PulmCrit (EMCrit)

SUP-ICU is a massive, modern RCT of stress ulcer prophylaxis (SUP) in the ICU. With 3298 patients, it is larger than many meta-analyses of SUP. Its primary mortality endpoint is deeply flawed.  However, the study still provides a wealth of information about SUP in the ICU.

Management of severe pancreatitis has remained in a state of controlled chaos and persistent debate for years (mirroring evolution in our treatment of septic shock).  This confusion shows no signs of abating in the near future.  This chapter explores a reasonable approach to pancreatitis, with the caveat that there is very little evidence available to guide our combat against this challenging foe.  

Recent publications have explored the role of ketamine in alcohol withdrawal.  Ketamine undoubtedly has some outstanding properties, which make it well suited for  this task.  The challenge is integrating ketamine into a unified, coherent treatment strategy. 

Management of severe heart failure and cardiogenic shock is difficult.  There is a notable lack of high-quality evidence regarding the sickest patients.  Treatment strategies validated among more stable patients may not be applicable to the most unstable heart failure patients.   

Severe hypoglycemia can be scary, especially when the patient isn’t responding to front-line therapies (e.g. IV dextrose).  However, some unconventional tools and an organized approach can make this extremely manageable.