General Glossary

RCT = randomized controlled trial; MA = metaanalisis; sr = systematic review; DX = diagnosis; inc_ = incident; w_ = with; wo_ = without; pxs = patients; EX = exclusion; IN = inclusion; ↗️ = improve; ↘️ = worsen; ↑ = increase; ↓ = decrease; 𝙄𝙌𝘾 BS = 𝙄𝙉𝘼𝘼𝙌𝘾 ᴮᴼ brief scope = year (Y), journal (J), country (C) ➖ type of study (T) ➕ number of patients/sample (N) ➕ time (t) ➖ population (P), intervention (I), comparison (C), outcome (O, OC);            p = primary; s = secondary; critILL = critically ill

1. A JC is an academic session where we go through a scientific article for 1 hour.
2. It takes place every Friday.
3. Its purpose is to understand and discuss relevant elements about the content taking interactive and pedagogic notes (highlighting, underlining and using other learning resources) about the content.
4. We generate further appraisal, identify the opportunities of learning and formulate some potential research questions.
5. We write down the key-points of every session and publish them on our website
6. The article for the next session is posted one week in advance the must-read JC channel of our DISCORD server.

March, 2025

Journal CLUBS

2018 CID - Renal Dosing of Antibiotics Are We Jumping the Gun (Crass) [r].pdf

Codified by ABFL

Glossary: 

🪲 = microorganisms;
♾ = renal;
ATB = antibiotics;
Ccr = creatinine clearance;
CKD = chronic kidney disease;

1. EVIDENCE
   - ATB dose adjustments applies for stable CKD
   - May not apply to late late-phase trials and practice.
   - Ceftolozane/tazobactam, ceftazidime/avibactam, and telavancin ➩ all have precautionary

     statements for ↓ clinical response (Ccr 30-50) ➩ no need to adjust doses
2. ATB elimination is mostly relevant in acute cases during the 1st 48h
3. Toxicity + efficacy should be considered in every ATB
4. FDA ➩ inferior EFFICACY in moderate ♾ impairment.
5. GOAL ➩ Keep efficacy with the ↓ toxicity possible.
6. CKD studies available in CKD are small, early phase of healthy
7. “Antibiotics do not fit cleanly into this paradigm due to overwhelmingly episodic, rather than

    chronic, use.” Crass 2018

⏳ TIME MANAGEMENT.
01:22:41
Round: 5 01:11:57 Comments
Round: 4 27:19:13 JC main points
Round: 3 32:18:27 JC intro
Round: 2 12:30:77 Codification discussion

Round: 1 09:21:62 Past JC

Friday, January 10 , 2025 at 18h30 at BO - 23h30 at BE

ABFL, CORA, AMA, MAAT, DFM, HIBN, AAQC

2024 CC - Feasibility and safety of ultra-low volume ventilation (≤ 3 mlkg) combined w_ECCO2R in ARF (monet) [R].pdf

Codified by MAAT

Glossary:  🫁 = lungs; 🤔 = analysis; ⏎ = return; ARDS = acute respiratory distress syndrome; BLUE = The American Journal of Respiratory and Critical Care Medicine.


1. 𝙄𝙌𝘾 BS ➩ Y, J, C ➖ T ➕ N ➕ t ➖ P I C O:
2. 𝙄𝙌𝘾 BS 🟰 2024, BLUE, FR ➖ retro_prag_🤔 - cohort ➕ 41pxs ➕ 8y (2014 - 2022) ➖ P I C O:
   - P: adults + ECCO2R
   - I: Vt ≤3mL/Kg (ultra-protective vent)
   - C: NA
   - O: p_OC = feasibiliy (proportion of sessions) ➖ s_OC = efficacy + safety + others (adverse

     events, SS90)
3. EVIDENCE:    - …

⏳ TIME MANAGEMENT.
01:13:20

Round: 4 10:34:78 Comments
Round: 3 51:30:02 ART ultra-low volume ventilation
Round: 2 05:36:00 Select ART
Round: 1 05:39:31 Past JC

Friday, January 3 , 2025 at 18h30 at BO - 23h30 at BE

ABFL, CORA, AMA, MAAT, DFM, HIBN, AAQC

Friday, January 24 , 2025 at 18h30 at BO - 23h30 at BE

ABFL, MAAT, JCAU, HIBN, MACR, GMC, AMA, AAQC

2021 HHP - How many fruits+vegetables do we really need (Circulation).pdf
2021 CIRCULATION - Fruit and Vegetable Intake and Mortality, 2 Prospective Cohort Studies + MA of 26 Studies (wang) [MA]

