Philippe Rola

Last few days for early bird! Join us in Montreal next september! #HR26 Nothing quite like it... thinkingcriticalcare.com/2026/01/16/fou…

@Shirley70210319 @JCM_MDPI Understanding the importance of balance between forward flow and congestion is key.

#mdpijcm #ResearchPaper Sharing Title: The VTI-VeXUS Index in Septic Shock: An Exploratory Proof-of-Concept Observational Study of a Novel Hemodynamic Parameter Citations: 4 📌link: mdpi.com/2077-0383/14/1… ✍by Dr. Ross Prager et al @ThinkingCC @JCM_MDPI

@YubSedhai @pjcotera

@YubSedhai @pjcotera Agree.

It is terrifying that 33% gave fluid to a struggling RV with an underfilled LV. Terrifying.

Come join us in FL this summer to learn about critical care hepatology Virtual option available too with discounted rates for trainees Agenda and signup link in 🧵

@pjcotera @YubSedhai Totally agree that has to be the first thing that needs to be ruled out, but I was going with the aim of the question that seemed to be about haemodynamic management.

@ThinkingCC @YubSedhai If suspicion is acute stent thrombosis wouldnt dobutamine in an hypoxic RV just increase RV O2 consumption and increase infarction size? No real right answer IMO. Would rush back to cath.

@MynephCC Absolutely! I’ve been burned by this so many times, very frustrating. A quick super pubic peek with any probe should be automatic in any patient with a Foley catheter, especially one who is intubated and sedated, and cannot complain!

Confirmation of Foley catheter placement is essential in patients with gross hematuria, especially prior CBI. While initial urine return may suggest correct placement, POCUS in this case demonstrated a persistently distended bladder with a large clot no Foley's in the bladder.

@ImagenCardiaca el titulo, no?

@ThinkingCC Y quien dice que sea nuevo

Acoplamiento ventriculoarterial derecho. Un nuevo parámetro en el estudio de la función del ventrículo derecho 📘 buff.ly/2xGCI37 ◀️ Repaso de la Trukipedia publicada en RETICweb

Just putting a feeler out there...Anyone up for #VExUSinMilan (Italy) next november? (did I mention participants will get to meet @khaycock2 in the flesh?)

@YubSedhai oh yes absolutely different animals!

@ThinkingCC I fully understand the concept, I was just highlighting the fact that are failure in setting of proximal RCA MI, and acute and chronic RV systolic dysfunction on a background of chronic pulmonary hypertension are two different physiological constructs!!

RAPID ECPR: Revolutionizing Accelerated Percutaneous Initiation and Deployment of ECPR: single center process and outcomes - Journal of Cardiothoracic and Vascular Anesthesia jcvaonline.com/article/S1053-…. Excited to finally share this data, really proud of the incredible Mayo team!

@GeorgesStPierre Can’t agree more! Can’t stop!

We don’t stop training because we get old. We get old because we stop training

Ping @TrinaAugustinMD see comments😉

@The_Nanashi_O @aribindi Absolutely. And there are, like anything else, many levels, each clinician has to understand the limits of their knowledge and skill. But at every level, there are valuable, relatively low hanging fruit that can benefit patients greatly.

@aribindi @ThinkingCC Similar to ECG interpretation, acute/critical care echocardiography boils down to interest and motivation — less to do with specialty.

@YubSedhai Not with a dilated RV and septal shift. RV limit has been hit. Additional increase in MSFP will only worsen ventricular interdependance. The only RV failure that benefits from fluids is the patient who is concomitantly hypovolemic.

@ThinkingCC Philippe, -RV failure from RCA MI ≠ RV failure in chronic PH. -PH → high PVR →Chronic dilated and weak RV-> fluids can worsen physiology and outcomes. -RCA MI → normal PVR → may tolerate volume better than folks with high PVR.

@aribindi @The_Nanashi_O We’ll just agree to disagree. You are clearly anti-pocus, and that stance is to me, a massive step backwards. Are there educational challenges? Sure. But limiting ultrasound to “pro” exams will harm more than help.

@The_Nanashi_O @ThinkingCC Are there expert crit care docs who can reliably get echocardiographer level views and data? Sure. But its not reliable. My point is not that echos are unreliable in sick patients, it is that the average person doing POCUS can't get reproducible, safe results.

@adventurelolo We all have those haunting cases my friend… comes with the territory.

@ThinkingCC This guy was only in his early 40's and had a family--he ultimately coded again and didn't make it and it haunts me to this day.

@adventurelolo Yup we’ve been battling these reflexes for years but culture is hard to break…

@ThinkingCC Will never forget a residency ICU pt we got after he coded from getting multiple fluid boluses for hypoTN. Attending POCUSed him and showed us how his RV was an overfilled hypokinetic mess and how just reflexively giving fluids for low BP without knowing their hx was dangerous.

@aribindi @fersaurin That is a fantastic luxury. I envy ease of ecmo access.

@ThinkingCC @fersaurin To be fair, I suppose I see this most commonly coming off of CPB. We play with the inotropes and lock in a good regimen with the ability to go back on immediately if needed.

@aribindi @fersaurin I would try inhaled milrinone but the risk with IV would be to worsen sam without improving lvedv.

@aribindi @fersaurin In dynamic lvoto? With a crap rv ? I think inotropes would be, well, lets say a hazardous choice.