ANDROMEDA-SHOCK @AndromedaShock Twitter profile

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ANDROMEDA-SHOCK

@AndromedaShock

2 years

Just released! Pulse Pressure and Diastolic Arterial Pressure critical variables for hemodynamic phenotyping and individualizing initial septic shock resuscitation in ANDROMEDA-SHOCK-2!!

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@AndromedaShock

2 years

Just out of the oven!!!!

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@AndromedaShock

3 years

I am not a fan of SSC guidelines but at least in this version they validated the use of CRT as a resuscitation target after the ANDROMEDA-SHOCK study (JAMA 2019)!!!

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@AndromedaShock

1 year

I STRONGLY recommend this paper (review/opinion)! One of the very best I have read in recent years! It displays some physiological concepts behind ANDROMEDA-SHOCK-2! Not strange since Daniel and Gustavo are part of the steering committee😎and all authors great physiologists😍😍

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@AndromedaShock

2 years

ANDROMEDA- SHOCK-2 Protocol paper just released in RBTI! 💪

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@AndromedaShock

2 years

Just released!

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@AndromedaShock

2 years

Just released!

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@AndromedaShock

2 years

Not all lactates are created equal. This is one of the flaws (among many merits) of Sepsis-3. A lot of persistent high lactate levels are not hypoperfusion related and thus pursuing normalization could be harmful. Some hypothesis generating ideas or data attached.

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@AndromedaShock

2 years

The first patient of ANDROMEDA-SHOCk-2 was randomized!!!!!!!! 18 months of previous work and the odyssey starts for real! 1499 patients to go, >80 centers around the world in 4 continents! Emotions on fire! 💪

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@AndromedaShock

1 year

The fundamental VExUS substudy for ANDROMEDA- SHOCK-2 was launched today!!! It will be for sure the largest prospective study comparing venous congestion in response to 2 different resuscitation strategies in septic shock, and validate the score itself and its components! 😎😎💪

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@AndromedaShock

2 years

10 years since we published “The holistic view on perfusion monitoring in septic shock” in COCC! This was and is our most beloved paper. The physiological background for all that came after including ANDROMEDA-SHOCK and also the PhD thesis with Can Ince. Nostalgia! Dreams! 😍😍💪

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ANDROMEDA-SHOCK

@AndromedaShock

2 years

Is it possible to individualize initial septic shock resuscitation using basic hemodynamic signals (as in ICM’s article) and targeting CRT? We don’t know but our dream is to prove it in ANDROMEDA-SHOCK-2! More than 90 centers around the world with already >30 recruiting 😍💪

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@AndromedaShock

1 year

Still trying to understand the pathophysiological basis of capillary refill time. Just released..

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ANDROMEDA-SHOCK

@AndromedaShock

10 months

The essential step of septic shock resuscitation is to couple macrohemodynamics to perfusion! We can easily manipulate macroH but for perfusion we have only surrogates. Severe pts lose hemodynamic coherence and in that phase further resusc may induce more harm (see figures)

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@AndromedaShock

10 months

The ANDROMEDA-SHOCK family is growing up! Protocol paper for VEXUS substudy just released! 85/350 pts already included💪. Will provide fundamental data for the score in a cohort of septic shock pts subjected to early personalized resuscitation! Aim is Perfusion w/o Congestion!💪

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ANDROMEDA-SHOCK

@AndromedaShock

2 years

ANDROMEDA-SHOCK-2: the epic voyage in septic shock! We started yesterday, full of energy and passion, with wonderful comrades all over the world! Let’s do it! No way back! 💪💪💪

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ANDROMEDA-SHOCK

@AndromedaShock

2 years

Grandes momentos donde tuve el honor de ser invitado por el Colegio Mexicano de Medicina Crítica al Curso de Monitoreo Hemodinámica! Gran nivel de todos, mucha fisiología, fraternidad! Inmensos agradecimientos😍Grande México!!!

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@AndromedaShock

9 months

Extremely nice and comprehensive review!!

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@AndromedaShock

1 year

Just appeared with a fresh review of recent data supporting peripheral perfusion assessment in different contexts, some physiological considerations, and perspectives on positioning as a key monitor

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ANDROMEDA-SHOCK

@AndromedaShock

2 years

Coming soon!

