Sebastian Proaño

Fresh post: BSI (bilevel sequence intubation) will become standard therapy based on PREOXI 🔥🔥 How should BSI be optimized? 🤿 CO2 clearance is irrelevant 🤿 maximize ePAP (PEEP) for recruitment 🤿 low driving pressure Post: emcrit.org/pulmcrit/bsi/

I was so jazzed about this article that I researched & updated the IBCC chapters on Mg if you're looking for a Mg review article, this one is *much* better: pubmed.ncbi.nlm.nih.gov/38372687/ (& incidentally, every @AJKDonline Core Curriculum article I've encountered is solid gold)

Non-invasive ventilation is an invaluable tool used take care of our critically ill patients with respiratory failure. This editorial summarizes what beginners should know when using this extremely helpful tool many call “BiPAP”. 🎩 tip to the authors. eddyjoemd.com/foamed/

Wang et al: Safety and Effect on Intracranial Pressure of 3% Hypertonic Saline Bolus Via Peripheral Intravenous Catheter for Neurological Emergencies Link: ow.ly/qa6w50Rkp0y @FJWANGMD @neurocritical #NeuroCritCare

Excellent paper from Colombia. Excelente publicación de Colombia. Driving pressure > 15 at 72h in patients with PARDS = increased mortality and time on MV.

It's an honor to be featured with an international cohort of audio-learning educators on the most recent @OPENPediatrics World Shared Practice Forum Podcast! Here's a compiled list of the most popular PICU podcasts: bit.ly/4bbDrjM #PedsICU

One more paper for our fruitful collaboration with @paccman_asia ! Now the time for early dysnatremias and TBI outcomes! Check it out!! link.springer.com/article/10.100…

After 5y, led by @KarsiesTodd the @BaconStudy is out in @PedCritCareMed! 1/3 children <2y intubated in #PedsICU for Bronchiolitis have🫁bacterias. Is this a bad thing? Open question! Global @PALISInet @LA_Rednetwork collaboration @PICJournalWatch journals.lww.com/pccmjournal/ab…

I couldn’t agree more with @LA_Rednetwork “If equipoise exists between ICP-monitor driven management and clinical and imaging-based management in children with sTBI, we encourage authors to expand this RCT to include children from HICs and LMICs.”

The new data-driven criteria for pediatric sepsis and septic shock based on measures of organ dysfunction had improved performance compared with prior pediatric sepsis criteria. ja.ma/3wBqNM7

👇Indications for dialysis in critically ill @NEJM nejm.org/doi/full/10.10…

Extremely honoured and proud to talk about bedside implementation of the new PALICC-2 guidelines on @OPENPediatrics #pedsICU podcasts.apple.com/nl/podcast/ope…

WV Delegates @wvhouse, As I prepare to drive to work this morning to provide medical care for our pediatric patients in WV, I know I do not have the freedom to drive 120 mph on the interstate because it could endanger the lives of other drivers. The same applies to immunizations. I respect the right for people to have freedoms. But when freedom has the potential to endanger others, it is not freedom for other people in our society. I am asking you to speak up for kids today who attend public/parochial/private schools and vote NO to HB 5105.  When we open the door for communicable diseases to occur, it will happen eventually. Maybe not tomorrow or next year. But it will happen eventually. You are risking that a child will become disabled or die by increasing their risk of contracting these preventable diseases.  I have many years left in my career to practice pediatric hospital medicine. Please....I don't want to be caring for a sick child with measles or polio and remember that it was this 2024 legislative session that opened the door for something like this to occur. Say no to HB 5105 today @kaylayoungforwv @BrandonSteeleWV @AmyMSummers @HeatherTully @wvhouse @Hoppercheval @wvgazettemail @WSAZnews @WVNews247 @JimJusticeWV @wvsenate @WVSenatePres @EricJTarr4WV @DrTomTakubo @lauraforwv @mikeoliverio4wv @amygrady13 @PatrickMartinWV @RyanWeld @Ben_Queen @mawtrout @4WVCoal @MikeCaputoWV @MikeStuartWV @JayTaylorWV47 @CharlesTrumpWV @GlennJeffriesWV @WVStateMedical

#PedsICU #PICUJW January collection has landed on the website picujournalwatch.com/journalwatchar… & on the #PICCHub app put together by @OsamaHosheh and @DrToyinOcholi

This 🧵 on bicarb from @nickmmark popped up in my feed today. Recent Am J Emerg Med article looked at bicarb in humans: ↗️ avg 20 mmHg (2.6 kPa) rise in EtCO2 🕐 onset within seconds (avg 17 sec) 🏔️ peak 30-60 sec ⌛ increase lasted 7-10 min doi.org/10.1016/j.ajem…

And here with the criteria: Sepsis is infection >= 2 points Septic shxok is sepsis + 1 CV point:

A "cognitive bias" is a systematic error in thinking that ruins decision-making. The 12 most powerful cognitive biases I've found:

Fresh blog: validation of my model for converting VBGs to ABGs 💉 simple equation improved precision, compared to estimating arterial pCO2 as 5 mm below venous pCO2 💉 venous O2% adds nuance to interpreting VBG results (key metric of VBG accuracy) link: emcrit.org/jorg

Do we need to get an ABG when a VBG is good enough? Here, the work of @PulmCrit shines as his formula to convert the PCO2 to PaCO2 is deemed the most accurate. 🎩 tip to the authors! eddyjoemd.com/foamed/

Fresh blog: New ARDS guidelines reveal a shambolic state of affairs 🫣 two major guidelines on "ARDS" were released in 2023 🫣 there is ongoing confusion about how to define "ARDS" 🫣 guidelines disagree on basic aspects of "ARDS" therapy blog: emcrit.org/pulmcrit/ards-…