Mer ✈️

Hincha de Boca⚽️ y de los Patriots 🏈. Volar ✈️. Bailar💃🏻. Fitness Fan 💪🏻. De UAQ, Arg.

[Mer ✈️ @meri2013]

@lucasllach Arcor?

[Mer ✈️ @meri2013]

@med_amargado El QT más largo que bufanda de jirafa

[Mer ✈️ @meri2013]

@marianoheller Recordemos además a este muchacho adepto al ácido hialuronico …

[Mer ✈️ @meri2013]

@IgnU12

[Martin Lübel @mlubelphoto]

Hoy se cumple un año de qué con @meri2013 adoptamos a este sujeto.
Yo venía de exactamente 10 años de no tener perro, y jamás uno tan chiquito (4kg de pura furia canina)
Simplemente nos lleno de cariño y ternura.
Gracias por este primer año Hulkito

[Mer ✈️ @meri2013]

@ChefPacoAlmeida @CopaAirlines El cartero que parece de cera pero es humano y te hace cag@r en las patas xq jamás pensas que se va a mover sigue? Jajajaja

[Mer ✈️ @meri2013]

@elmauro1 Flat white frío? 🤔🤔

[Mer ✈️ @meri2013]

@nanomotorblog BMW 325i

[Mer ✈️ @meri2013]

@cladaco Poesía …

[Mer ✈️ @meri2013]

@stizzwhatitiz @JakeWally I really hope that was the case 🤞🏻🤞🏻

[Mer ✈️ @meri2013]

Ese no sera mi hermano no? Jajaja

[ElBuni @therealbuni]

Rescatista : ahora me toca sacar a los astronautas del artemis 2, prepárate que este momento va a marcar toda tu vida

*se cae*

[Mer ✈️ @meri2013]

Well … it’s nice to know that Wiseman and I have something in common

[Curiosity @CuriosityonX]

Iconic space quotes... Apollo 11 vs Artemis II

[小谷祐樹 Yuki Kotani｜集中治療医 @YukiKotani5]

ノルアドレナリン換算式：2023 Critical Care
10種類の血管収縮薬の投与量を換算できます！

例えば
・バソプレシン 0.04 U/min → ノルアド 0.10 µg/kg/min
・アドレナリン 0.20 µg/kg/min → ノルアド 0.20 µg/kg/min
・ドパミン 15 µg/kg/min → ノルアド 0.15 µg/kg/min
https://t.co/nngNDv8AvG

[ASA® @ASALifeline]

Anesthesiologists around the world have become aware of a rare genetic variant found in some patients of Venezuelan lineage, which can result in severe neurologic complications after general anesthesia.

Find up-to-date information here: https://t.co/i31cjGrJtu

[Andrés J. Colmenares @wawawiwacomics]

I'm so nervous!! 🌔 #ArtemisII #NASA #Moon

[Anish Moonka @anishmoonka]

Reid Wiseman told his two teenage daughters where to find his will before he got on this rocket. He’s raised them alone since their mom died of cancer six years ago. Right now, he is 252,757 miles from home, farther from Earth than any human being has ever been.

Wiseman grew up outside Baltimore. Got rejected from the Naval Academy, went to Rensselaer Polytechnic Institute instead, studied computer engineering. Became a Navy fighter pilot, flew F-14 Tomcats (the jet from Top Gun) on combat missions over Iraq and Afghanistan. Two Middle East deployments by his mid-twenties. He saw a Space Shuttle launch in person in 2001 and couldn’t let go of it. Applied to NASA while at sea on the aircraft carrier USS Dwight D. Eisenhower. They picked him. Nine people out of 3,500 applicants. His astronaut class, nicknamed “The Chumps,” included Jeremy Hansen, the Canadian who’s floating next to him right now.

Wiseman’s first trip to space was 165 days on the Space Station in 2014. Two spacewalks. Thirteen hours outside the hull in nothing but a suit. He climbed all the way up to Chief of the Astronaut Office, the person who decides which astronauts fly and which ones sit. Then he gave it up in 2022 to put himself back on the flight list.

His wife Carroll was a nurse in a newborn intensive care unit. She got cancer. Fought it five years. Died in May 2020 at 46. His mother died from Alzheimer’s just weeks before that. Wiseman raised both daughters by himself after that. NASA’s own bio says he considers being a single parent his hardest challenge and the best part of his life. Even while she was dying, Carroll told Reid not to step back from his career. She made him keep going. His brother is a Navy SEAL. His father is 83 and battling cancer too. The old man told reporters he wanted to stay alive long enough to see his son launch.

