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)
This article is hot-off-the-press regarding vitamin C, thiamine and hydrocortisone in refractory septic shock. This regimen is known as HAT therapy in some corners of the world. It was actually published today, 5/5/20. It is NOT a randomized control trial but at least they went through the trouble of conducting a propensity matched, before-after, case …
Continue reading IV Vitamin C in Sepsis with Thiamine and Hydrocortisone
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 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”
