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Romain Barthélémy

@rombarthelemy.bsky.social
489 followers 46 following 27 posts

ICU physician, Hôpital Lariboisière, Paris, France #Hemodynamics #Monitoring #Echo #AcuteBrainInjury #CriticalCare #NeuroCriticalCare #Physiology #Rstats

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Romain Barthélémy @rombarthelemy.bsky.social · 17/11/2025
Therefore, yes. There is a separate effect in hypoxia with vasodilators: one from impairment of HPV and one from the increase in CO
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Romain Barthélémy @rombarthelemy.bsky.social · 17/11/2025
If PaO2 increase with PEEP but CO decrease, it’s not alveolar recruitment We most recently tried to highlight this in this paper pubmed.ncbi.nlm.nih.gov/33223045/
pubmed.ncbi.nlm.nih.gov
Haemodynamic impact of positive end-expiratory pressure in SARS-CoV-2 acute respiratory distress syndrome: oxygenation versus oxygen delivery - PubMed
Haemodynamic impact of positive end-expiratory pressure in SARS-CoV-2 acute respiratory distress syndrome: oxygenation versus oxygen delivery
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Romain Barthélémy @rombarthelemy.bsky.social · 17/11/2025
It is an overlooked effect by which PEEP improves PaO2 pubmed.ncbi.nlm.nih.gov/6988180/
pubmed.ncbi.nlm.nih.gov
Depression of cardiac output is a mechanism of shunt reduction in the therapy of acute respiratory failure - PubMed
The relationship between changes in cardiac output and intrapulmonary shunt associated with mechanical ventilation was evaluated in 20 patients with the adult respiratory distress syndrome (ARDS). The distribution of ventilation-perfusion (VA/Q) ratios and the level of intrapulmonary shunt was deter …
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Romain Barthélémy @rombarthelemy.bsky.social · 17/11/2025
There’s an impact of change in CO on Qs/Qt, it has been known for decades and the same magnitude of effect is observed whether CO is manipulated pharmacologically or mechanically pubmed.ncbi.nlm.nih.gov/422447/
pubmed.ncbi.nlm.nih.gov
Influence of cardiac output on intrapulmonary shunt - PubMed
The effect of changing cardiac output on intrapulmonary shunt was studied in the setting of hemorrhagic pulmonary edema induced by intravenous oleic acid in 17 alpha-chloralose-anesthetized dogs. The dogs were mechanically ventilated and cardiac output was alternately depressed and augmented using e …
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Romain Barthélémy @rombarthelemy.bsky.social · 17/11/2025
In the case of milrinone used in treatment of cerebral vasospam following SAH, we observed an increase in hypoxemia as well as an increase in CO pubmed.ncbi.nlm.nih.gov/38579430/
pubmed.ncbi.nlm.nih.gov
Systemic tolerance of intravenous milrinone administration for cerebral vasospasm secondary to non-traumatic subarachnoid hemorrhage - PubMed
Intravenous milrinone for CVS treatment seems associated with significant impact on systemic hemodynamics leading sometimes to treatment discontinuation.
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Romain Barthélémy @rombarthelemy.bsky.social · 17/11/2025
Pure vasodilators might decrease hypoxic pulmonary vasodilation, but in the case of inodilators (milrinone), the increase in CO will lead to an increase in Qs/Qt
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martinabaiardo.bsky.social @martinabaiardo.bsky.social · 20/03/2025
Professor Jan Bakker presented the interesting relationship between CVP and prediction of respiratory weaning failure 💦An early increase in CVP >= 5mmHg is highly predicative of weaning failure #ISICEM25
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martinabaiardo.bsky.social @martinabaiardo.bsky.social · 19/03/2025
In Brussel for #ISICEM25 🇧🇪 The 44th International Symposium on Intensive Care & Emergency Medicine
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Tommaso Scquizzato, MD @tscquizzato.com · 19/03/2025
2nd day starts with a great session on subphenotying at #ISICEM25 Why do we bother about subphenotypes? First talk by @seymoc.bsky.social @ISICEM.bsky.social
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Damien BARRAUD @damienbarraudmd.bsky.social · 19/03/2025
Jan BAKKER at #ISICEM25 Congestion coexisting w/ fluid responsiveness With some @argaiz.bsky.social inside
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Filippo D’Amico @filippodamico.bsky.social · 19/03/2025
#ISICEM25 | Endotypes & Mortality – A key framework for personalizing sepsis management. Understanding distinct biological profiles could shape targeted therapies and improve outcomes with Prof Evangelos Giamarellos–Bourboulis
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Filippo D’Amico @filippodamico.bsky.social · 19/03/2025
#ISICEM25 | Over 300 posters showcased in 4 days, highlighting the latest breakthroughs in intensive care and emergency medicine. A deep dive into innovation, research, and future clinical practice! Don’t miss it!
