Eduardo Sánchez

Anesthesiology MD Hospital Gregorio Marañón

[Anesthesia&Analgesia @IARS_Journals]

Don't miss the editorial "The Myth of Depth of Anesthesia Monitors: When a “Normal” Bispectral Index Does not Mean What You Think It Means" from Drs. Paul Garcia and Peter Goldstein

Anesthetic “depth” and quality can’t be reduced to a single value: BIS cannot reliably ensure both optimization and safety. Recognizing monitor limits and adjusting care will.

https://t.co/Ydpp8MOCZU

[ASA Monitor @ASAMonitor]

The June @ASAMonitor serves as a clinical roadmap to help anesthesiologists navigate the transition from intraoperative specialists to holistic “guardians of the aging brain.”

Find articles about:
🔸Safeguarding #BrainHealth
🔸#Neurocognitive assessment
https://t.co/4jaaMb4WCo

[Anesthesiology News @anesthesianews]

New ASA & SPA alert: ND4 gene mutation linked to severe neuro complications after anesthesia in patients of Venezuelan ancestry. Guidance urges avoiding volatile agents & genetic screening. https://t.co/mkKYzfoe8B #Anesthesia #Genetics #PatientSafety #ND4mutation

[Anesthesia&Analgesia @IARS_Journals]

Should cognitive screening become routine before surgery?

Preoperative cognitive dysfunction linked with #EEG suppression and cerebral hypoxia🧠

https://t.co/uGpswgDVRp

#Anesthesia #PerioperativeMedicine #CognitiveImpairment #CardiacSurgery #PatientSafety #Neuroscience

[Anesthesia&Analgesia @IARS_Journals]

Can #AI identify who actually benefits from #steroids?
These investigators uncovered distinct #cardiac #surgery phenotypes with different responses to perioperative steroids. Are we getting closer to precision medicine in the OR?? 🤖💉
#ArtificialIntelligence #PrecisionMedicine #CardiacAnesthesia #PerioperativeMedicine #MachineLearning #anesthesia
https://t.co/1SS4YT6zBi

[Journal of Cardiothoracic and Vascular Anesthesia @JCVAonline]

Perioperative Inflammation and Immune Response in Anesthesia
This JCVA review synthesizes 54 studies on how propofol, volatiles, opioids, and regional anesthesia differentially regulate cytokines, infection risk, and organ outcomes. https://t.co/aksudVu7iy

[British Journal of Anaesthesia @BJAJournals]

New #editorial discussing ‘exercise snacking’, #prehabilitation and #exerkines

https://t.co/3Nv5SUhCWs

[RECAT👩🏽‍⚕️🏥👨🏽‍⚕️🇲🇽🫀 @LeslieMegom]

🧠💥Extubación después de una lesión cerebral aguda: ¡¡un dilema sin resolver!!🔎📚📜
La decisión de extubar a un paciente en cuidados neurocríticos se basa en 3️⃣ condiciones básicas:
1️⃣ Los predictores generales en la UCI incluyen la estabilidad hemodinámica y respiratoria, junto con un resultado positivo en la prueba de aliento espontáneo.
2️⃣ Estado neurológico🧠 según ventilación espontánea de soporte: lesión cerebral en proceso de resolución, no hay cirugía planificada, considerando la trayectoria de la condición neurológica y el nivel de conciencia sin establecer un umbral mínimo de puntuación de Glasgow.
3️⃣ Permeabilidad de la vía área, capacidad de manejar secreciones ambas evaluadas con la puntuación de Coplin o escalas similares.
👇🏽👇🏽👇🏽👇🏽
https://t.co/x9lyGLcSo7
🔓🗝
https://t.co/ba0rsRHrrL

[𝘈𝘯𝘢𝘦𝘴𝘵𝘩𝘦𝘴𝘪𝘢 @Anaes_Journal]

New from our "Core Topics" series - here is a mechanistic framework for interpreting shock and hypotension!

#anaesethesia #MedTwitter

@icmteaching @PARADicmSHIFT @ICUltrasonica @Wilkinsonjonny

https://t.co/bGvetfnZIo

[literland @literlandweb1]

A principios de los años 90, poco antes de morir, Bukowski pronosticó un mundo de incomunicación y tecnología. Han pasado casi treinta años y su poema se ha convertido en profecía cumplida. El fragmento pertenece al poema "Esta bandera no ondea con cariño".

