An intensivist on a learning frenzy. Caring for the critically ill using evidence-based medicine.
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?
High flow nasal cannula, aka nasal high flow, high flow oxygen, etc. is a technology that I have reviewed extensively before. It has numerous uses including pneumonia, asthma, heart failure, and even COPD. The ROX Index will also help us predict who will likely need to be intubated after failing high flow. That being said, …
Continue reading High Flow Nasal Oxygen & The Berlin Definition of ARDS
We are all looking for strategies to improve outcomes in our critically ill patients. Could probiotics come to the rescue to help out patients in the ICU? This is a work-in-progress post, like the vast majority of my work. Here's something I'm fairly certain we (meaning your team and mine) do not do in our …
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.
To begin, I will disclose my bias. I wanted plasma-lyte to outperform 0.9% NaCl, also called normal saline in critically ill patients. It turns out that after the publication of the PLUS trial, I have to chill the heck out to an extent. On this blog as well as social media, I have scrutinized 0.9% …
Continue reading Plasma-lyte vs. Saline (0.9% NaCl): The PLUS Trial was a Negative Study
Many people over the years have asked me how I stay up to date with the medical literature. Particularly, they tend to mean how I stay up to date in critical care. Hopefully, this post will explain things. Several years ago I created a youtube video which is linked below. I value staying up to …
Continue reading How to Stay Up To Date with the Critical Care Medical Literature
My love for ACLS goes back far in my career. I fondly recall taking an ACLS/BLS course after completing medical school and prior to starting residency. It was a small class, just a couple students. The instructor was a charismatic firefighter (who I remain friends with to this day) who noted that I was particularly …
Continue reading Vasopressin & Methylprednisolone: Time to Add Them to ACLS Protocols?
It bears repeating that I am quite the fan of inexpensive, readily available therapies to help save the lives of our patients. When I received this article from Caroline Welch, Pharm D. I was excited because I was hoping it would be a positive study. Unfortunately, it did not pan out and based on these …
Continue reading Atorvastatin for ICU COVID Patients: Not Ready for Prime Time
First of all, I'd like to thank you for supporting my work and motivating me to continue trucking along. I'm not a big resolutions guy, but I would like to share what my 2022 resolutions are for my podcast, YouTube, and social media channels. My personal resolutions usually are limited to staying healthy and trying …