Bharat Balan, MD, MS
@bharatbalan.bsky.social
#PCCM fellow at Northwestern ◦ MICU Hospitalist and s/p IM Residency @pennmedicine.bsky.social ◦ MD, MS at MCV/VCUSOM◦ Rutgers Alumni ◦ 🫁 #MedEd #POCUS #iPulm ◦ 🇮🇳➡️🇺🇸 ◦ He/Him/His
Reposted by Bharat Balan, MD, MS
Meet two heroes of our times.
December 1, 2025 at 11:30 PM
Meet two heroes of our times.
Reposted by Bharat Balan, MD, MS
Finished updating the IBCC chapter on septic shock
This algorithm is where I ended up 👇
Therapies should be based on several factors (not solely whether CRT is <3; CRT isn't precise so this dichotomy is problematic)
Beware of vasopressin; it may depress digital perfusion & block the goal #EMIMCC
This algorithm is where I ended up 👇
Therapies should be based on several factors (not solely whether CRT is <3; CRT isn't precise so this dichotomy is problematic)
Beware of vasopressin; it may depress digital perfusion & block the goal #EMIMCC
November 19, 2025 at 2:01 PM
Finished updating the IBCC chapter on septic shock
This algorithm is where I ended up 👇
Therapies should be based on several factors (not solely whether CRT is <3; CRT isn't precise so this dichotomy is problematic)
Beware of vasopressin; it may depress digital perfusion & block the goal #EMIMCC
This algorithm is where I ended up 👇
Therapies should be based on several factors (not solely whether CRT is <3; CRT isn't precise so this dichotomy is problematic)
Beware of vasopressin; it may depress digital perfusion & block the goal #EMIMCC
Reposted by Bharat Balan, MD, MS
We dive into the subtle art of placing, understanding, and interpreting the PA (Swan Ganz) catheter, on a new lesson at icu101.com.
#emimcc #medsky
#emimcc #medsky
November 10, 2025 at 8:12 PM
We dive into the subtle art of placing, understanding, and interpreting the PA (Swan Ganz) catheter, on a new lesson at icu101.com.
#emimcc #medsky
#emimcc #medsky
Reposted by Bharat Balan, MD, MS
The most corrupt administration in American history.
November 7, 2025 at 12:46 AM
The most corrupt administration in American history.
Reposted by Bharat Balan, MD, MS
Among more than 800 000 CKD-PC participants, discordance between cystatin C and creatinine eGFR values was associated with increased risk of death, cardiovascular events, and kidney failure.
#KidneyWK @asnkidney.bsky.social
ja.ma/4oV4DtU
#KidneyWK @asnkidney.bsky.social
ja.ma/4oV4DtU
November 7, 2025 at 8:15 PM
Among more than 800 000 CKD-PC participants, discordance between cystatin C and creatinine eGFR values was associated with increased risk of death, cardiovascular events, and kidney failure.
#KidneyWK @asnkidney.bsky.social
ja.ma/4oV4DtU
#KidneyWK @asnkidney.bsky.social
ja.ma/4oV4DtU
Reposted by Bharat Balan, MD, MS
Reposted by Bharat Balan, MD, MS
Reposted by Bharat Balan, MD, MS
They called it! Abigail Spanberger won the Virginia gubernatorial race!
November 5, 2025 at 12:24 AM
They called it! Abigail Spanberger won the Virginia gubernatorial race!
Reposted by Bharat Balan, MD, MS
Today's Paper of the Day is:
How to approach a patient hospitalized for pneumonia who is not responding to treatment?
criticalcarereviews.com/latest-evide...
Join us to read 1 paper per day and stay up-to-date as we cover the spectrum of critical care across 2025
How to approach a patient hospitalized for pneumonia who is not responding to treatment?
criticalcarereviews.com/latest-evide...
Join us to read 1 paper per day and stay up-to-date as we cover the spectrum of critical care across 2025
November 3, 2025 at 10:42 AM
Today's Paper of the Day is:
How to approach a patient hospitalized for pneumonia who is not responding to treatment?
criticalcarereviews.com/latest-evide...
Join us to read 1 paper per day and stay up-to-date as we cover the spectrum of critical care across 2025
How to approach a patient hospitalized for pneumonia who is not responding to treatment?
criticalcarereviews.com/latest-evide...
Join us to read 1 paper per day and stay up-to-date as we cover the spectrum of critical care across 2025
Reposted by Bharat Balan, MD, MS
The BICAR-ICU-2 trial just dropped!
