Prasad Nadendla @ventwhisperer.bsky.social · 02/04/2026🚨 Follow up post to my review of HI-PEITHO. Does catheter directed Thrombolysis actually work? STRATIFY Trial suggests CDT doesn't work. 🧵👇 #MedSky #CritCare #FOAMed #emimcc 131
Prasad Nadendla @ventwhisperer.bsky.social · 31/03/2026🚨 Intermediate-high risk PE: RV strain + troponin. Stable for now, but will they crash? HI-PEITHO (NEJM 2026) finally gives us RCT data for Catheter-Directed Lysis (USCDT). Is this the new standard for the "sickest of the stable"? 🧵👇 #MedSky #CritCare #FOAMed #emimcc 110
Reposted by Prasad NadendlaKathleen Bachynski @bachynski.bsky.social · 31/03/2026I showed this graph in class yesterday on how measles cases in the United States plummeted dramatically after the vaccine was licensed in 1963. It’s not subtle and I could not resist observing: “This stunning design in measles cases was not thanks to vitamin A. It was not due to beef tallow.” 1678232539
Prasad Nadendla @ventwhisperer.bsky.social · 27/03/2026It's quite shocking the practice differences between SICU and MICU even for overlapping conditions. 121
Prasad Nadendla @ventwhisperer.bsky.social · 26/03/2026🚨 New Trial: TIGRIS 🚨 Polymyxin B Hemoadsorption (PMX) in endotoxic septic shock. ✅ 99.4% probability of benefit for 90-day survival. ✅ 15.5% absolute risk reduction in mortality. ✅ NNT of 6.5 Interesting step towards endotyping shock and immune mediated management.🧬 #FOAMed #emimcc #critcarethelancet.comPolymyxin B haemoadsorption in endotoxic septic shock (Tigris): a multicentre, open-label, Bayesian, randomised, controlled, phase 3 trialIn patients with endotoxic septic shock defined by high endotoxin activity and multiorgan failure, polymyxin B haemoadsorption was associated with a high probability of lower mortality at 28 days and ... 241
Prasad Nadendla @ventwhisperer.bsky.social · 16/03/2026Patient with cardiogenic shock, EF <10%. Micro axial flow device is placed. Is there loss of the Windkessel effect due to the micro axial device? #emimcc #critcare #FOAMed #Physiology 310
Prasad Nadendla @ventwhisperer.bsky.social · 15/03/2026Following up on the HD-CPR post: here is Per Olav Berve at Big Sick 2018 explaining exactly why monitors lie to us during mechanical CPR. If you want to understand "pre-tidal" CO2 and true diastolic pressure, watch this. #CritCare #FOAMed #emimccyoutu.beHemodynamics during mechanical CPR | Per Olav Berve | Big Sick 2018YouTube video by scanFOAM 252
Prasad Nadendla @ventwhisperer.bsky.social · 13/03/2026Hemodynamic-directed CPR question for everyone: If you have an A-line during arrest and compressions are generating a dBP >30-40 mmHg, do you consider holding ACLS epi pushes? Curious who is individualizing CPR here. #CritCareresuscitationjournal.comThe association between intra-arrest arterial blood pressure and return of spontaneous circulation in out-of-hospital cardiac arrestThe optimal haemodynamic parameter for goal-directed resuscitation in out-of-hospital cardiac arrest (OHCA) remains uncertain. This study aimed to characterise the association between invasive blood p... 331
Prasad Nadendla @ventwhisperer.bsky.social · 09/03/2026We are moving more and more into an individualized shock management era and POCUS is leading the way. I've been working on incorporating the interfaces model and estimating Ea/Ees for ventricular arterial uncoupling. #FOAMED #CritCare #POCUSskypmc.ncbi.nlm.nih.govPoint of View: A Holistic Four-Interface Conceptual Model for Personalizing Shock ResuscitationThe resuscitation of a patient in shock is a highly complex endeavor that should go beyond normalizing mean arterial pressure and protocolized fluid loading. We propose a holistic, four-interface conceptual model of shock that we believe can benefit ... 120
Prasad Nadendla @ventwhisperer.bsky.social · 25/02/2026🚨 Septic shock, AKI, pH 7.15. Do you start a Bicarb drip? Does it save kidneys or just treat a number? I built an open-access "Landmark ICU Trials" cheat sheet/reference for rounds. Let's look at a new addition: BICARICU-2. 👇 #MedSky #CritCare #Nephrology #FOAMed #MedEd 120
Reposted by Prasad Nadendlajosh farkas 💊 @pulmcrit.bsky.social · 23/11/2025ADQI/ICA guidelines finally scrapped the 48-hour mandatory albumin infusion before formally diagnosing HRS-AKI I’ve argued against this for years (it delays tx for 3 days & you miss optimal window for intervention) HRS-AKI carries a massive ~30% in-hospital mortality, its an emergency…media.tenor.coma close up of a man 's face with a beard looking at the camera .ALT: a close up of a man 's face with a beard looking at the camera . 1191
