ESICM LIVES 2026: Haemodynamic effects of prone positioning in ARDS Prone positioning is usually discussed as a strategy to improve oxygenation. At LIVES 2026, Dr Jennifer Hastings highlighted a further physiological dimension: turning a patient prone can profoundly change right ventricular afterload and systemic venous return. In ARDS, the right ventricle faces several simultaneous threats. Hypoxia, hypercapnia, inflammatory vasoconstriction and microvascular thrombosis increase pulmonary vascular resistance. Atelectasis narrows extra-alveolar vessels, while overdistension compresses alveolar capillaries. The consequence may be RV dilatation, septal displacement, reduced LV filling and circulatory failure. Proning redistributes lung inflation and perfusion. By recruiting dependent regions while limiting overdistension, it may reduce pulmonary vascular resistance and unload the RV. Improved gas exchange can further attenuate hypoxic and hypercapnic pulmonary vasoconstriction. RV function may therefore improve even when the change in the PaO₂/FiO₂ ratio is modest. Moreover, oxygenation indices can be influenced by low mixed venous oxygen saturation or intracardiac shunting and cannot substitute for circulatory assessment. But the effect on cardiac output is more complex. Prone positioning can increase intra-abdominal pressure and mean systemic filling pressure, potentially increasing the driving pressure for venous return. Yet resistance to venous return may rise as well. In a physiological study of 22 patients, cardiac index increased by at least 15% in only seven, all of whom were preload responsive. Increased filling pressure does not automatically mean increased flow. This distinction matters at the bedside. A patient with RV pressure overload may benefit from proning through afterload reduction, whereas a patient without preload reserve may show little increase in cardiac output. Abdominal compression, intravascular volume and RV function all modify the response. The PROSEVA trial demonstrated a major survival benefit of early prolonged proning in severe ARDS, with 28-day mortality of 16.0% versus 32.8% in the supine group. Whether cardiovascular unloading contributes to this benefit remains an important physiological question, not a proven mechanism of mortality reduction. Prone positioning is therefore not merely a way to increase PaO₂. Its effects should be assessed through respiratory mechanics, echocardiography, cardiac output and tissue perfusion alongside gas exchange. #ESICM #LIVES2026 #ARDS #PronePositioning #RightVentricle #Hemodynamics #CriticalCare

It’s hard to fathom that it has been three years since the October 7 Hamas massacre. Three years since the deadliest day for the Jewish people since the Holocaust. The pain of that dark day has not faded. But neither has the strength, resilience and enduring hope of the Jewish people. Today, we remember the innocent lives stolen, stand with the survivors and the families forever changed, and pray for a lasting peace.

My 2nd talk #AABIP2026: Why tPA/DNase over surgery for pleural infection? Key points 1: Treatment success is NOT CXR clearance. If infection settles, residual pleural opacities will resolve with time - don't send to VATS just for CXR clearance. #MedEd #MedStudent @AAB_IP @wabipconnect @PleuralPOCUS @tsanz_thoracic 🧵👇

HI-PEITHO key takeaways #ACC26 🫀 Intermediate-risk PE = stable patients with RV strain + positive biomarkers ⚖️ ultrasound-facilitated catheter-directed thrombolysis + AC vs AC alone in this “gray-zone” group 📉 ↓ Early clinical deterioration: 4.0% vs 10.3% 🚑 Benefit driven by ↓ hemodynamic collapse—not mortality 🩸 No ↑ major bleeding or ICH → supports selective early intervention

One of my favorite UCLA peeps visits SD! Great reunion!

Likely the best ad for any product ever.

If you know undergraduates interested in spending time with us for a summer of #KUH , please pass along @NIDDKgov

Was great awesome to catch up with mentor, friend and #aldosterone guru @BhallaResearch!

🚨🔥NEW EPISODE🔥🚨 @CritCareTime is BACK to talkin’ #PE; covering #CDT, #PERT and more with Dr. Rich Channick - PE expert and past president of @PERTConsortium ! Thx to @GiladJaffe for his production help and @SeaStarMedical for their continued support! 👇‼️Links Below‼️👇

A RCT for HIGH risk PE? - no way , cant do it , shouldn’t do it , yup we are doing it @roblookstein @jameshorowitzmd @FMaeWestMD

Following the latest guideline on antithrombotic therapy for VTE disease, a journal CHEST® Special Feature serves as a unified collection of relevant statements from the preceding 3 guidelines. Read the article in the August issue: hubs.la/Q02LZjN90 #MedEd #JournalCHEST

Massive PE: systemic tPA vs. CDT

So sad but true and unfortunately hilariously relatable @DrLBenjamin @HeyDrHay_Ward @EmilySchwitzer

Second law of medicine= No one cares how much you know, until they know how much you care. #compassion #empathy

Wow this is such exciting news for all of our pulmonary patients! Thank you @BernieSanders !

ICU Pharmacology Secrets: Some drug side effects, even if relatively rare, are well entrenched in our memory. For example, most intensivists & hospitalists are aware of cefepime-induced neurotoxicity or clindamycin’s association w C difficile infection (or even the seemingly

Hydrocortisone + fludrocortisone always 3 reasons: 1️⃣Every RCT that showed a survival advantage used H+F; none of the H alone RCTs did. 2️⃣Multiple large observational studies show survival benefit of H+F over H alone 3️⃣Fludrocortisone is a cheap pill (<$1/day)

Congrats @NidaQadirMD !

Had such a great time with mentors and meeting so many amazing colleagues doing such amazing things for our field! ⁦@atscommunity⁩ ⁦@UCLAPCCM⁩ ⁦⁦@ucsdpccm⁩ ⁦@drtishawang⁩ ⁦@rchannick⁩ ⁦⁦