An intensivist on a learning frenzy. Caring for the critically ill using evidence-based medicine.
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
This is a difficult subject to discuss because we all have people we love who suffer from issues that have led to them having a higher weight than what they should and, in turn, carry the diagnosis of obesity. This post is not intended to shame anyone. But there's definitely a link between obesity and …
Continue reading Obesity in Critical Illness & COVID-19: A Very Bad Combination
Way back when I was just a baby intern, I remember placing these large IJ cannulas in the patients who suffered cardiac arrests to proceed with hypothermia. Later in my training, in December of 2013, the NEJM published the Targeted Temperature Management (TTM trial) looking at 33°C versus 36°C after Cardiac Arrest. The paradigm began …
Continue reading Hypothermia (33°C) vs. Normothermia (37.5°C) in Cardiac Arrest – TTM2
Those of us who have placed COVID-19 ICU patients on mechanical ventilation know that this is not a process that is going to resolve overnight. Patient with decompensated congestive heart failure with pulmonary edema? Better in 24-48 hours. Aspiration pneumonia in a young kid who partied a little too hard? Better in a few days. …
Continue reading ICU COVID-19 Patients Don’t Get Well Soon, Unfortunately
This page is a work in progress regarding anaphylaxis and was first updated on 4/26/21 and last updated on 4/22/22. Stay tuned for updates.Cite this post as: Eddy J. Gutierrez, "Anaphylaxis: Act Fast and Save a Life", eddyjoemd blog, April 26, 2021. Available at: http://eddyjoemd.com/anaphylaxis/. Citations for Anaphylaxis: (Updated 4/14/22) Li X, Ma Q, Yin …
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
I have quite a love-hate relationship with central lines. They sometimes give me the warm and fuzzies when my Emergency Medicine colleagues call me for a sick patient in the ED who is entirely appropriate for the ICU. I see a right internal jugular central venous catheter on the chest x-ray. In my practice, I …
Continue reading Peripheral Vasopressors: Are They Safe for our Patients?
Yesterday, in the Journal of Cardiothoracic and Vascular Anesthesia, there was a Letter to the Editor by a group of physicians in Italy were where they described the five reasons why people die of COVID-19. I found it quite interesting that this article was published in that particular journal. Given that the audience to my …
Continue reading The five reasons why COVID-19 causes death.
The pendulum has swung when it comes to deciding when to proceed with intubation of our COVID-19 patients when it comes to timing. The early data suggested early intubation was the way to go as we were all terrified or aerosolization of the virus caused by the high-flow nasal oxygen or different modes of non-invasive …
Continue reading Timing of Intubation in COVID-19 Patients: Early or Late?
I've always had a strong interest in Procalcitonin and how to use it appropriately for our hospitalized patients in the ICU. For that reason, I am creating this work-in-progress page to take a deep dive into all evidence-based clinical questions you and I may have regarding procalcitonin. This post will be continuously updated. Don't trust …
Continue reading Procalcitonin Levels: The Ultimate Guide for Use in Sepsis