Discover and read the best of Twitter Threads about #isicem19

Most recents (5)

Evaluating volume status and fluid responsiveness - what is new in 2019? by @PrXaMonnet #ISICEM19

fluid challenge
mini-fluid challenge
recruitment maneuver
passive leg raise => less reliable during abdominal hypertension
Excellent talk by @PrXaMonnet #ISICEM19 Detection of fluid responsiveness
Advantages and drawbacks of fluid challenge and mini-fluid challenge @PrXaMonnet #ISICEM19
Read 4 tweets
The question is: How to achieve the right balance
not too much
not too little
just enough
excellent talk by #NateShapiro
How do we currently assess therapeutic response to fluids
interesting mortality prediction model presented by #NateShapiro looking at a fluid propensity model predicting when we need to give more or less fluids
Bottom line: mortality increases with too little or too much fluids
Read 5 tweets
There are many advantages of continuous IAP measurement as listed in infographic #ISICEM19
Start measuring IAP (abdominal pressure) in ICU patients when there are 2 or more risk factors related to
-increased intra-luminal contents
-increased intra-abdominal contents
-decreased compliance
-fluid overload and capillary leak

Some causes of increased intra-luminal contents resulting in abdominal hypertension #ISICEM19
Read 11 tweets
Thrilling to see so much focus on #sepsis endotyping and reducing heterogeneity at #ISICEM19 @ISICEM! For the non-expert, perhaps a brief review is helpful: /1
Lots of prognostic tools for #sepsis exist, and many are well-validated. Although endotypes often show outcomes differences at baseline, they are NOT for outcomes prediction! Purpose-built tools and biomarkers are better for this. /2
Instead, the goal of #sepsis endotyping is PREDICTIVE enrichment, by which we mean, predicting which patients will respond favorably to a given drug (classically an immunotherapy). Since no drug has ever been shown to work in the broad sepsis population, the idea is that /3
Read 10 tweets
Assessment of Fluid Overload and Hypervolemia (1/8)

Clinical assessment and signs for #FO are aspecific and unreliable:
-pitting edema
-positive fluid balance
-hepatojugular reflux

Preparing for #smacc #ISICEM19 #IFAD2019 #WCACS2019
Assessment of Fluid Overload and Hypervolemia (2/8)

Biochemical Assessment for #FO is aspecific and unreliable:
-low COP
-low osmolality

Preparing for #smacc #ISICEM19 #IFAD2019 #WCACS2019
Assessment of Fluid Overload (FO) and Hypervolemia (3/8)

Radiological and #POCUS imaging and signs for #FO are aspecific and unreliable:
- Absence of #IVCC
- Kerley-B lines
- Lung ultrasound B-lines
- Pleural effusions

Preparing for #smacc #ISICEM19 #IFAD2019 #WCACS2019
Read 7 tweets

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