The DDAVP clamp technique has considerably simplified the management of severe hyponatremia.  The fundamentals of the technique are as follows: Before the use of the DDAVP clamp, the primary cause of sodium overcorrection was endogenous free water excretion by the kidneys. For example, patients would present to the hospital with retention of free water due […]

Acute ischemic stroke (AIS) is a common cause of admission to the neurological ICU, as well as a complication of critical illness that may occur among patients within any ICU.  The stroke neurology team will take the lead in managing these patients (including decisions regarding tPA and endovascular intervention).  This chapter focuses more on aspects […]

A billion years ago (or so it seems), the RECOVERY trial demonstrated mortality benefit from dexamethasone 6 mg/day for up to 10 days in hypoxemic COVID patients.  This rapidly became a standard treatment.  It’s a fundamental therapy that has saved lives.   Nonetheless, questions linger about the optimal steroid dose.  6 mg/day dexamethasone is equivalent […]

Quantitative waveform capnography is rapidly becoming a standard of care for any intubated patient.  Although this may appear simple, it provides a host of information about ventilation and cardiac output.  When further integrated with clinical context (such as trends in minute ventilation), there is a potential for fundamentally changing how we monitor our patients.  If […]

SCAPE (Sympathetic Crashing Acute Pulmonary Edema) is a specific form of severe heart failure which is seen predominantly in the emergency department and intensive care unit (as opposed to the outpatient cardiology clinic).  Consequently, there is a tendency to overlook SCAPE in articles and chapters about heart failure. SCAPE is critical to recognize and intervene […]

There probably isn’t much to say about ARDS that hasn’t been said in some form within the past couple years.  We’ve debated continually about the optimal approach to this syndrome, in the absence of much solid evidence (the only large, multi-center RCT which has been replicated in ARDS was ACURASYS – and it failed to […]

Here is a 10-minute video I made for the Cooper Critical Care Conference.  It explores some basic & useful concepts about hypoxemia physiology, including how to apply this at the bedside.  The algorithms in the video aren’t intended to be strictly followed, but rather merely as general conceptual schemas. related For more information about the […]

Right ventricular failure is extremely common among critically ill patients (e.g., affecting a quarter of patients with ARDS).  Unfortunately, this is often overlooked in critical care curricula.  We tend to spend lots of time focusing on pulmonary arterial hypertension (which is far more rare), thereby overlooking the everyday conundrum of right ventricular failure.  It’s called […]

Liberation from invasive ventilation is one of the most important goals of critical care medicine.  Numerous RCTs have improved our understanding of this process, but it remains as much an art as a science.  When in doubt, empirical trials of spontaneous breathing and extubation are more accurate than our predictive ability. The IBCC chapter is […]

The case: A ~65 year-old human presents to the ICU with a working diagnosis of vasopressor-dependent septic shock.  The patient was previously healthy with no significant medical problems or medications.  History is notable for mild nonspecific symptoms (chills, nausea, and a headache), with nothing in particular standing out.  Physical examination is unrevealing, with the patient […]

It’s very difficult to write a good chapter about respiratory alkalosis (hypocapnia) or respiratory acidosis (hypercapnia).  These states remind me a bit of grand central station, because each encompasses such a broad range of patients with different conditions – who need enormously different treatments.  So any discussion of these conditions is by definition a gross […]

Historically it was believed that allergic reactions could be mediated by the core structures. This would imply that a patient could be allergic to all penicillins, all cephalosporins, or even all beta-lactams. That would be hugely problematic, because a patient could simultaneously be allergic to dozens of antibiotics – greatly complicating their management.

Neuroprognostication following cardiac arrest is one of the most important responsibilities of the ICU team.  This process begins as soon as ROSC is achieved, with the avoidance of confounding factors (e.g., sedatives and opioids).  An organized, multimodal approach is essential.  Incidentally, strategies which are aimed at accurate neuroprognostication will also facilitate early awakening – and as […]

Subarachnoid hemorrhage remains a challenging disease, with ongoing controversy surrounding several key aspects (including the optimal diagnostic pathway and management of vasospasm). The IBCC chapter is located 👉 here. The podcast & comments are below. Follow us on iTunes

Traumatic brain injury is an extremely common problem, which is likely to be encountered in any type of intensive care unit.  Management is predominantly supportive, illustrating many principles of neurocritical care. The IBCC chapter is located 👉 here. The podcast & comments are below. Follow us on iTunes