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Low-Dose Dopamine as Bruce Banner and High-Dose Dopamine as the Hulk. Different effects at different strengths! 4/9

COVID-19 2.0. Il buonumore non ci manca 😭😰. Ospedale Niguarda Università degli Studi di Milano-Bicocca

Volantinaggio alla #marciadellaliberazione ! Business is Business

Ventilating #COVID19 pts ➡️ #COVID19 ARDS is #ARDS ➡️ subphenotypes? to be properly defined & specific approach to be clearly demonstrated ➡️ limited data/lot to learn, but enough evidence to recommend management similar to other ARDS causes case tailored bit.ly/34NBidD

Interesting debate on asaiojournal on upper age limit for implementing VV #ECMO in respiratory failure Do we need fixed limit? Maybe narrower indications considering comorbidities/baseline performance status? On asaiojournal ➡️ bit.ly/3m0TTtL ➡️ bit.ly/2Hctt9P

❤️ #forzaniguarda #ospedaleniguarda #niguarda #hospitallife #nurselife #medlife #covid_19 #covid19italia #coronavirus

Ventilation in #COPD & asthma ➡️ respiratory mechanics/gas exchange ➡️ heart–lung interactions ➡️ HFNO & NIV ➡️ managing invasive MV from intubation to (early) weaning limiting hyperinflation ➡️ long‑term outcome & role of tracheostomy ➡️ future strategies bit.ly/3lrmGYk

Nebulizing aminoglycosides & colistin for VAP caused by MDR Gram‑negative bacteria: substitution should be preferred vs adjunctive therapy to evidence therapeutic benefit; moreover, mesh nebulizers should be preferred vs jet nebulizers to optimize lung deposition #FOAMcc Intensive Care Medicine

Editorial on Marco Giani et al Feasibility, safety, effect on lung mechanics/oxygenation of prone positioning on #ECMO, study (6 italian #ECLS centers/240 pts). PP: ⬆️oxygenation ⬇️intrapulmonary shunt significantly ⬇️H mortality minor complications in 6% bit.ly/3iMLOrl

Prone position in #COVID19, use & effect: ➡️PP widely adopted, the more severe the respiratory failure, the more frequent the use ➡️PP improved oxygenation in most (better V/Q matching?) ➡️mortality of O2-Non-Responders significantly higher Critical Care rdcu.be/cidPR

#CritCare #OA #Marini & #Gattinoni: Do diverse mechanical responses to local #chest wall #compressions open to possibilities for important therapeutic interventions? bit.ly/2VkEpZD #FOAMed #FOAMcc #BMC @ ISICEM Jean-Louis Vincent Luciano Gattinoni #ARDS #COVID_19 #prone #ventilation

ECMO associated salt wasting? In pts developing polyuria on VA #ECLS consider pressure natriuresis; confirmed? - expand volume vs hypovolemia - retract return cannula if too close to renal arteries - reduce EBF if tolerated #FOAMcc #FOAMecmo asaiojournal bit.ly/3a3jIW0

Our last review on transfusions during ECMO: so many open questions! Waiting for the results of the ProtECMO study.. Thanks to our great residents team ClarissaForlini Dario Winterton Simone Redaelli MD et al aob.amegroups.com/article/view/6… @Thom_Langer Giacomo Bellani Unimib Anesthesia, Critical Care and Pain Medicine

Safety & efficacy of bivalirudin vs unfractionated heparin in adults on #ECMO, retrospective cohort: 🩸low overall incidence of thrombosis: 1 event in bivalirudin group/no event in UFH group 🩸no difference in bleeding rates, 6% vs 10% asaiojournal bit.ly/3nGP6ju

Prone positioning on VV #ECMO for severe #ARDS: in this large analisys including 889 pts from 5 studies comparing conventional management (supine position) vs proning, PP not significantly associated with reduced ICU mortality. Critical Care #FOAMcc #FOAMecmo rdcu.be/cEsjH

Francesco Marrazzo Stefano Spina ClarissaForlini The Phlegmfighter

Communication & #ICU visiting policies during 1st #pandemic wave/lockdown in 🇮🇹 🔒practically no access 📱remote communications as surrogate Time to reopen, considering improved #COVID19 transmission understanding, PPE availability, growing immunization 📎rdcu.be/cQETY

ENPAM: petizione per una trasparenza illimitata - Firma la petizione! chng.it/CjZ7By8y via Change.org Italia

Fluid de-escalation ☔️ should I withdraw fluids? ☔️ is it right time to attempt fluid withdrawal? Tissue perfusion = adequate + pts must not be preload responsive ☔️ how to proceed? ☔️ when to stop? ☔️ how to react when hemodynamic instability occurs? 🖇️ bit.ly/43CeVnQ

◾️In memory of Prof L Gattinoni, towering figure in ICM, profoundly shaping understanding of #ARDS & #ECMO. The “father" of prone position revolutionized MV with a pioneering "baby lung” concept. His legacy will guide/inspire for generations to come. 🔗esicm.org/obituary-lucia…