[Anesthesia&Analgesia @IARS_Journals]

Can in-plane #ultrasound guidance improve success and reduce complications during subclavian central line placement? 💉📊
#POCUS #CriticalCare #PatientSafety #PerioperativeMedicine #Anesthesiology
https://t.co/br4DkCi5uY

[Critical Care Reviews @CritCareReviews]

Today's Paper of the Day is:

Nuts and bolts of lung ultrasound: utility, scanning techniques, protocols, and findings in common pathologies

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

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

🍽️ ICU nutrition: we’ve been doing it wrong for years?

More calories
More protein
Earlier feeding

Sounds logical

But physiology disagrees

⚠️ The key update

High-quality RCTs now show:

❌ Early full-dose nutrition
→ NO benefit
→ Potential harm

Especially in:

• Shock
• Multiorgan failure
• High metabolic stress

👉 This is not neutral
👉 This is dangerous practice

🧠 Critical illness is not static

It evolves through metabolic phases:

1. Acute catabolic phase

2. Stabilization phase

3. Recovery phase

👉 Feeding must follow physiology
Not protocols

🔥 Phase 1: Acute catabolic

• High inflammation
• Insulin resistance
• Endogenous substrate mobilization

👉 The body is NOT ready for full nutrition

💡 Strategy:
✔️ Permissive underfeeding
✔️ Low protein

Why?

Because early overload leads to:

• Hyperglycemia
• Hepatic dysfunction
• Renal stress
• Impaired autophagy

👉 You are feeding dysfunction, not recovery

⚖️ Phase 2: Stabilization

• Inflammation decreasing
• Organ function improving

👉 Now metabolism starts to tolerate nutrition

💡 Strategy:
✔️ Slow escalation
✔️ Daily reassessment

⚠️ Red flags:

• Hypophosphatemia
• Hyperglycemia

→ Patient is NOT ready

💪 Phase 3: Recovery

• Anabolism returns
• Mobility improves

👉 NOW nutrition matters most

💡 Strategy:
✔️ Higher calories
✔️ Higher protein
✔️ Combine with rehab

👉 This is where you rebuild muscle and function

📊 The real takeaway

Nutrition is NOT:

❌ A fixed prescription
❌ A calorie target

It is:

✔️ A dynamic therapy
✔️ A metabolic intervention

🎯 The new principle

“Start low
Advance judiciously
Individualize throughout”

👉 Precision ICU nutrition

⚠️ Final thought

Overfeeding early harms
Underfeeding late harms

👉 Timing is everything

📚 Stoppe C et al. Curr Opin Clin Nutr Metab Care 2026
DOI: 10.1097/MCO.0000000000001186

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

🫁 Lung Ultrasound 2.0, From Art to Science

The new international consensus on lung ultrasound marks a clear transition:

👉 From qualitative interpretation
➡️ To standardized, reproducible, and quantitative medicine

⚠️ What is truly NEW in this update

🔴 1. Standardization is now mandatory, not optional

LUS is highly operator- and machine-dependent

👉 The same patient can generate different findings depending on settings

New recommendation:

• Always report probe, frequency, MI, depth, protocol
• Move toward reproducible imaging frameworks

🧠 2. B-lines are no longer “simple artifacts”

They are:

• Frequency-dependent
• Physically complex
• Linked to lung microstructure

👉 Counting B-lines is semi-quantitative at best

➡️ Future: quantitative ultrasound spectroscopy

🤖 3. AI enters LUS, but with caution

AI is emerging in:

• Image segmentation
• Severity scoring
• Pattern recognition

BUT:

👉 Strong warning against overinterpretation and poor methodology

Key requirement:

• Proper dataset splitting
• Standardized acquisition
• Clinical validation

⚙️ 4. Multidisciplinary shift

This is not just a clinical update

👉 Engineers + physicists are now part of the consensus

Why?

• Ultrasound physics matters
• Signal processing matters
• Image formation matters

➡️ LUS is now a true bioengineering field

📊 5. From subjective to objective metrics

Major gap identified:

• Pleural line abnormalities
• Subpleural consolidations
• Artifact interpretation

👉 Need for:

• Measurable parameters (mm, not “small/large”)
• Quantitative imaging endpoints

🛑 6. Safety is finally addressed

New concern:

👉 Potential pulmonary capillary hemorrhage (animal data)

Recommendation:

• Apply ALARA principle
• Monitor Mechanical Index (MI)
• Limit exposure time

➡️ LUS is safe, but not risk-free

📚 7. Education becomes a core pillar

Clear statement:

👉 LUS must be formally taught and standardized

Including:

