Friday, January 30, 2026 at 17:05:52 in BE

MASP, AAQC

[2025 JAMA - SOFA-2 (Ranzani) [RCT].pdf]

Codified by MLHG

Glossary: 

Glossary: 🧠 = brain, 🫀 = heart, 🫁 = lungs, 🫃🏽 = abdomen = abdominal, 🩸 = blood = hematology, ♾️ = kidneys = renal, ◸ = liver = hepatic, AUROC = area under the receiver operating characteristic, icuMM = ICU mortality

1. 𝙄𝙌𝘾 BS ➩ Y, J, C ➖ T ➕ N ➕ t ➖ P I C O:
2. 𝙄𝙌𝘾 BS 🟰 2025, JAMA, WW ➖ federated 🤓 ➕ 2M (>1k ICUs, 9 countries) ➕ 2014 - 2023 ➖ P I C O:
     - P: P: ICU pxs
     - 🅸: SOFA 1 variables 🤓
     - 🅲: NA
     - O: O: pOC = icuMM
3. EVIDENCE:
      a. SOFA-1 in 1996
      b. Changes ➩ 30 years

      c. SOFA-1 does not capture DRUGS ➕ DEVICES

      d. The new one should be GENERALIZABLE ➩ high-, middle-, low- income countries. 

4. METHODS.

      a. Expert selection (60) ▶︎ mDelphi ➕ sr ➕ internal + external validation

      b. 8 stages:

         i. 1-3 = identification (variables)➕ management (dysfunction)

         ii. Discussions ➩ evidence gaps ➕ clinical relevance

         iii. Scoreable construct ➩ defined by:

            1. YES operational criteria

            2. NOT precise biological truth

            3. Priorities: SIMPLICITY + CLINICAL USABILITY + WIDESPREAD APPLICABILITY + - CONTENT VALIDITY. 

      - 6 domains: reliability ➕ content ➕ construct ➕ criterion ➕ predictive validity

      INTERV ➠

         - Expert input

         - internal + external validation

         - mDelphy - STAGE 1-5 

            - Expert input

      - Data-driven component (SOFA-2) - STAGE 6-8

         - geographical setting

         - resource setting

Validity

      - mDelphy ➩ predictive validity w_AUROC curve (1st day of ICU)

5. RESULTS.

      1. Same 6 systems 🧠 ➖ 🫁 ➖ 🫀 ➖ ♾️ ➖ ◸ ➖ ♾️ ♾️ 
      2. w_new variables ➕ thresholds
      3. SOFA-2 (AUROC 0.79) 🆚 SOFA-1 (AUROC 0.77)      4. Sequential SOFA-2 data ➩ ICU day 1 to 7 = same predictive validity      5. No data + No validity ➩ 🫃🏽 + immune DYSF

⏳ TIME MANAGEMENT.
01:33:02

Round: 10 00:17:92 Close
Round: 9 23:26:56 Wrap-up
Round: 8 05:47:34 Results
Round: 7 01:15:95 Comments
Round: 6 10:32:13 Interpretation
Round: 5 02:18:07 Reading + notes
Round: 4 27:21:39 Interpretation
Round: 3 16:48:65 Reading + notes
Round: 2 03:21:14 ART selection
Round: 1 01:53:22 Past JC

[2025 ICM - Cardiogenic shock diagnosis, phenotyping + mm (Moller) [r].pdf]

Codified by 𝙄𝙉𝘼𝘼𝙌𝘾 ᴮᴼ (MASP)

Glossary: ABG w_lactate = arterial blood gas, AMI-CS = acute myocardial infarction with cardiogenic shock, BP = blood pressure, CAT LAB = catheterization laboratory, CRT = capillary refill time, CS = cardiogenic shock, DX = diagnosis, ID = identification, MCS = mechanical circulatory support, PAC = pulmonary artery catheter, TTO = treatment, UO = urine output, ∑ = so, ➰ = pressure, 💨 = flow, 🤓 = analysis, 🗣 = suggestion(s), ★ = recommendation(s).

