An intensivist on a learning frenzy. Caring for the critically ill using evidence-based medicine.
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
There's a pendulum in medicine. Some things are over recognized and aggressively treated, some things are under appreciated (like subtle decreases in serum bicarb showing that the patient is becoming more acidotic and no one notices because the patient has obesity hypoventilation syndrome and their baseline bicarb is 34 and now has a bicarb of …
Continue reading Lactic Acid has a WIDE Differential Diagnosis (not just Sepsis)
I need to eat my words on this one, because now there's data to show that there's a benefit to rechecking lactate levels in septic patients, but not for the reasons why one would think. During my rounds over the course of the weekend, I recall telling several nurses that there's no data to suggest …
Continue reading Lactic Acid is an Alarm, not a Treatment in Sepsis and Septic Shock
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
I've had very similar patients with very similar infections where one was out of the ICU in a short amount of time and the other died in flames. Many variables in play, of course, but you get my point. Could the gut microbiome hold a key regarding which patients do well and which patients don't …
Continue reading The gut microbiome alters immunophenotype and survival from sepsis