Prasad Nadendla @ventwhisperer.bsky.social · 31/10/2025New ESICM guidelines on circulatory shock. www.esicm.org/esicm-guidel... 000
Reposted by Prasad Nadendlajosh farkas 💊 @pulmcrit.bsky.social · 29/10/2025New RCT: Avoiding A-line in shock didn't affect mortality (trend towards *reduction*) & decreased line complications They avoided A-lines despite patients requiring pretty substantial doses of vasopressors Very #zentensivist Don't need to rush to an A-line www.nejm.org/doi/full/10.... #EMIMCC 22612
Reposted by Prasad NadendlaATSScholar @atsscholar.bsky.social · 07/08/2025Decay in Physiologic Knowledge Since Med School Among Critical Care Fellows 1st-yr PCCM/CCM fellows perform worse than med students on assessment of pulmonary physiologic concepts, suggests decay in knowledge during training @atscommunity.bsky.social #medsky tinyurl.com/tfwutc76 022
Prasad Nadendla @ventwhisperer.bsky.social · 16/04/2025A good review of the furosemide stress test. www.mdpi.com/2077-0383/14...mdpi.com 000
Prasad Nadendla @ventwhisperer.bsky.social · 14/04/2025Have been learning about hemodynamic coupling, currently reviewing interface IV (RV-PA coupling). This is a great review article on RV failure. pmc.ncbi.nlm.nih.gov/articles/PMC...pmc.ncbi.nlm.nih.govManagement of Acute Right Ventricular Failure in the Intensive Care UnitRight ventricular (RV) failure occurs when the RV fails to maintain enough blood flow through the pulmonary circulation to achieve adequate left ventricular filling. This can occur suddenly in a previ... 000
Reposted by Prasad Nadendlajosh farkas 💊 @pulmcrit.bsky.social · 11/04/2025is contrast nephropathy in the room with us right now? another article showing that contrast nephropathy isn’t a thing I wonder how long these articles will keep getting published, since I kinda thought this was settled 🤷♂️ www.jem-journal.com/article/S0736-4… #EMIMCC 34716
Reposted by Prasad NadendlaKatie Wiskar @katiewiskar.bsky.social · 06/02/20251/ One of the BIGGEST #POCUS misconceptions is that B lines 🟰 pulmonary edema 🤦♀️ Did you know that there is actually a wide DDx for B lines? Check out my latest video about #LungUltrasound for interstitial syndromes 👀; or read on for the highlights 👇 🧵 #emimcc www.youtube.com/watch?v=eSuA...youtube.comLung Ultrasound for Interstitial SyndromesYouTube video by UBC IM POCUS 25120
Prasad Nadendla @ventwhisperer.bsky.social · 15/01/2025Been doing some reading and listening on advanced resuscitation/hemodynamics. Dr. Per Olav Berve gave a fantastic lecture at the Big Sick in 2018. Takeaways: 1. Diastolic BP goal > 25 using late diastolic peak on A-line 2. EtCo2 monitoring during code, use the peak alveolar plateau readings. 100
Prasad Nadendla @ventwhisperer.bsky.social · 11/12/2024How does everyone feel about the Peerless trial?ahajournals.orgLarge-bore Mechanical Thrombectomy Versus Catheter-directed Thrombolysis in the Management of Intermediate-risk Pulmonary Embolism: Primary Results of the PEERLESS Randomized Controlled Trial | Circul...Background: There is a lack of randomized controlled trial (RCT) data comparing outcomes of different catheter-based interventions for intermediate-risk pulmonary embolism (PE). Methods: PEERLESS is a... 000
Prasad Nadendla @ventwhisperer.bsky.social · 28/11/2024Sometimes we get so wrapped up in aggressive management and intervention. I think early palliative care discussions are really important for the patient, their family, and for us. The idea of zentensive care fits well with this. Less is more.atsjournals.orgThe Zentensivist Manifesto. Defining the Art of Critical Care | ATS Scholar 000
Prasad Nadendla @ventwhisperer.bsky.social · 28/11/2024ICU Case Discussion: Part 1 Young patient presents with AMS, found with numerous empty pill bottles including NSAIDs, muscles relaxants, and metformin. Lactic acid >15 mmol/L. pH 6.9. Kussmaul breathing. Suspicion of metformin overdose. What is everyone's fluid of choice? #CriticalCare #ICU 550
