Philippe St-Arnaud

[Philippe St-Arnaud @phil_starno]

@norfolk_tim @msiuba @load_dependent 2/2
1) pushing patients to their limit of fluid responsiveness is putting them in a non physiological state.

2) I find that often, as opposed to me!, patient in the ICU are not fluid tolerant. So I don't go far on the FR path..

@ThinkingCC

[Philippe St-Arnaud @phil_starno]

@norfolk_tim Agree with @msiuba and @load_dependent .

1/2
You and I right now are fluid responder. Yet we don't need fluid. If I receive 2 l of LR, it won't hurt me much. I am fluid tolerant as well.

[ACTIV4a @ACTIV4a]

We are releasing the interim (final data coming and publication submission pending) data from our amazing mpRCT collaboration w/ @ATTACC_COVID @remap_cap to aid in clinician decision making on anticoagulants for #COVID19: https://t.co/Tg78vM5xfD @nih_nhlbi @macky_neal

[Philippe St-Arnaud @phil_starno]

@JSchoolerMDPhD @PulmCrit @Jopo_dr And this
https://t.co/f0Oizph0Tk

[Paul Wischmeyer MD @Paul_Wischmeyer]

Great paper by @danni_dietitian on “continuous versus intermittent feeding in #ICU”
HEAR more at my #CCC49 lecture @SCCM Congress- “Intermittent Enteral Feeding: The ICU's New Fad Diet". @LifeWithoutDiet @SICUPharmD #nutrition #dietitian https://t.co/8LLikCNamA

[Philippe St-Arnaud @phil_starno]

@JSchoolerMDPhD @PulmCrit @Jopo_dr From "our" nutritionist

[Philippe St-Arnaud @phil_starno]

@JSchoolerMDPhD @PulmCrit @Jopo_dr

[Philippe St-Arnaud @phil_starno]

@erico_vale @Francofoam1 @khaycock2 @PulmCrit My understanding is that it's best if the patient is spontaneously breathing on top of T high. It improves PCO2 (Among other things).
Hence avoiding if possible NMB and use the least amount of sedatives.
I have seen comfortable and awake patient under this mode. Cheers

[Philippe St-Arnaud @phil_starno]

Covid-19 ventilation.
Volume control vs APRV-TCAV
@ThinkingCC
@EMNerd_
Tldr : massive FiO2 drop. Better compliance.
Any thoughts/comments?

[Philippe St-Arnaud @phil_starno]

@ashutoshmeena Patient was intubated the evening before in the ER of the transferring hospital. I forgot how many days in illness.

[Philippe St-Arnaud @phil_starno]

@khaycock2 @Francofoam1 @PulmCrit @ThinkingCC @EMNerd_ One could argue that I would've got the same recruitment with the same PEEP on volume controlled...
APRV-TCAV end-expiration was 17.

[Philippe St-Arnaud @phil_starno]

@EMNerd_ @ThinkingCC Minute ventilation is 9l, Th is 2.2
It gives a release volume around 400cc.
@PulmCrit said PCO2 was so 2019... 🤔
It's 53

[Philippe St-Arnaud @phil_starno]

@Francofoam1 @khaycock2 @PulmCrit

[Philippe St-Arnaud @phil_starno]

After 8 hours on APRV-TCAV (9:30pm)
∆P 11, FiO2 40%, SpO2 99.
("Auto-peep with 75% PEFR at 17)

[Philippe St-Arnaud @phil_starno]

@dakaufman123 APRV-TCAV @ThinkingCC

[Philippe St-Arnaud @phil_starno]

@load_dependent @NephroP Great point about septum.
I find that PW Doppler analysis on portal vein is easier (less subjective?! at least for non cardiologist...).
Also, by septum movement alone, isn't more difficult to have a diuresis stop point?

[Philippe Rola @ThinkingCC]

Registration opens Friday October 25th! Bookmark https://t.co/pkDPzYaoD5 for registration link avail in 2d! join @iceman_ex @EMNerd_ @khaycock2 @phil_starno @WBeaubien @FTeranMD @CriticalCareNow @FMaeWestMD @heart_lung @PulmCrit @PendellM @drlauraduggan @drmarcogarrone #HResus20

[Lawrence Leroux @LawrenceELeroux]

Big thanks to @ResusTEEproject @FTeranMD @ThinkingCC @FMaeWestMD @drlauraduggan @bretpnelson for the great workshop in Montreal.

[The Rounds 🩺 @TheRounds]

Join Dr. Mallemat [@CriticalCareNow] for the next week at The Rounds Virtual Conference #FOAMed #resuscitation https://t.co/8F6dNoUBS8