Codified by ABFL
Codified by ACE ᵗᵉᵃᵐ

Glossary: 

🫁 = lungs, COPD; 🧠 = brain, stroke; 🫀 = heart, cardiovascular disease; WHO = World Health Organization; WCRF = World Cancer Research Fund; NHSE = National Health Service of England


1. 𝙄𝙌𝘾 BS ➩ Y, J, C ➖ T ➕ N ➕ t ➖ P I C O:
2. 𝙄𝙌𝘾 BS 🟰 2021, CIRCULATION, USA ➖ obs_PROS + MA ➕ 2M | pros = >66k in ♀ (1984-2014) – >42k iin ♂ (1986-2014) ▶ MA = 1.8M ➕ 30y ➖ P I C O:
   - P: adults
   - I: pooled self-reported health and diet information
   - C: NA
   - O: MM ➩ Results:
            • 10%. ↓r CA - (0.90)
            • 12%. ↓r 🧠 🫀 (HR 0.88)
            • 13%. ↓r MM (HR 0.87)
            • 15 35%. ↓r 🫁 COPD (0.65)
3. EVIDENCE:
  - Leafy green vegetables: kale + spinach
  - Fruits & vegetables: vitamin C + beta carotene (ANTIOXIDANTS)
  - NO BENEFIT in MM ➩ >5 servings OR starchy veggies OR potatoes OR drinking fruit juices.
  - Veggies only = no ↓ CA (p=0.62)
  - RECCO diver among countries ➩
       * 8.5 servings in AUS
       * 6 servings in DEN
       * 5 servings in WHO, WCRF, NHSE

  - Fruit juices + potatoes = ↑ glycemic load (various DIETARY RECOMM include them)

  - How much you eat in average MATTERS ➩ if NOT achieved THE GOAL, you can

    compensate the day after.

⏳ TIME MANAGEMENT.
01:27:38

Round: 8 00:01:30 The end
Round: 7 06:31:64 Wrap-up
Round: 6 12:09:86 Images + keypoints
Round: 5 37:44:75 ART 1 original
Round: 4 21:01:46 ART 1 prequel
Round: 3 04:19:04 Selection
Round: 2 02:13:15 Past JCRound: 1 03:37:75 Past JC

2024 CC - Comparison of methods to normalize urine output in CIpxs, a multicenter cohort study (monard) [R].pdf

Codified by MAAT

Glossary: 

♾ = kidneys; ABW = actual body weight; AKD = acute kidney disease;

CH = Switzerland; coh = cohort; DE = Germany; h_DIS  =  Hospital discharge; IBW = ideal body weight;

mc = multicentric; UO = urinary output.

1. 𝙄𝙌𝘾 BS ➩ Y, J, C ➖ T ➕ N ➕ t ➖ P I C O:
2. 𝙄𝙌𝘾 BS 🟰 2024, CC, CH + USA ➖ mc_coh ➕ 15,322 + 28,610 (derivation + validation) ➕ CH 2010-2020 ➖ P I C O:
     - P: adults, CI pxs
     - I: CH (Laus’AKI, derivation coh) 🆚 USA (MIMIC-IV, validation coh)
     - C: NA
     - O: best predictor for UO
3. EVIDENCE:
   - Oliguria = <0.5mL/Kg/h in ≥6h
   - Presents in 75% of CI pxs + ↔ MM90
   - Estimation of weight is inaccurate
   - ABW ➩ massive variations (fluid overload + muscle mass loss + obesity + underweight)
   - Types of BW: pre-admission + actual + ideal + adjusted
   - Series (493 pxs = overestimation) + 2 large studies (USA + DE = confirmed)
   - 4th study (S + 569pxs) not influenced by the method (oliguria & MM)
   - The four studies = single center
4. METHODS.
- DEF ➠ Best predictor for UO = most closely ↔ w_mean UO d_UCI
- IN ➠
  * Laus’AKI: ≥18yo, Lausanne, Jan 2010 - Jun 2020
  * MIMIC-IV: Boston, 2008 - 2019
- EX ➠
  * Laus’AKI + MIMIC-IV: refused, u_HD, <6h UO measurement, no sCr, no weight, no height,

    vesical irrigation d_ICU stay.
- RANDOM ➠
- INTERV ➠ 1st. Best predictor was chosen 2nd. Compared OLIGURIA INCIDENCE w_: a. MM90, b. AKD at H+dis ➩ according to ABW or IBW (which normalized better)
6. RESULTS
   - USA cohort: heavier, older, lower in SAPS-II (than CH cohort)
   - Best UO predictor = IBW (‘oliguria incidence’ was constant)