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@AndromedaShock

3 years

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@AndromedaShock

2 years

Very nice article from Armand Mekontso-Dessap and three ICUs in the Paris area! More data challenging dobutamine use in septic shock. In my humble opinion it should be used only in limited situations, after en echo to rule out phenotypes where it may be harmful, and as a test!

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@AndromedaShock

4 months

Just from the oven! A must read! “Towards the personalization of septic shock resuscitation: the fundamentals of ANDROMEDA-SHOCK-2 trial”. Now rapidly approaching 1000 recruited patients 💪

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@AndromedaShock

2 years

The first milestone in ANDROMEDA-SHOCK-2! Patient number 100 was recruited! Alrrady 35 active centers but opening 2-4 new ones every week! We can do it! Thanks to all! 💪💪💪 And in the next couple of months US, Western Europe, Middle East, and SE Asia centers will join!😍

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@AndromedaShock

8 months

Our International Hemodynamic Monitoring and Tissue Perfusion IV Course is a few weeks away! All the hot topics discussed by the masters and 40 international professors and researchers! Not to be missed😎

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@AndromedaShock

3 years

80y old septic shock pt. After initial resuscitation still with CRT 5s! Tested the future ANDROMEDA-2 algorithm, normal PP, MAP 65 with 0.02 NE, low DBP 43! No fluids, slightly increase in NE to 0.06 and DBP 51, MAP 69: 1h later CRT 2s; doing Ok! Just clin hem phenotyping!💪💪😎

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@AndromedaShock

2 years

My forward to the fantastic book by my dear and admired friend Supradip Ghosh!!

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@AndromedaShock

2 years

We hope ANDROMEDA-SHOCK-2 really makes a difference! The 1st trial mixing hemodynamic phenotyes with the best target (CRT) to individualize management. Also targeting DAP! The beauty of hemodynamics and perfusion assessed with simple tools. So different than CLASSICS! 💪💪💪👏

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@AndromedaShock

10 months

I respect everybody’s opinion but being ICM a physiology-based specialty, where the north is to try to personalize management due to the extreme heterogeneity of our pts, it is perplexing how worldwide experts still believe that responses will be found in metaanalyses and EBM!

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@AndromedaShock

2 years

By september we expect to have a critical mass of at least 50-60 centers recruiting pts for ANDROMEDA-SHOCK-2 and then! Phillipe Rola et al will push for one of the most relevant substudies: VEXUS-1000!! Systematic VEXUS in 1000 pts in septic shock! Eager for results! 😍😎🍷💪

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@AndromedaShock

2 years

ANDROMEDA- SHOCK-2 is a winner!! Already 11 centers started the final step to recruitment! With the spirit of Rafa Nadal and all the friends in Spain and around the world, we will win!!! 😎😎😎💪💪🍷

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@AndromedaShock

2 months

Patient 1000 just recruited for ANDROMEDA-SHOCK-2 in Cali Colombia!!!! 😍😍🙃💪💪

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ANDROMEDA-SHOCK

@AndromedaShock

1 year

After CLASSIC/CLOVERS, obviously a one-size-fits-all approach (liberal or restrictive? Just flip the coin) is not Ok! indvidualization by simple hemodynamic phenotypes, repeated FR, and CRT targeting as being tested in A2 trial may make a diff! Not more or less, just rational! 😎

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ANDROMEDA-SHOCK

@AndromedaShock

2 years

Opening 5 centers per week! Spain on fire, and NYU coming! 36 pts already recruited. Algorithm functioning very smoothly when applied! Data quality monitoring Ok! Aiming at 100 centers/4 continents! The largest RCT in septic shock history! External validity 💪ANDROMEDA-SHOCK-2😍

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@AndromedaShock

3 years

Our bilingual Online Course on Hemodynamic and Perfusion Monitoring in the critically ill is coming!! Great international faculty! The ideas behind ANDROMEDA-SHOCk-2 will be discussed at length! Programme next week! Save the date! The main subject: Perfusion without Congestion!

