An intensivist on a learning frenzy. Caring for the critically ill using evidence-based medicine.
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)
This is a one minute journal club-ish on Sepsis Deaths. This is not medical advice. Read the FREE article for yourself and do not trust me.Hat tip to the authors.This article was published in 2020 in the Lancet but is still relevant.Almost 49 million cases of sepsis were recorded in 2017.It is estimated that there …
The intention of this post is going to be to take a deep dive into the states of vasopressors using the best evidence based practices available. It will be routinely updated. This is a work-in-progress blog post on vasopressors. Last updated 02/25/2022.If you find this blog post useful, and you want to cite it in …
The blood pressure is low, give a bolus of fluids. Many times that leads to a "nurse dose" as many of us joke about. But are we causing harm? I keep reiterating that fluid responsiveness is when you achieve an increase in cardiac index/output or an increase in stroke volume due to that fluid or …
Continue reading IV Fluid Overload: Don’t Drown your Patients!
Your patient is in septic shock. They've gotten the correct source control, antibiotics, fluids, vasopressors. They remain hypotensive. Getting worse, actually. Could they have relative adrenal insufficiency or one of these fancy-termed conditions such as "critical illness-related corticosteroid insufficiency" (CIRCI)? Some clinicians insist on checking cortisol levels in patients who are in septic shock. Should …
Continue reading Cortisol Levels: Check prior to SDS in Septic Shock?
The VITAMINS trial looking at IV Vitamin C didn’t pan out was not a positive study as it was conducted. It was surprising as intravenous (IV) Vitamin C in sepsis should help decrease vasopressor dose and duration. My contention with that study is that they took too long to initiate the study drug. A median …
Continue reading IV Vitamin C in Sepsis: It Should Decrease Vasopressor Dose & Duration
You’re following along on my page bc you know I’m trying to find the most cutting-edge treatments and therapies for my critically ill patients. I hope to keep on pumping out eye catching content such as this article on melatonin for sepsis. Please share with you’re nerdy friends who would also find this nerdy content …
Continue reading Melatonin for Sepsis: The potential benefits to improve outcomes
You all know my bias. It shouldn't be a surprise given my body of work: I wanted the VITAMINS Trial to be a positive study. I wanted patients to benefit from this therapy and SURVIVE. I cannot understand the vitriol I have received in my direct messages when I shared my initial take on the …
Continue reading VITAMINS Trial: Timing was delayed to administer the “vitamins”
I don’t know about you all, but I’m constantly working on finding new ways to treat my septic shock patients who, based on the numbers from more extensive studies, have a mortality rate between 25-35%. I have used methylene blue occasionally for post-CPB vasoplegia, but would it work in septic shock? UPDATE: This page was …
I am constantly reading and educating myself in an attempt to gain whatever edge I possibly can for my patients. Their survival and quality of life is what I have personally dedicated my life to. Being someone who is following along on my journey, I can safely assume you're doing the same. I have become …
Continue reading Vitamin D Supplementation in Critically Ill ICU Patients