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