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@AndromedaShock

3 years

I prefer a thousand of times managing stressful ICU situations than dealing with extremely complex regulatory issues in 20 countries with different laws, procedures, and obstacles! This is the present for ANDROMEDA-SHOCK-2! Requires strength and resilience, but we will win💪💪💪

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@AndromedaShock

2 years

Happy New Year dear friends! Very excited about ANDROMEDA-SHOCK-2! First 5 centers will open on March 15th, and then new ones progressively every 2 weeks! Training programme ready and rolling. Will include 80 centers around the world aiming at 1500 pts! Let’s go for the best!💪

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@AndromedaShock

1 year

More and more proofs of the relevance of assessing Capillary Refill Time! Just appeared in Crit Care Med! It may basically provide the same info as sublingual MC evaluation. Indeed it may represent in some way MC status but also microvascular reactivity (Contreras JCMC 2012) 💪

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@AndromedaShock

2 years

With the availability of echo, the use of dobutamine has decreased from 50% cases of septic shock in the 90’s to 10-15% nowadays (ANDROMEDA). The SSC recommended its use for persistent hypoperfusion irrespective of CO based on earlier studies suggesting a direct effect on

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@AndromedaShock

2 years

200th ANDROMEDA-SHOCK-2 patient randomized today! This great project sponsored by important academic centers and LIVEN plus SEDAR (Spain)! Very proud of the growing group of already 52 centers in 3 continents. Now we go for the first safety interim analysis 💪😎

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@AndromedaShock

2 years

Diastolic blood pressure, the forgotten variable; Optimal MAP; NE vs Vasopressin! With Profs Olfa Hamzaoui, Arnaldo Dubin, and Djillali Annane! In our 3rd International Hemodynamic Monitoring and Tissue Perfusion Course (bilingual)! Info: daniela.villarroel @uc .cl

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@AndromedaShock

2 years

2nd Newsletter ANDROMEDA-SHOCK-2 just released! Advancing from regulatory phase 2 to training/phase 3! Gradual progressive opening of centers March 2022! >80 centers in Europe, NA, LA, and Asia! Target 1500 pts randomized to UC vs phenotype-driven, CRT targeted resuscitation 💪😎

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ANDROMEDA-SHOCK

@AndromedaShock

2 years

Working with the great Eduardo Kattan on a new research protocol focused on the RR between Fluid Responsiveness, Fluid Tolerance, Fluid-induced Harm, hydraulic signals, in ventilated CAP patients with septic shock. Nothing replaces a nice blackboard during early brain-storming!😎

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ANDROMEDA-SHOCK

@AndromedaShock

3 years

Dear friends: registration for the Course is open with the QR link. Registration process is in spanish but for doubts mailing Daniela (mail in the poster) is the solution (she speaks several languages) for getting support! Thanks!

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ANDROMEDA-SHOCK

@AndromedaShock

3 months

ANDROMEDA-PEGASUS coming March 2025! Will keep posted for interested colleagues and A2 followers💪 A cross-sectional, milticentric, transcontinental study exploring the RR between pulse pressure and stroke volume from an epidemiological perspective💪Aimed at 2000 pts

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ANDROMEDA-SHOCK

@AndromedaShock

3 years

In ANDROMEDA-2 we will compare CRT-targeted, hemodynamic phenotype tailored resusc vs usual care! BUT besides the 1ry outcomes in 1500 pts worldwide, for the 1st time we will assess VExUS, arterial doppler and MC to test if this leads to harmonic resusc: perfusion w/o congestion!

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ANDROMEDA-SHOCK

@AndromedaShock

2 years

Just back home after 3 weeks in Belgium, Spain, and France! Great journey meeting friends, visiting ICUS and enthusiastic teams linked to ANDROMEDA-SHOCK-2. Unforgettable moments in Barcelona, Valencia, Madrid, Paris, Brussels! Tired but is this not happiness? 😍😍😍

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ANDROMEDA-SHOCK

@AndromedaShock

3 years

Our Course is coming soon!!!! Hours are CET - 5. Info pls write to: daniela.villarroel @uc .cl

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@AndromedaShock

1 year

ANDROMEDA-SHOCK was presented in the “Late Breaking Studies” session at the SCCM’s meeting on Feb 19th 2019 and simultaneously published in JAMA. 4 years later it has changed practice and CRT targeting is in the last SSC guideline. Now A2 almost 400 pts recruited in >70 centers💪

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ANDROMEDA-SHOCK

@AndromedaShock

2 years

Finally, today we started ANDROMEDA-SHOCK-2 with the first 5 centers from LA! Opening ceremony and 8 weeks ahead for formal training and all previous steps! Official start of recruitment March 14th! New centers entering every 2 weeks💪! 17 already IRB approved! Happiness!!😍😍💪

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ANDROMEDA-SHOCK

@AndromedaShock

3 months

Fifth Anniversary of the ANDROMEDA-SHOCK paper in JAMA! A great success of LIVEN (Latin America Intensive Care Research Network) and a breaktrough study with almost 400 citations💪 And now short of 1000 pts in A2 ongoing trial! Cheers!

