PulmCrit (EMCrit)

The Surviving Sepsis Campaign is a blight on modern, evidence-based medicine.​1​  It’s been clear for some years that its fundamentals were flawed (centering around rapid, large-volume fluid resuscitation).  Rather than adapt guidelines to modern evidence, the campaign recently doubled down on immediate administration of fluid and antibiotics within one hour.  This provoked widespread protest, including […]

Hypocalcemia in the ICU is one of the more confusing electrolyte abnormalities, because it’s frankly unclear exactly what to do with it.  Most patients in ICU are hypocalcemic, but there is little evidence that trying to “replete” hypocalcemia back to euboxia is beneficial (or even feasible).  Of course, there are some patients who have severe […]

We are constantly hunting for newer and better sources of information.  This leads to a perpetual generation of newer lab tests, different hemodynamic gizmos, and fresh decision tools.  Some of these pan out.  Most don’t. Why are these new sources of information generally disappointing?  The answer is simple:  we’re already doing pretty well.  In order […]

The diagnosis of toxic alcohols is a particularly controversial topic, based on recent evidence that the osmolal gap has a fairly awful sensitivity and specificity.  This chapter describes an approach to toxic alcohol diagnosis which doesn’t depend on the osmolal gap.  Although this may seem radical, this strategy has been previously recommended by other authors […]

The PEPTIC multi-center RCT compared histamine-2 receptor blockers (H2RBs) versus proton pump inhibitors (PPIs) for stress ulcer prophylaxis among ventilated ICU patients.​1​  It’s a landmark trial of unprecedented size and statistical power.  PEPTIC was presented at the Critical Care Reviews meeting in Ireland and live-cast around the world (available here).  This presentation and the editorials […]