Sepsis resuscitation: start vasopressors earlier (w/ fluid restriction) vs fluids-first. CLOVERS: restrictive strategy (vasopressors first) did not lower 90d mortality vs liberal fluids. NE first; MAP 65; peripheral start ok; add vasopressin if needed. #KidneyWk #Sepsis #CLOVERS
November 7, 2025 at 5:47 PM
Subphenotyping can change answers. In CLOVERS: SP2 (“leaky endothelium”) had lower mortality with early vasopressors (restrictive fluids), while SP1 favored fluids. EUPHRATES/TIGRIS: endotoxin 0.6–0.9 subgroup signaled benefit → smarter, targeted trials. #KidneyWk #Sepsis #AKI
November 6, 2025 at 11:21 PM
First peripheral vasopressors, now deferred arterial catheterization – critical care is becoming less-invasive every day.
#medsky
www.evidencetriage.com/p/arterial-c...
#medsky
www.evidencetriage.com/p/arterial-c...
Arterial Catheters Don't Save Lives
"Change my mind."
www.evidencetriage.com
November 3, 2025 at 8:26 PM
First peripheral vasopressors, now deferred arterial catheterization – critical care is becoming less-invasive every day.
#medsky
www.evidencetriage.com/p/arterial-c...
#medsky
www.evidencetriage.com/p/arterial-c...
I completely agree that if this was entirely driven by a reduction in vasopressors then this is more of a process measure than a patient centred outcome, but the supplement suggests ventilation and RRT were also reduced
October 29, 2025 at 6:48 PM
I completely agree that if this was entirely driven by a reduction in vasopressors then this is more of a process measure than a patient centred outcome, but the supplement suggests ventilation and RRT were also reduced
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
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
October 29, 2025 at 3:19 PM
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
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
🩺 “The next level of trauma care” is happening now at #LIVES2025
Room 13B is packed!
🤖 AI in trauma
💨 Oxygen
🩺 Vasopressors
🩸 Transfusion beyond Hb
#LIVES2025 #ESICM #ESICMCongress #LIVESMunich
@esicm.bsky.social
Room 13B is packed!
🤖 AI in trauma
💨 Oxygen
🩺 Vasopressors
🩸 Transfusion beyond Hb
#LIVES2025 #ESICM #ESICMCongress #LIVESMunich
@esicm.bsky.social
October 27, 2025 at 1:56 PM
🩺 “The next level of trauma care” is happening now at #LIVES2025
Room 13B is packed!
🤖 AI in trauma
💨 Oxygen
🩺 Vasopressors
🩸 Transfusion beyond Hb
#LIVES2025 #ESICM #ESICMCongress #LIVESMunich
@esicm.bsky.social
Room 13B is packed!
🤖 AI in trauma
💨 Oxygen
🩺 Vasopressors
🩸 Transfusion beyond Hb
#LIVES2025 #ESICM #ESICMCongress #LIVESMunich
@esicm.bsky.social
#ERC2025 are out with some interesting specifications esp @trauma
- enforcement of clinical priorities and treatment of rev causes OVER CCs (+de-enforcement of #REBOA)
- causes and pathophysio of #TCA (also met acidosis)
- role of vasopressors
- CCs specified (usually not useful)
- enforcement of clinical priorities and treatment of rev causes OVER CCs (+de-enforcement of #REBOA)
- causes and pathophysio of #TCA (also met acidosis)
- role of vasopressors
- CCs specified (usually not useful)
October 15, 2025 at 4:05 PM
Healthcare is maxed out on vasopressors, PF ratio of 98, pH 6.9, completely clamped and mottled, no sbp, hr just dropped to 37, SPO2 53. Call the doc and RT, get the pads on and the board underneath them, and open the crash cart. They are going to code.
That's where we are in life.
That's where we are in life.
October 14, 2025 at 5:52 PM
Healthcare is maxed out on vasopressors, PF ratio of 98, pH 6.9, completely clamped and mottled, no sbp, hr just dropped to 37, SPO2 53. Call the doc and RT, get the pads on and the board underneath them, and open the crash cart. They are going to code.
That's where we are in life.
That's where we are in life.
Comparative Efficacy and Safety of Intravenous Vasopressors in Pre-Hospital Cardiac Arrest: A Systematic Review and Meta-Analysis - Journal of Emergency Medicine www.jem-journal.com/article/S073...
