Maria Bernadette Cilona

MD, Allergist and Clinical Immunologist, San Raffaele Hospital

[ISICEM @ISICEM]

𝐒𝐞𝐫𝐢𝐨𝐮𝐬 𝐬𝐜𝐢𝐞𝐧𝐜𝐞. 𝐔𝐧𝐞𝐱𝐩𝐞𝐜𝐭𝐞𝐝 𝐟𝐨𝐫𝐦𝐚𝐭.
The @ISICEM Critical Care Input — presented this time in a new way. Watch it now and enjoy.
Credits @DrFDamico
#ISICEMelearning @NEJM
Full article https://t.co/rOeUBP3bQE

[Filippo D'Amico @DrFDamico]

📢 Our second review on protective hemodynamics now published in @JCVAonline

“Protective haemodynamics: C.L.E.A.R.!”

The C.L.E.A.R. approach

It is CLEAR!

https://t.co/STHD8hGjVE

[Filippo D'Amico @DrFDamico]

Evidence on blood pressure targets in critically ill patients shows that Mean Arterial Pressure is not always equal to end-organ perfusion. 🩸

The future? Customize blood pressure targets. 🔄💡

All discussed in our review on Protective Haemodynamics!

https://t.co/STHD8hGjVE

[Filippo D'Amico @DrFDamico]

Our latest article explains the CLEAR approach to protective hemodynamics

Discover how to customize targets, limit catecholamines, enhance flow, adjust fluid balance, and resolve underlying conditions.

https://t.co/STHD8hGjVE

[Filippo D'Amico @DrFDamico]

The C.L.E.A.R. approach of protective hemodynamics in critically ill patients is a step forward in embracing complexity, moving beyond simple pressure targets. 🩺🔄

It’s time to rethink how we manage cardiovascular stability in critical care.

Read our full review for more insights! 📄💡

https://t.co/u6hXWo2cLh

[Filippo D'Amico @DrFDamico]

Excited to share our review “Protective Hemodynamics: A Novel Strategy to Manage Blood Pressure”🚨🫀

@giovannilandoni

This approach aims to maintain cardiovascular stability while minimizing risks associated with interventions. Check it out! 📄💡

https://t.co/MFkxyv3UAq

[Filippo D'Amico @DrFDamico]

Protective hemodynamics!

Our review highlights the importance of reducing catecholamine load by using the right vasopressor for the right patients at the right time 🩸⏱️

https://t.co/MFkxyv3UAq

[Filippo D'Amico @DrFDamico]

Protective hemodynamics!

Finding the right balance in hemodynamic management is crucial—excess and deficiency both deserve the same caution. ⚖️

Too much is just as risky as too little.

Read our full review for in-depth insights!

https://t.co/MFkxyv4spY

[Filippo D'Amico @DrFDamico]

⚡ Breaking new ground in blood pressure management!

🫀 How should we manage blood pressure in critical care and perioperative settings?

📈 Check out our latest meta-analysis, which could redefine how we manage blood pressure in #criticalcare and #perioperative

https://t.co/McZ9uhD0Ln

[Filippo D'Amico @DrFDamico]

6/6 To learn about the outcomes of 28 RCTs (12 in critically ill and 16 in perioperative settings) involving 15,672 patients, stay tuned to our meta-analysis updates.

Our upcoming posts will shed light on vital BP management insights.

[Filippo D'Amico @DrFDamico]

5/6 @LamontagneFran5 study found no benefits in randomizing septic shock patients to high vs low blood pressure targets.

[Filippo D'Amico @DrFDamico]

1/6🧐 Observational studies have long noted that hypotension is linked to adverse events in perioperative and critical patients, influencing clinical practice and guidelines.

🔗 But is this a true cause-effect relationship, or just bias due to confounding?

🔀 Let’s see what the randomized trials say.

@CritCareMed

[Filippo D'Amico @DrFDamico]

10/10
⚠️ Important Clarification:

- Lower blood pressure is not better than normal pressure.
- Our study does not advocate for actively pursuing lower BP targets.

For a thorough understanding of our findings, please read the full paper

[Filippo D'Amico @DrFDamico]

9/10
🌟 Positive Secondary Outcomes!
Patients with lower BP targets experienced fewer complications:

🫀Lower rate of atrial fibrillation 3.1% vs 4.0% (OR 0.7, p=0.003)

🩸less frequently required transfusion 16.5% vs 20.5% (OR 0.71, p=0.03).

[Filippo D'Amico @DrFDamico]

8/10
🚀 Overwhelming Evidence!
20 out of 21 sensitivity analyses demonstrated a similar magnitude and direction for mortality in favor of lower targets.

🎯 10 of these analyses are statistically significant, proving the power and reliability of our findings.

[Filippo D'Amico @DrFDamico]

7/10
In Trial Sequential Analysis (TSA), a method used to reduce the risk of random errors in data during cumulative meta-analyses, the cumulative z-curve crossed the benefit boundary for low blood pressure targets confirming primary results

[Filippo D'Amico @DrFDamico]

6/10
📉The Absolute Risk Reduction indicates 10 fewer deaths per 1000 patients , which translates to an Number Needed to Treat of 100.

⚰️For every 100 patients where we choose lower blood pressure targets (defined as the minimum tolerated level), we prevent one death.

[Filippo D'Amico @DrFDamico]

5/10
🎯Our Bayesian meta-analysis shows a 97.4% probability that higher blood pressure targets could increase mortality.

💔This means there's a very high likelihood that aiming for higher BP might be more harmful than beneficial.

[Filippo D'Amico @DrFDamico]

4/10
💥Lower BP targets led to reduced mortality compared to higher targets

13.3% vs 14.4%

RR 0.93, 95% CI, 0.87–0.99

p=0.03

This suggests a significant benefit of lower targets.

[Filippo D'Amico @DrFDamico]

3/10
🦣Our meta-analysis is the largest ever on blood pressure management in critically ill and perioperative setting

- 28 RCTs

-15,672 patients

It's the first to include both critically ill and perioperative populations, evaluating each group separately.