RCT involving IV bicarb in metabolic acidosis among patients with mod-severe AKI
Bicarb didn't affect mortality but it reduced the need for dialysis & risk of bacteremia
VERY similar conclusions to BICAR-ICU-1
🧵 #1/
jamanetwork.com/journals/jam... #EMIMCC
RCT involving IV bicarb in metabolic acidosis among patients with mod-severe AKI
Bicarb didn't affect mortality but it reduced the need for dialysis & risk of bacteremia
VERY similar conclusions to BICAR-ICU-1
🧵 #1/
jamanetwork.com/journals/jam... #EMIMCC
October 29, 2025 at 2:59 PM
The BICAR-ICU-2 trial just dropped!
RCT involving IV bicarb in metabolic acidosis among patients with mod-severe AKI
Bicarb didn't affect mortality but it reduced the need for dialysis & risk of bacteremia
VERY similar conclusions to BICAR-ICU-1
🧵 #1/
jamanetwork.com/journals/jam... #EMIMCC
RCT involving IV bicarb in metabolic acidosis among patients with mod-severe AKI
Bicarb didn't affect mortality but it reduced the need for dialysis & risk of bacteremia
VERY similar conclusions to BICAR-ICU-1
🧵 #1/
jamanetwork.com/journals/jam... #EMIMCC
Reposted by Bharat Balan, MD, MS
Some disorganized thoughts about this trial will follow here.
In the EVERDAC trial involving patients with shock, results for death at day 28 indicated that management without early arterial catheter insertion was noninferior to early catheter insertion. Full trial results: nej.md/3LmOO0D
#LIVES2025 | @esicm.bsky.social
#LIVES2025 | @esicm.bsky.social
October 29, 2025 at 2:53 PM
Some disorganized thoughts about this trial will follow here.
Reposted by Bharat Balan, MD, MS
Happy Diwali 🪔 to all
The world needs more light, compassion and peace
The world needs more light, compassion and peace
October 19, 2025 at 5:03 AM
Happy Diwali 🪔 to all
The world needs more light, compassion and peace
The world needs more light, compassion and peace
Reposted by Bharat Balan, MD, MS
If you think someone has infectious or noninfectious encephalitis, a CSF pleocytosis may be missing in a +/- quarter of cases including HSV academic.oup.com/cid/advance-... Disturbing …
Absence of Cerebrospinal Fluid Pleocytosis in Encephalitis
We describe the association between pleocytosis in initial CSF studies with clinical, etiological, and prognostic factors in 597 patients with encephalitis
academic.oup.com
November 23, 2024 at 12:40 AM
If you think someone has infectious or noninfectious encephalitis, a CSF pleocytosis may be missing in a +/- quarter of cases including HSV academic.oup.com/cid/advance-... Disturbing …
Reposted by Bharat Balan, MD, MS
In a retrospective cohort of 273 pts with HSV encephalitis:
➖ 4% had an initial -ve HSV PCR
➖ 17% had CSF WCC <5
‼️ If you have a high clinical suspicion, continue aciclovir & repeat the LP (all false -ve occurred within 4 days of symptom onset)
#EMIMCC
pubmed.ncbi.nlm.nih.gov/35167501/
➖ 4% had an initial -ve HSV PCR
➖ 17% had CSF WCC <5
‼️ If you have a high clinical suspicion, continue aciclovir & repeat the LP (all false -ve occurred within 4 days of symptom onset)
#EMIMCC
pubmed.ncbi.nlm.nih.gov/35167501/
Herpes Simplex Virus Encephalitis With Initial Negative Polymerase Chain Reaction in the Cerebrospinal Fluid: Prevalence, Associated Factors, and Clinical Impact - PubMed
In severe herpes simplex encephalitis, initial negative CSF HSV PCR occurred in 4% of cases and was independently associated with worse neurologic outcome at hospital discharge. In these patients, a s...
