An intensivist on a learning frenzy. Caring for the critically ill using evidence-based medicine.
We often overload our septic shock patients with IV fluids.The CLASSIC trial looked at the fluids we give in the ICU after resuscitation in the ED.This is not medical advice. Read the article for yourself.Almost 1600 patients were enrolled in either the standard or restrictive IV fluid group.Before arriving to the ICU, these patients received …
Continue reading CLASSIC Trial: IV Fluids for Septic Shock in the ICU
This is a one-minute journal club.This is not medical advice. Read the full free article for yourself (link below).Hat tip to the authors.Link in my stories for the next 24 hours.How do you predict whether a patient on high-flow will need to be intubated?Eyeballing your patient is not quite good enough.The ROX index is a …
Continue reading VOX Index: Predicting HFNC Failure (One-Minute Journal Club)
This is a one-minute journal club.Check out the link to download the full free article.I recommend you read this article for yourself.This is not medical, nor professional advice.Hat tip to the authors.Do you work or are you considering working night shift?For 24 years they followed over 46,000 night shift nurses in this prospective cohort study.Unfortunately, …
Continue reading Night Shift Nurses: Is your Health at Risk? One-Minute Journal Club
This is a one minute journal club-ish on Sepsis Deaths. This is not medical advice. Read the FREE article for yourself and do not trust me.Hat tip to the authors.This article was published in 2020 in the Lancet but is still relevant.Almost 49 million cases of sepsis were recorded in 2017.It is estimated that there …
This is a one minute journal club-ish. This is not medical advice. Read the article for yourself and do not trust me.Patients with severe, symptomatic aortic stenosis: what’s the best way to fix it, surgical AVR or a TAVR.TAVR and TAVI are the same thing.This is a non-inferiority trail meaning they didn’t think there would …
Continue reading TAVR vs. Surgical Aortic Valve Replacement (AVR): 1-Minute Journal Club
For historical context, today is 05.11.22, and I am going to start compiling the data showing the benefits of having a palliative care team in the ICU. This post will be updated regularly as time permits. I have been fortunate to work, and have worked, with some great people on these teams during the course …
Albumin is a colloid that is frequently used in the resuscitation of critically ill patients. Amongst those indications we see it used in sepsis and very frequently in the cardiac surgery space. What prompted me to write this post was an article by Joannidis et al. published in Intensive Care Medicine last month. In that …
Continue reading Albumin in Resuscitation: Sepsis, Cardiac Surgery, & Other Indications
So this particular study is a little bit outside my wheelhouse from the typical critical care data that I routinely appraise. I did find it quite interesting and worth my time to dissect because I have looked into intermittent fasting in the past. It is easy for me to admit that it is impossible for …
There are numerous guidelines that have been published over the recent years regarding the use of high-flow nasal cannula. Those guidelines address different populations and can be found HERE. In addition, there are studies currently cooking to look at using high-flow in COPD patients. Colleagues are also looking into include high flow oxygen in the …
Continue reading High Flow Nasal Oxygen or NIV in the Immunocompromised?
How do you define a last-ditch effort to save someone's life from COVID-19? Perhaps giving tPA to a severe COVID patient? At this point, I am certain many of us have attempted, with informed consent of course, therapies for our patients that may make theoretical sense but have no evidence to support its use. At …
Continue reading tPA for Critically Ill ICU Patients with COVID-19: Does Alteplase Help?