   - IBW ➩ ↗️ association ↔ oliguria w_: MM90 & AKD

   - After correction (sex, SAPS-II): ALL FINDINGS PERSISTED

Friday, January 17 , 2025 at 18h30 at BO - 23h30 at BE

ABFL, MAAT, JCAU, HIBN, MACR, GMC, AMA, AAQC

⏳ TIME MANAGEMENT.
01:18:15
Round: 5 06:07:41 Figures
Round: 4 20:28:69 Content + wu
Round: 3 33:11:79 Article UO

Round: 2 06:06:67 Article choice

Round: 1 12:21:18 Past JC

2025 CC - Changes in pulse pressure variation induced by passive leg raising test to predict preload responsiveness in MV pxs w_low Vt in ICU (mallat) [srMA].pdf

Codified by MAAT

Glossary: 

💨 = flow = perfusion; 🫁 = lungs; 🫀 = heart; FC = fluid challenge; FR = fluid responsiveness; PPV = pulse pressure variation.


1. 𝙄𝙌𝘾 BS ➩ Y, J, C ➖ T ➕ N ➕ t ➖ P I C O:
2. 𝙄𝙌𝘾 BS 🟰 2025, CC, UAE ➖ srMA ➕ 5 studies (474 pxs) ➕ PROSPERO - publication (1y) ➖ P I C O:
     - P: ↓Vt 
     - I: ∆PPV & ∆PPV% a_PLR following ‘…not a drop of fluid’
     - C: fluid challenge or response to PLR
     - O: ability to predict FR in ↓ Vt MV
3. EVIDENCE:
   - 1st line therapy = fluid administration ➩ tissue hypoperfusion context
   - FC AIM = ↑ preload + CI ➩ 🔝 DO2 + tissue 💨
   - Excessive fluid ➩ peripheral + 🫁 edema + poor OC
   - Deficient fluid ➩ MOF + MM
   - 50% are fluid responsive- PPV accurately predicts FR in MV pxs ➩ only if Vt ≥8 ➩

     OTHERWISE (Vt <8), insufficient to induce changes in THORACIC PRESSURE &

     PRELOAD.

Friday, January 31 , 2025 at 18h30 at BO - 23h30 at BE

AMA, HIBN, AAQC

⏳ TIME MANAGEMENT.
01:28:32
Round: 4 06:18:93 Comments
Round: 3 01:07:40 ART
Round: 2 09:17:00 ART selection
Round: 1 05:16:43 Past JC

January, 2025

2025 CC - Cardiovascular effects of lactate in healthy adults (berg-hansen) [R].pdf

Codified by MAAT

Glossary: 

🫀 = heart; AHF = acute heart failure; CABG = coronary artery bypass graft; eo_PER = end organ perfusion; GFR = glomerular filtration rate; GLS = global longitudinal strain; Ea = effective arterial elastance; HEC = hyperinsulinemic-euglycemic clamp; LAC = half-molar lactate; Lac 45g/L + Na 15g/L; MAP = mean arterial pressure; SAL = sodium-matched hypertonic sodium chloride; Na 15g/L, Cl 23 g/L; SV = stroke volume; SVR = systemic vascular resistance. .