Before liftoff, Wiseman’s daughters snuck homemade cookies into his flight bag. He posted a photo with them in front of the rocket and wrote “I’m boarding that rocket a very proud father.”

The previous distance record from Earth belonged to the Apollo 13 crew. 248,655 miles, set in April 1970, and it was an accident. An oxygen tank blew up and the emergency route home happened to swing them farther out than anyone before. Wiseman broke that record by 4,100 miles, and his distance is on purpose. Today he flies within 4,600 miles of the Moon, photographs stretches of the far side that were too dark or at the wrong angle for any of the 24 Apollo astronauts to see, and watches a solar eclipse that nobody on Earth can see, only the four people inside that capsule.

Then he turns around and spends four days flying home to his girls.

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

🧠We’ve been treating ICP… but ignoring the waveform.

For decades, neurocritical care has focused on:

👉 Absolute ICP values
👉 Fixed intervention thresholds

But what if we’ve been missing the most important signal?

->New insight: ICP is not just a number, it’s a waveform

This review highlights a major paradigm shift:

➡️ From static ICP thresholds
➡️ To dynamic intracranial compliance assessment

->What the waveform tells you

A single ICP value = a snapshot

The waveform = physiology in motion

👉 Key parameters:

P2/P1 ratio → compliance status

Mean pulse amplitude → compensatory reserve

Pulse shape index (AI-based) → early deterioration

When P2 > P1:

⚠️ The brain is losing its buffering capacity
⚠️ Decompensation may already be underway

->Why this matters

You can have:

✅ “Normal ICP”
❌ But severely impaired compliance

👉 Meaning:

The patient is already at risk…
before ICP even rises.

->The real shift

We are moving toward:

🧠 Physiology-driven neurocritical care

Instead of reacting to ICP spikes, we can:

Detect early deterioration

Optimize CPP and ventilation

Individualize interventions

Prevent secondary brain injury

->Even more interesting…

Non-invasive technologies are emerging:

👉 Devices that detect skull micro-deformations
👉 Provide real-time waveform surrogates
👉 Correlate with invasive ICP metrics

🤓Key takeaway

ICP alone is not enough.

👉 The future is:

Waveform + compliance + autoregulation = true brain monitoring

Bottom line

Stop treating numbers.

Start understanding physiology.

📃Reference
Brasil S, Taccone FS. Critical Care Science, 2026.
https://t.co/aY4UlRpgap

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

🤓🫀We keep asking: “What’s the cardiac output?”
But maybe the better question is:
“How efficiently is the heart working?”

In septic shock, we often focus on:

Preload
Cardiac output
MAP

But we forget something fundamental:

👉 The heart doesn’t work alone.
👉 It works against the arterial system.

1. The missing concept: Ventriculo–arterial coupling (LVAC)

LVAC = interaction between:

Ees → contractility

Ea → arterial load

👉 Expressed as Ea / Ees

This ratio reflects:

How efficiently the heart converts energy into forward flow

2. What is “normal”?

LVAC ≈ 0.5 → optimal efficiency

LVAC ≈ 1 → maximal stroke work

LVAC > 1 → uncoupling (inefficient system)

But here’s the twist:

👉 In septic shock, LVAC is often >1
👉 Not just due to vasodilation—but also myocardial dysfunction

3. Why this matters clinically

Two patients can have:

Same MAP

Same CO

But completely different physiology:

✔ One → efficient coupling
❌ One → energy wasted, poor flow generation

4. The key insight

Septic shock is NOT just:

❌ “low preload”
❌ “vasodilation”

It is:

👉 A mismatch between heart and arterial system

5. Therapy changes the balance

Fluids → may improve coupling (↓ LVAC)

Norepinephrine → can improve OR worsen coupling

Inotropes → target Ees

Important:

👉 Increasing MAP ≠ improving flow
👉 Increasing pressure can worsen afterload

6. The most interesting part

From the data:

LVAC >1 can predict response to norepinephrine

But improving LVAC ≠ guaranteed tissue perfusion and outcomes follow a U-shaped curve

👉 Both too high AND too low LVAC can be harmful

7. The limitation we must respect

Even if you “optimize” LVAC:

👉 Microcirculation may still be impaired
👉 Lactate may still rise
👉 Shock may persist

Because: Macro ≠ micro

🤓Final message

We need to move from:

❌ “Fix the blood pressure”

To:

✅ “Optimize the interaction between heart and vessels”

LVAC doesn’t replace hemodynamics.
It completes it.

📃Reference
Caicedo Ruiz JD et al. Journal of Critical Care, 2026. https://t.co/1ZNMHqwBl4

[Mer ✈️ @meri2013]

Me be like …