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ANDROMEDA-SHOCK

@AndromedaShock

8 months

Manipulating macrohemodynamics following simple physiological principles to personalize resuscitation may increase likelihood of achieving “perfusion without congestion!“ This is the goal of ANDROMEDA-SHOCK-2, a worldwide RCT just reaching 750/1500 recruited pts! 50%💪💪

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ANDROMEDA-SHOCK

@AndromedaShock

2 years

Perfusion without congestion! Harmonic resuscitation is the hallmark of ANDROMEDA-SHOCK-2! CRT target, hemodynamic phenotypes (determines by pulse pressure and DAP), and FR assessment in proper time! AND the substudy on VEXUS in 1000 patients! The best! Great researchers together

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@AndromedaShock

2 months

Two interesting Editorials appeared today in Intensive Care Medicine (online first). All authors deeply involved in ANDROMEDA-SHOCK-2, a major ongoing septic shock RCT with already 1020 (of 1500) pts recruited worldwide😎. Several ideas discussed there💪😎

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ANDROMEDA-SHOCK

@AndromedaShock

1 year

Coming soon!

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@AndromedaShock

2 years

Save the Date!! September 28-30! Third International (online) Bilingual Course: Hemodynamic Monitoring and Tissue Perfusion! Lectures, Workshops, Roundtables! Monitoring a Perfusion Crisis! Integrating Hemodynamics and Perfusion! POCUS in septic shock! First Announcement soon!

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ANDROMEDA-SHOCK

@AndromedaShock

9 months

Glorious days for ANDROMEDA-SHOCk-2😍😍! Yesterday patient #100 recruited for VExUS substudy (A-VExUS) and today patient #700 for the main study in Zurich😍😍Thanks to all the wonderful investigators around the world!!

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ANDROMEDA-SHOCK

@AndromedaShock

10 months

A humble plea. 1. Stop the abuse of metaanalyses (MA) in crit care! We face heterogeneity day after day. MA are not a clue, nor tablets of Moses for bedside decisions. 2. Stop promoting undifferentiated RCTs! Try adding some way to personalize: clinical, (follow the thread)

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@AndromedaShock

10 months

More and more data on early NE in septic shock! Now a fundamental experimental high-quality study by Ospina-Tascón et al! Impressive elegant data! Plus previous ones I have no doubts concerning early NE in predominant vasoplegic septic shock pts (high DSI with normal PP)! 💪

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@AndromedaShock

2 years

Now registration online! Simultaneous bidirectional Spanish/English translation. Live streaming and Reply on Demand!

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@AndromedaShock

2 years

So happy in our III International Course on Hemodynamic Monitoring and Tissue Perfusion! 450 attendees! Wonderful Professors!! Thanks to all!😍

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@AndromedaShock

2 years

I call it the miracle of ANDROMEDA-SHOCK-2! Already 41 of 90-100 centers in 4 continents opened! Today with the steering committee of the fundamental VEXUS substudy! So proud to be here: Prof Denault, Philippe, Curro and all! VEXUS prime data in septic shock 💪💪

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@AndromedaShock

7 months

Milestone!!! 750 patients recruited today for ANDROMEDA-SHOCK-2!!! 50% of the Sample Size! Now let’s go for the second half😍💪💪

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ANDROMEDA-SHOCK

@AndromedaShock

6 months

Brainstorming with Jan Bakker, Gustavo Ospina, Fernando Ramasco and Eduardo Kattan about the future ANDROMEDA-SURGERY to be conducted in Spain initially in 2024, starting with an Observational one!

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ANDROMEDA-SHOCK

@AndromedaShock

2 years

Here is a training video on how to assess CRT developed for ANDROMEDA-SHOCK-2! It is in spanish although it will soon be translated to english but it is easy to follow anyway.