1. 𝙄𝙌𝘾 BS ➩ Y, J, C ➖ T ➕ N ➕ t ➖ P I C O:
2. 𝙄𝙌𝘾 BS 🟰 2025, CC, DK ➖ RCT, single-blinded, crossover ➕ 8 ➕ March - June 2021 ➖ P I C O:
   - P: healthy
   - I: LAC (4h infusion)
   - C: SAL
   - O: CO (by ECHO); sOC = SV, LVEF, GLS, Ea, SVR
3. EVIDENCE:
   - Usually large amounts of fluids are needed to ↑ CO + ↗ eo_PER
   - No consensus about the optimal type of fluid resuscitation.
   - MORTALITY = ↑ fluids OR ↓ fluids
   - Small-volume resuscitation w_hypertonic saline ➩ proposal ➩
        * ➕ : ↗ CO + vascular tone + microcirculation.
        * ➖ : Careful w_hyperchloremia + metabolic acidosis
        * ➖ : ♾ vasoconstriction + ↓ GFR
   - Hypertonic crystalloid solutions
        * ➕ : ↗ HD effects wo_chloride + ↗ eo_PER & CO (AHF + af_CABG)
4. METHODS.
   - IN ➠ ♂ + ≥18yo + BMI 18-30
   - EX ➠ daily med + abnormalities in routine screening tests + acute or chronic disease

     (known 🫀 failure)
   - RANDOM ➠ 14 day interval (minimum) = washout
        * ⊖ strenuous physical activity + alcohol
        * ⊕ regular diet for 48h before each study day
   - INTERV ➠ ECHO + blood samples
        * T0, 60, 120, 240
        * HEC was used at 180 min (main study) ➩ 240min was w_HEC
        * HEC = insulin (0.6mU/Kg/min) + glucose (20%)
   - CONSORT was used (as stated by Equator)
6. RESULTS. LAC 🆚 SAL
   - LAC ↑ :
        1. Lactate = ↑ 1.9mmol/L 
        2. CO = ↑ 1L/min = due to SV of 11mL
        3. LVEF = ↑ 5 percentage points
        4. GLS = ↑ 1.5 percentage points
        5. Contractility = ↗
   - LAC = :
       1. HR = no change
       2. MAP = similar
   - LAC ↓ :
       1. Afterload (SVR + Ea)= ↓
   - SAL:
       1. Preload indicator = ↑
7. RATIONALE
   - ↗ 🫀 function ➩ ↑ CO, SV, LVEF in LAC

   - Contractility ↗ ➕ afterload ↓ ➕ preload = (stable)

⏳ TIME MANAGEMENT.
01:29:52
Round: 8 03:32:41 Comments
Round: 7 27:45:06 Wrap-up
Round: 6 15:06:89 Figures
Round: 5 17:55:76 Methods
Round: 4 06:36:59 Intro
Round: 3 11:21:90 Abstract
Round: 2 01:17:91 ART selection
Round: 1 06:16:33 Past JC

Friday, February 14, 2025 at 18h30 at BO - 23h30 at BE

AMA, MACR, DFM, JQB, MAAT, HIBN, AAQC

CC 2015 - Passive leg raising, five rules, not a drop of fluid (monnet, teboul).pdf


1. ↑ 300mL venous blood from ↓body → right 🫀

2. 5 rules:
      - 1st. Start from semi-recumbent position ▶ 1 study = poor reliability if this rule is not

        followed
      - 2nd. Measure CO ▶ not w_BP only (mechs: arterial compliance + pulse wave

        amplication) ▶ HOWEVER, MAP ≥10% could be a good predictor. (2016 CHEST -

        Passive Leg Raise Prediction of Fluid Responsiveness Using Nicom and Flatcar Devices

        in Septic Shock: Preliminary Findings. It worked w_NICOM)

     - 3rd. In 1 min. ▶ Real time CO measurement is needed
     - 4rd. Measure CO a_PLR

     - 5th. Do not touch (avoid adrenergic stimulation) ➕ PLR does not ↑ HR

2025 CC - Changes in pulse pressure variation induced by passive leg raising test to predict preload responsiveness in MV pxs w_low Vt in ICU (mallat) [srMA].pdf

Codified by MAAT

Glossary: 





1. 𝙄𝙌𝘾 BS ➩ Y, J, C ➖ T ➕ N ➕ t ➖ P I C O:
2. 𝙄𝙌𝘾 BS 🟰 2025, CC, UAE ➖ srMA ➕ 5 studies (474 pxs) ➕ PROSPERO - publication (1y), till Aug 2024 ➖ P I C O:
    - P: ↓Vt
    - I: ∆PPV & ∆PPV% a_PLR following ‘…not a drop of fluid’
    - C: fluid challenge or response to PLR
    - O: ability to predict FR in ↓ Vt MV
3. EVIDENCE:
   - 1st line therapy = fluid administration ➩ tissue hypoperfusion context
   - FC AIM = ↑ preload + CI ➩ 🔝 DO2 + tissue 💨
   - Excessive fluid ➩ peripheral + 🫁 edema + poor OC
   - Deficient fluid ➩ MOD + MM
   - 50% are fluid responsive
   - PPV accurately predicts FR in MV pxs ➩ only if Vt ≥8 ➩ OTHERWISE (Vt <8 of ideal body

