An intensivist on a learning frenzy. Caring for the critically ill using evidence-based medicine.
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 …
Continue reading Hydrocortisone for Severe Community-Acquired Pneumonia (CAP)
The concept of metabolic resuscitation has been around for several years. Unfortunately, the data for using ascorbic acid, thiamine, and glucocorticoids has not been as robust as we would like. There have been challenges replicating the miraculous data seen in the first trial in every subsequent trial performed after that. There have been numerous limitations …
Continue reading Hydroxocobalamin (Vitamin B12) for Septic Shock
Did you know that zinc is the second-most abundant trace metal in the human body? A quick reminder that iron comes in first place. Zinc is an essential component of protein structure and function. It enables gene transcription and is a "catalytic component of approximately 2000 enzymes" (Read, et al). Could we use zinc for …
Continue reading Zinc for Metabolic Resuscitation in Critical Illness
Many think that the interest in IV thiamine in septic shock is a relatively novel idea after Paul Marik's paper was published in CHEST back in 2017. It actually goes a lot further than that. We've actually known that 20% of critically ill patients have a thiamine deficiency upon presentation to the ICU. More recent …
Continue reading IV Thiamine: Can it Help Critically Ill Septic Shock Patients?
Every possible option to decreased morbidity, mortality, and costs are worth looking at in my book. The study that I am reviewing at this moment was published in 2017. I am ashamed that I had not run into it until today (10/19/19). It's challenging to stay up to date in everything. I digress. It is …
Continue reading Thiamine and Renal Failure in Septic Shock Patients
