An intensivist on a learning frenzy. Caring for the critically ill using evidence-based medicine.
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
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
There are numerous methodologies that we can utilize to determine fluid responsiveness in our critically ill patients in the emergency department or in the intensive care unit. In this post, I will be taking a deep dive into pulse pressure variation, PPV as the shorthand. For details about the other methods for determining fluid responsiveness, …
Continue reading Pulse Pressure Variation (PPV) for Fluid/Volume Responsiveness
I am thrilled the Choosing Wisely Campaign has looked upon this data. Upon my first foray into the ICU as a PGY-1 many moons ago, we would not be able to go home until we put in orders for all of our patients. Amongst those things that we would order daily included chest x-rays for …
Continue reading Choosing Wisely: Daily Chest X-ray while on Mechanical Ventilation
Sometimes medicine behaves like the stock market; a whole bunch of enthusiasm followed by a realistic pullback. This has now occurred with the concept of using one ventilator for multiple patients. I agree that we need to use some ingenuity in this crisis, but this one never sat well with me, hence me not commenting …
I am a huge fan of proning patients who are in ARDS. At one point or another I'll cover the data behind proning like the PROSEVA trial (no time today or until at least June). There are a variety of ways to prone patients which reflect the disposable income of the facilities where you work …
Continue reading Prone Positioning for ARDS: A Guide on How to Do It.
There has been quite a bit of variation regarding pressure support trials, spontaneous breathing trials, liberation trials, whatever you want to call it. I recently looked at the data for my academic curiosity and would like your input as to how you do it at your shop. I’d like to apologize in advance if I …
Continue reading Spontaneous Breathing Trials: How Does Your Shop Handle This?
I have great disdain for delirium. Natural light brings me great joy. Today, for example, the sun isn't shining bright. The day is cloudy and gloomy. I am, in turn, a little grouchy. Daylight savings is coming and I'm already upset about it. I can turn on the light but it won't be the same. …
Continue reading Delirium in Mechanically Ventilated Patients: Let the Natural Light in!