     weight), insufficient to induce changes in THORACIC PRESSURE & PRELOAD.
   - PLR is an ACCUTE METHOD to predict FR in ↓ Vt (real-time CI is needed)
   - Real-time CI NOT ALWAYS AVAILABLE ➩ or technically ineligible (ECHO echogenicity)
   - PPV after PLR = good method (predict FR) ➩ SBA + ↓ Vt + MV pxs + PO critILL pxs (2021    - 2024) ▶ ROC curve issues (0.78 to 0.98) + wide 95%CI
4. METHODS.
- IN ➠ PubMed, Embase, Cochrane
- INTERV ➠
  - ∆PPV = end_PPV - baseline_PPV
  - ∆PPV% = end _ PPV - baseline_PPV) / baseline_PPV 1 x 100 ▶ baseline = the patient in

    the 45 semi-recumbent position BEFORE PLR test
  - A PLR test was then performed using an automatic elevation bed by raising the patient’s

    lower limbs to a 45 angle while the patient’s trunk was lowered from a semi-recumbent to

    supine position with no changes in the hip angle

  - …


💨 = flow = perfusion; 🫁 = lungs; 🫀 = heart; CI = cardiac index; FC = fluid challenge; FR = fluid responsiveness; MOD = Multiorgan disfunction; PO = postoperative; PPV = pulse pressure variation; SBA = spontaneous breathing activity.

⏳ TIME MANAGEMENT.
01:38:37
Round: 4 12:19:53 Wrap-up
Round: 3 42:23:90 PLR technique
Round: 2 37:11:54 JC

Round: 1 06:42:31 Past JC

Friday, February 7 , 2025 at 18h30 at BO - 23h30 at BE

DFM, AMA, DD, HIBN, AAQC

2024 JACC - From ST-Segment Elevation MI to Occlusion MI (McLaren) [r].pdf

Codified by AMA

Glossary: 

ACC = American College of Cardiology, ACO = acute coronary occlusion, INT = interpretation, MI = myocardial infarction, OMI = occlusion MI, STEMI = ST-segment elevation MI.


1. Q-wave/non-Q wave ➩ STEMI 🆚 non-STEMI ➩ OMI
2. 25% from non-STEMI have ACO ➩ limitation
3. OMI rises based on ✔ or ✖ of ACO
4. OMI paradigm = advanced ECG (INT aided by AI ➕ ECHO ➕ imaging ➕ refractory

    ischemia (clinical signs).
5. Benefits of OMI paradigm = opportunity to transform ER 🫀 +↗️pxs care.
6. Thomas Kuhn introduced the concept of PARADIGM SHIFT
7. To guide problem solving activities ➩ definition + methods
8. 2021 CIRCULATION ➩ although the dichotomuos classification (STEMI/non-STEMI), IT IS

    LIKELY that the main pathophysiological event is ACUTE VESSEL OCCLUSION

    (determining prognosis + natural history).
9. ACC consensus (2022) ➩ STEMI criteria (12-lead ECG) misses A SIGNIFICANT MINORITY

    of pxs w_ACO.
10. Alencar, 3 studies ➩ STEMI criteria for ACO = sensibility 44%

⏳ TIME MANAGEMENT.
01:09:58
Round: 5 01:33:50 Comments
Round: 4 13:41:71 wrap-up
Round: 3 34:16:12 ART
Round: 2 08:23:64 ART selection
Round: 1 12:03:40 Past JC

Friday, February 28 , 2025 at 18h30 at BO - 23h30 at BE

AMA, MAAT, GMC, MACR, HIBN, AAQC

2025 CC -Effect of an intensive care unit virtual reality interventions on mental health (Drop) [RCT].pdf

Codified by AMA

Glossary: 

C19 = COVID-19; DIS = discharge; HRQoL = health-related quality of life; ICU-VR = intensive care unit virtual reality; MH = mental health; PICS-F = post-intensive care syndrome-family; PTS = post-traumatisc stress; rel = relatives; SOC = standard of care; TECH = technology


