An intensivist on a learning frenzy. Caring for the critically ill using evidence-based medicine.
I have a question for you. I hope you answer it honestly.Now that ICU admissions are incredibly low from you-know-what we can take a look back and dig through the ashes to see what could we have done better.Recently, data was published from a certain institution where they reported that they had only 40% mortality …
Continue reading Mortality of Patients on Mechanical Ventilation: One-Minute Journal Club
With so many simultaneous issues transpiring in our critically ill patients, it is naive to think that one lab marker or one calculation would tell an absolute story. This has led to the erroneous mindset that every time the lactate is elevated, the patient has sepsis when we know that is not true. Another such …
Continue reading RSBI (Rapid Shallow Breathing Index) for Extubation Success? Nope.
We all like to make the numbers pretty in our critically ill patient. Euboxic is a term that is thrown out there. It's like there's a check box in our brains that we need to fill in when turning a lab value back to the default color rather than red in our EMR. But one …
Continue reading Bicarbonate for Respiratory Acidosis: Not So Fast
On 8/9/21 I put out a tweet discussing (in a certain limited number of characters) how difficult it is to get a patient who is intubated and placed on mechanical ventilation because of severe COVID-19 ARDS. I used the analogy of landing an airplane in a hurricane. Definitely not easy. Something came over me where …
Continue reading Expectations for Families of COVID-19 Patients on the Ventilator
Patients placed on mechanical ventilation carry a certain mortality by default. Obviously it is not a good thing to end up intubated in the ICU. It's one thing to set up a patient on mechanical ventilation and then just twist the knobs to get a pretty arterial blood gas that's satisfactory to keep the patient …
Continue reading Driving Pressure in ARDS: Improving Survival By Any Means Necessary
Let's start off by defining double triggering. No, it's not saying two things interpreted as inflammatory to someone back to back while they lose their minds. These are strange times we live in. I digress. Double triggering is something that occurs to patients who are mechanical ventilation. The lay person would interpret this as the …
Continue reading Double Triggering and Ventilator Asynchrony/Dyssynchrony
Those of us who are in the ICU, especially those of us taking care of the patients caught up in this pandemic have learned that certain patients can be quite challenging to oxygenate and ventilate. For the uninitiated, the whole purpose of mechanical ventilation is to be a band-aid of sorts for patients who we …
Continue reading Hypercapnic Respiratory Failure: Tricks for Ventilator Management
I am thrilled the Choosing Wisely Campaign has looked upon this data. Upon my first foray into the ICU as a PGY-1 many moons ago, we would not be able to go home until we put in orders for all of our patients. Amongst those things that we would order daily included chest x-rays for …
Continue reading Choosing Wisely: Daily Chest X-ray while on Mechanical Ventilation
The WeVent team came together to create this respiratory management protocol to help us take care of patients with COVID-19. First of all, a big hat tip to the authors: Aurio Fajardo C; MD. Medicina Interna. Unidad de Paciente Crítico. MsC en Ventilación Mecánica, Universitat de València. MsC en Medicina Intensiva. Grupo Ventilación Mecánica Chile …
Continue reading Respiratory Management Protocol for SARS-CoV-2 by WeVent
Sometimes medicine behaves like the stock market; a whole bunch of enthusiasm followed by a realistic pullback. This has now occurred with the concept of using one ventilator for multiple patients. I agree that we need to use some ingenuity in this crisis, but this one never sat well with me, hence me not commenting …