An intensivist on a learning frenzy. Caring for the critically ill using evidence-based medicine.
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 don’t know about you all but I’m constantly working on finding new ways to treat my septic shock patients who, based on the numbers from larger studies, have a mortality rate between 25-35%. I have used methylene blue on various occasions for post-CPB vasoplegia but would it possibly work in septic shock? Well, there’s …
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
Sometimes we need to make minor adjustments in what we do in the ICU to see a difference. I have been going off for several years now on my instagram account as well as YouTube channel regarding the importance of utilizing balanced crystalloids such as lactated ringers or plasma-lyte and I keep on hearing "there's …
Continue reading Does using Balanced Crystalloids vs. Saline improve mortality in sepsis?
