Kaspar Bachmann

My issue with ScvO2 is, that it can be high while true mixed venous (SvO2) is low. It is a bad surrogate for SvO2.
So when in doubt, float a PAC and know for sure.

LEVOECMO RCT: early administration of levosimendan to facilitate weaning from VA #ECMO in severe but potentially reversible cardiogenic shock
🔍 205 adults/11 ICUs in 🇫🇷
⚖️ early levosimendan administration did not significantly shorten the time to successful weaning of #ECLS at day 30
🔗 bit.ly/4iAwGwT

Thanks for sharing our review! Monitoring GI function when initiating / stepping up nutrition is key to prevent harm from too aggressive nutrition.

My question is, does it truly matter? If there’s a strong signal, shouldn’t I be able to detect it using either method (and vice versa)? And if the signal is borderline, shouldn’t I arrive at the same interpretation if my application and understanding of the statistics used are accurate?

New 📝

We know RV dysfunction occurs on VV-ECMO in ARDS despite ECMO mitigating many of the traditional RV dysfunction risk factors (hypercapnia etc)

We don’t understand RV function dynamically over time on ECMO…

@gurujosh.bsky.social presents the results of the MSSA domain of the SNAP 🫰 trial at #ESCMID2025

fluclox caused more acute kidney injury than cefazolin; early mortality favored cefazolin

Absolutely Herculean effort by the entire global trial team and practice changing data #teamcefazolin

Diagnoses supported by a computerised diagnostic decision support system versus conventional diagnoses in emergency patients (DDX-BRO): a multicentre, multiple-period, double-blind, cluster-randomised... Use of a CDDSS did not reduce the occurrence of diagnostic quality risk compared with the usual diagnostic process in adults presenting to emergency departments. Future research should aim to identify...

Have you ever wondered what it takes before a clinical trial ends up in your timeline?
Well… we recently published the DDx-BRO trial ⬇️
Here is a 🧵 of its lifecycle: from 💡to 🏁, well, if the latter actually exists.

Core outcome set of daily monitoring of gastrointestinal function in adult critically ill patients: a modified Delphi consensus process (COSMOGI) - Critical Care Purpose Gastrointestinal (GI) dysfunction is common in critically ill patients and associated with poor outcomes. There is a lack of standardised methods for daily monitoring of GI function. COSMOGI a...

Core outcome set of daily monitoring of gastrointestinal function in adult critically ill patients: a modified Delphi consensus process (COSMOGI)
Thanks to @criticalcarereviews.com
ccforum.biomedcentral.com/articles/10....

I don’t think that offering specific therapies out of the context of goals of care is helpful and may negatively impact the discussion and patient trajectory.

I think we want to define where a patient wants to be in 1/3/6/12 months and with what level of quality of life. We as a team can then offer specific therapies (i.e. Trach/PEG but also other options such as mech. assist devices), if and only if these therapies align with the defined goals of care.

#Halo #SwissMountains #Freeride

I got tired of opening a dozen PDFs to find the ECMO pressure/flow curve I need.

So I made an app!

Choose the cannula/size and you can see the max flow for a given pressure drop. Or compare multiple different cannula.

Lmk what ya’ll think. Useful? What’s it need?

onepagericu.com/ecmo-calcula...

Recently listened to this:

soundphysicians.com/podcast-epis...

Has some good pearls and pitfalls and some resources in the shownotes.

a countdown clock with the number 10 in the center ALT: a countdown clock with the number 10 in the center

Let us start 2025 in a positive mood: here are 10 methods things researchers can worry *less* about in 2025

📌

ICYMI #emimcc

Impella percutaneous ventricular assist device malrotation in social media: a call to action This study suggests that correct Impella orientation is often overlooked, and that Impella malrotation is a common issue in real-world clinical practice, potentially associated with relevant complicat...