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Shai @shaiuk.bsky.social · 18/03/2025
Prof Xavier Monnet addresses the HD effects of prone positioning. Great take homes about the risk of the waterfall effect and the use of Trendelenburg position in the prone patient to predict fluid responsiveness. Linked paper below #ISICEM25 #EMIMCC ccforum.biomedcentral.com/articles/10....
Opening slide regarding Haemodynamic effects of Prone Positioning by Prof X. MonnetInfographic describing potential outcomes of prone positioning g on the cardiovascular system Four keys messages on the impact of prone positioning on patient Haemodynamics
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Shai @shaiuk.bsky.social · 18/03/2025
The liver IS evil. Is does needs exercise The day ends with a phenomenal talk from one of my favourite hepatologists - Prof Julia Wendon. ACLF… a difficult topic that we all should know more about. Prognosis is everything. #ISICEM25 #EMIMCC
Prof. Julia Wendon finishing her talk on acute on chronic liver failure (ACLF) and encouraging hepatology sustaining behaviours.
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JAMA @jama.com · 18/03/2025
The initiation of vasopressin following recommendations by a reinforcement learning model was associated with decreased mortality in patients with septic shock already receiving norepinephrine. ja.ma/3FOK2WU #ISICEM25
Figure 2. Comparison of Clinician-Observed Administration of Vasopressin With Treatment Recommended by the Reinforcement Learning Rule
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JAMA @jama.com · 18/03/2025
Among patients with moderate to severe ARDS, inhaled sedation with sevoflurane resulted in fewer ventilator-free days at day 28 and lower 90-day survival than sedation with propofol. ja.ma/4kxDZGm #ISICEM25
Visual Abstract. Inhaled Sedation in Acute Respiratory Distress Syndrome
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Shai @shaiuk.bsky.social · 18/03/2025
At #ISICEM Fodder for the evening run is gathering. Not least the OVISS study looking at a reinforcement learning tool for the optimal timing of vasopressin introduction. jamanetwork.com/journals/jam...
jamanetwork.com
Optimal Vasopressin Initiation in Septic Shock
This multicenter study uses reinforcement learning to examine the treatment implications of a vasopressin initiation rule developed to improve short-term and hospital outcomes in critically ill adults...
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Romain Barthélémy @rombarthelemy.bsky.social · 22/01/2025
A good start to the year with the publication of this work in #JCBFM pmc.ncbi.nlm.nih.gov/articles/PMC... #neurocrit
pmc.ncbi.nlm.nih.gov
Association between cerebral oxygenation and usual parameters of cerebral perfusion in critically ill patients with acute brain injury
In patients with acute brain injury (ABI), optimizing cerebral perfusion parameters relies on multimodal monitoring. This include data from systemic monitoring–mean arterial pressure (MAP), arterial c...
