Zbigniew Putowski @ZPutowski

MD, PhD, Center for Intensive And Perioperative Care, Jagiellonian University, Poland. Interested in hemodynamics. Dum spiro spero intensywna.pl Kraków, Poland Joined August 2011

Tweets

462
Followers

631
Following

195
Likes

459

Zbigniew Putowski @ZPutowski

3 months ago

Do you have any thoughts on using hypertonic saline or bicarbonate for *fluid expansion* in critically ill? @ThinkingCC @PulmCrit @emcrit @khaycock2

1 0 1 428 0

View Details

@ThinkingCC @icmteaching @EMNerd_ @khaycock2 @PulmCrit @emcrit repetition of the same mantra that there is some sort of linear relationship between map and perfusion. map is a highly dependent variable...

0 0 4 812 0

View Details

Zbigniew Putowski @ZPutowski

4 months ago

@PatientStormDoc @PulmCrit I’ve read majority of your work and admire your intellectual input to the debate. I Think you are right, but what i am comparing is Mediocre guidelines versus ridiculous decision making that we encounter routinely that is based essentialy on nothing (not physiology or Logic)

1 0 1 101 0

View Details

Zbigniew Putowski @ZPutowski

4 months ago

@PulmCrit @PatientStormDoc Tens of thousands patients were saved by SSC. Mediocre guidelines are better than completely retarded clinical decisions 😄

1 0 0 223 0

View Details

Zbigniew Putowski @ZPutowski

4 months ago

@PulmCrit @SaurinPatel77 @nickmmark True but i am not sure about the „few underperforming hospitals”…. If not for SSC we still would using nephro dose dopamine in many cases. SSC do not follow physiology but are often closer to physiology than eminence based medicine which is still practiced in many places

0 0 2 68 0

View Details

Zbigniew Putowski @ZPutowski

5 months ago

@khaycock2 @ThinkingCC great study. do you think that phenomenon should be studied more or is it well grounded already

1 0 2 41 0

View Details

Zbigniew Putowski @ZPutowski

5 months ago

1/6 Question to ultrasound/physiology freaks @PhilGuerci @PulmCrit @RCastro_L @eddyjoemd @thomaswoodcock @ross_prager @f_g_sanfilippo @PulmCCM @khaycock2 @avkwong @PulmPEEPs @phlegmfighter @ThinkingCC

2 0 1 451 0

View Details

Zbigniew Putowski @ZPutowski

5 months ago

@khaycock2 @ThinkingCC Do you happen to have a paper about this ?

2 0 1 31 0

View Details

Zbigniew Putowski @ZPutowski

5 months ago

@khaycock2 @ThinkingCC @RCastro_L @PhilGuerci @PulmCrit @eddyjoemd @thomaswoodcock @ross_prager @f_g_sanfilippo @PulmCCM @avkwong @PulmPEEPs @phlegmfighter Awesome !

0 0 1 48 0

View Details

Zbigniew Putowski @ZPutowski

5 months ago

@khaycock2 @ThinkingCC Like MCA...? A lot of papers say that MCA does not change the diameter in response to vasopressors, so any increase in Vmean should mean increased flow

1 0 1 24 0

View Details

Zbigniew Putowski @ZPutowski

5 months ago

@khaycock2 @ThinkingCC @RCastro_L @PhilGuerci @PulmCrit @eddyjoemd @thomaswoodcock @ross_prager @f_g_sanfilippo @PulmCCM @avkwong @PulmPEEPs @phlegmfighter I can't imagine RI going down without concomitant CO increase. Do you?

2 0 1 31 0

View Details

Zbigniew Putowski @ZPutowski

5 months ago

@PulmCrit @ThinkingCC @thomaswoodcock @RCastro_L @PhilGuerci @eddyjoemd @ross_prager @f_g_sanfilippo @PulmCCM @khaycock2 @avkwong @PulmPEEPs @phlegmfighter Also changing finger on which you monitor SatO2 after some time is important. Too much pressure from finger clamp confounds the measurements

0 0 2 86 0

View Details

Zbigniew Putowski @ZPutowski

5 months ago

@thomaswoodcock @PulmCrit @ThinkingCC @RCastro_L @PhilGuerci @eddyjoemd @ross_prager @f_g_sanfilippo @PulmCCM @khaycock2 @avkwong @PulmPEEPs @phlegmfighter Excluding edge cases like MAP 35, I never see improvements in PPI or CRT after raising vasopressors (e.g. MAP 55 > MAP 70).

0 0 1 66 0

View Details

Zbigniew Putowski @ZPutowski

5 months ago

@thomaswoodcock @ThinkingCC @RCastro_L @PhilGuerci @PulmCrit @eddyjoemd @ross_prager @f_g_sanfilippo @PulmCCM @khaycock2 @avkwong @PulmPEEPs @phlegmfighter peripheral perfusion index might be a good alternative

1 0 3 78 0

View Details

Zbigniew Putowski @ZPutowski

5 months ago

@ThinkingCC @RCastro_L @PhilGuerci @PulmCrit @eddyjoemd @thomaswoodcock @ross_prager @f_g_sanfilippo @PulmCCM @khaycock2 @avkwong @PulmPEEPs @phlegmfighter Thank you!! We should study this

1 0 1 68 0

View Details

Zbigniew Putowski @ZPutowski

5 months ago

@ThinkingCC Through increased EDV?

0 0 0 22 0

View Details

Zbigniew Putowski @ZPutowski

5 months ago

@ThinkingCC @RCastro_L @PhilGuerci @PulmCrit @eddyjoemd @thomaswoodcock @ross_prager @f_g_sanfilippo @PulmCCM @khaycock2 @avkwong @PulmPEEPs @phlegmfighter Are you familiar with any ultrasound way of assessing the effect of vasopressor MAP up-titration on the brain or kidney perfusion? Knowing that PI, EDV and PSV are more complex and context-dependent?

2 0 1 113 0

View Details

Zbigniew Putowski @ZPutowski

5 months ago

@RCastro_L @PhilGuerci @PulmCrit @eddyjoemd @thomaswoodcock @ross_prager @f_g_sanfilippo @PulmCCM @khaycock2 @avkwong @PulmPEEPs @phlegmfighter @ThinkingCC Do you believe there is a room for utilizing doppler to assess the effect of vasopressor-driven MAP up-titration to assess perfusion of an organ? I thought increasing EDV would be highly correlated with increased flow, as EDV usually goes down in high intracranial pressure cases

0 0 2 54 0

View Details

Zbigniew Putowski @ZPutowski

5 months ago

@RCastro_L @PhilGuerci @PulmCrit @eddyjoemd @thomaswoodcock @ross_prager @f_g_sanfilippo @PulmCCM @khaycock2 @avkwong @PulmPEEPs @phlegmfighter @ThinkingCC What would you think would be the effect on doppler parameters if vasopressor indeed increased TPP?

2 0 1 87 0

View Details

Zbigniew Putowski @ZPutowski

5 months ago

@ThinkingCC Lets say you raise MAP with a vasopressor to improve renal perfusion, and in fact you improve it. What changes in doppler parameters would you expect ?