This was a fun study leveraging social media to demonstrate the high prevalence in Impella malrotation among cases shared on old Twitter.
If it's malrotated, but it works well, without suction alarms or other problems, do you change it? #cccsky #cardiosky #emimcc
www.pcronline.com/News/Whats-n...

Do you/does anyone know if there are data repositories with patient data, timepoints and vanco levels as well as reference clearence (maybe from observational studies)?
We could then use that to 1) validate and 2) develop new models.

#emimcc
I plan to do a thread on the paper/topic soon. This project has kept me busy over the last two years and it has been a pleasure working alongside an awesome steering committee and Delphi panel. 🙏

Core outcome set of daily monitoring of gastrointestinal function in adult critically ill patients: a modified Delphi consensus process (COSMOGI) - Critical Care Purpose Gastrointestinal (GI) dysfunction is common in critically ill patients and associated with poor outcomes. There is a lack of standardised methods for daily monitoring of GI function. COSMOGI a...

Fresh off the press: COSMOGI 🗞️🗞️🔥🔥
What variables should we use to daily monitor #gastrointestinal function in #criticalcare?
We have developed a core outcome set and have defined 13 variables for daily GI assessment. Published today in Critical Care:

ccforum.biomedcentral.com/articles/10....

Potassium Supplementation and Prevention of Atrial Fibrillation After Cardiac Surgery This randomized clinical trial examines whether a lower serum potassium concentration trigger for supplementation is noninferior to a high-normal trigger for the prevention of atrial fibrillation afte...

#MedSky #EMIMCC #IDsky #cardiosky
@pulmcrit.bsky.social

What is the culture at your hospital for potassium replacement?

At most hospitals I'm at it seems to be a culture of replace to K 4.0 and the individual doctor makes the call.

This paper confirms my bias...
jamanetwork.com/journals/jam...

Liberal or Restrictive Transfusion Strategy in Aneurysmal Subarachnoid Hemorrhage | NEJM The effect of a liberal red-cell transfusion strategy as compared with a restrictive strategy in patients during the critical care period after an aneurysmal subarachnoid hemorrhage is unclear. We ...

Results of the #SAHARAtrial released after #CCRdownunder. A lot to discuss…

www.nejm.org/doi/full/10....

#neurocriticalcare

No, this was just a (very simple) approximation; imagine a trial that onlynlooked atbthis group and enrolled that number of patients. As the groups are exclusive, this was a first step to get a feeling of how much of a difference there really is…

The immunocompromised group was stopped for futility. I think that these groups are not powered enough to draw any conclusion and the difference is just statistical noise. Early intubation may be warranted in these patients who can deteriorate rapidly, also for early diagnosis via bronch/lavage.

I agree, for cardiogenic NIPPV treats the not only the lungs but also the heart; this is why the results were suprising to me and I struggle with interpretation.

Awesome and interesting work by the late Luciano Gattinoni and colleagues.

#emimcc

CVP has the same function: it is the intersection of RV function curve and venous return, so it tells you how well the RV handles the VR and if there is RV dysfunction for that given state. It is no measure of volume status or responsiveness (but probably tolerance, as is VEXUS).

I think of VEXUS as volume overload combined with RV dysfunction/failure. If you give a healthy person five liters of fluid, the rv might very well handle the venous return and vexus is low; only once RV dysfunction develops (either due to hypervolemia itself or for other reasons), VEXUS goes up.

As an additional remark:
Figure 2 shows the median estimated OR without borrowing, which line up better with frequentist results, although the superiority threshold was still not met. I wonder whether borrowing is valid for this group, as a cardiogenic pathology will differ from a respiratory one?

#ADAPTtrial released & the results are interesting…

Compared to SOC, Procalcitonin guided antibiotics in sepsis resulted in:
- FEWER antibiotic days: 10.7 vs 9.8 (p=0.01) BUT
- HIGHER 28 day mortality: 19.4% vs 20.9% (p=0.02) though this did not meet the pre-specified non-inferiority margin

🤔
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