Comparative Efficacy and Safety of Intravenous Vasopressors in Pre-Hospital Cardiac Arrest: A Systematic Review and Meta-Analysis
The effectiveness of vasopressors in out-of-hospital cardiac arrest (OHCA) remains
unclear, despite their widespread use.
www.jem-journal.com
October 12, 2025 at 9:21 PM
Comparative Efficacy and Safety of Intravenous Vasopressors in Pre-Hospital Cardiac Arrest: A Systematic Review and Meta-Analysis - Journal of Emergency Medicine www.jem-journal.com/article/S073...
💉📊 Ephedrine affects nociception monitoring (NOL & ANI) during surgery.
Anaesthesiologists must interpret indices cautiously when vasopressors are given.
Read 👉 pubmed.ncbi.nlm.nih.gov/40657144/
#IJA #Anaesthesia #PatientSafety #Ephedrine
Anaesthesiologists must interpret indices cautiously when vasopressors are given.
Read 👉 pubmed.ncbi.nlm.nih.gov/40657144/
#IJA #Anaesthesia #PatientSafety #Ephedrine
Effects of ephedrine on the nociception level and analgesia nociception index: A prospective observational study - PubMed
Effects of ephedrine on the nociception level and analgesia nociception index: A prospective observational study
pubmed.ncbi.nlm.nih.gov
October 2, 2025 at 12:38 AM
💉📊 Ephedrine affects nociception monitoring (NOL & ANI) during surgery.
Anaesthesiologists must interpret indices cautiously when vasopressors are given.
Read 👉 pubmed.ncbi.nlm.nih.gov/40657144/
#IJA #Anaesthesia #PatientSafety #Ephedrine
Anaesthesiologists must interpret indices cautiously when vasopressors are given.
Read 👉 pubmed.ncbi.nlm.nih.gov/40657144/
#IJA #Anaesthesia #PatientSafety #Ephedrine
If you ever wonder about vasopressors in pts with RV failure here’s a quick read with some basics. @accpchest.bsky.social #shock #sepsis #rvfailure
www.chestphysician.org/is-there-a-b...
www.chestphysician.org/is-there-a-b...
Is there a ‘best’ vasopressor and inotrope combination for shock with RV failure? - CHEST Physician
Review unique pathophysiologic challenges of RV failure in shock and comparative data on vasopressors and inotropes.
www.chestphysician.org
October 1, 2025 at 6:48 PM
If you ever wonder about vasopressors in pts with RV failure here’s a quick read with some basics. @accpchest.bsky.social #shock #sepsis #rvfailure
www.chestphysician.org/is-there-a-b...
www.chestphysician.org/is-there-a-b...
Replace blood w/ blood
-No role for crystalloid in resus of a shocky trauma patient - dlutes hgb + clotting factors
-What if no blood?
1) Transport
2) Stop bleeding: tourniquet, direct pressure, pelvic binder
3) Tolerate lower BP + consider vasopressors
youtube.com/shorts/u0J9i...
#EMIMCC
-No role for crystalloid in resus of a shocky trauma patient - dlutes hgb + clotting factors
-What if no blood?
1) Transport
2) Stop bleeding: tourniquet, direct pressure, pelvic binder
3) Tolerate lower BP + consider vasopressors
youtube.com/shorts/u0J9i...
#EMIMCC
Replace Blood With Blood #emergencymedicine #criticalcare #trauma
YouTube video by EMSwami
youtube.com
September 24, 2025 at 2:01 PM
Replace blood w/ blood
-No role for crystalloid in resus of a shocky trauma patient - dlutes hgb + clotting factors
-What if no blood?
1) Transport
2) Stop bleeding: tourniquet, direct pressure, pelvic binder
3) Tolerate lower BP + consider vasopressors
youtube.com/shorts/u0J9i...
#EMIMCC
-No role for crystalloid in resus of a shocky trauma patient - dlutes hgb + clotting factors
-What if no blood?
1) Transport
2) Stop bleeding: tourniquet, direct pressure, pelvic binder
3) Tolerate lower BP + consider vasopressors
youtube.com/shorts/u0J9i...
#EMIMCC
New guidelines on safe vascular access from @assocanaes.bsky.social - important update on an area of growing importance given the numbers of patients needing long term vascular access as well as the short-term central access. Notable comment on peripheral vasopressors too.