1. 𝙄𝙌𝘾 BS ➩ Y, J, C ➖ T ➕ N ➕ t ➖ P I C O:
2. 𝙄𝙌𝘾 BS 🟰 2025, ICM, DN ➖ r ➕ NA ➕ NA

3. DEF. 

      a. ↓💨 critical → end-organ ▶︎ function

      b. primary 🫀 failure ▶︎ cause

      c. 🫀 cannot generate → SUFFICIENT OUTPUT ▶︎ consequence 

      d. despite → adequate preload ▶︎ condition
4. DX can be challenging ➩ ∑ we need HD measurements:

      a. ↓ CI ▶︎ ≤2,2 “typically”

      b. ↑ PCWP ▶︎ ≥15 

      c. LVOT-VTI ▶︎ gives SV
5. Identification
      a. EARLY recognition + therapy ▶︎ cornerstone

      b. Lesson from STEMI ➩ 1st “golden hour” 

      c. 🚑 + ER deparment

         i. ID and TTO ➩ CS ➕ AMI-CS

         ii. Transfer directly to CAT LAB w_MCS (STEMI, NSTEMI, CS SCAI ≥class B)

            1. Class B = ↓BP ↑HR

            2. Class C = ↓💨 

      d. 🏥 ➩ ECG 12 + tropoinin + lactate (10 min)

         i. Score ORBI ➩ 🔗:  Orbi Risk Score

         ii. Score STOPSHOCK ➩ 🔗: 🤯 [Stop Shock calculator ]

      e. SHOCK team ➩ 30min evaluation

      f. Therapy ➩ 60 min af_1st medical contact. 

6. Special attention.

      a. ♀ ➕ old pxs ➩ ATYPICAL symptoms

      b. Younger ➩ ↓ likelihood ➩ ∑↑ likelihood to MISS CS DX. 

7. Af_DX ➩ monitoring (BP, ECG, ABG w_lactate, UO)

      a. response

      b. progression

8. ECHO is mandatory ➩ severity ➕ etiology ➕ phenotyping. 

9. PAC ➩ IF a) unresponsive to INITIAL therapy, b) DX uncertainty (not supported by RCTs)

10. Clinical tools ➩ mottling ➕ CRT

11. Microcirculation

      a. may persist DESPITE NORMAL macrocirculation. 

      b. Method ➩ sidestream dark field imaging. 

      c. DAMIS trial ▶︎ sublingual microcirculation in mixed CS population ▶︎ led to mm changes BUT did not correlate w_↑OC. 

Friday, January 16, 2026 at 17:15:00 in BE

MASP, AAQC, PFLC, MNVC

⏳ TIME MANAGEMENT.
01:42:18

Round: 10 00:41:09 Comments
Round: 9 17:17:59 Wrap-up
Round: 8 30:08:20 Identification (interpretation)
Round: 7 04:43:25 Identification (notes)
Round: 6 19:24:49 Definition
Round: 5 00:18:75 Titles + subtitles (4 min)
Round: 4 09:36:83 Interpretation (abstract)
Round: 3 04:52:36 Abstract (reading + notes)
Round: 2 06:28:64 ART selection
Round: 1 08:47:54 PAst JC

Friday, February 20, 2026 at 17:08:25 in BE

MASP, AAQC

2025 JAMA - The CDC No Longer Recommends C19 Shots During Pregnancy Now What (rubin) [mn].pdf

Codified by 𝙄𝙉𝘼𝘼𝙌𝘾 ᴮᴼ (ABFL)

Glossary: CATE = conditional average treatment effect, cHTA = chronic hypertension, CKD = chronic kidney disease, f = CDC Advisory Committee for Immunization Practices, FRT-CI = Fisher Randomization Test for Confidence Intervals, NE = norepinephrine, RRT = renal replacement therapy, UP = urine output, VP_fd = vasopressor free days. 