A2 Capillary Refill Time measurement

null

www.youtube.com

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@AndromedaShock

2 years

ANDROMEDA-SHOCK-2 is recruiting!!!! Live!!! First centers opened this Monday! 💪💪💪

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@AndromedaShock

1 year

A very nice twitt from Cruces, one of the 32 Spanish centers participating in ANDROMEDA-SHOCK-2😍😍😍

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ANDROMEDA-SHOCK

@AndromedaShock

10 months

Coming soon!!! Info mail to “Alejandra Gonzalez: agonzal8 @uc .cl

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@AndromedaShock

3 years

Coming soon!!

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@AndromedaShock

1 year

Introducing our new Website: Latin American Intensive Care Network: LIVEN!! Behind the Andromeda-Shock studies and several other research projects! Nice trilingual interphase. Welcome and open for contacts! 💪

Inicio | Liven

www.livenresearch.com

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@AndromedaShock

3 years

The Programme of our Course is in Chilean Time-Zone. To convert to Western Europe add 5h and to UK add 4h. It is completely bilingual, in streaming, and video-recorded for off-line delayed view💪

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@AndromedaShock

3 years

ANDROMEDA-SHOCK-2 may be the end of “one size fits all” resuscitation strategies in septic shock! At the very least it is worth trying simple bedside, universally available hemodynamic variables to tailor initial resuscitation, even before the first echo!!

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@AndromedaShock

8 months

Life was so simple!!! Just ordering a fluid bolus when facing persistent hypoperfusion during the optimization phase of septic shock fluid resuscitation (SOSD or ROSE) 🤣🤣🤣OMG🙃

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@AndromedaShock

2 years

Managing anxiety 😬!! Only one week left to start recruitment in ANDROMEDA-SHOCK-2!!!

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@AndromedaShock

3 years

ANDROMEDA-SHOCK-2 is in. The heart of this course!!!

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@AndromedaShock

2 years

Yesterday was a great day for ANDROMEDA-SHOCK-2! More patients randomized in Spain and México! And the project won a national grant in France by the Programme hospitalier de recherche clinique (PHRC)! Great work of Olfa Hamzaoui and this allows the 10 French centers to start! 😍

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@AndromedaShock

2 years

Daniel speakung about the future of hemodynamic and perfusion monitoring!

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@AndromedaShock

11 months

Coming soon

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@AndromedaShock

3 years

Friends, my deep admiration to Fernando and Alex (and BRICNET) for BASICS! Hats off! I have some major concerns about the reactions particularly on the fluid challenge concept which for me is healthy, strong and alive for still hypoperfused septic shock pts. Pls see attached doc!

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@AndromedaShock

1 year

Coming soon!!!!!

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@AndromedaShock

1 year

Concerning phenotypes in my opinion it is time for action! From molecular biology to clinical practice. The proposal being tested by ANDROMEDA-SHOCK-2 is that in pts with septic shock with persisting hypoperfusion after initial fluid loading and a MAP of 65, further action

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@AndromedaShock

2 years

Spain, France, Germany, Italy, Netherlands, Portugal, Croatia, UK, US, Canada, Mexico, Salvador, Colombia, Ecuador, Chile, Argentina, Brazil, Uruguay, Paraguay, India, China, Iran, Malaysia, Kuwait, Emirates, Israel! This is ANDROMEDA-SHOCK-2!! The largest septic shock study😍😎

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@AndromedaShock

3 years

Very happy with ANDROMEDA-SHOCK-2 progress! Around 70 centers worldwide will participate with the aim of recruiting 1500 pts. A2 will compare a CRT-targeted, CV phenotype based, resuscitation strategy with usual care in early septic shock! Perfusion without congestion the goal💪

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@AndromedaShock

3 years

Congratulations to SEDAR for their excellent digital Congress! Great partnership with ANDROMEDA-SHOCK-2! Lots of talented intensivists emerging from the anesthesiology world, active researchers, and new friends! Hats off for SEDAR👋👋👋 Proud to work with you 😍

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@AndromedaShock

2 years

Very proud and grateful about the progress of ANDROMEDA SHOCK-2! Today we counted and there are already 15 centers recruiting. And a total of 97 centers of 4 continents have started the official process! And most of them are close (<2 months) to start recruiting. The largest

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@AndromedaShock

9 months

Out next IV Hemodynamic Monitoring and Tissue Perfusion International (online/bilingual) Course is close!! Xavier Monnet, Maurizio Cecconi, Daniel de Backer! 42 speakers. Take a look! 💪 Not to be missed!

