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PulmCrit – The 65 trial: Is 60 the new 65?
The 65 trial compares MAP targets of >65 mm to >60 mm in treating vasodilatory hypotension. This trial challenges decades of protocols which have targeted a MAP >65 mm. As such, it is a courageous and practice-changing study. However, we need to be realistic about the study’s limitations. trial overview This multi-center RCT was […]
IBCC chapter & cast – Anaphylaxis
Anaphylaxis is a somewhat unique emergency, as one of the few conditions which can kill an otherwise healthy person within a matter of minutes. This is very treatable, so immediate and definitive management is paramount. To make matters worse, different patients will manifest with a variety of diverse presentations, so a high index of suspicion […]
PulmCrit – Steroid for ARDS? The DEXA-ARDS trial
A fresh trial shows considerable efficacy of dexamethasone in ARDS. This may come as a bit of a surprise, but it’s actually entirely consistent with prior evidence. To understand the study, we need to start with previous data… Part I: Background: The Rabbit hole of ARDS, pneumonia, and septic shock We often think about ARDS, […]
PulmCrit Wee: The Yale experience with hyperdiuresis
Hyperdiuresis involves combining hypertonic saline with a loop diuretic for management of diuretic-resistant volume overload. This may seem a bit counter-intuitive, but there are several reasons why it might work: Hypochloremia promotes sodium retention; this could be reversed with hypertonic saline. Hypertonic saline could osmotically pull fluid into the intravascular space, thereby promoting diuresis without […]
IBCC chapter & cast – Status epilepticus
Status epilepticus is one of the true neurologic emergencies, where minutes may actually count. Prompt and definitive treatment often yields excellent outcomes, whereas sluggish or inappropriate treatment can have severe consequences. Management has changed substantially over the past decade including a new definition of convulsive status epilepticus (>5 minutes of seizing, rather than >30 minutes) […]
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