1. 𝙄𝙌𝘾 BS ➩ Y, J, C ➖ T ➕ N ➕ t ➖ P I C O:
2. 𝙄𝙌𝘾 BS 🟰 2025, CC, NL ➖ mc_px-cluste_RCT ➕ 189 rel ➕ 1y3m = Jan 2021 - Apr 2022 (+6m after DIS) ➖ P I C O:
   - P: rel (adult pxs)
   - I: SOC + ICU-VR (100 rel of 81 pxs)
   - C: SOC (89 rel of 80 pxs)
   - O: symptoms of MH distress (DIFF ↔ prevalence + severity of PTSD + anxiety +

     depression). sOC = understanding of ICU environment & procedure ➕ perspectives

     toward ICU-VR
3. EVIDENCE:
   - Mental health challenges in CI pxs’ rel: PTS + anxiety + depression
   - MH sequealae
4. METHODS.
   - IN ➠ rel 1st or 2nd degree ➕ ICU stay ≥72h ➕ multiple rel could participate
   - EX ➠ language barrier ➕ no TECH ➕ no formal 🏡 address.
   - RANDOM ➠ all relatives from one px were assigned to the SAME GROUP (↓ r of cross-

     contamination) ➩ STRATIFIED in centers ➕ ability to visit the hospital (C19)
   - INTERV ➠ 48h after admission (time to approach the rel) ➕ rel could share the study-

     relation info
      * 14 min
      * Voice-over pre-recorded
      * Mock patient lying
6. RESULTS
   - Baseline, discharge, 1, 3, 6 months ➩ study periods (questionnaire)
   - NO DIFF in pOC
   - DIFF on understanding of ICU treatment ➕ perception/perspective on ICU-VR ➩ BOTH ↗
7. RATIONALE
      * A more tailored, multifaceted approach, incorporating a combination of interventions like         ICU-VR at different stages of the ICU experience may prove more effective.
8. LIMITATIONS    

   - Not blinded to rel & investigators (blinded to researcher)

⏳ TIME MANAGEMENT.
01:25:47
Round: 7 07:25:35 Comments
Round: 6 11:46:41 Results
Round: 5 30:00:94 Methods
Round: 4 16:27:26 INTRO
Round: 3 11:42:31 JC, abstract
Round: 2 03:16:61 ART selection
Round: 1 05:08:43 past JC

Friday, February 21 , 2025 at 18h30 at BO - 23h30 at BE

AMA, MAAT, DFM, MACR, HIBN, AAQC

Friday, March 14 , 2025 at 18h30 at BO - 23h30 at BE

AMA, MACR, DFM, JQB, MAAT, HIBN, AAQC

2024 JACC - From ST-Segment Elevation MI to Occlusion MI (McLaren) [r].pdf

Codified by ABFL

Glossary: 

ACC = American College of Cardiology, ACO = acute coronary occlusion, Computerized Tomography, Delayed Invasive Intervention in Patients With Non–ST-Segment–Elevation Myocardial Infarction, INT = interpretation, MI = myocardial infarction, OMI = occlusion MI, RIDDLE-NSTEMI = Randomized Study of Immediate Versus, STD = ST-segment depression, STEMI = ST-segment elevation MI, TIMACS = Timing of Intervention in Acute Coronary Syndromes, VERDICT = Very EaRly vs Deferred Invasive evaluation using.


1. Image of non-STEMI = STEMI (occluded) + non-STEMI (nonocclusive thrombus)
2. Clear deviation from actual evidence ➩ real occlusion in non-STEMI
3. ST criteria (age, sex) = Healthy 🆚 CKMB measured MI pxs ➩ DESPITE THIS… REC

    differentiation of MI w_ & wo_ACO
4. NORMAL SCIENCE = persistence of a paradigm (successful in its aim, steady expansion) =

    DOES NOT aim at novelties
5. OCs of STEMI criteria ➩ best reperfuse + ↓ reperfusion delays
6. STEMI paradigm ➩
       * ↗️REPERFUSION strategies & techniques
            - Angiography
            - Stenting
            - Medications
            - Door-to-balloon (time is myocardium)
       * ↗️🫀 ER + INTERdisciplinary collaboration:
            - ⊕ Cath lab
            - Paramedics BYPASSING ER departments
            - Rapid assembling of interventional 🫀 teams
       * 2 quality ↗️:
            - ↓ reperfusion delays
            - ↓ false positives STEMI
       * NOVELTY:
            - No false negatives found ➩ ECG wo_STEMI criteria + ACO = NOT considered a false