• Medical curriculum integration
• Structured training
• Remote mentoring

🎯 Take-home message

Lung ultrasound is evolving from:

❌ Operator-dependent bedside tool
✅ Standardized, physics-driven, AI-supported diagnostic modality

⚖️ My reflection

We are entering a phase where:

👉 Understanding how ultrasound interacts with lung tissue
is as important as interpreting the image itself

This is where critical care, cardiology, and engineering finally meet

📖 Libertario D et al J Ultrasound Med 2023
doi:10.1002/jum.16088

#LungUltrasound #CriticalCare #POCUS #MedicalAI #ICU #Ultrasound #PrecisionMedicine #ACVC

[SEDAR @sedar_es]

#DocenciaSEDAR📚 Artículo de revisión

Rotura uterina intraparto, manejo anestésico y resultados materno-fetales. Un artículo fundamental para prevenir no una catástrofe sino dos.

Lectura imprescindible para práctica clínica.
🔗 https://t.co/VgmKyQO6tu

[SEDAR @sedar_es]

#CardioToVascSEDAR 🫀📊 Revisión 2026: Anestesia en cardiopatías congénitas:
Cuatro ejes principales: ERAS, manejo de CEC, seguridad perioperatoria, adultos con patología compleja

Impacto directo en outcomes y organización de equipos.

🔗https://t.co/rsHTwc75v5

[British Journal of Anaesthesia @BJAJournals]

This excellent new #BJAEd Article by Kovac & Choksi on the prophyalxis and treatment of Postoperative Nausea and Vomiting, is available to read now: https://t.co/7VwFazUJj7

[Ethic @Ethic_]

La mente que rumia se enfrasca en un bucle de #pensamientos negativos. Pero, aunque parezca complicado, la psicología demuestra que es posible escapar de la espiral.
https://t.co/z7ENYalFVh

[The Lancet @TheLancet]

Depression affects approximately a quarter of a billion people globally, of all ages and from all walks of life.

A new Seminar provides a comprehensive overview of the epidemiology, diagnosis, & management of depression in adults: https://t.co/f8qW9C7RLt

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

More about VAC in sepsis... 🤓
🫀 Why do some septic shock patients respond to treatment… and others don’t?

We often blame:

• “Refractory shock”
• “Severe sepsis”
• “Late presentation”

But physiology tells a different story.

⚙️ The real problem: ventriculo-arterial decoupling

Septic shock is not only vasodilation or myocardial depression.

👉 It is a failure of interaction between the heart and the arterial system

This interaction is called:

➡️ Ventriculo-arterial coupling (VAC)

And it defines:

✔️ Cardiac output
✔️ Arterial pressure
✔️ Perfusion efficiency

🧠 What can be often ignored in daily ICU practice

You can have:

✔️ Normal cardiac output
✔️ Acceptable MAP

❗ And still have inefficient circulation

Because:

👉 Energy transfer from the ventricle to the arterial system is impaired

📉 What happens in septic shock?

• Decoupling is common
• LV ejection becomes inefficient
• Cardiovascular treatments become less effective

💉 Clinical paradox

Same intervention. Different outcomes.

Example with norepinephrine:

🔵 Patient A
→ Adequate contractility (Ees preserved)
→ ↑ arterial tone
→ VAC improves
→ ↑ CO

🔴 Patient B
→ Depressed contractility
→ ↑ arterial tone (afterload)
→ VAC worsens
→ ↓ stroke volume

🔥 This explains a lot of what we see

• Why MAP increases but CO drops
• Why some patients “fail” vasopressors
• Why fluids work in some and not others
• Why lactate persists despite “normal numbers”

🧬 Even more important

VAC is:

👉 A determinant of treatment responsiveness, not just a descriptor of physiology

📊 Bedside implication

We should stop asking only:

❌ “What is the MAP?”

And start asking:

✅ “Is the system coupled?”
✅ “Are we improving efficiency or just pressure?”

⚡ Practical shift

Instead of protocol-only resuscitation:

➡️ Move toward physiology-guided resuscitation

Using:

• Ea (arterial load)
• Ees (contractility)
• VAC (their interaction)

🧠 Final thought

Septic shock is not just:

❌ A pressure problem
❌ A volume problem

👉 It is an interaction problem

And until we treat it as such:

➡️ Some patients will continue to “not respond”

📚 Pinsky MR, Guarracino F. (2023)
Intensive Care Medicine Experimental
https://t.co/3bYkZ1G7wG