background Today the Van de Bergh group in Belgium released a RCT investigating tight versus liberal glycemic control in the ICU. Before diving into this study, let’s take a walk down memory lane. Major interest in tight glycemic control in the ICU began in 2001 with an RCT by the same group of investigators, also […]

In many countries, pulmonary and critical care are commonly bundled together. Consequently, a single person will often be responsible for both inpatient ICU management as well as inpatient pulmonary consultation. Honestly, I have some doubts about whether this is an ideal system. As both pulmonology and critical care medicine become increasingly complex, it’s becoming impossible […]

My dear pulmonologists, I have some bad news.  Santa Claus isn’t real.  Neither is “ARDS.” “ARDS” has traditionally been conflated with a specific histopathological form of lung injury: diffuse alveolar damage (DAD).  Lectures, chapters, and articles typically juxtapose these two entities, promoting the concept that they’re one and the same. But they aren’t. The ability […]

The precise utilization of ABG, VBG, and pulse oximetry remains controversial. Unfortunately, there is little high-level evidence investigating whether these interventions affect patient outcomes (for example, there is precious little evidence to support most of the target values that we’re chasing after). This chapter attempts to explore the strengths, weaknesses, and indications for various techniques. […]

CAR-T cell therapy is rapidly expanding as a miraculous therapy for numerous malignancies.  However, it also causes a variety of unique and severe side-effects, which frequently cause ICU admission.  This chapter explores current approaches to complications including CRS (cytokine release syndrome), HLH (hemophagocytic lymphohistiocytosis), and ICANS (immune effector cell-associated neurotoxicity syndrome).  Updates will be needed […]

Recently, two sets of guidelines for neuroprognostication following cardiac arrest were released – almost simultaneously. In a perfect world, two evidence-based guidelines based on the same evidence would be the same.  But of course, this isn’t actually the case.  The guidelines differ significantly. The Neurocritical Care Society guidelines recommended this general approach:(36949360)  Meanwhile, the Canadian […]

(Blogitorials are short, informal blogs that are written in the spirit of a tweetorial).  Stress hyperglycemia is an everyday occurrence in the ICU, but we hardly know how to treat it. I’ve been waiting years for this topic to be clarified… but I’ve realized that such clarity will probably never be reached. Why? The traditional […]

Steroid is worthless for pneumonia! Wait, a new study shows it’s beneficial! Hang on, a fresh meta-analysis shows that steroid is useless! And wait, here’s a fresh NEJM study showing mortality benefit!! This feels like a roller coaster. What’s going on here? Several factors may explain this: Steroid is beneficial, but only in a subset […]

This is SIESTA syndrome.  The patient is locked in a cycle of unconsciousness, punctuated with brief episodes of agitation.  Most of the time the patient is sedated to the point of having minimal EEG activity, which may hinder their ability to regain consciousness.  

Historically, many patients admitted with congestion due to heart failure have been treated with furosemide monotherapy.  However, a strategy of furosemide monotherapy has numerous drawbacks:  Furosemide tends to stimulate production of dilute urine, leading to a greater amount of water loss than sodium loss.  Predominant loss of water may cause loss of volume from the […]

This chapter explores some general aspects of neurological infectious diseases, including important historical features and high-risk groups.  It also includes a more general discussion of lumbar puncture performance and interpretation. The IBCC chapter is located 👉 here. The podcast & comments are below. Follow us on iTunes

This chapter explores the approach to acute neuromuscular weakness in the ICU, as well as selected disorders.  As with any acute presentation, an organized approach is essential.  Understanding the limitations of various tests is also critical (since there is considerable confusion about this). The IBCC chapter is located 👉 here. The podcast & comments are […]

Management of the a patient following craniotomy focuses on the fundamentals of supportive neurocritical care.  However, special attention is required to unique postoperative complications that may occur (depending on the procedure). The IBCC chapter is located 👉 here. The podcast & comments are below. Follow us on iTunes

Imagine you’re in the ICU and the cuff of an ETT (endotracheal tube) ruptures.  You exchange it for a fresh ETT over a catheter, right?  Easy peasy.  Blind airway exchange over a catheter has been the standard practice in various ICUs that I’ve rotated through.  ETT exchange over a catheter is a simple and effective […]

We throw around the term “nonconvulsive status epilepticus” a lot, and generally think that we know what that is.  However, nonconvulsive status epilepticus is an enormously complex and heterogeneous diagnosis.  This chapter attempts to clarify matters based on the most recent definitions, but in some situations the diagnosis may remain murky. The IBCC chapter is […]