PulmCrit (EMCrit)

Several years ago a mentor suggested that I write a book.  I nearly laughed at her.  A book??  Inconceivable!  Who would buy it?  Would they actually read it?  Would it be there at 3 AM when they needed it?  How could it be updated?  A physical book didn’t seem compatible with the breakneck speed of critical care or our internet-based culture.

Meta-analyses are widely assumed to be robust, without any attempt to test their fragility. This post describes two techniques to evaluate the fragility of a meta-analysis

Historically, emphasis has rested on the distinction between noninvasive versus invasive BP (e.g., cuff pressure vs. radial arterial pressure).  Attention focused on whether noninvasive oscillometric BP monitoring is adequate. Meanwhile, it has been assumed that all invasive BP measurement sites are created equal.

Circadian rhythms and melatonin are best known for their relationship to sleep.  However, they have a much broader range of functions.  Circadian rhythms cause many organs to enter a resting state at night (e.g. heart rate decreases, cortisol levels increase).  

Metabolic resuscitation for sepsis is currently quite controversial.  Marik et al. published a before-after study in 2017 describing the combination of hydrocortisone, ascorbate, and thiamine for septic shock. That study incited a media storm of surprising intensity.  Currently, several multi-center RCTs are underway to answer this question more definitively.  In the interim, some additional before/after trials may emerge.  These studies likely won’t answer the question, but they may provide us with some clues about whether metabolic resuscitation is on the right track.