ClarissaForlini
@clarissaforlini
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Anesthesia&CriticalCare Specialist @ospniguarda @etherBicocca | TraumaCare | Respiratory pathophysiology | RockBeliever | Aemilian
Milano, Lombardia
Joined October 2016
◾️In memory of Prof L Gattinoni, towering figure in ICM, profoundly shaping understanding of #ARDS & #ECMO. The “father" of prone position revolutionized MV with a pioneering "baby lung” concept. His legacy will guide/inspire for generations to come. 🔗 https://t.co/kjuqkQoPoc
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Low-Dose Dopamine as Bruce Banner and High-Dose Dopamine as the Hulk. Different effects at different strengths! 4/9
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Fluid de-escalation ☔️ should I withdraw fluids? ☔️ is it right time to attempt fluid withdrawal? Tissue perfusion = adequate + pts must not be preload responsive ☔️ how to proceed? ☔️ when to stop? ☔️ how to react when hemodynamic instability occurs? 🖇️ https://t.co/lUGmUdajKh
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ENPAM: petizione per una trasparenza illimitata - Firma la petizione! https://t.co/PT87pubJVI via @ChangeItalia
change.org
Cambiare l’ENPAM, gli iscritti devono poter verificare come vengono spesi i contributi
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Communication & #ICU visiting policies during 1st #pandemic wave/lockdown in 🇮🇹 🔒practically no access 📱remote communications as surrogate Time to reopen, considering improved #COVID19 transmission understanding, PPE availability, growing immunization 📎 https://t.co/GpaHgYXxb5
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Prone positioning on VV #ECMO for severe #ARDS: in this large analisys including 889 pts from 5 studies comparing conventional management (supine position) vs proning, PP not significantly associated with reduced ICU mortality. @Crit_Care #FOAMcc #FOAMecmo
https://t.co/JpYWcdyWD9
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Safety & efficacy of bivalirudin vs unfractionated heparin in adults on #ECMO, retrospective cohort: 🩸low overall incidence of thrombosis: 1 event in bivalirudin group/no event in UFH group 🩸no difference in bleeding rates, 6% vs 10% @asaiojournal
https://t.co/qvZDAdXMj7
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Our last review on transfusions during ECMO: so many open questions! Waiting for the results of the ProtECMO study.. Thanks to our great residents team @clarissaforlini @DarioWinterton @SimonRedaelliMD et al https://t.co/LsNulo8CQH
@Thom_Langer @GicoBellani @etherBicocca
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ECMO associated salt wasting? In pts developing polyuria on VA #ECLS consider pressure natriuresis; confirmed? - expand volume vs hypovolemia - retract return cannula if too close to renal arteries - reduce EBF if tolerated #FOAMcc #FOAMecmo @asaiojournal
Polyuria after initiation of VA ECMO due to marked natriuresis persisting despite low cardiac filling pressures & highly negative drainage P suggesting clinical hypovolemia due to pressure natriuresis from high P at renal artery (ECLS inflow) @asaiojournal
https://t.co/G3PIPUkkQy
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#CritCare #OA
#Marini & #Gattinoni: Do diverse mechanical responses to local #chest wall #compressions open to possibilities for important therapeutic interventions? https://t.co/VR6WCAfTpA
#FOAMed #FOAMcc #BMC @ ISICEM @jlvincen @gattinon #ARDS #COVID_19 #prone #ventilation
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Prone position in #COVID19, use & effect: ➡️PP widely adopted, the more severe the respiratory failure, the more frequent the use ➡️PP improved oxygenation in most (better V/Q matching?) ➡️mortality of O2-Non-Responders significantly higher @Crit_Care
https://t.co/Q2Z15a8Pvr
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Editorial on @marcogiani et al Feasibility, safety, effect on lung mechanics/oxygenation of prone positioning on #ECMO, study (6 italian #ECLS centers/240 pts). PP: ⬆️oxygenation ⬇️intrapulmonary shunt significantly ⬇️H mortality minor complications in 6% https://t.co/iaHoBWZfrN
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Nebulizing aminoglycosides & colistin for VAP caused by MDR Gram‑negative bacteria: substitution should be preferred vs adjunctive therapy to evidence therapeutic benefit; moreover, mesh nebulizers should be preferred vs jet nebulizers to optimize lung deposition #FOAMcc @yourICM
Understanding nebulization of aminoglycosides & colistin for VAP caused by MDR Gram‑negative bacteria: ➡️why & when to administer ➡️inhaled substitution better vs adjunct ➡️optimizing ABT nebulization to maximize antibiotic lung deposition #FOAMcc @yourICM
https://t.co/9FzLyuxQ29
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Ventilation in #COPD & asthma ➡️ respiratory mechanics/gas exchange ➡️ heart–lung interactions ➡️ HFNO & NIV ➡️ managing invasive MV from intubation to (early) weaning limiting hyperinflation ➡️ long‑term outcome & role of tracheostomy ➡️ future strategies https://t.co/zBBlwo7EEI
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Interesting debate on @asaiojournal on upper age limit for implementing VV #ECMO in respiratory failure Do we need fixed limit? Maybe narrower indications considering comorbidities/baseline performance status? On @asaiojournal ➡️ https://t.co/vtLBYMoQp1 ➡️ https://t.co/ZCYBQFkCPZ
Is an age barrier for VV #ECMO advisable? Where should It be? https://t.co/ci2PsgoDai Referred to Giani et al. Age over 65?? not firm contraindication to #ECLS
https://t.co/qx1dG7sDTo In reply to Deatrick et al. VV #ECMO: Do we need to consider age? https://t.co/PENHmwM2or
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Ventilating #COVID19 pts ➡️ #COVID19 ARDS is #ARDS ➡️ subphenotypes? to be properly defined & specific approach to be clearly demonstrated ➡️ limited data/lot to learn, but enough evidence to recommend management similar to other ARDS causes case tailored https://t.co/tUPS7xRalu
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