PulmCrit (EMCrit)

Skillful use of BiPAP and high-flow nasal cannula (HFNC) can avoid intubation and improve outcomes.  However, there isn't comprehensive evidence about the nitty-gritty details of these techniques.  In this post I will use my opinions to fill some gaps in the evidence (1).  Noninvasive respiratory support remains more of an art than a science, perhaps a dark art at … [Read more...]

Escalation-deescalation There are roughly two strategies for adjusting the intensity of treatment:Titrated strategy: Treatment intensity is adjusted to match the severity of the disease. Escalation-deescalation strategy: Treatment intensity is increased rapidly to exceed disease severity and gain control of the disease.  After the patient improves, treatment … [Read more...]

Introduction with a case A young woman presented to Genius General Hospital with a week of malaise and progressive shortness of breath.  She was found to have diffuse pulmonary infiltrates due to Hantavirus infection.  In the ICU she was treated with high-flow nasal cannula, but eventually she tired out and required intubation.  Prior to intubation, she was saturating 87% on … [Read more...]

Upon first reading the ATHOS-3 trial, I was pleasantly optimistic.  Who wouldn't be interested in a shiny new vasopressor?  The trial didn't prove much, but it was intriguing.  However, it was alarming to hear that the FDA has approved angiotensin II based on it.  Precious little evidence is available about this drug.  With angiotensin II arriving at hospitals soon, some … [Read more...]

Introduction with two cases Case #1 The first case of steroid use for refractory hypoglycemia at Genius General occurred several years ago.  A patient developed numerous episodes of hypoglycemia requiring large volumes of IV dextrose.  In efforts to avoid recurrent hypoglycemia, 125 mg IV methylprednisolone was given.  Hypoglycemia resolved immediately, but the patient … [Read more...]