              (-) STEMI ➩ “As a result, the patient will be denied emergent reperfusion”
            - McLaren stated this problem in 2023 AJEM, Missing occlusion
       * Evidence
            - Trials have not regarded this type of cases
            - Many non-STEMI trials have reperfusion time limitations ➩ TIMACS 16h (unstable

              angina, non-STEMI) to reperfusion.
            - VERDICT (unstable angina, non-STEMI) = benefit from 4.7h of reperfusion.
            - RIDDLE-NSTEMI = ↓ MM in immediate reperfusion
            - NSTEMI exclude refractory ischemia OR HD/electrical instability

            - 6.4% of VERY-HIGH NSTEMI ➩ angio in 2h

⏳ TIME MANAGEMENT.
01:24:22
Round: 4 00:50:82 Comments
Round: 3 23:33:13 wrap-up
Round: 2 47:53:53 JC
Round: 1 12:05:49 Past 2 JCs

⏳ TIME MANAGEMENT.
01:25:47
Round: 7 07:25:35 Comments
Round: 6 11:46:41 Results
Round: 5 30:00:94 Methods
Round: 4 16:27:26 INTRO
Round: 3 11:42:31 JC, abstract
Round: 2 03:16:61 ART selection
Round: 1 05:08:43 past JC

2024 JACC - From ST-Segment Elevation MI to Occlusion MI (McLaren) [r].pdf

Codified by ABFL

Glossary: 

ACC = American College of Cardiology, ACO = acute coronary occlusion, INT = interpretation, MI = myocardial infarction, OMI = occlusion MI, STEMI = ST-segment elevation MI.


1. SHIFT ➩ scope + precision change OR stay when PARADIGM is more successful (few

    problems resolved) - acute ones
2. STEMI criteria as SURROGATE of ACO = limited in scope + precision
3. 1994 MA ➩ “ECG w_STEMI criteria = emergent reperfusion”
      - Suspected MI
      - w_limited or NO ECG
      - Treated w_streptokinase
      - MI determined by CK-MB
      - CRUDE separation = poor definition
      - 4 studies ➩ no ECG requirements for enrollment
      - cautioned about denying reperfusion in patients without STE.
      - Few deaths + data-dependent emphasis could be misleading
4. Kuhn ➩ paradigms start FLEXIBLE… and then become RIGID
5. GLs:
      1. 1996 ➩ advised THROMBOLYTICS for hyper acute T or ST-seg depression V1-V4 from

           POSTERIOR MI (experienced expertise is needed)
      2. 1999 ➩ advised CLASSIFY “w_STE or LBBB” + “nonDx ECGs” (even being posterior

           infarctions)
      3. ∑ STEMI paradigm emerged w_2 ≠ entities: STEMI 🆚 non-STEMI

Friday, March 07 , 2025 at 18h30 at BO - 23h30 at BE

MAAT, HIBN, AAQC

February, 2025

2025 ICM - How we use ultrasound in the mm of weaning from MV (Tuinman) [ed].pdf

Codified by ABFL

Glossary: 

🫁 = lungs, 🫀 = heart,🫃🏽 = abdomen = abdominal, DW = difficult weaning, SBT = spontaneous breathing trial, CCUS = critical care ultrasound, WF = weaning failure, Di = diaphragm, iFunction = impaired function, MV = mechanical ventilation, DIS = disease, AbP = abdominal pressure, DYSF = dysfunction, PSLA = parasternal long axis, PSSA = parasternal short axis, PSIC = parasternal intercostal, HTA = hypertension, antiISCHE = anti-ischemic, af_ = after, DE = diaphragm excursion, MIP = maximal inspiratory effort = maximal inspiratory pressure, TFdi = thickening fraction of the diaphragm, IAP = intraabdominal pressure, TECHS = techniques.


