PulmCrit (EMCrit)

Hypertriglyceridemia causes ~9% of pancreatitis, the third most common cause after alcohol and gallstones.  It is a risk factor for severe pancreatitis, making it more frequent among ICU patients with pancreatitis.  I see this a few times each year.  Nonetheless, it has low penetration into educational curricula or our collective awareness.The treatment of … [Read more...]

Introduction with a clinical conundrum A 66-year-old man is transferred from an outside hospital due to inability to be liberated from the ventilator.  He presented a week earlier with pneumonia and sepsis.  He received six liters of fluid initially, and has been running net positive 1-2 liters daily since then (for a total of about 15 liters net positive).  Despite receiving … [Read more...]

Introduction with a case An elderly woman is admitted with atrial fibrillation and fast ventricular rate.  She is asymptomatic, with a heart rate of 160 b/m.  She is treated with a 20 mg diltiazem bolus followed by an infusion at 15 mg/hour for several hours.  Her heart rate slows to 110 b/m.She is then treated with 5 mg IV metoprolol.  A few minutes later, her heart rate … [Read more...]

Early Goal-Directed Therapy:  A house collapsing in slow motion The original foundation of the Surviving Sepsis Campaign was the Rivers trial on early goal-directed therapy.  This is basically the NINDS trial of the critical care world:  a study with ~300 patients showing implausibly positive results, published in NEJM, and rapidly brainwashing an entire discipline.  The NINDS … [Read more...]

Foreword This post is about a research project I did as a pulmonary critical care fellow in 2011.  To understand it, you need to know a bit of the story behind it.I had some ideas for converting VBG values into ABG values.  To investigate further, I requested post-publication data from several researchers who had published studies comparing ABG vs. VBG data.  Many … [Read more...]