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@AndromedaShock

2 years

Approaching the first 100 pts in ANDROMEDA-SHOCK-2! There is equipoise between arms, but in case our hypothesis is rejected, it is still worth! Intensivists in 100 centers around the world will practice resuscitation guided by simple clinical tools such as PP, DAP, CRT!!😍💪

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ANDROMEDA-SHOCK

@AndromedaShock

2 years

Today, patient number 150 (10% of the sample size) of ANDROMEDA-SHOCK-2 was recruited in Spain! With barely 50% of final centers activated in the last couple of months, the study is flowing very nicely!!! Let’s go for it!!💪💪😎

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@AndromedaShock

2 years

Regional or MC flow but this has also been challenged by more recent studies (ICM 2013). In some Geri’s phenotypes it may be harmful. In severe LV dysf with abnormal periph perf, it may be used as a 1-2h test to look at tolerability and efficacy. Nice discussion in ICM 2021😎

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ANDROMEDA-SHOCK

@AndromedaShock

2 months

Save the Date!!!😎💪

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@AndromedaShock

1 year

The great team of Miguel Ibarra in Fray Antonio Alcalde Hospital in Guadalajara, Mexico just randomized patiente 400 in ANDROMEDA SHOCK-2!!!! 😍😍😍😍

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ANDROMEDA-SHOCK

@AndromedaShock

2 years

Day after day, news centers are being IRB-approved for ANDROMEDA-SHOCK-2! From the US, Penn University and Columbia in NY!!! And so on, so forth! Two Centers in Malaysia will join soon! 16 centers from LA will start recruiting during March! Let’s go for it!! 💪💪

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ANDROMEDA-SHOCK

@AndromedaShock

1 year

When you launch an investigator-generated non-funded trial like A2, involving 20 countries and app 80 centers, the worst nightmares are regulatory affairs. Dealing with Everest like obstacles, frustrations, sleepless nights (UK was impossible to win). Sometimes you want to run😔

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ANDROMEDA-SHOCK

@AndromedaShock

1 year

ANDROMEDA-SHOCK-2 on fire! 62 recruiting centers around the world and still many to go! 1/6 of the sample size reached! Yesterday a glorious day with six recruited patients!! Let’s go for it!💪😎

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ANDROMEDA-SHOCK

@AndromedaShock

3 years

Research has so many dark moments: complex regulatory issues, failed grant applications, adverse results, hostile reviewers, you name it! However, it is also a dream, a privilege, an opportunity to contribute to a better care or world. ANDROMEDA-SHOCK-2 has been a life-event!

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58

ANDROMEDA-SHOCK

@AndromedaShock

5 months

It is so wonderful to be involved in a trial like ANDROMEDA-SHOCK-2! So many people around the world! 90 centers around! Fantastic smiling MOs recruiting people at 2 AM yesterday!! Without any money retribution, just spirit! So proud about this! Great journey! Again, only spirit!

2

8

58

ANDROMEDA-SHOCK

@AndromedaShock

3 years

After the Course!!!!

1

0

58

ANDROMEDA-SHOCK

@AndromedaShock

4 months

ANDROMEDA-SHOCK-2: today the pt 901 of 1500 was recruited in Mexico!!!!! So great!!

3

8

57

ANDROMEDA-SHOCK

@AndromedaShock

2 years

Upcoming III International Bilingual Course (online) on Hemodynamic Monitoring and Tissue Perfusion. Will update when registration open. Unfortunately not free as organized by our University but ALL incomes will be directed at supporting ANDROMEDA-SHOCK-trial! Attached First Day!

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17

56

ANDROMEDA-SHOCK

@AndromedaShock

2 years

Physiology, venous return, perfusion pressure, fluid responsiveness and tolerance, V-A coupling, fluid responsiveness, optimal monitors and targets, fluids and vasoactives, hemodynamic coherence, venous congestion, de-resuscitation, perfusion variables, MC, etc Can’t wait!! 😍😍

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