1. 𝙄𝙌𝘾 BS ➩ Y, J, C ➖ T ➕ N ➕ t ➖ P I C O:

2. 𝙄𝙌𝘾 BS 🟰 2025, ICM, FR ➖ post-HOC ➕ 776 ➕ Mar 2010 - Dec 2011 ➖ P I C O:
      - P: septic shock
      - 🅸: MAP 80-85
      - 🅲: MAP 65-70
      - O: pOC = heterogeneity of treatment effect (HTE) | sOC = variable trajectories (MAP ➕             NE ➕ lactate ➕ mottling ➕ UO)
3. EVIDENCE:
      a. 2014 NEJM - SEPSIS PAM (asfar)

         i. 2014, NEJM, FR ➖ mc_prag_RCT ➕ 776 ➕ Mar 2010 - Dec 2011 ➖ 🅿️ Septic                  shock, 🅸 MAP 80-85 🅲 MAP 65-70 🅾️ pOC = MM28 | sOC = MM90 ➕ AKI ➕ sAKI                ➕ nRRT 7d➕ RRT ➕ VP_fd.

         ii. cHTA in high MAP group = ↓ RRT ▶︎ heterogeneity may exist 🤔  
      b. SSC 2021 implemented ➩ MAP 65
      c. Debate (higher BP better?) ➩ chronic HTA ⌄ CKD
      d. Personalized approach ➩ has been repeatedely called out.
      e. FRT-CI helps TESTING heterogeneity ▶︎ if substantial heterogeneity, CATE helps

4. METHODS.

      - INTERV ➠ during 24h af_ VP start. 

          - Step 1. Randomization inference ➕ FRT
          - Step 2. CATE ➕ HTE variables <10%

      - Prespecified trajectories:

          - MAP. 80% of hourly MAP values (met 🆚 unmet)
          - Lactate. ≥ 🆚 < 2 d_1st 24h
          - UO: ≥ 🆚 < 0.5 d_1st 24h
          - Mottling. yes 🆚 no d_1st 24h

      - Unadjusted ➩ then adjusted ▶︎ logistic regression models ➕ alluvial plots. 

      - Multi-mediation analyses w_4 randomization components: UO, lactate, mottling, NE ↔               MAP goal responsiveness

5. RESULTS.

      1. Not meeting targets ➩ ↑r MM
      2. MAP not reached ➕ UO ↓ (24h) ➕ lactaet ↑ (24h) ➕ mottling (24h) 🟰 ↑r MM
      3. The indirect effect was driven by NE exposure ➕ mottling.
      4. See table 3

⏳ TIME MANAGEMENT.
01:43:52

Round: 9 00:53:23 Comments
Round: 8 42:13:02 Interpretation all
Round: 7 08:52:45 Interpretation
Round: 6 02:51:21 I: read + notes
Round: 5 05:10:92 Structure
Round: 4 19:19:16 Reading + notes + interpretation
Round: 3 06:37:83 ART selection
Round: 2 00:35:50 Comments

Round: 1 17:19:20 Past JC

2025 ICM - Echocardiography guided management of AFib (Balik) [nr].pdf

Codified by YAPG

Glossary: 📈 = arrhthmias, 🗣 = suggestion(s), 🫀 = heart, 🫀 SØ = cardiogenic shock, 🫁 = lungs, AF = Atrial fibrilation, AL = afterload, antiCOA = anticoagulation, CCE = critical care echocardiography, DISF = disfunction, HD = hemodynamic, HR = heart rate, IVC = inferior vena cava, LVSF = left ventricular systolic function, LVF = Left ventricular filling, mm = management, MV = mechanical ventilated, NOAF = new onset atrial fibrillation, PH = pulmonary hypertension, RAP = right atrial pressure, r = risk, S&D = systolic and diastolic

