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Prasad Nadendla

@ventwhisperer.bsky.social
140 followers 181 following 87 posts

Critical Care Fellow @UCRiverside | #Zentensivist 🧘 | #POCUS & #Physiology. ​Sharing my open-access Landmark Critical Care Research Summary Library here: bit.ly/46MTzJ2 📚 #FOAMed #CritCare #emimcc

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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
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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
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Kathleen Bachynski @bachynski.bsky.social · 31/03/2026
I 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.”
A graph titled “the public health success of the measles vaccine” that shows the number of measles cases in the United States plummeting after the vaccine was introduced in 1963
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Prasad Nadendla @ventwhisperer.bsky.social · 27/03/2026
It's quite shocking the practice differences between SICU and MICU even for overlapping conditions.
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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 #critcare
thelancet.com
Polymyxin B haemoadsorption in endotoxic septic shock (Tigris): a multicentre, open-label, Bayesian, randomised, controlled, phase 3 trial
In 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 ...
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Prasad Nadendla @ventwhisperer.bsky.social · 16/03/2026
Patient 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
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Prasad Nadendla @ventwhisperer.bsky.social · 15/03/2026
Following 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 #emimcc
youtu.be
Hemodynamics during mechanical CPR | Per Olav Berve | Big Sick 2018
YouTube video by scanFOAM
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Prasad Nadendla @ventwhisperer.bsky.social · 13/03/2026
Hemodynamic-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. #CritCare
resuscitationjournal.com
The association between intra-arrest arterial blood pressure and return of spontaneous circulation in out-of-hospital cardiac arrest
The 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...
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Prasad Nadendla @ventwhisperer.bsky.social · 09/03/2026
We 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 #POCUSsky
pmc.ncbi.nlm.nih.gov
Point of View: A Holistic Four-Interface Conceptual Model for Personalizing Shock Resuscitation
The 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 ...
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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
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josh farkas 💊 @pulmcrit.bsky.social · 23/11/2025
ADQI/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.com
a 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 .
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Prasad Nadendla @ventwhisperer.bsky.social · 31/10/2025
New ESICM guidelines on circulatory shock. www.esicm.org/esicm-guidel...
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josh farkas 💊 @pulmcrit.bsky.social · 29/10/2025
New 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
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Prasad Nadendla @ventwhisperer.bsky.social · 29/10/2025
Andromeda Shock 2 Trial is out.
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ATSScholar @atsscholar.bsky.social · 07/08/2025
Decay 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
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Prasad Nadendla @ventwhisperer.bsky.social · 16/04/2025
A good review of the furosemide stress test. www.mdpi.com/2077-0383/14...
mdpi.com
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Prasad Nadendla @ventwhisperer.bsky.social · 14/04/2025
Have 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.gov
Management of Acute Right Ventricular Failure in the Intensive Care Unit
Right 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...
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josh farkas 💊 @pulmcrit.bsky.social · 11/04/2025
is 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
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Katie Wiskar @katiewiskar.bsky.social · 06/02/2025
1/ 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.com
Lung Ultrasound for Interstitial Syndromes
YouTube video by UBC IM POCUS
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Prasad Nadendla @ventwhisperer.bsky.social · 15/01/2025
Been 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.
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Prasad Nadendla @ventwhisperer.bsky.social · 11/12/2024
How does everyone feel about the Peerless trial?
ahajournals.org
Large-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...
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Prasad Nadendla @ventwhisperer.bsky.social · 28/11/2024
Sometimes 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.org
The Zentensivist Manifesto. Defining the Art of Critical Care | ATS Scholar
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Prasad Nadendla @ventwhisperer.bsky.social · 28/11/2024
ICU 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
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Katie Wiskar @katiewiskar.bsky.social · 26/11/2024
1/ 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
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Sarah Sanghavi @sarahsanghavi.bsky.social · 23/11/2024
Optimist: 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
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josh farkas 💊 @pulmcrit.bsky.social · 23/11/2024
Optimist: 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.
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Jon Mosser @jonmosser.com · 23/11/2024
Now 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...
A three-panel figure from an academic paper. Panel A shows changes in infant mortality from 1974 to 2024, with 40% of the reduction attributed to vaccination. Panel B shows cumulative infant deaths over the same time period, again with 40% of the reduction attributed to vaccination. Panel C shows coverage of routine childhood vaccines over time, with increases across all vaccines but some plateauing in later years and decreases in coverage for multiple vaccines since 2020. A three panel figure from an academic paper. Panel A shows cumulative total deaths averted over time between 1974 and 2024 by vaccine (total 154 million). Panel B shows cumulative life years gained over the same time period (9 billion). Panel C shows total years of full health gained (10.2 billion). The measles vaccine has the largest contribution across all metrics.
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Prasad Nadendla @ventwhisperer.bsky.social · 23/11/2024
A 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 #CriticalCareMedicine
link.springer.com
Risk Stratification of Acute Pulmonary Embolism - Current Treatment Options in Cardiovascular Medicine
Purpose 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...
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Prasad Nadendla @ventwhisperer.bsky.social · 19/11/2024
Slow correction of hyponatremia associated with increased mortality. Interested to hear how everyone feels about these findings.
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Prasad Nadendla @ventwhisperer.bsky.social · 18/11/2024
I'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.
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Prasad Nadendla @ventwhisperer.bsky.social · 18/11/2024
Ultrasound 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.
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Prasad Nadendla @ventwhisperer.bsky.social · 18/11/2024
Working on putting together a post on my approach to undifferentiated shock. Stay tuned.
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Prasad Nadendla @ventwhisperer.bsky.social · 17/11/2024
pubmed.ncbi.nlm.nih.gov/28279723/
pubmed.ncbi.nlm.nih.gov
Physiologic Cryoamputation in Managing Critically Ill Patients with Septic, Advanced Acute Limb Ischemia - PubMed
Lower 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 ...
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Prasad Nadendla @ventwhisperer.bsky.social · 17/11/2024
Case 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.
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Prasad Nadendla @ventwhisperer.bsky.social · 17/11/2024
Lets 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.
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Prasad Nadendla @ventwhisperer.bsky.social · 16/11/2024
Just 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?
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Conrad Hackett @conradhackett.bsky.social · 15/11/2024
Disease prevalence in US states before & after vaccine introduction Graphic from Edward Tufte More graphics.wsj.com/infectious-d... 🧪
Graphic shows dramatic reduction in polio, rubella, mumps, measles, and hepatitis A cases after the introduction of vaccines for each disease.
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Nick Mark, MD @nickmark.bsky.social · 15/11/2024
One 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...
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