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)
Midodrine (brand name Proamatine), is an alpha-1 adrenergic agonist that is orally administered. It is used in both in the outpatient setting as well as inpatient setting to restore vascular tone and increase blood pressure. One of the benefits of this medication in the Intensive Care Unit (ICU) is that we can administer it to …
This is a question that is often asked. Do we give fluids until the patient no longer "responds to fluids" or start vasopressors early? Should we start early vasopressors in septic shock or wait until fluids resuscitation is complete?Here's my bias: I dislike arbitrarily pounding patients with fluids. It causes harm. We know this. I …
This is what I love about the community in social media. We all just push each other to be better. Rishi posted today about titratable Vasopressin and, me being the data junky that I am wanting to know every study I could possibly know under the sun, had two studies in my back pocket ready …
Continue reading Vasopressin: Titratable Doses? Monotherapy in Septic shock?