An intensivist on a learning frenzy. Caring for the critically ill using evidence-based medicine.
It is my personal opinion that sepsis-induced cardiomyopathy has been under recognized and understudied. Our current practice pattern of starting patients on norepinephrine is good. But automatically going to vasopressin, then either phenylephrine or epinephrine as they continue to deteriorate overlooks the fact that they may have sepsis-induced cardiomyopathy. Going down the typical route we …
Continue reading Sepsis Induced Cardiomyopathy: A Forgotten Factor in Septic Shock
Fluid responsiveness is defined as "as the ability of the left ventricle to increase its stroke volume (SV) in response to fluid administration". There are multiple strategies to define fluid responsiveness in patients who are on mechanical ventilation such as PPV, SVV, EEOP. Positive end-expiratory pressure (PEEP) can decrease cardiac output in mechanically ventilated patients. …
Continue reading PEEP-Test for Fluid/Volume Responsiveness in Resuscitation
Today, we're going to be reviewing what some might consider to be a landmark study: the CLOVERS trial. The first thing most clinicians do when a patient is hypotensive is provide IV fluids. The surviving sepsis guidelines recommend 30cc/kg in patients who are in septic shock. It often bears reminding that the objective of providing …
Continue reading More Fluids vs. Vasopressors in the First 24h of Septic Shock (CLOVERS Trial)
We all like to make the numbers pretty in our critically ill patient. Euboxic is a term that is thrown out there. It's like there's a check box in our brains that we need to fill in when turning a lab value back to the default color rather than red in our EMR. But one …
Continue reading Bicarbonate for Respiratory Acidosis: Not So Fast
You've heard all these fancy terms, mixed venous blood gas, ScvO2, SvO2, thrown around the ICU all the time. Here, I explain what they are. Regardless of whether you're a nurse, respiratory therapist, medical student, resident, or even a fellow, these terms may sometimes be quite confusing as everyone talks about them like, "duh, you're …
Continue reading SvO2 and ScvO2 to Guide Resuscitation in Septic & Cardiogenic Shock