1. DW ➩ ↑ adverse clinical OCs➕ resources (limited healthcare)
2. DW = failure SBT ➩ causes of WF ▶ iFunction: 🫁 🫀 Di
3. CCUS ➩ valuable DX tool ➩ MV, weaning, readiness for weaning, causes of WF, 🫀–🫁 function, TTO response.
4. ABCDE-US ➩ pathophysioly of WF ➩ DX ➕ monitoring = CAUSE oF WF
       1. ABCDE ➩
              - it is an ADJUNCT to clinical parameter + physical examination
              - Timing: MV > 48h
              - Frequency: follow-up determined by a. Cause, b. Course DIS     
        2. 🫀:
              - DYSF ➩ MOST frequent causes of WF
              - 1st. TTE. views (PSLA, PSSA, apical 2, 3, 4, 5 chamber, subcostal) ➩ eye-balling: to

                 estimate SIZE + FUNCTION both ventricles ➕ wall abnormalities OR 🫀 effusion
              - 2nd. TTE by educated in ECHO. If CAUSE not clear
              - 3rd. TEE. Diastolic function (E/A and E/e’ ratios) when FAILING an SBT. Wall motion

                abnormalities + 🫀 valves (stenosis + regurgitation)
              - TTO ➩ fluid removal ➕ antiHTA ➕ antiISCHE
        3. 🫁 :
              - Aeration score + P.eff.
                  * QUALITATIVE ▶ 6 views DX cause of ARF (sliding, pleural abnormalities, lung

                     profiles ABC, pleural effusion, consolidation w_or wo_ air bronchograms) ➖

                     careful w_deterministic fashion interpretation
                  * QUANTITATIVE ▶ 12 views ➩ calculare 🫁 aeration score ➩ monitor 🫁

                     pathology over time
                  * r_extubation failure ▶ 8 views ➩ ← → SBT ➩
                  * ≥5 B-lines = extubation failure (independent fro LV filling presssures)
                  * OCs ▶ weaning readiness + WF cause + monitor DIS progression & TTO

                     response.
         4. 🫃🏽:
               - ↑ AbP ➩ can affect MECHS ∑ weaning
               - US ▶ screen aspect FREE FLUID (↓ anechoic) 🆚 heterogenous (↑ echoic) +

                  septum (useful for the cause of free fluid)
               - Paracentesis DX and TTO
           5. Di:
               - Highly prevalent ➩ DYSF of Di
               - US: to exclude Di DYSF ➩ af_FAILED initial SBT
               - DE = subcostal OT subxiphoid (liver OR spleen as acoustic windows)
                  * F not clear ▶ use INTERCOSTAL (zone of apposition to DISPLACEMENT of liver

                     OR spleen) = qualititve alternative.
                  * Measured d_spontaneous breathing wo_ventilator support.
                  * In cooperative PXS ➩ MIP to assess MAX excursion
               - Contractility: TFdi (via INTERCOSTAL) ▶
                  * ↑ = edema ➖ fibrosis (careful)
                  * ↓ = atrophy
                  * DYSF = DE <20mm
                  * WF (predictive) = TFdi <30-35% ➕ DE <10-15mm
            6. Extra-Di
                - ExtraDi muscles help Di weakness ➩ successful SBT BUT potential WF
                - Expiratory muscle atrophy = impairment of airway clearance ➩ WF
                - US: PSIC + rectus abdominis muscle + external oblique, internal oblique &

                  transversus abdominis (same window).
                - Consider always IAP (due to GEOMETRY + MOBILITY)
                - Thickening fraction of INTERCOSTAL MUSCLES >10% = ↑r_WF
7. FUTURE DIRECTIONS
                - CLINICAL trials ▶↗️  predictive performance of 🫁 + Di
                - DX continuous data ▶ ↗️ predictive performance of 🫁 + 🆕 indications
                - Advanced TECHS ▶ speckle tracking (quantification of perfusion + better function

                  estimation).

8. These measurements can be used to form a definition of diaphragm dysfunction, although

    there is variation in this definition: It has been defined as a thickening fraction of less than

    20% or a tidal excursion of less than 10 mm – 2019 UJ - A narrative review of diaphragm

    ultrasound to predict weaning from MV, where are we and where are we heading (turton) [r]

Friday, March 28 , 2025 at 18h30 at BO - 23h30 at BE

AMA, AHO, GMC, HIBN, AAQC

⏳ TIME MANAGEMENT.
02:13:08
Round: 5 06:52:74 Comments
Round: 4 58:27:56 Wrap-up
Round: 3 46:41:93 ART
Round: 2 06:47:19 ART selection
Round: 1 14:19:46 past JC