Reposted by Prasad NadendlaKatie Wiskar @katiewiskar.bsky.social · 26/11/20241/ Back to the basics today: let's talk about common pitfalls in obtaining cardiac #POCUS images ❤️ Here are some very common image acquisition errors in basic views, as well as the simple moves to correct them ✅ 🧵 #emimcc #POCUSky #echosky #MedSky 811254
Reposted by Prasad NadendlaSarah Sanghavi @sarahsanghavi.bsky.social · 23/11/2024Optimist: The cup is half full Pessimist: The cup is half empty Intensivist: We need VEXUS to determine how congested this cup really is. #icusky #medsky 1325
Reposted by Prasad Nadendlajosh farkas 💊 @pulmcrit.bsky.social · 23/11/2024Optimist: The cup is half full Pessimist: The cup is half empty Pragmatist: There’s an IV fluid shortage, the cup’s volume status is fine. 3403
Reposted by Prasad NadendlaJon Mosser @jonmosser.com · 23/11/2024Now seems like a good time to remember that #vaccines are the greatest #publichealth intervention in history, saving 154 million lives in the 50 years since the start of the Expanded Programme on Immunization in 1974. #EpiSky #IDSky #PedsIDSky doi.org/10.1016/S014... 47123
Prasad Nadendla @ventwhisperer.bsky.social · 23/11/2024A few days ago we talked about different types of shock, including obstructive shock. This is a great article on acute PE risk stratification and it includes some helpful diagrams. #Medsky #CriticalCare #ICU #CriticalCareMedicinelink.springer.comRisk Stratification of Acute Pulmonary Embolism - Current Treatment Options in Cardiovascular MedicinePurpose of review Acute pulmonary embolism (PE) is a heterogeneous disease process whose presentation varies widely between individuals who are asymptomatic, develop cardiogenic shock, or experience a... 170
Prasad Nadendla @ventwhisperer.bsky.social · 19/11/2024Slow correction of hyponatremia associated with increased mortality. Interested to hear how everyone feels about these findings. 010
Prasad Nadendla @ventwhisperer.bsky.social · 18/11/2024I'm on nights this month and always struggle with switching back and forth. Anyone have any tips for successfully switching back to days? I've thought about trying bright light therapy. 010
Prasad Nadendla @ventwhisperer.bsky.social · 18/11/2024Ultrasound has to be one of the greatest tools in an intensivists arsenal. So many questions can be answered with it. Echo, vexus, VTI, I love it all. 030
Prasad Nadendla @ventwhisperer.bsky.social · 18/11/2024Working on putting together a post on my approach to undifferentiated shock. Stay tuned. 020
Prasad Nadendla @ventwhisperer.bsky.social · 17/11/2024pubmed.ncbi.nlm.nih.gov/28279723/pubmed.ncbi.nlm.nih.govPhysiologic Cryoamputation in Managing Critically Ill Patients with Septic, Advanced Acute Limb Ischemia - PubMedLower extremity physiologic cryoamputation is an effective, immediate bedside procedure that can provide local source control and the opportunity for correction of metabolic derangements in initially ... 010
Prasad Nadendla @ventwhisperer.bsky.social · 17/11/2024Case discussion: Patient is admitted with right lower extremity compartment syndrome and profound shock requiring max dosing on 4 vasopressors. Too unstable for OR. After discussions with surgical team, opted to perform a Cryoamputation. The patient's leg is demarcated and covered in dry ice. 110
Prasad Nadendla @ventwhisperer.bsky.social · 17/11/2024Lets talk about ARDS. Amato, M. B. P., Meade, M. O., Slutsky, A. S., Brochard, L., Costa, E. L. V., Schoenfeld, D. A., ... & Network, O. S. S. (2015). Driving pressure and survival in the acute respiratory distress syndrome. The New England journal of medicine, 372(8), 1 747-755. 120
Prasad Nadendla @ventwhisperer.bsky.social · 16/11/2024Just had our difficult airway training session as well as Minnesota tube placement. Almost immediately got the chance to employ my new skills. Do you guys tend to use traditional three way stop cock or Lopez valves with your Minnesota tubes? 010
Reposted by Prasad NadendlaConrad Hackett @conradhackett.bsky.social · 15/11/2024Disease prevalence in US states before & after vaccine introduction Graphic from Edward Tufte More graphics.wsj.com/infectious-d... 🧪 13038731694
Reposted by Prasad NadendlaNick Mark, MD @nickmark.bsky.social · 15/11/2024One of my favorite @criticalcaretime.bsky.social infographics: Comparison of vasodilator scavengers. When to choose 🟦 Methylene Blue 🟥 Hydroxocobalamin (Cyanokit) For more discussion you can read here: onepagericu.com/blog/mini-le... 44715