pubmed.ncbi.nlm.nih.gov
December 29, 2024 at 9:24 PM
In a retrospective cohort of 273 pts with HSV encephalitis:
➖ 4% had an initial -ve HSV PCR
➖ 17% had CSF WCC <5
‼️ If you have a high clinical suspicion, continue aciclovir & repeat the LP (all false -ve occurred within 4 days of symptom onset)
#EMIMCC
pubmed.ncbi.nlm.nih.gov/35167501/
➖ 4% had an initial -ve HSV PCR
➖ 17% had CSF WCC <5
‼️ If you have a high clinical suspicion, continue aciclovir & repeat the LP (all false -ve occurred within 4 days of symptom onset)
#EMIMCC
pubmed.ncbi.nlm.nih.gov/35167501/
Reposted by Bharat Balan, MD, MS
Curious about decompensation pattern, RRT activation and transfer to higher level of care among pts w/ #ESLD waiting for LiverTx? Read our work below! #medsky #liversky #PCCM #criticalcare
pubmed.ncbi.nlm.nih.gov/39584698/
pubmed.ncbi.nlm.nih.gov/39584698/
Exploring Rapid Response Team Activation Impact in Patients with Cirrhosis with Acute Decompensation - PubMed
Liver transplant candidacy in patients with cirrhosis with acute decompensation is not clearly correlated with ICU transfer. Liver transplant candidates are more likely to be younger, have higher MELD...
pubmed.ncbi.nlm.nih.gov
November 26, 2024 at 9:18 PM
Curious about decompensation pattern, RRT activation and transfer to higher level of care among pts w/ #ESLD waiting for LiverTx? Read our work below! #medsky #liversky #PCCM #criticalcare
pubmed.ncbi.nlm.nih.gov/39584698/
pubmed.ncbi.nlm.nih.gov/39584698/
Reposted by Bharat Balan, MD, MS
🦠We call a lot of things “sepsis”
🔎Our #AnnalsofIM study examined how broad this grab bag really is
⚠️Among ~75,000 patients with sepsis, we found remarkably wide spectrum of presentations & outcomes across infection source & organ dysfunction patterns
Thread ⬇️
#medsky #emimcc #idsky #pharmsky
🔎Our #AnnalsofIM study examined how broad this grab bag really is
⚠️Among ~75,000 patients with sepsis, we found remarkably wide spectrum of presentations & outcomes across infection source & organ dysfunction patterns
Thread ⬇️
#medsky #emimcc #idsky #pharmsky
December 17, 2024 at 4:08 PM
🦠We call a lot of things “sepsis”
🔎Our #AnnalsofIM study examined how broad this grab bag really is
⚠️Among ~75,000 patients with sepsis, we found remarkably wide spectrum of presentations & outcomes across infection source & organ dysfunction patterns
Thread ⬇️
#medsky #emimcc #idsky #pharmsky
🔎Our #AnnalsofIM study examined how broad this grab bag really is
⚠️Among ~75,000 patients with sepsis, we found remarkably wide spectrum of presentations & outcomes across infection source & organ dysfunction patterns
Thread ⬇️
#medsky #emimcc #idsky #pharmsky
Reposted by Bharat Balan, MD, MS
Published in JAMA with #CCRdownunder:
In critically ill adults with suspected sepsis, antibiotic regimens were safely reduced when guided by measurement of procalcitonin but not by C-reactive protein. @criticalcarereviews.com
ja.ma/3BovM5v
In critically ill adults with suspected sepsis, antibiotic regimens were safely reduced when guided by measurement of procalcitonin but not by C-reactive protein. @criticalcarereviews.com
ja.ma/3BovM5v
December 9, 2024 at 10:20 PM
Published in JAMA with #CCRdownunder:
In critically ill adults with suspected sepsis, antibiotic regimens were safely reduced when guided by measurement of procalcitonin but not by C-reactive protein. @criticalcarereviews.com
ja.ma/3BovM5v
In critically ill adults with suspected sepsis, antibiotic regimens were safely reduced when guided by measurement of procalcitonin but not by C-reactive protein. @criticalcarereviews.com
ja.ma/3BovM5v
Reposted by Bharat Balan, MD, MS
𝟯. 𝗥𝗲𝘃𝗶𝗲𝘄𝘀. Go deep into the current literature on timely topics written by experts in the field.
🖼️ Image: Sepsis and Septic Shock nej.md/3OFrGZR
🖼️ Image: Sepsis and Septic Shock nej.md/3OFrGZR
December 7, 2024 at 12:33 AM
Reposted by Bharat Balan, MD, MS
'Conclusion
Based upon the available literature, the use of IV contrast for CT imaging does not appear to be associated with an increased risk of #AKI' acute kidney injury, IV contrast dye for imaging probably dsnt harm kidneys. #angiogram
#emimcc #cardiosky
www.jem-journal.com/article/S073...
