Geok Seen

Anything about perfusion and ventilation to keep someone alive.

[Geok Seen @geokseenong]

@peachyhaengbbok @MelGohCNA Bot

[M Velia Antonini @FOAMecmo]

Mitochondria serve as central hubs integrating various cellular functions, including lactate metabolism:
🏭 ⬆️ clearance may be due to enhanced NADH use
🏭 immune cells among most relevant sources of lactate in #sepsis
🏭 lactate associated with ⬇️ mitochondrial activity in skeletal muscle in sepsis
🏭 lactate biosynthesis in lymphocytes increase upon glycolytic demands, despite O2 availability Understanding lactate as metabolic product involving several phenomena & different organs makes it a biomarker indicative of prognosis/clinical response, more than therapeutic target. #FOAMcc on @yourICM
🔓 https://t.co/IPbPlOFWwT

[M Velia Antonini @FOAMecmo]

Ethics of #ECLS, from beginning to present: balancing reasons, rather than deriving norms from facts...
Narrative review
➡️ethical impact of trials & evidence
➡️resource allocation, decision‑making, WLST
➡️defining death on #ECMO & #EISOR in DCD
@Crit_Care https://t.co/CfSG9mgKqZ

[M Velia Antonini @FOAMecmo]

Insights into contact activation on #ECMO
FXII activity on run
⬇️at any timepoint in 98% of pts (may impair aPTT)
➡️median 30%
⬆️after weaning
⬇️is associated with ⬇️ thromboembolic complications: FXII as anticoagulation target?
@CritCareMed @MedUni_Wien https://t.co/B3LWVS9VRN

[Molly💙👩‍⚕️ @NurseM0lly]

Felt so emotional today picking up my nurse uniform. I feel like I’ve waiting forever for this moment, to finally wear my blues 🥺👩‍⚕️ #NewlyQualifiedNurse #NQN

[M Velia Antonini @FOAMecmo]

Might MV settings, lung mechanics, clinical data predict VV #ECMO weaning in severe #ARDS? Safe liberation (= no early need for re-cannulation/other rescue, ⬆️MV, nor hemodyn instability) less likely if
⬆️Vt
⬆️HR
⬆️VR
⬆️ΔPes
during SG off trial @accpchest https://t.co/LZGOJYTvwi

[Intensive Care Medicine @yourICM]

Post #COVID19 critical care in China, lessons & renaissance:
➡️resources (re)organization
➡️(judicious) use of antivirals/antibiotics
➡️clinical management
➡️PPE according to @WHO
➡️preventing #SARSCoV2 recurrence & coping with future outbreaks/#pandemics
https://t.co/tHsOoEIgVl

[Intensive Care Medicine @yourICM]

Very rarely Vaccine-associated Immune Thrombosis & Thrombocytopenia VITT has been reported: here successful early thromboaspiration + 12h intraportal fibrinolysis for extensive portomesenteric thrombosis, with full veins recanalization.
#COVID19 #COVIDFOAM https://t.co/lErBMJnylj

[M Velia Antonini @FOAMecmo]

Venous Excess UltraSound?? window on venous (congestion) pathophysiology, which might guide precise fluid management! Here conceptual review + case series focused on #VExUS grading system: pathological basis, pitfalls, limitations #FOAMus #echofirst #POCUS
https://t.co/s5OC8cwSyu

[EuroELSO @EuroELSO]

#ECMO in #COVID19, comparing first vs second wave: increase in mortality vs weaning/survival: successful weaning in 58% vs 47%, overall survival 53% vs 44%. Time on ECMO appears longer in #SARSCoV2 pts: long runs(>28 days) & futile cases also increased. https://t.co/pzg3dVKi29

[M Velia Antonini @FOAMecmo]

#ECMO for #COVID19: analysis of #ECLS provision during 1st/2nd waves from @EuroELSO EuroECMO survey indicate picture has changed: increased mortality vs weaning/survival. Conclusions premature, many bias & questions still requiring answer. @LancetRespirMed https://t.co/iIkaIKJ5Mw

[Intensive Care Medicine @yourICM]

'Matters of Time' is a thoughtful piece on those moments; seconds that last hours and hours that pass in seconds.

In #ICMfromtheinside this week, free read on @yourICM at https://t.co/9pAlgVMONN

[Intensive Care Medicine @yourICM]

Environmental sustainability of critical care
🌲contribution to carbon footprint
🌲how to get #ICU in order?
First? do not harm! Also maintaining healthy ecosystem & dissolving developed/developing countries disparities in ICM availability @KlimaGesundheit
https://t.co/HQdOmfItpd

[M Velia Antonini @FOAMecmo]

VA #ECMO gap
🔸mortality 38% on #ECLS run, more than ⅓ of patients; most commonly due to MOF, cardiac failure, neuro causes
🔸15.3% mortality post-weaning: many successfully weaned pts decease during hospital stay
🔸44% discharged
@ArtifOrgans #FOAMecmo https://t.co/kzd8hRrXMk

[Giuseppe Citerio @Dr_Cit]

Does intracranial pressure measuring&treatment matters?read on @TheLancetNeuro the results of @SYNAPSE_ICU @ESICM @unimib https://t.co/0jnKZl9CoS

[ELSO @ELSOOrg]

Defining & understanding VA #ECMO gap, patients successfully weaned but eventually die during hospital stay: SR (1993 - 2020) including 60 studies & 9,181 patients aimed to investigate timing & causes of death in adults supported with VA ECMO. @ArtifOrgans
https://t.co/dbKIv6oVAZ

[M Velia Antonini @FOAMecmo]

#TTM2
❄️targeted hypothermia 33°/controlled rewarming
vs
🌡️normothermia/early fever control BT ≥37.8°C
in pts with coma after #OHCA
NO ⬇️ death (6 months) 50 vs 48%
↔️ moderately severe disability or worse
⬆️arrhythmia resulting in hemodynamic compromise
https://t.co/a6ENPGaqsb

[Segun Olusanya (He/Him) [email protected] @iceman_ex]

Lovely thread on M-mode. It’s not dead. #echofirst

I just need to improve my colour M mode understanding...

[Healthcare Hashtag Project @healthhashtags]

Top Influencers of #CCAS2021: @PedsCardiacAnes @SGrantMD @nasr_viviane @CongenitalHear3 @gracebichara More 📊 https://t.co/3GesPu83UF

[Intensive Care Medicine @yourICM]

All that glitters is not gold: an unusual presentation of S. aureus #sepsis during #ECMO run in a #COVID19 patient https://t.co/ZfRfko9wLG
Free read on @youricm #FOAMcc #COVIDFOAM #FOAMecmo @gutopell @RicardoCremo @edinoparolo