#foamcc — Public Fediverse posts

Selective digestive tract decontamination to prevent nosocomial infections in #ICU
🧭 practical guidance
♟️comprehensive implementation strategy
🔗 multidisciplinary team: substantial group effort required!
Pharmacy & microbiology support essential for SDD, to be integrated in hospital Antimicrobial Stewardship Program and Infection Prevention policy. To be effective, meticulous execution of the full SDD protocol + bedside follow up required for every pr
#FOAMcc on @ICM
🔓 https://rdcu.be/dL87U

Investigating in #sepsis??
🪡 tailoring treatment to individual needs
⏱️ temporal dynamics of intervention
🔎 population selection challenges
🚧 choose appropriate endpoints
🎨 considerations on design
Editorial free to read #FOAMcc on @ICM
🔓 https://rdcu.be/dL22c

Refers to 🇫🇷🇪🇸 stepped wedge, cluster randomized trial on impact of implementing 1-h bundle in patients with suspected sepsis in ED: not associated with a significant change in in-hospital mortality.
🔓 https://rdcu.be/dL27N

Gut microbiome?? Organ implicated in both health and disease... What happens in critical illness?
🧫 intestinal microbiome in #ICU: dysbiosis as potential therapeutic target?? Early & profound disruption with loss of commensals/overgrowth of potential pathogens may occur! These derangements may be associated with acute/chronic organ dysfunction + adverse outcome
⛑️ protective/ecological restorative strategies
Free to read #FOAMcc on Intensive Care Medicine
🔓 https://rdcu.be/dLuHN

Consumptive coagulopathy during #ECLS
🔎 close monitoring & follow up pivotal during the #ECMO run
⛔️ giving platelets/clotting factors to fix numbers often worsens underlying process
🩸 low doses of anticoagulants may protect both circuit (vs thrombotic complications) & patient (vs bleeding & thrombosis)
⛔️ bleeding complications should NOT always prompt complete cessation of UFH
Detailed underlying pathophysiological process & physiological rationale free to read #FOAMcc
🔓 https://rdcu.be/dLmXO

🚀 Extended reality in #ICU: ready for take-off?? Here translation of NASA Technology Readiness Levels into clinically applicable scale for XR research + identification of maturity of all recent XR-related critical care studies to determine its applicability.
XR increasingly important tool but small minority of clinically implemented projects identified, highlighting a gap to be bridged to move from testing to structured clinical application.
Free to read #FOAMcc on @ICM
🔓 https://rdcu.be/dKSPm

🫁 Management of dyspnea is a teamwork! Should be the next great goal of #ICU multi-professional team caring for critically ill mechanically ventilated patients. PS distinction between dyspnea & breathlessness essential!
Free to read #FOAMcc on Intensive Care Medicine
🔓 https://rdcu.be/dKPpy

In reply to
🔓 https://rdcu.be/dKPp2

All refer to ERS ESICM statement on dyspnea in acutely ill adults on MV
🔓 https://rdcu.be/dzq9F

📢 June issue of Intensive Care Medicine is now available!!
💦 European Society of Intensive Care Medicine (ESICM) fluid therapy guidelines
🗺️ critical care in LMICs
🩸emergency chemotherapy for hematological patients in #ICU
🫘 #RRT in PedsICU
🧫 #sepsis & bloodstream infection
🫁 proning in #ECMO
🫁 Pes
🫀 #ECLS in cardiogenic shock
🧠 neuromonitoring
& more! Full texts free to read #FOAMcc if you follow the links we share in our social media posts... enjoy!
📎 https://bit.ly/ICMJun2024

🫘Optimal time to stop continuous renal replacement therapy in children? Decision based on anticipated pathophysiology, underlying diagnoses, fluid balance & recovery of residual renal function (with increasing UO easily available sign, to date). Less CRRT may be more, but right time to cease still open question.
🔓https://rdcu.be/dKiC7

