@e_mongardini

Med Student 🩺 @MyUniSR

 Milan, Lombardy
Joined November 2022
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  • Followers45
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When a heart stops, the people nearby matter first. 2025 CARES data: 42.5% received bystander CPR. Survival was 12.8% with bystander CPR vs. 7.7% without. This World Restart a Heart Day, know what to do: Call 911. Start CPR. Use an AED. #worldrestartaheart
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Fresh blog: Hot take on the VASSPR trial 🔥 🗜️Numerous correlational and target-trial-emulation studies published in the past five years suggested that early vasopressin initiation could cause huge mortality benefits. 🗜️ The VASSPR trial, a new multicenter RCT, shows that early initiation of vasopressin doesn't affect mortality or renal failure. 🗜️This is a great illustration of why we need RCTs. Sometimes a dozen retrospective & target-trial emulation studies are all consistently wrong. 🗜️Vasopressin can impair digital perfusion, which may be VERY problematic if you're using capillary refill time as a resuscitative target. (#1/2)
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After ROSC, does a conservative oxygen target help? Meta-analysis, 11 RCTs, 4,136 ventilated adults: - mortality RR 0.96 (95% CI 0.88–1.06) - poor neuro outcome RR 0.96 (0.88–1.04) - more hypoxaemia (RR 1.65), +2.1 ventilator-free days Which SpO2 target do you use?
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Source: Khan MM, et al. Acad Emerg Med 2026;33(10):e70422. DOI 10.1111/acem.70422 · PMID 42872895 Trial sequential analysis: trend toward futility under normothermia, but the required information size is not yet reached. #FOAMcc
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Most ICU fluid is not resuscitation. New in JAMA: 2,454 ventilated adults, 206 ICUs, 41 countries - maintenance/replacement 31.9% of volume - creep (drug diluents, line patency) 30.9% - resuscitation only 16.0% Do you count creep fluids in your ICU? #FOAMcc
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🔗Link here: jamanetwork.com/journals/jam…

Fluid Therapy in Mechanically Ventilated Critically Ill Adult Patients

This cohort study characterizes contemporary global fluid therapy practices in mechanically ventilated critically ill adult patients in intensive care units.

jamanetwork.com
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Wondering how to deliver #CRRT during #ECMO? Best practices by the Joint ADQI & @ELSOOrg Consensus Conference on ECMO, AKI, Fluid Management & CRRT are out! 📋 institutional standards required for delivery 🔧 technical considerations #ECMO ⚠️ factors guiding integration of CRRT into ECMO circuit vs use of separate vascular access sites 🔑 key performance indicators 🩸 factors guiding choice of anticoagulation Open access #FOAMcc #FOAMecmo 🔓 bit.ly/4hLY0K2
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Replying to @e_mongardini @a_serpaneto @alebelletti1 @LosiggioRosario @YukiKotani5 @GiacomoMonti
Source: Blok SG, … Serpa Neto A, … Paulus F, Tuinman PR. JAMA 2026. DOI 10.1001/jama.2026.21291 · PMID 42872606 Prospective observational cohort: it describes practice and does not link fluid strategy to outcomes.
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🎧 L’anestesia come non te l’hanno mai raccontata! Ecco i primi 9 #PodcAnest che spiegano in parole semplicissime, a chi medico non è, l’affascinante mondo dell’anestesia e della terapia intensiva. Bravissimo @e_mongardini che coordina 👏 👉 collegio-cpar.it/podcanest/
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Tomorrow 5 PM CEST: Early multimodal vasoconstrictors in vasoplegia 🩺 Webinar @UNI_FIRENZE with Žiga Kalamar, in English. NE + vasopressin + Ang II together, from day one? Let’s discuss the TRICYCLE RCT. DM me for the link 📩 #Vasoplegia #SepticShock #CritCare
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After our ANHtrial in @NEJM we focused on blood transfusion in women #ANH vs usual care in #cardiacsurgery 🩸 RBC transfusion 38.8% vs 44.6% (NS) ⚠️ Hypotension 16.0% vs 4.8% 🏥 +21h ICU, +1.9 days hospital Caution with ANH in women. Now in @JAMASurgery doi.org/10.1001/jamasurg.202…
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Acute normovolemic hemodilution in women undergoing cardiac surgery: less transfusion? No. Post hoc analysis of the ANH RCT, 405 women: - RBC transfusion 38.8% vs 44.6% (RR 0.87, 95% CI 0.69–1.10) - hypotension 16.0% vs 4.8% - ICU stay +21 h Would you still use ANH in women?
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Source: Pruna A, … Landoni G, Paternoster G, Zangrillo A, Monaco F. JAMA Surg 2026. DOI 10.1001/jamasurg.2026.4786 · PMID 42873487 Post hoc, exploratory subgroup: hypothesis-generating, needs a dedicated trial. #FOAMcc
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#Review by Bornemann-Cimenti et al reporting the anaesthetic core items consistently present in #ERAS guidelines: temperature, PONV, fluid therapy, neuromuscular block management, airway management and analgesia. bjanaesthesia.org/article/S0…
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Wednesday's ARDS quiz: prone positioning. P/F <150 on FiO2 ≥0.6 and PEEP ≥5: in PROSEVA (n=466), prone sessions ≥16 h cut 28-day mortality 16.0% vs 32.8% (HR 0.39, 95% CI 0.25–0.63). VV-ECMO comes after proning fails. How long are your prone sessions?
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Source: Guérin C, et al. N Engl J Med 2013;368:2159-68. DOI 10.1056/NEJMoa1214103 · PMID 23688302
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Prognostic implications of complications during veno-arterial #ECLS for cardiogenic shock 🔍 ELSO Registry analysis including > 22.5K adults 🪦 54% patients died during hospitalization; 74% non-survivors vs 54% survivors experienced complications 🧠 neuro complications increased mortality by 3.6 Complications on VA #ECMO have a significant and cumulative effect on on survival. Absolute 30-day risk of mortality greater if a complication occurred, increasing from 48.6% (0 complications) to 93.1% with neurologic complication. Neurologic and pulmonary complications associated with greatest risk 🖇️ bit.ly/4dxaHWu
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Septic shock: all vasopressors early instead of stepwise? TRICYCLE (phase II RCT, n=79): angiotensin II + vasopressin + norepinephrine. Faster renin/lactate decline, fewer tachyarrhythmias (15.6% vs 68.6%). Not powered for mortality. Phase III next? @GiacomoMonti @DrFDamico
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Source: Kalamar Ž, Landoni G, et al. Crit Care 2026. DOI 10.1186/s13054-026-06323-z · PMID 42827265 Primary outcome: change in plasma renin. 28-day mortality 36.8% vs 46.3% (RR 0.80, 95% CI 0.47–1.35), not significant.
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207 RCTs, 63,785 patients, 55 interventions to prevent AKI after cardiac surgery. Most trials were neutral. Signals (≥4 RCTs): dexmedetomidine OR 0.48, fenoldopam 0.57, nitric oxide 0.61, RIPC 0.78. Mostly small, single-centre trials. Which one deserves a big RCT? #FOAMcc
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Source: D'Amico F, Bonizzoni MA, … Landoni G. J Cardiothorac Vasc Anesth 2026. DOI 10.1053/j.jvca.2026.09.020 · PMID 42859065 Systematic review of RCTs, meta-analysis when ≥4 RCTs: associations with lower odds of AKI, not proof of benefit.
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