hydrocortisone cap

Hydrocortisone for Severe Community-Acquired Pneumonia (CAP)

I have to admit the glucocorticoids are amongst my favorite medications that we use regularly in the ICU. Whether it be hydrocortisone, dexamethasone, or methylprednisolone, I have order sets built into my EMR with the dosing for the respective indications. The indications appear to be endless. Today, I am going to be discussing an article …

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ROX Index: Predicting Who Is or Isn’t Going to Fly on HFNC

We have all had this patient. Someone who is in acute hypoxemic respiratory failure, let's just call it pneumonia of some sort or ARDS, and the regular nasal cannula or a venti-mask can't cut it. They're not at the severity where you can eyeball the patient and just know that they need to be intubated. …

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Pre-oxygenation: High flow nasal cannula vs. BVM

A sentinel event is one where, amongst other different outcomes, leads to death. In critical care, anesthesia, and emergency medicine, we often deal with emergent airways on patients who are on the brink of death unless we intervene expediently. Despite having performed many intubations in my young career, I have the utmost respect for every …

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High Flow Nasal Cannula (HFNC): Does it Ventilate COPD Patients?

I've reviewed numerous mechanisms of action and functions of High Flow Nasal Cannula (HFNC) but I haven't touch on whether or not it works to help ventilate patients. I have discussed in the mechanisms of action that it does wash out the CO2 from the dead space in the nasopharynx, oropharynx, etc, but does that …

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High Flow Nasal Cannula in Acute Decompensated Heart Failure

Fortunately in the critical ill population, we do not necessarily have to abide by the saying that "if all you have is a hammer, everything looks like a nail". What I'm referring to is regarding utilizing high-flow nasal cannula in acute heart failure exacerbations. I already dissected how HFNC generated a "PEEP" equivalent airway pressure …

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High Flow Nasal Cannula in the Emergency Department: Avoid Intubations

This study was the first randomized control trial looking at whether high-flow nasal cannula (HFNC) decreases the need for mechanical ventilation in the emergency department. In addition they looked at emergency department and hospital lengths of stays, 90 day mortality, adverse effects in the hospital, and patient experience. I sympathize for the authors of this …

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High Flow Nasal Cannula: Physiologic Effects

I have extensively covered high flow nasal cannula, HFNC on this page due to a talk I'm creating on the matter. We've witnessed it first hand keep patients off of the ventilator. This article published in the American Journal of Respiratory and Critical Care Medicine, which as an aside is the highest impact factor publication …

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high flow DNR

Do Not Resuscitate (DNR) does NOT mean you can’t use high flow.

This topic is very dear to me because I am a huuuuuuuge proponent for appropriate end of life care. I'm an Intensivist after all and people unfortunately die on my service. We all are going to have our day. My goal with the patients I take care of is to make their passing to the …

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High Flow Nasal Cannula: Does my patient need to be intubated?

The article I'm referencing in this post is titled: An Index Combining Respiratory Rate and Oxygenation to Predict Outcome of Nasal High-Flow Therapy. It was published in the American Journal of Respiratory and Critical Care Medicine in June of 2019.  We see this every day in the intensive care unit. A patient with pneumonia sucking wind. Tachypenic. Slightly …

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