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Matt Siuba @zentensivist.bsky.social · 19/01/2025
I think it’s underappreciated how often aspiration is the symptom of worsening systemic illness rather then the cause
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Lars Mølgaard Saxhaug @load-dependent.eurosky.social · 16/01/2025
What do you think about radial vs femoral arterial catheters for blood pressure monitoring in shock? Risks vs benefits ? #emimcc #cccsky
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Neurocritical Care Society @neurocritical.bsky.social · 13/01/2025
New #neurocriticalcare guidelines from NCS 💡 Guidelines for Seizure Prophylaxis in Patients Hospitalized With Nontraumatics ICH: ow.ly/o7wi50UFCps
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Katie Wiskar @katiewiskar.bsky.social · 13/01/2025
I am SO thrilled to share this paper, which has truly been a labour of love on a topic I care about deeply. "Demystifying Volume Status: An Ultrasound-Guided Physiologic Framework," now published online in @accpchest Let us know what you think! #emimcc journal.chestnet.org/article/S001...
journal.chestnet.org
Demystifying Volume Status: An Ultrasound-Guided Physiologic Framework
Accurate assessment of a patient’s volume status is crucial in many conditions, informing decisions on fluid prescribing, vasoactive agents, and decongestive therapies. Determining a patient’s volume ...
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Steven Mathern @stevenmathern.bsky.social · 14/12/2024
read both links plz . 'Electrical impedance tomography (EIT) is an emerging technology for the non-invasive monitoring of regional distribution of ventilation and perfusion' #p-sili #vili #pulmsky #critcaresky #emimcc #peep #ventilator ccforum.biomedcentral.com/articles/10....
ccforum.biomedcentral.com
Electrical impedance tomography monitoring in adult ICU patients: state-of-the-art, recommendations for standardized acquisition, processing, and clinical use, and future directions - Critical Care
Electrical impedance tomography (EIT) is an emerging technology for the non-invasive monitoring of regional distribution of ventilation and perfusion, offering real-time and continuous data that can g...
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Romain Barthélémy @rombarthelemy.bsky.social · 15/12/2024
I think the appropriate outcome is still undefined
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Romain Barthélémy @rombarthelemy.bsky.social · 10/12/2024
I can't believe it doesn't change the prognosis for survivors (which is the only real patient-centered outcome).
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Romain Barthélémy @rombarthelemy.bsky.social · 10/12/2024
Results of the #SAHARAtrial released after #CCRdownunder. A lot to discuss… www.nejm.org/doi/full/10.... #neurocriticalcare
nejm.org
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 ...
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Romain Barthélémy @rombarthelemy.bsky.social · 10/12/2024
Sure, it’s Pinsky’s sense of humour. It’s the negative of the picture: a single value of HR APB CO CVP and presence/absence of peripheral oedema does not describe the hemodynamics of the patient
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Romain Barthélémy @rombarthelemy.bsky.social · 10/12/2024
Nice work from colleagues, confirming risks factors of ventriculatis in our cohort of #NeuroCriticalCare patients and proposing the VERI-score for risk stratification journals.lww.com/neurosurgery...
journals.lww.com
The VEntriculostomy-Related Infection Score: An Antibiotic... : Neurosurgery
antibiotic therapy initiation when VRI is suspected. METHODS: This retrospective, single-center cohort study included patients admitted to the intensive care unit after EVD placement who were suspe...
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Romain Barthélémy @rombarthelemy.bsky.social · 10/12/2024
It could be added to the Pinsky’s “Hemodynamic Monitoring Truths »
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Romain Barthélémy @rombarthelemy.bsky.social · 10/12/2024
Lactate has the same clinical value as tachycardia: it tells you something is going on, but something may be going on anyway
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Lars Mølgaard Saxhaug @load-dependent.eurosky.social · 08/12/2024
Reposting this brilliant must read paper, highlightkng some common misunderstandings regarding EF. A supranormal EF is not a sign of hypovolemia! #echosky #pocus #emimcc
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@IM_Crit_ @imcrit.bsky.social · 08/12/2024
ICU Hemodynamics: Refresher from Michael Pinsky's lecture:
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Critical Care Reviews @criticalcarereviews.com · 03/12/2024
➡️ 8 major critical care trial results live from Melbourne ➡️ Full free livestream ➡️ Tuesday & Wednesday, December 10th & 11th ➡️ Times are UTC +11 ➡️https://criticalcarereviews.com
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Bluesky @bsky.app · 03/12/2024
Scientists, academics, researchers: We’re excited to share that @altmetric.com is now tracking mentions of your research on Bluesky! 🧪
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Aoife Abbey 📟 🩺 ⚕️ @whistlingdixie.bsky.social · 02/12/2024
A sad day for critical care - and what a phenomenal legacy he has left us. RIP Prof Gattinoni, a Giant ⚕️📟 www.esicm.org/obituary-luc...