Association of Anaesthetists guidelines: safe vascular access 2025
Introduction Safe vascular access is integral to anaesthetic and critical care practice. However, despite technological and procedural advances, it remains a frequent source of adverse events and pa...
associationofanaesthetists-publications.onlinelibrary.wiley.com
September 22, 2025 at 9:17 AM
New guidelines on safe vascular access from @assocanaes.bsky.social - important update on an area of growing importance given the numbers of patients needing long term vascular access as well as the short-term central access. Notable comment on peripheral vasopressors too.
Such an important teaching point. In patients who respond poorly to vasopressors, always question whether the blood pressure measurement you are targeting is actually representative. #emimcc #cardiosky
ICU Snapshots:
Walking from room to room in the ICU, you see this on the monitor of a 60 yo female patient admitted the previous night with severe community-acquired pneumonia & what you were told was "refractory" septic/cardiogenic shock. Arterial line was in the R fem artery:
Walking from room to room in the ICU, you see this on the monitor of a 60 yo female patient admitted the previous night with severe community-acquired pneumonia & what you were told was "refractory" septic/cardiogenic shock. Arterial line was in the R fem artery:
September 21, 2025 at 10:55 AM
Such an important teaching point. In patients who respond poorly to vasopressors, always question whether the blood pressure measurement you are targeting is actually representative. #emimcc #cardiosky
It feels like all one big tease. To have hope and a miracle happen only to have one of the side effects of vasopressors take your hope away.
September 21, 2025 at 4:09 AM
It feels like all one big tease. To have hope and a miracle happen only to have one of the side effects of vasopressors take your hope away.
🫀 Haemodynamic collapse after ICU intubation: remember all the key mechanisms.
• Hypovolaemia
• LV/RV dysfunction
• Drug-induced vasodilation
• Transition to positive pressure ventilation
Optimise fluids & vasopressors early.
#Airway #ICU
👉 www.bjaed.org/article/S205...
• Hypovolaemia
• LV/RV dysfunction
• Drug-induced vasodilation
• Transition to positive pressure ventilation
Optimise fluids & vasopressors early.
#Airway #ICU
👉 www.bjaed.org/article/S205...
Airway management in critically ill patients
Airway management in the critically ill patient is a challenging task, with an estimated 45% risk of adverse events. Cardiovascular collapse (defined in most studies as a systolic pressure <65 mmHg…
www.bjaed.org
September 18, 2025 at 10:15 AM
🫀 Haemodynamic collapse after ICU intubation: remember all the key mechanisms.
• Hypovolaemia
• LV/RV dysfunction
• Drug-induced vasodilation
• Transition to positive pressure ventilation
Optimise fluids & vasopressors early.
#Airway #ICU
👉 www.bjaed.org/article/S205...
• Hypovolaemia
• LV/RV dysfunction
• Drug-induced vasodilation
• Transition to positive pressure ventilation
Optimise fluids & vasopressors early.
#Airway #ICU
👉 www.bjaed.org/article/S205...
When we care for patients with cardiogenic shock, we in the ICU oftentimes have no immediate tools other than vasopressors and inotropes. Although these temporarily make the numbers pretty, they likely do not address the etiology. 🎩 tip to the authors.
eddyjoemd.com/foamed
eddyjoemd.com/foamed
September 12, 2025 at 10:11 AM
When we care for patients with cardiogenic shock, we in the ICU oftentimes have no immediate tools other than vasopressors and inotropes. Although these temporarily make the numbers pretty, they likely do not address the etiology. 🎩 tip to the authors.
eddyjoemd.com/foamed
eddyjoemd.com/foamed
Endothelial Glycocalyx Degradation in Sepsis: Analysis of the Crystalloid Liberal or Vasopressors Early Resuscitation in Sepsis (CLOVERS) Trial, a Multicenter, Phase 3, Randomized Trial
@atscommunity.bsky.social #medsky
🔗 tinyurl.com/3r5rwfew
@atscommunity.bsky.social #medsky
🔗 tinyurl.com/3r5rwfew
September 9, 2025 at 4:04 PM
Endothelial Glycocalyx Degradation in Sepsis: Analysis of the Crystalloid Liberal or Vasopressors Early Resuscitation in Sepsis (CLOVERS) Trial, a Multicenter, Phase 3, Randomized Trial
@atscommunity.bsky.social #medsky
🔗 tinyurl.com/3r5rwfew
@atscommunity.bsky.social #medsky
🔗 tinyurl.com/3r5rwfew
📣The ESAIC-grant sponsored SQUEEZE study is out in the British Journal of Anaesthesiology!
