Philippe Rola

#zentensivist, EMCrit Teammate, Proud daddy and husband. BJJ🟪. ICU Santa Cabrini Hospital.

[Philippe Rola @ThinkingCC]

Last few days for early bird! Join us in Montreal next september! #HR26 Nothing quite like it... https://t.co/OAOke4UlwM

[Philippe Rola @ThinkingCC]

Good for her. Reality is reality. Being forced to buy into other people’s fantasies is 100% coercive. People can be with whomever they wanna be, fantasize about whatever they want to be just like I used to fantasize about playing ball like Michael Jordan, but at the end of the day reality is reality. And imposing alternate viewpoints doesn’t change it. There’s no perspective on reality, there’s just reality.

[Gad Saad @GadSaad]

Watch and then think very carefully about whom to vote for. Good job, @RubinReport.

[Philippe Rola @ThinkingCC]

Just about everywhere in the world, lives people who took the land from someone else who had taken the land from someone else. It’s time to stop this divisive narrative and everyone move forward together. Tribalism exists in human genes. You’ll never eradicate it, and you’re sure as hell will never legislate it or leverage it away using political means without actually making things worse. As far as I’m concerned, there’s far more racial tension and divide since the 90s when things were actually pretty mellow on all identity ends. All this frenzy has been whipped up to use by politicians as leavers to gain power and immense riches. Everyone of these so-called social justice movements has been abused by a small minority of people who benefit from it. Everyone else is a pawn. The whole identity politics will be looked at in history as one pathetic period of nonsense, and worse, it is leading to the rapid decline of western civilization, which has been unequivocally what has improve the quality of life of humanity across the board.

[Mathieu Bock-Côté @mbockcote]

Le terme technique pour qualifier cette décision est "hostie de niaisage".

[Rafael Melo @intensivaev]

Corrected link: https://t.co/2W4CjLNTsA

[Israel Now @neveragainlive1]

Moshe Feiglin provides a proper Jewish response to a hostile reporter from Canada

[Daniel Tyrie @DanielTyrie]

Muslim community leader brags that Alvin Tedjo's unexpected win in Mississauga can be credited to his statement against Islamophobia and the genocide in Gaza.

Takeaways are two-fold.

1. Our municipal elections are being hijacked by ethnic voting blocs to focus foreign issues that have nothing to do with local government.

2. This is the sort of impact an organized community can make in elections with only 17% of the electorate.

Imagine the impact Canadians can have if we just take our own side.

[Philippe Rola @ThinkingCC]

@EABeauregard @FrChapleau @cardusca @QubRadio @mariodumont Tout a fait d’accord. Les frais de lobbying devraient venir purement des poches des politiciens, pas des notres. Incluand mckinsey et compagnie.

[Philippe Rola @ThinkingCC]

I would argue that it is not a disease at all. So trying to come up with an unifying pathophysiology is, to me, utter nonsense. Ping @TheEMNerd @PatientStormDoc

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

🫁ARDS is not only a disease of the alveoli but also a disease of the pulmonary circulation.

Sixty years after its original description, our understanding of ARDS continues to evolve.

In this article Vieillard-Baron, Chew, and Pinsky revisit a fundamental concept: pulmonary vascular dysfunction is both a consequence and an amplifier of lung injury.

The pulmonary circulation normally accommodates large variations in cardiac output through vascular recruitment and distension, maintaining low pulmonary vascular resistance (PVR).

During ARDS, endothelial injury, inflammation, alveolar hypoxia, and mechanical ventilation disrupt this adaptation.

The consequences extend beyond impaired oxygenation.

Increased PVR raises right ventricular (RV) afterload, potentially causing RV dilation, septal displacement, reduced left ventricular filling, and circulatory failure.

The ventilator can either protect or compromise the pulmonary circulation.

The relationship between lung volume and PVR follows a U-shaped curve.

At low lung volumes, alveolar collapse and hypoxic pulmonary vasoconstriction increase vascular resistance. Recruitment may reduce PVR by restoring aeration and vascular flow.

However, excessive lung inflation compresses alveolar capillaries, increases RV afterload, and may worsen cardiac output.

Therefore, higher PEEP is not necessarily better or worse. Its cardiovascular effect depends on recruitment versus overdistension.

Another important observation concerns acute cor pulmonale.

In moderate to severe ARDS, pneumonia, driving pressure ≥18 cmH₂O, PaO₂/FiO₂ <150 mmHg, and PaCO₂ ≥48 mmHg are associated with increased risk of RV dysfunction.

