PulmCrit (EMCrit)

Over the past year, the five papers below were published regarding the use of phenobarbital in alcohol withdrawal. These studies aren’t massive, glittering multicenter RCTs (and, realistically, it’s dubious whether such a study will happen). However, these papers bring some unique and interesting perspectives to the table. This post will summarize them briefly – a bit like a sampler flight of beers (figure above).

Biliary infection is a fairly common cause of septic shock (especially ascending cholangitis).  Evidence isn’t terrific regarding exactly when and how interventions should be done to obtain source control (particularly among cholecystitis).  This chapter attempts to reach some clarity on the topic but honestly, it remains a bit murky.  

Clostridioides (previously clostridium) difficile is an inescapable problem within the critical care arena.  This may arise as a nosocomial complication, in which case it is usually diagnosed early and treated successfully.  It may also be the primary cause of admission to the ICU, in which case it is generally more severe.  

background There has long been debate about exactly how to design a spontaneous breathing trial.  If the trial is made too easy, then patients would be extubated before being ready (leading to re-intubation).  Alternatively, if the trial is too hard, that would prolong mechanical ventilation beyond the point of being beneficial.  The figure above shows […]

Based on this polling data, 42% of you will hate this chapter.  It’s a good thing I’m not running for president. Seriously though, fluid selection remains controversial.  This chapter presents an approach which makes sense physiologically and is supported by a substantial amount of animal and human data.