1. EVIDENCE:

      a. AF ➩ ↑ incidence
      b. In the ICU is MORE impactful ➩ aggravated by illness severity
      c. NOAF ➩ independent predictor MM
      d. 🫀 GL ▶︎ MAJOR TRIALs:

          i. ambulatory pxs
          ii. different DEGREES ventricular S&D DYSF.
          iii. Variable dependences of LVF on ATRIAL SYSTOLE.

      e. Rate control ➕ antiCOA ➕ LIMITING any 🫀 depression in structural DIS scenarios                  (🗣) 🟰 emphasis 

2. CCE:

      a. Diagnosis + monitoring. ➩ in HD unstable pxs
      b. ID risk factors
      c. ID parameters ↔ 📈 chronicity
      d. Guides therapy (sinus rhythm return) ➩ rhythm control
      e. Decide: rhythm 🆚 rate CONTROL
      f. Monitors ➩ left atrial recovery post cardioversion
      g. Conflicting mm goals ➩ **anticoagulation** (especially in significant r of bleeding)

3. LIMITED DATA ➩ ACUTE benefits of rhythm OVER rate control ▶︎ long-term seems to be the same. 

4. RCTs failed to CONSIDER the **degree** of “pre-existing LV S&D DYSF” (important for acutely decompensated pxs)
5. Rhythm control might be useful in certain populations ➩ PHYSIOLOGICAL RATIONALE.
6. CCE ➩ structure + function + risk stratification + mm guidance
7. LVSF ➩ ↑ incidence 📈: atrial ➕ ventricular. Prevalence: 

      a. 10-15% = AF w_moderate ↓ LVEF
      b. 49% = AF w_severe ↓ LVEF

8. NOAF ↔ LVEF <35% ➩ non 🫀 CIpxs
9. RIght ventricule + PH

      a. RV Dilatation ↔ 📈
      b. AF prevalence 26-31% in all forms of PH
      c. 📈 INDICATE (harginger) of clinical deterioration w_RV failure (context: PH)
      d. RA change ➩ spherical remodelling ➕ ↑ RAP ▶︎ ↔ ↑ AF prevalence
      e. MV pxs w_SØ ➩ PH (SPAP ≥51) after cardioversion ↔ MULTIPLE AF                                        RECURRENCES.
      f. 🫀 GL ▶︎ use PEAK TRICUSPID PRESSURE GRADIENT wo_RAP (IVC diameter +                   respiratory variation) ➩ although CVC is present (RAP is feasible)

10. Cor pulmonale

     a. May TRIGGER AF ➩ ↑ HD instability
      b. Chronic PH ➩ RV develops adaptaive wall hypertrophy ➩ ↑ systolic pressure to                        counteract the AL.
      c. IF ↪︎ ↓ RV contractility, ↪︎ RV failure ➕ 🫀 SØ [NOAF or ↑HR]

Friday, February 13, 2026 at 17:08:15 in BE

MASP, AAQC, PFLC, MNVC

⏳ TIME MANAGEMENT.
01:39:50

Round: 11 01:09:41 Comments
Round: 10 40:00:54 Wrap-up
Round: 9 14:52:95 Interpretation
Round: 8 02:56:81 Reading + notes
Round: 7 08:52:19 Interpretation
Round: 6 04:12:06 REading + notes
Round: 5 11:53:50 Interpretation
Round: 4 03:10:69 Reading + notes
Round: 3 04:19:05 ART selection
Round: 2 00:55:75 Comments

Round: 1 07:27:80 Past JC

Friday, February 27, 2026 at 17:05:25 in BE

MASP, AAQC, PFLC, MNVC

⏳ TIME MANAGEMENT.
01:29:16

Round: 10 01:59:19 Comments
Round: 5 15:02:89 Wrap-up
Round: 4 07:09:52 Interpretation
Round: 3 05:49:09 Reading + notes
Round: 2 03:07:86 ART selection
Round: 1 07:57:68 Past JC + 10min

