PulmCrit (EMCrit)

VAP is a perennial riddle in the intensive care unit.  There are numerous murky diagnostic tests, but no single gold-standard diagnostic test.  Consequently, we are usually left wondering whether or not the patient truly has a VAP.  This makes VAP an unsatisfying diagnosis, as we are continually walking a blurred line between undertreatment and overtreatment. […]

Sedation is one of the details of ICU care which seems unimportant…  until it’s not.  Over the past decade we’ve seen a burgeoning repertoire of agents used for sedation and agitated delirium.  Unfortunately, the number of medications has out-stripped available Level-I evidence regarding how exactly to use them.  This chapter attempts to create a framework […]

Lithium intoxication is a tricky issue, with a variety of different forms which may call for different therapies (acute, chronic, or acute-on-chronic intoxication).  To further complicate matters, the pathophysiology of lithium toxicity isn’t understood – particularly, how lithium levels might relate to chronic neurotoxicity (SILENT syndrome).  Finally, as is often the case in toxicology, there […]

Glycemic control in the ICU is a topic of perpetual controversy.  We’ve come full circle in the past 20 years – beginning with permissive hyperglycemia, then moving to tight control, and finally now moving back to permissive hyperglycemia.  The final answer remains unknown, but in the interim this chapter attempts to muddle through available evidence. […]

Wernicke encephalopathy is important because it’s surprisingly common, potentially debilitating, and fully treatable.  Some patients may present to the hospital due to Wernicke encephalopathy, while many others may develop this while in the ICU as an iatrogenic complication of criical care. The IBCC chapter is located 👉 here. The podcast & comments are below. Follow […]