This reinforces the importance of monitoring respiratory mechanics together with echocardiographic RV assessment.

Prone positioning offers benefits beyond oxygenation. By improving aeration, reducing regional collapse, and preserving pulmonary perfusion, it may decrease PVR and improve RV performance.

In refractory cases, VV ECMO may facilitate RV unloading by improving gas exchange and reducing pulmonary vascular stress.

Lung-protective ventilation should also be right-ventricle-protective ventilation.

Optimizing oxygenation while ignoring pulmonary vascular resistance, RV function, and venous return may improve blood gases without improving the patient’s circulation.

Reference 📚
Vieillard-Baron A, 2026. Intensive Care Medicine. https://t.co/eALXvO4r4R

#ARDS #CriticalCare #Hemodynamics #MechanicalVentilation #RightVentricle

[Philippe Rola @ThinkingCC]

Yep, immigrants, or children of immigrants (my case), especially if you’ve lived all over the world, do not have this crazy nonsensical western guilt that has been driven in by strategic propaganda, and also know how the rest of the world is and that if you mix everything to that point without selection of immigrants than you’re going to become the global south, this is simple math. You cannot lump all immigrants into a single category. They’re not all created equal and they’re not all compatible with Western world values.

[Philippe Rola @ThinkingCC]

@the_jefferymead If they did it would be a bit of an issue with the islamoleftist alliance - can’t change hats between oppressed and oppressor narrative without glitching the system…

[Eric Duhaime @E_Duhaime]

Parce que le gouvernement conservateur de Terre-Neuve explore ses hydrocarbures, il vient d’effacer le déficit de sa province.

Mieux encore: il suspend la taxe provinciale sur l’essence à partir du 1er décembre prochain.

Au Québec, cette taxe représente 19,2 cents/litre.

Pendant ce temps-là, les Québécois paient l’essence beaucoup plus cher de taxes que pratiquement partout ailleurs en Amérique et le gouvernement interdit toute exploitation responsable de notre importante réserve de gaz naturel.

La véritable souveraineté, ça ne commence pas par un référendum perdant, mais bien en étant indépendant sur le plan énergétique et économique.

Espérons que les conservateurs québécois feront comprendre ça aux péquistes, au cours des prochains mois…

[Rafael Melo @intensivaev]

Very happy to share this review. It is time to push needle forward! Special thanks to Einstein Research team, which is composed by amazing people and to H&amp;R gang, which is always inspiring me to push the boundaries.

Read here: https://t.co/jBrbp6de5y~

[Philippe Rola @ThinkingCC]

@RafaelOliveLeit Yes, i’ve met @FH_Verbrugge irl and he is a healthy skeptic and a powerhouse in challenging dogma!

[IMCrit @IM_Crit_]

And the answer is… complicated.

The course says amiodarone.

But there are two problems with this question:

1. Where are we in the algorithm?

Persistent VF/pVT alone doesn’t tell us what drug comes next.
After the 2nd shock → epinephrine
After the 3rd shock → amiodarone OR lidocaine

2. And that “OR” matters.

If we’re at the antiarrhythmic step, the AHA algorithm doesn’t say “amiodarone, and lidocaine if amiodarone isn’t available.” It says amiodarone OR lidocaine.

Maybe the real ACLS pearl here is:

Before asking “which drug?”, tell me where we are in the algorithm.

Thoughts?

[Philippe Rola @ThinkingCC]

@vincentneilho You gotta love their complete refusal to engage time and time again in actual logical discussion. Because they don’t have any consistent arguments based on principle or logic. It’s all ideological garbage.

[Vincent Neil Ho @vincentneilho]

Canadian university research is funded by federal taxpayer dollars.

In return, the Liberals claim to fund "divesity" but end up with conformity of viewpoints, and a system where 88% of faculty lean left and 12% lean right.

For a government that seems to care so much about identity politics and mandated equality, where's the balance in that?

[Ashley Miller @icmteaching]

Why did we ever think ScvO₂ told us what to do in shock?
Part 1 of 'Complicated Ways to Learn Very Little' is out on Friday at https://t.co/WadEnKwntn
Sound on....

[Philippe Rola @ThinkingCC]

Great little inaugural, informal meeting of the Praxis Founders Group! We chatted about TCAV, vexus, pulmonary embolism, great exchange! https://t.co/9NNcfOIcZf

[McMich @McMichelSim]

Incroyable !!!!