2026 FPHYS - Real-time change in Dynamic CAR af_acupuncture at GB34 Yanglingquan, a self-controlled study (ZHANG) [R].pdf

Codified by YAPG

Glossary: ABP = arterial blood pressure, AdvEve = adverse events, af_ = after, BMI = body mass index, BP = blood pressure, CA = cerebral autoregulation, CBF = cerebral blood flow, dCA = dynamic cerebral autoregulation, DIS = disease, DM = diabetes mellitus, EtCO₂ = End-tidal carbon dioxide, GAD = generalized anxiety disorder, HR = heart rate, LF = low frequency, MCA = middle cerebral artery, MIN = minimum, NO DIFF = no difference, PV = phase value, SAH = subarachnoid hemorrhage, VRBPAC = FDA’s Vaccines and Related Biological Products Advisory Committee, ↑THY = hyperthyroidism, 🥃 = alcohol consumption, 🚬 = tabaquism, 🧠 = brain

1. 𝙄𝙌𝘾 BS ➩ Y, J, C ➖ T ➕ N ➕ t ➖ P I C O:

2. 𝙄𝙌𝘾 BS 🟰 2026, FP, CH ➖ sef-con_INT cross-over ➕ 20 healthy ➕ Sep — Dec 2021 ➖ P I C O:

      - P: Healthy volunteers
      - 🅸: 2 acupunture interventions (active)
      - 🅲: Sham acupuncture
      - O:pOC = ←→phase levels af_GB34 | sOC = other CA parameters, MCA velocity, mean             BP, HR af_GB34.
3. EVIDENCE:
      a. CA ➩ 🧠 maintains CBF despite ABP changes.
      b. dCA ➩ transient response of CBF to rapid changes of BP ▶︎ compromised:

         1. Stroke
         2. SAH

         3. Parkinson
         4. Panic disorder

         5. DM
         6. Depression

      c. 3. Few 🅸 ↑ CA function.
      d. Acupuncture ➩ popular in China ➩ ✔︎ clinical effects ➕ ↓ AdvEve
      e. GB34 = Yanglingquan ➩ common function TTO in the clinic ▶︎ used for:

         i. Stroke
         ii. Parkinson

      f. GB34 ➩ ↑ CO2 reactivity in the ipsilateral MCA ➩ ↗️ vasodilatory potential of 🧠 vasculature. 

4. METHODS.

      - 𝗘𝗫 ➠ mental diseases + cerebrovascular DIS + TBI + HTA + 📈 + DM + ↑THY + GAD +             depression + insomnia ➕ 🥃 ⌄ 🚬 ➕ poor cooperation, bone window.

      - INTERV ➠ each par = 2 acupuncture 🅸

         - sterile, single-use needle
         - 20mm depth
         - Deqi sensation = needle reaction
         - 20s stimulation
         - 1 week interval ↔ acupuncture 🅸
         - Sequence of stimulus ➩ active, sham.
         - dCA measurements ➩ quiet room, controlled room, same technician.
         - Par AVOIDED ▶︎ ↑ caloric meals (4h MIN), mod-vig exercise (12h MIN), coffee + 🚬 +                chocolate + 🥃 (12h MIN).
         - 15-min rest.

