayoPCCM @DrivingPressure @roeckler The specific power (concentrated power) on the “baby lung” in severe ARDS gets higher and higher, shrinking the baby 🫁 further.

#DrJohnMarini @DrivingPressure @roeckler @MayoPCCM

[Mayo Clinic Mechanical Ventilation Conference @MayoVentilation]

And to close out the #MechanicalVentilation 2023 conference, Dr. John Marini talking to us about mechanical power 💪!!

#DrMarini @DrivingPressure @roeckler @MayoPCCM

[Hamilton Medical @HamiltonMedical]

#VentilationQuiz! Based on this P/V curve, what is this patient’s recruitment potential? Answer below &amp; click the link to see if you were right! https://t.co/6Yupk3P2O2

#MedicalEducation #MedEd #RespiratoryCare #MedTwitter #LungRecruitment #TestYourIntelliVence #TriviaTuesday

[MayoPCCM @MayoPCCM]

Join @MayoVentilation to receive high-quality hands-on #mechanicalventilation instruction. Aug 23-25 in Rochester, MN. @DrivingPressure @roeckler

Register here:
https://t.co/OdnRSD6SBr

[José de Jesús Román Sandoval @drChuyRoman]

@lopezdoriga @SantiagoCreelM Gracias por participar. Por mi, nunca.

[Dr. FEVI🫀🩺 @javier20ch]

✅️Rosuvastatina 20 mg es el más📈potente y con misma eficacia que estatina intensidad moderada + ezetimibe.
🚫Requiere ajuste renal y puede causar ⬆️LRA a dosis altas por tiempos prolongados⏩️ STICS trial.
✅️Atorvas y fluvastatina no requieren ajuste renal.

@OOllarvide 👌

[Critical Care Reviews @CritCareReviews]

Today's paper of the day is by Alfred Wong on short-term mechanical circulatory support (IABP, Impella, ECMO, TandemHeart)
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 2023