An intensivist on a learning frenzy. Caring for the critically ill using evidence-based medicine.
This article is hot-off-the-press regarding vitamin C, thiamine and hydrocortisone in refractory septic shock. This regimen is known as HAT therapy in some corners of the world. It was actually published today, 5/5/20. It is NOT a randomized control trial but at least they went through the trouble of conducting a propensity matched, before-after, case …
Continue reading IV Vitamin C in Sepsis with Thiamine and Hydrocortisone
Some legendary names came out to play for this article regarding corticosteroids in COVID-19. Meduri is the author of the famous Meduri Protocol for methylprednisolone in ARDS and Villar is the author of the article I shared on February 13th (seems like forever ago, really) where they provided dexamethasone for ARDS and showed a mortality …
This is a big impactful study looking at administering Dexamethasone to patients with ARDS. I'm happy it came out, really happy. To start off a big hat tip to my colleagues in España who put this together. ARDS sucks. It's a b-word to treat and patients spend a frustratingly long time to come off of …
Continue reading Dexamethasone in ARDS: DEXA-ARDS Trial Improved Outcomes
Your patient is in septic shock. They've gotten the correct source control, antibiotics, fluids, vasopressors. They remain hypotensive. Getting worse, actually. Could they have relative adrenal insufficiency or one of these fancy-termed conditions such as "critical illness-related corticosteroid insufficiency" (CIRCI)? Some clinicians insist on checking cortisol levels in patients who are in septic shock. Should …
Continue reading Cortisol Levels: Check prior to SDS in Septic Shock?
The VITAMINS trial looking at IV Vitamin C didn’t pan out was not a positive study as it was conducted. It was surprising as intravenous (IV) Vitamin C in sepsis should help decrease vasopressor dose and duration. My contention with that study is that they took too long to initiate the study drug. A median …
Continue reading IV Vitamin C in Sepsis: It Should Decrease Vasopressor Dose & Duration
You’re following along on my page bc you know I’m trying to find the most cutting-edge treatments and therapies for my critically ill patients. I hope to keep on pumping out eye catching content such as this article on melatonin for sepsis. Please share with you’re nerdy friends who would also find this nerdy content …
Continue reading Melatonin for Sepsis: The potential benefits to improve outcomes
You all know my bias. It shouldn't be a surprise given my body of work: I wanted the VITAMINS Trial to be a positive study. I wanted patients to benefit from this therapy and SURVIVE. I cannot understand the vitriol I have received in my direct messages when I shared my initial take on the …
Continue reading VITAMINS Trial: Timing was delayed to administer the “vitamins”
I am constantly reading and educating myself in an attempt to gain whatever edge I possibly can for my patients. Their survival and quality of life is what I have personally dedicated my life to. Being someone who is following along on my journey, I can safely assume you're doing the same. I have become …
Continue reading Vitamin D Supplementation in Critically Ill ICU Patients
Every possible option to decreased morbidity, mortality, and costs are worth looking at in my book. The study that I am reviewing at this moment was published in 2017. I am ashamed that I had not run into it until today (10/19/19). It's challenging to stay up to date in everything. I digress. It is …
Continue reading Thiamine and Renal Failure in Septic Shock Patients
Here's my bias before I even read the article. I want to see a positive response in providing IV Vitamin C/ascorbic acid in patients who have Acute Respiratory Distress Syndrome (ARDS). Why? Because I want me patients to do better with treatments that are inexpensive and easy to manufacture rather than the latest immunologic that …