      - TCD + photoplethysmography + EtCO2
      - dCA recording for 30 min ▶︎ including 10min ← acupuncture + 10min → needle removal.
      - TFA for CBFV + BP [page 3 detailed]

5. RESULTS.

     1. NO DIFF age ➕ BMI
     2. NO changes 🟰 mean MCA + BP + EtCO2
     3. Left & right PV in LF band af_GB34 🟰 🅸 ↑ than baseline.
     4. Other dCA af_GB34 🟰 NO DIFF than baseline
     5. No real-time changes in dCA ➩ in SHAM.
     6. Real-time changes in HR af_GB34. ➩ ↓ hrvCAR mentioned

Friday, March 13, 2026 at 16:31:12 in BE

MASP, AAQC, PFLC, MNVC

⏳ TIME MANAGEMENT.
01:01:21

Round: 6 03:29:58 Comments
Round: 5 28:48:61 Interpretaion
Round: 4 09:56:25 Reading + notes
Round: 3 07:27:69 ART selection
Round: 2 01:37:51 Comments

Round: 1 10:01:43 Past JC

2026 AIC - Subphenotyping hypotension in early S•, A physiology-guided therapeutic approach (sanchez) [ed].pdf

Codified by YAPG

Glossary:
🧠 = brain
🫁 = lungs
🫀 = heart
🫃🏽 = abdomen = abdominal

◸ = liver = hepatic
♾️ = kidneys = renal
🩸= blood = hematology
🪲 = infections
💨 = flow
➰ = pressure
🤓 = analysis;
⚡️ = cardiac arrest;
📈 = arrhythmia;
🗣 = suggestion(s)

★ = recommendation(s)

AF = atrial fibrillation;

VRBPAC = FDA’s Vaccines and Related Bio-
logical Products Advisory Committee

ACIP = CDC Advisory Committee for Immunization Practices

CRT = capillary refill time

PP = pulse pressure

DAP = diastolic arterial presssure

DSI = diastolic shock index

cHTA = chronic hypertension

DM = diabetes

SI = shock index

SAP = systolic arterial pressure

DYSF = dysfunction

1. ↓ MAP ➩ poor OC

2. S• induced ↓BP ▶︎

      a. ↓ VOL ➩ preload
      b. ↓ vascular tone ➩ afterload
      c. 🫀 DYSF ➩ contractility
      d. Combination
3. Vasoplegia does NOT allow ↑ tissue perfusion

4. FLUID ACCUMULATION ➩ worse OC
5. Concerns ▶︎ need for early subphenotype-tailored therapeutic strategy.
6. Bedside variables to guide therapy:
      a. CRT. Does not define ↓AP subphenotype alone, but CENTRAL to decision-making

         i. Prolonged = need for therapy. 

         ii. Normal = correction of ↓➰ unnecessary UNLESS other signs of ↓💨 (altered mental                 status)

         iii. Its RESPONSE helps identify the underlying mech and the plan (continue ⌄ change ). 
      b. PP.

         i. ↓PP = ↓SV
         ii. Arterial stiffness 🚨
         iii. Elderly + cHTA + DM ▶︎ “apparently” normal (40-50 mmHg) 🟰 ↓SV

      c. DAP.

         i. Except ↓HR, ↓ DAP (<45-50) 🟰 ↓ vascular tone
      d. DSI

         i. HR / DAP.
         ii. ↑DSI (>3) ▶︎ severe VASODILATION
         iii. More reliably than ↓DAP
         iv. ≠ SI ▶︎ HR / SAP.

4. P-PHY subphenotypes

      a. ↓VOL
      b. ↓ vascular tone
      c. 🫀 DYSF

1. 𝙄𝙌𝘾 BS ➩ Y, J, C ➖ T ➕ N ➕ t ➖ P I C O:

2. 𝙄𝙌𝘾 BS 🟰 2021, IJGO, UK ➖ srMA ➕ 2524, 59 IN ➕ -Nov 11, 2020 ➖ P I C O:

      - P: hALT pregnant
      - 🅸: preg hALT
      - 🅲: preg non-hALT
      - O: pOC = hALT impact on LBW, SGA, SPTB | sOC = magnitude LBW

3. EVIDENCE.
4. METHODS.

      - 𝗜𝗡 ➠
      - 𝗘𝗫 ➠
      - RANDOM ➠
      - INTERV ➠

5. RESULTS.
6. RATIONALE.
7. LIMITATIONS.