Based upon the available literature, the use of IV contrast for CT imaging does not appear to be associated with an increased risk of #AKI' acute kidney injury, IV contrast dye for imaging probably dsnt harm kidneys. #angiogram
#emimcc #cardiosky
www.jem-journal.com/article/S073...
Is Intravenous Contrast Associated with Increased Risk of Acute Kidney Injury?
Computed tomography (CT) is a common imaging modality used in the Emergency Department.
Intravenous (IV) contrast can assist with visualization of pathology, particularly
for inflammatory conditions a...
www.jem-journal.com
December 2, 2024 at 9:45 PM
'Conclusion
Based upon the available literature, the use of IV contrast for CT imaging does not appear to be associated with an increased risk of #AKI' acute kidney injury, IV contrast dye for imaging probably dsnt harm kidneys. #angiogram
#emimcc #cardiosky
www.jem-journal.com/article/S073...
Based upon the available literature, the use of IV contrast for CT imaging does not appear to be associated with an increased risk of #AKI' acute kidney injury, IV contrast dye for imaging probably dsnt harm kidneys. #angiogram
#emimcc #cardiosky
www.jem-journal.com/article/S073...
Reposted by Bharat Balan, MD, MS
New paper just dropped in @jama.com showing the miracle that are HPV vaccines
Full article here: jamanetwork.com/journals/jam...
TL;DR version of article: Get your kids vaccinated (both boys and girls) because it prevents cancer
Full article here: jamanetwork.com/journals/jam...
TL;DR version of article: Get your kids vaccinated (both boys and girls) because it prevents cancer
November 29, 2024 at 1:32 PM
New paper just dropped in @jama.com showing the miracle that are HPV vaccines
Full article here: jamanetwork.com/journals/jam...
TL;DR version of article: Get your kids vaccinated (both boys and girls) because it prevents cancer
Full article here: jamanetwork.com/journals/jam...
TL;DR version of article: Get your kids vaccinated (both boys and girls) because it prevents cancer
Reposted by Bharat Balan, MD, MS
PCCM starter pack growing
If you are not on this and should be, reply and I’ll fix it
Feel free to share!!
go.bsky.app/88wg6oG
If you are not on this and should be, reply and I’ll fix it
Feel free to share!!
go.bsky.app/88wg6oG
November 17, 2024 at 12:17 PM
PCCM starter pack growing
If you are not on this and should be, reply and I’ll fix it
Feel free to share!!
go.bsky.app/88wg6oG
If you are not on this and should be, reply and I’ll fix it
Feel free to share!!
go.bsky.app/88wg6oG
Reposted by Bharat Balan, MD, MS
First post here to highlight our new CHEST paper on pragmatic studies in IP: how did we enroll 30 times faster in RELIANT than in VERITAS, 2 bronchoscopy RCTs currently under review? Answers here pubmed.ncbi.nlm.nih.gov/39577764/
Keeping up with technological innovation: the moral imperative for pragmatic clinical trials in interventional pulmonology - PubMed
The advances in minimally invasive lung cancer diagnostics of the last decade have transformed patient care but have also raised important concerns about the regulatory processes used to approve new d...
pubmed.ncbi.nlm.nih.gov
November 23, 2024 at 5:03 PM
First post here to highlight our new CHEST paper on pragmatic studies in IP: how did we enroll 30 times faster in RELIANT than in VERITAS, 2 bronchoscopy RCTs currently under review? Answers here pubmed.ncbi.nlm.nih.gov/39577764/
Reposted by Bharat Balan, MD, MS
If you are looking for a new doctor a good rule of thumb is to avoid those that sell supplements
November 23, 2024 at 1:42 AM
If you are looking for a new doctor a good rule of thumb is to avoid those that sell supplements
Reposted by Bharat Balan, MD, MS
Is sharing our writing a thing here? 😊
Proud of this piece because it represents the work of so many trying to make medicine and communication better for our patients. #MedSky
www.mayoclinicproceedings.org/action/showP...
Proud of this piece because it represents the work of so many trying to make medicine and communication better for our patients. #MedSky
www.mayoclinicproceedings.org/action/showP...
November 19, 2024 at 3:42 PM
Is sharing our writing a thing here? 😊
Proud of this piece because it represents the work of so many trying to make medicine and communication better for our patients. #MedSky
www.mayoclinicproceedings.org/action/showP...
Proud of this piece because it represents the work of so many trying to make medicine and communication better for our patients. #MedSky
www.mayoclinicproceedings.org/action/showP...