Zbigniew Putowski

MD, PhD, Center for Intensive And Perioperative Care, Jagiellonian University, Poland. Interested in hemodynamics. Dum spiro spero

[Zbigniew Putowski @ZPutowski]

1/24 Recently, I started reading a lot about vascular waterfall (VW) and its importance in cardiovascular physiology. It seemed confusing at first, but the more I read about it, the more it fascinated me. 🧵 about physiology!

[Zbigniew Putowski @ZPutowski]

Do you have any thoughts on using hypertonic saline or bicarbonate for *fluid expansion* in critically ill? @ThinkingCC @PulmCrit @emcrit @khaycock2

[Zbigniew Putowski @ZPutowski]

@ThinkingCC @icmteaching @EMNerd_ @khaycock2 @PulmCrit @emcrit repetition of the same mantra that there is some sort of linear relationship between map and perfusion. map is a highly dependent variable...

[Zbigniew Putowski @ZPutowski]

@PatientStormDoc @PulmCrit I’ve read majority of your work and admire your intellectual input to the debate. I Think you are right, but what i am comparing is Mediocre guidelines versus ridiculous decision making that we encounter routinely that is based essentialy on nothing (not physiology or Logic)

[Zbigniew Putowski @ZPutowski]

@PulmCrit @PatientStormDoc Tens of thousands patients were saved by SSC.
Mediocre guidelines are better than completely retarded clinical decisions 😄

[Zbigniew Putowski @ZPutowski]

@PulmCrit @SaurinPatel77 @nickmmark True but i am not sure about the „few underperforming hospitals”…. If not for SSC we still would using nephro dose dopamine in many cases. SSC do not follow physiology but are often closer to physiology than eminence based medicine which is still practiced in many places

[Zbigniew Putowski @ZPutowski]

@khaycock2 @ThinkingCC great study. do you think that phenomenon should be studied more or is it well grounded already

[Zbigniew Putowski @ZPutowski]

1/6 Question to ultrasound/physiology freaks
@PhilGuerci @PulmCrit @RCastro_L @eddyjoemd @thomaswoodcock @ross_prager @f_g_sanfilippo @PulmCCM @khaycock2 @avkwong @PulmPEEPs @phlegmfighter @ThinkingCC

[Zbigniew Putowski @ZPutowski]

@khaycock2 @ThinkingCC Do you happen to have a paper about this ?

[Zbigniew Putowski @ZPutowski]

@khaycock2 @ThinkingCC @RCastro_L @PhilGuerci @PulmCrit @eddyjoemd @thomaswoodcock @ross_prager @f_g_sanfilippo @PulmCCM @avkwong @PulmPEEPs @phlegmfighter Awesome !

[Zbigniew Putowski @ZPutowski]

@khaycock2 @ThinkingCC Like MCA...? A lot of papers say that MCA does not change the diameter in response to vasopressors, so any increase in Vmean should mean increased flow

[Zbigniew Putowski @ZPutowski]

@khaycock2 @ThinkingCC @RCastro_L @PhilGuerci @PulmCrit @eddyjoemd @thomaswoodcock @ross_prager @f_g_sanfilippo @PulmCCM @avkwong @PulmPEEPs @phlegmfighter I can't imagine RI going down without concomitant CO increase. Do you?

[Zbigniew Putowski @ZPutowski]

@PulmCrit @ThinkingCC @thomaswoodcock @RCastro_L @PhilGuerci @eddyjoemd @ross_prager @f_g_sanfilippo @PulmCCM @khaycock2 @avkwong @PulmPEEPs @phlegmfighter Also changing finger on which you monitor SatO2 after some time is important. Too much pressure from finger clamp confounds the measurements

[Zbigniew Putowski @ZPutowski]

@thomaswoodcock @PulmCrit @ThinkingCC @RCastro_L @PhilGuerci @eddyjoemd @ross_prager @f_g_sanfilippo @PulmCCM @khaycock2 @avkwong @PulmPEEPs @phlegmfighter Excluding edge cases like MAP 35, I never see improvements in PPI or CRT after raising vasopressors (e.g. MAP 55 > MAP 70).

[Zbigniew Putowski @ZPutowski]

@thomaswoodcock @ThinkingCC @RCastro_L @PhilGuerci @PulmCrit @eddyjoemd @ross_prager @f_g_sanfilippo @PulmCCM @khaycock2 @avkwong @PulmPEEPs @phlegmfighter peripheral perfusion index might be a good alternative

[Zbigniew Putowski @ZPutowski]

@ThinkingCC @RCastro_L @PhilGuerci @PulmCrit @eddyjoemd @thomaswoodcock @ross_prager @f_g_sanfilippo @PulmCCM @khaycock2 @avkwong @PulmPEEPs @phlegmfighter Thank you!! We should study this

[Zbigniew Putowski @ZPutowski]

@ThinkingCC Through increased EDV?

[Zbigniew Putowski @ZPutowski]

@ThinkingCC @RCastro_L @PhilGuerci @PulmCrit @eddyjoemd @thomaswoodcock @ross_prager @f_g_sanfilippo @PulmCCM @khaycock2 @avkwong @PulmPEEPs @phlegmfighter Are you familiar with any ultrasound way of assessing the effect of vasopressor MAP up-titration on the brain or kidney perfusion? Knowing that PI, EDV and PSV are more complex and context-dependent?

[Zbigniew Putowski @ZPutowski]

@RCastro_L @PhilGuerci @PulmCrit @eddyjoemd @thomaswoodcock @ross_prager @f_g_sanfilippo @PulmCCM @khaycock2 @avkwong @PulmPEEPs @phlegmfighter @ThinkingCC Do you believe there is a room for utilizing doppler to assess the effect of vasopressor-driven MAP up-titration to assess perfusion of an organ? I thought increasing EDV would be highly correlated with increased flow, as EDV usually goes down in high intracranial pressure cases

[Zbigniew Putowski @ZPutowski]

@RCastro_L @PhilGuerci @PulmCrit @eddyjoemd @thomaswoodcock @ross_prager @f_g_sanfilippo @PulmCCM @khaycock2 @avkwong @PulmPEEPs @phlegmfighter @ThinkingCC What would you think would be the effect on doppler parameters if vasopressor indeed increased TPP?

[Zbigniew Putowski @ZPutowski]

@ThinkingCC Lets say you raise MAP with a vasopressor to improve renal perfusion, and in fact you improve it. What changes in doppler parameters would you expect ?

[Zbigniew Putowski @ZPutowski]

@ThinkingCC If MAP leads to increased perfusion, should I expect any change in doppler parameters?