Data from 25,675 patients across 42 countries; the result reveals a huge variation in how vasopressors are used after non-cardiac surgery.
Read more - zurl.co/ENYLa
#ESAICCTN
Data from 25,675 patients across 42 countries; the result reveals a huge variation in how vasopressors are used after non-cardiac surgery.
Read more - zurl.co/ENYLa
#ESAICCTN
September 8, 2025 at 1:32 PM
📣The ESAIC-grant sponsored SQUEEZE study is out in the British Journal of Anaesthesiology!
Data from 25,675 patients across 42 countries; the result reveals a huge variation in how vasopressors are used after non-cardiac surgery.
Read more - zurl.co/ENYLa
#ESAICCTN
Data from 25,675 patients across 42 countries; the result reveals a huge variation in how vasopressors are used after non-cardiac surgery.
Read more - zurl.co/ENYLa
#ESAICCTN
It means many inductions are closer to RSI, because there is no waiting time and thus no need for ventilation. If you are used to maintaining cardiovascular tone with high sympathetic activity, BP/HR will drop a bit more with this technique and we ofte use vasopressors.
September 7, 2025 at 4:25 PM
It means many inductions are closer to RSI, because there is no waiting time and thus no need for ventilation. If you are used to maintaining cardiovascular tone with high sympathetic activity, BP/HR will drop a bit more with this technique and we ofte use vasopressors.
My approach to mild septic shock from acute cholecystitis is often to trial medical tx with antibiotics, fluid, and low-dose vasopressors.
Most pts will improve and avoid getting a drain.
The whole situation is giving appendicitis vibes (dogma was to operate STAT, but actually not needed). #3/3
Most pts will improve and avoid getting a drain.
The whole situation is giving appendicitis vibes (dogma was to operate STAT, but actually not needed). #3/3
a cartoon of homer simpson standing in a grassy yard
ALT: a cartoon of homer simpson standing in a grassy yard
media.tenor.com
September 5, 2025 at 4:51 PM
My approach to mild septic shock from acute cholecystitis is often to trial medical tx with antibiotics, fluid, and low-dose vasopressors.
Most pts will improve and avoid getting a drain.
The whole situation is giving appendicitis vibes (dogma was to operate STAT, but actually not needed). #3/3
Most pts will improve and avoid getting a drain.
The whole situation is giving appendicitis vibes (dogma was to operate STAT, but actually not needed). #3/3
I’m fucking serious. That’s how much his ICU care was for his ongoing life support. Vasopressors are EXPENSIVE. So is everything else they did just to keep him alive to see if he COULD survive. He couldn’t, ultimately, because of how acute his sepsis was. And it likely affected his brain, too.
September 5, 2025 at 1:13 AM
I’m fucking serious. That’s how much his ICU care was for his ongoing life support. Vasopressors are EXPENSIVE. So is everything else they did just to keep him alive to see if he COULD survive. He couldn’t, ultimately, because of how acute his sepsis was. And it likely affected his brain, too.
Don't even understand the concept... If someone's bleeding to death resus him via periph IV/IO. Art line useful but CVC for vasopressors deserves the time to fire up a us machine... Plus doing something rarely in crash situations means you're probably poor at it unless frequently drilled...
September 3, 2025 at 4:41 AM
Don't even understand the concept... If someone's bleeding to death resus him via periph IV/IO. Art line useful but CVC for vasopressors deserves the time to fire up a us machine... Plus doing something rarely in crash situations means you're probably poor at it unless frequently drilled...
Restricted Fluids and Early Vasopressors versus Liberal Fluids and Later Vasopressors for Initial Resuscitation of Septic Shock: Protocol for a Systematic Review and Meta-Analysis https://www.medrxiv.org/content/10.1101/2025.08.28.25334538v1
August 29, 2025 at 12:57 AM
Restricted Fluids and Early Vasopressors versus Liberal Fluids and Later Vasopressors for Initial Resuscitation of Septic Shock: Protocol for a Systematic Review and Meta-Analysis https://www.medrxiv.org/content/10.1101/2025.08.28.25334538v1