🫘 Refers to analysis on #CRRT in critically ill children & young adults.
#PedsICU #FOAMcc on @ICM
🔓 https://rdcu.be/dAs4w

What is happening in this 44-year-old man on VA #ECMO??
🚨 #ECPR after 30 min of refractory cardiac arrest post-myocardial infarction
🫀 recovered native cardiac activity but severe postresuscitation vasoplegia leading to important fluid filling to maintain #extracorporeal blood flow
🖥️ TEE showed right atrial collapse
…. cardiac tamponade?? Collapse reversed within seconds during a transient reduction in EBF
Free to read #FOAMcc #FOAMecmo on @ICM
🔓 https://rdcu.be/dJW8S

Replicating Spanish 🇪🇸 donor transplant coordination model led by intensivists to increase OD rates in other regions, including LMICS?? Here implementation in Santa Catarina, a Southern Brazilian 🇧🇷 state, resulting in 48.9 pmp deceased donor rates in 2023 ( = approaching Spanish), even without DCD program: This organization might provide more persons the opportunity of donating their organs after death + increase transplant options for patients in need
#FOAMcc on @ICM
🔓 https://rdcu.be/dJErS

🧫 Outcome of hospital-acquired bloodstream infection?? Not only a matter of bacteria & hosts... several aspects of healthcare organization may have clinical implications! Editorial
🔓 https://rdcu.be/dJymM

🧫 Refers to analysis on data on hospital-acquired BSI from EUROBACT-2 study highlighting that centre/country factors should be targeted to improve management strategies and outcome of HABSI in #ICU.
🔓 https://rdcu.be/dJyqE

All free to read #FOAMcc on Intensive Care Medicine

Broad use of processed EEG: ready for prime time??
🧠 anesthesia & sedation monitoring
🔮 future applications
detection of seizure
detection of cerebral hypoperfusion
closed‑loop anesthesia delivery systems
⚠️ limitations
PEEG monitoring systems widely available, easy to apply (but training required to avoid misinterpretation), relatively inexpensive & increasingly used outside OR, with potential for #ICU use.
Free to read #FOAMcc on @ICM
🔓 https://rdcu.be/dJpvI

Managing perioperative myocardial injury
🫀 etiology: ischemic & non-ischemic, cardiac & extra-cardiac causes
⏱️ management: early detect & tailor etiology-driven treatment
PMI? marker of complications! Increased cardiac troponins prognostically important for mortality & adverse cardiovascular outcomes in patients undergoing non-cardiac surgery.
Free to read #FOAMcc on @ICM 🔓 https://rdcu.be/dJkab

How to use face-mask noninvasive ventilation:
🫁 set‑up & ventilatory settings
🚦 indications & contraindications
🖥️ monitoring to assess response, adjust settings, identify need to transition to IMV
⚠️ constraints associated with delivering NIV through face-mask
Free to read #FOAMcc on @ICM
🔓 https://rdcu.be/dJex8

Norepinephrine dose reporting? No reason to delay standardization!
💉NE dose has known prognostic implications: dose reporting heterogeneity could bias perception of severity & prognosis, with the risk of triggering early, delayed, inadequate decisions
💉 absolute gap of NE base equivalence wide among different saltbased dose preparation/labeling
Free to read #FOAMcc
🔓 https://rdcu.be/dISUF

In reply to
🔓 https://rdcu.be/dISSr

💉 All refer to editorial focusing on NE
🔓 https://rdcu.be/dGazg

Treating necrotizing skin & soft-tissue infections in #ICU
⏱️ early diagnosis & source control
🖥️ imaging techniques
🧫 microbiological issues
💉 empirical antibiotic therapy & adjuvant therapies
🤝 multidisciplinary management
Free to read #FOAMcc on @ICM
🔓 https://rdcu.be/dIcGD

