Ritwik Bhatia, M.D.

Ten things that -for no good reason- we don't do in the ICU: OK, in general a "less is more" approach is reasonable & there is a "rationale" behind many of the following but the truth is that they don't make sense if scrutinized Here it begins: 1. Holding tube feeds or

Here are 5 lessons I've learned about the ICU that no-one teaches you in fellowship 👇

Status Epilepticus Protocols vary a lot from center to center. In this analysis of protocols from >200 centers, 1/3 did not specify optimal door-to-needle times, and 15% specified doses that are under what is recommended. We need #CodeICH for SE neurology.org/doi/10.1212/WN…

I was presenting on Subarachnoid Hemorrhage as a part of case discussion in the class. Let me share the resources I have studied for this presentation 🧵👇 @Srivatsa34 @AshuPJadhav @neurona_critica @Neuroptimist23 @nirmalregency @SikandarAdwani @NCSIofficial

How do neurointensivists use Tier III therapies for refractory #ICP? In this excellent real world observational study of TBI pts who advanced to Tier III, craniotomy was by far the most commonly-used intervention (70%), and was associated with ⬇️ mortality and ⬆️good outcome. Barbiturates were associated with worse outcomes. Mild hypothermia was somewhere in the middle. 45% of patients advanced to Tier III intervention without fully exhausting Tier II interventions. #curingcoma link.springer.com/article/10.100…

How many of us look carefully for well-formed sleep spindles (WFSS) in patients with Disorders of Consciousness? Data from @claassen_jan at @ColumbiaNCC suggest we should. WFSS predict and improve upon #CMD for coma recovery. nature.com/articles/s4159…

Until reading this review I have to admit I never understood the point of non-inferiority trials. The point is to test a new treatment that has a clear advantage over the established control in terms of cost, convenience, toxicity or safety. ahajournals.org/doi/abs/10.116…

The entire narrative of work-life balance is flawed: It's less about balance, more about harmony. It's about how your work can flourish within the context of your life—how you can include your kids in the why, how work and life support each other (rather than be in tension).

Here are 5 things that I use to help prognosticate patients in the ICU 📉 Most importantly, prognostication reminds me of the quote "prediction is difficult, especially about the future". Stay humble and don't be afraid to express uncertainty to pts. and families (Note: #5 is often missed and one of the most powerful) A 🧵 #medtwitter #foamed

An intensivist has reached the top of his game if a nurse comes to him appropriately concerned that a patient has X (where X: ⬇️ blood pressure, ⬇️ urine output, ⬆️ lactate etc) & he responds "Thanks, let me check what's happening" instead of saying "Give bolus 1 liter of fluids"

Ritu Bansal, @MonishaBhatia3, and @LekshmiMD published their article in @JHospMedicine which sheds light on the crucial aspect of ensuring health equity in handoff communications within hospital settings. Read more: …mpublications.onlinelibrary.wiley.com/doi/10.1002/jh…

I had some thoughts… on death. We are overdue for a reconsideration of mortality vs disability in our new large core stroke world. ahajournals.org/doi/10.1161/SV…

Intensive Care needs to have an eye on the long-term outcomes of patients and the end goal should not merely be getting us out of the ICU alive. There is giving us back life and giving us back life worth living … two distinct outcomes. #PICS #ARDS #A2F

A New Era in Critical Care Trials: Linking ICU Practice to Long-Term Outcomes tinyurl.com/26hev7rn #icurehab #A2Fbundle

In this excellent multicenter study, attaining SBP <140 within 60 minutes of hitting the door in acute #ICH was associated with less hematoma expansion, less neuroworsening, and better outcomes. Do it! #CodeICH baby! neurology.org/doi/10.1212/WN…

Such an important thread! Med reconciliation for the win. Must read. @ucsfccm @UCDavisPCCM @StanfordCCM @PittCCM @SCCM @CCPharmacists

In a family meeting, you should try to remain calm. But when you actually deliver extremely bad news (like, "Time is short"), you can (sometimes should) look uncomfortable. That, in itself, helps convey the gravity of the situation.

Medicaid leads to worse access for post-acute care. In our latest series, @JohnKYueMD and the @UCSF_BASIC team show how Medicaid insurance is correlated to longer hospital stay after traumatic brain injury, across all severities of injury. Brain injured patients often need post-acute care due to neurologic deficits. Medicaid simply doesn't pay post-acute care facilities enough for them to take on these patients. Patients linger around for weeks waiting to find a facility that will accept them. There are ways to fix this. Managed Care Organizations for Medicaid, special needs plans for institutionalized adults, subsidies for high-cost care would all help. De-regulation and removing needless barriers to access is also crucial. Brain injured patients have different needs than those with typical nursing-home requirements, so flexibility is paramount. @AnilMakam @mercatus @MedicareMeddler journals.lww.com/neurosurgery/a…

Here’s data that should encourage you NOT to worry when aggressively treating refractory status. In this single center study, RSE pts who had Dose Escalation of Anesthetics had lower mortality in MV analysis than those who did not. #curingcoma neurology.org/doi/abs/10.121…