esicm.org
Obituary: Luciano Gattinoni - ESICM
In Memory of Professor Luciano Gattinoni
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Romain Barthélémy @rombarthelemy.bsky.social · 27/11/2024
The first author I also emailed send it to me in less than 4 hours For the moment, Bluesky is less effective than a good old e-mail
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Romain Barthélémy @rombarthelemy.bsky.social · 26/11/2024
Dear #NeuroCriticalCare folks, does anyone have the fulltext of this paper? Thx journals.lww.com/neurosurgery...
journals.lww.com
External Validation of the HATCH (Hemorrhage, Age,... : Neurosurgery
e collected data on 761 patients with aSAH from 4 different hospitals. The HATCH score for prediction of functional outcome was validated using calibration and discrimination analysis (area under the ...
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Lars Mølgaard Saxhaug @load-dependent.eurosky.social · 14/11/2024
I once made a #shiny leaf plot app, demonstrating the relationship between prevalence/pre-test probability, sensitivity, specificity and post-test probabilities has moved! I’ve been very happy to hear some actually use it in #meded! lmsaxhaug.shinyapps.io/Leaf_App/ #rstats #imemcc #cardiosky #foamed
Example of a webpage where you can enter sensitivity and specificity of a test, the get a plot of a green leaf showing the relationship between pretest probability, and post test probability given wither negative or positive test.
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Rosie Baruah @rosieicm.bsky.social · 23/11/2024
I use US more and more for ICU a-lines - for radials it helps site them more proximallly so they are less ‘positional’ and in femoral esp in those with high BMI it helps position more distally and therefore have a less steep angle of insertion Who else uses US regularly for arterial cannulation?
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Romain Barthélémy @rombarthelemy.bsky.social · 22/11/2024
Never heard about this feed thing but I'll have a look. And I'm obviously interested in #NeuroCriticalCare
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Lars Mølgaard Saxhaug @load-dependent.eurosky.social · 22/11/2024
Reposting an old thread on the history of MAPSE! The first to recognise long axis movement as the primary movement of the heart was none other than da Vinci! #echosky #pocus #medsky # #cardiosky www.onlinejase.com/article/S089...
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Romain Barthélémy @rombarthelemy.bsky.social · 21/11/2024
Maybe #neurocriticalcare or #neurocc
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Romain Barthélémy @rombarthelemy.bsky.social · 21/11/2024
L’Ambroise Paré, encore un peu sous la neige
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Romain Barthélémy @rombarthelemy.bsky.social · 21/11/2024
mg per hour It tells you how long you have before you need to change the syringe. Very down-to-earth
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Romain Barthélémy @rombarthelemy.bsky.social · 21/11/2024
Il pleut maintenant, je garde mes boots
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Romain Barthélémy @rombarthelemy.bsky.social · 21/11/2024
Snowing at the hospital
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Romain Barthélémy @rombarthelemy.bsky.social · 21/11/2024
Middle Meningeal Artery Embolization for Nonacute Subdural Hematoma: 3 RCT with consistent results published in NEJM. Becoming the standard of care overnight! www.nejm.org/doi/full/10.... www.nejm.org/doi/full/10.... www.nejm.org/doi/full/10....
nejm.org
Adjunctive Middle Meningeal Artery Embolization for Subdural Hematoma | NEJM
Subacute and chronic subdural hematomas are common and frequently recur after surgical evacuation. The effect of adjunctive middle meningeal artery embolization on the risk of reoperation remains u...
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