🖥️ Using #echocardiography to predict fluid-responsiveness & manage need for fluids in #ICU, bedside experience + literature based approach:
💧💧 when to fill??
☔️ when NOT to fill??
💦 optional filling... gray zone of #POCUS parameters
PS adequate training pivotal to avoid misinterpretation!!
Free to read #FOAMcc #FOAMus #echofirst #POCUS on @ICM
🔓 https://rdcu.be/dH6nb

Finding optimal tidal volume in #ARDS
🫁 is ΔP indicator of unsafe VT & does it directly impact on outcome?
🫁 what factors can influence CRS + interplay between VT & ΔP?
We should continue using protective mechanical ventilation but, rather than fixed cut-of (6 ml/kg PBW) it may be more advantageous individualize VT considering multifactorial contribution of ∆P, CRS, ECW, PEEP + regional lung mechanics.
Free to read #FOAMcc on @ICM
🔓 https://rdcu.be/dHUzd

Empirical antimicrobials in #ICU? Timely & appropriate ABT therapy paramount iin critically ill patients presenting with suspected infection, potentially leading to #sepsis or septic shock. Here, review aimed to provide a step-by-step approach for prescription:
⏱️ assessing the need & the urgency
🧫 pathogen profiling
⚖️ selecting the right arsenal
🔮 future perspectives
Free to read #FOAMcc on @ICM
🔓 https://bit.ly/4ai3zss

Cardiogenic shock in 2024:
🫀 #extracorporeal life support #ECLS
🫀 left ventricular unloading strategies in #ECMO
strategies & evidence from recent trials (& beyond)
Free to read #FOAMcc #FOAMecmo on @ICM
🔓 https://rdcu.be/dHzLz

Diuretics in #ICU
🫘 what are the indications?
🫘 how to monitor diuretic therapy
what if diuretic responsive but UO too low or prescribed fluid balance cannot be achieved?
what if serum creatinine rises?
which adverse effects are anticipated?
🫘 continuous infusion more effective vs intermittent dosing?
🫘 any role for combining diuretics with albumin to improve effectiveness?
🫘 role of the furosemide stress test?
🫘 how to manage diuretic resistance
#FOAMcc
🔓 https://rdcu.be/dG6xx

A tiny tip: you can measure RR with M-mode if breathing is regular! #foamus #FOAMed https://cloud.butterflynetwork.com/-/shared/3B4gR72yQTCTNdmxlN9Kvg?utm_source=image_share_sheet #FOAMcc

Important point: don’t be fooled by a hyperdynamic ventricle, could be due to valvular or mechanical complication. #EuroEcho #foamcc

RE: https://bsky.app/profile/did:plc:wl5zwdwkg4kqg25gtxbepfh4/post/3lb2upkv7of22

A wee bit of circulation simulation with #Circadapt (http://circadapt.org/) of severe acute AR. Purple: aortic root, red LV, green aortic valve. Reference: no AR, HR 70, MAP 92. Snapshot: 25% area AV deficit (1cm2 "ROA"), HR70. Current: HR increased to 120 #FOAMed #FOAMcc 1/7

Here's a little visual #POCUS trick: When the mitral valve is opening a lot (low EPSS) and the LV is hyperdynamic, but the aortic valve is not opening that much, something is wrong (loop at 50% speed). #FOAMus #FOAMed #FOAMcc

McConnell's sign is not specific for PE, nor for acute pressure overload. This patient had a persistent McConnell's sign secondary to extensive perimyocarditis. Estimated SPAP 25mmHg, collapsing IVC. #FOAMed #FOAMcc #FOAMed #FOAMus #Echo

TEE showes papillary muscle rupture with torrential eccentric mitral regurgitation. Single lobe/lung pulmonary oedema can mimic pneumonia! #FOAMed #FOAMcc

TTE in the ICU gave a clue #FOAMcc #FOAMed, TEE to follow

Pt admitted with sups sepsis from infected diabetic foot ulcer. Increasingly hypotensive and hypoxic through night. Put on NA, HFNC. SA in blood culture and systolic heart murmur, routinely performed TEE #Echofirst #FOAMed #FOAMcc #FOAMus