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We know about fluid responsiveness + fluid tolerance, but what about dynamic fluid intolerance? This is a new concept that Jon-Emile Kenny et al. described: pts. can be not-congested, but on a preload challenge (fluid bolus or passive leg raise) they demonstrate congestion. A 🧵

Ross Prager IMCrit Irene Ma Segun Olusanya (He/Him) [email protected] Pulmonary-POCUS Cardio Crit CardioNerds 𝙟𝙤𝙨𝙝 𝙛𝙖𝙧𝙠𝙖𝙨 💊 John Basmaji Marat Slessarev MD PhD CriticalCareWestern Katie Wiskar kylie baker Mathilde Gaudreau-Simard key consideration is that if patient has upright Starling curve, a PLR will cause less/little change in venous/VExUS and large change in LVOT. worse the Starling curve means proportionally more change in venous/VExUS less change in LVOT. there won't be a defined response in all.

A common phrase passed down to interns during their ICU rotations used to be “you have to swell to get well, and pee to get free”. Although rhyming, this is physiologic nonsense. Fluid overload is harmful for critically ill patients, and can be prevented through individualized IV

(1/x)🚀 Excited to announce the upcoming launch of a V1 of a free web-app designed specifically for clinicians and researchers! We want to help overcome barriers to performing high-quality and efficient research. Stay tuned for the launch but I need your help.. #medtwitter

We all know that that we shouldn't be using IVC to predict fluid responsiveness... but what about the IVC in short axis? We studied healthy volunteers to see whether IVC in LAX or SAX predicts fluid responsiveness. A few take homes 🧵: mdpi.com/2075-4418/13/2…

Modifying "Diamond-Forrester" profiles using echography, are you still basing your clinical decisions just using physical examination and analytics? Including this tools in our daily practice will help us to take better decisions with our patients. journals.lww.com/ccejournal/ful…

1/7: This year, let's fully understand the concepts of fluid responsiveness, fluid tolerance, venous congestion, dynamic fluid intolerance, and perfusion. This is crucial for all providers as dedicated RCTs (1500 pts!) (ANDROMEDA-SHOCK 2) will help inform how to integrate

2/7: Fluid responsiveness asks whether a patient will increase their cardiac output by 10-15% in response to a preload challenge (e.g. fluid bolus, passive leg raise). Some key points: 🔑 ✅ Fluid responsiveness is a healthy physiologic state. The absence of fluid responsiveness

(1/7) We previously proposed a 4 quadrant approach to phenotyping shock based on stroke volume and markers of venous congestion. Check out our study of hypoperfused ED patients that helps support this paradigm. A 🧵 TLDR:❌Low preload does NOT mean fluid responsive!

(2/7) We studied 41 pts in ED (68 assessments) deemed to be hypo-perfused and in need of IV fluid expansion. We stratified them based on corrected carotid flow time (surrogate of stroke volume) and internal jugular Doppler morphology (surrogate of preload - kind of like #vexus

The ability to do continuous, high-resolution ultrasound imaging of an organ in people on the go through a wearable patch is an important innovation nature.com/articles/s4158… Nature Biotechnology Jon-Emile Kenny

Thanks for the shoutout from Eric Topol - we agree, wearable ultrasound is a huge innovation with the potential to improve our patient's outcomes. With #FloPatch we can 1) personalize fluid resuscitation to individual physiology 2) assess for fluid responsiveness 3) avoid

Thank you, Professor Eric Topol. The work of Sheng Xu group, Muyang Lin et al. is extremely inspiring. I am humbled for the invitation Nature Biotechnology, Jared Fudge. There is promising investigation ahead. The future is wearable ultrasound and it is now! x.com/EricTopol/stat…

Plans for a #HRTorontoVEXUS course in the fall are starting to concretize… follow my blog for the announcement in the next weeks! Time to add some venous congestion skills!!! Ping korbinhaycockmd Jon-Emile Kenny Ross Prager The Hospitalist and Resuscitationist Conference

New study alert from St. Mike's in Toronto & JAMA: 3% of CVC placements lead to major complications like arterial puncture & pneumothorax. jamanetwork.com/journals/jamai… How can we mitigate these risks? #FloPatch shines in our recent case study, avoiding a central line for an

June #Infographic on #Carotid #Ultrasound and its role in #FluidResponsiveness #Anesthesia #CardiacAnesthesia #UltrasoundEducation #POCUS buff.ly/3Kr1HmD

Here are all the reasons you should be coming to the VEXUS Masterclass on Sept 28th in Toronto. Only a handful of spots left! info.flosonicsmedical.com/hr-toronto-vex… Can’t wait to see you there!

🎉 We did it! #FloPatch won the Best in Class – Provider Diagnostic award at the 2024 Digital Health Hub Foundation Awards! Our co-founder Dr. Jon-Emile Kenny accepted this honor at #HLTH2024. Thank you to the judges & congrats to all the winners! Read the full press release here:

(4/4) Without understanding a patient’s fluid responsiveness, a patient may receive physiologically ineffective fluids that could cause potential harm. Check out this article which discusses the physiology of fluid intolerance: hubs.ly/Q02ZyBHM0 #MedTwitter #FOAMed

(1/5) 📍Picture this: It’s 2 a.m. Your patient has a new 2cm pericardial effusion. They’re worsening, but BP hasn’t tanked—yet. The echo tech isn’t available. Your gut says early tamponade. You grab a FloPatch and perform a carotid Doppler assessment. The FloPatch assessment