The MENDS2 trial was intended as a study comparing dexmedetomidine to propofol. However, the doses of these medications used in the study weren’t high enough to be impactful. In retrospect, the study may actually be an investigation of how clinicians approach the agitated intubated patient – potentially revealing an over-reliance on opioid infusions.
PulmCrit Wee – Follow-up Bamlanivimab study unmasks statistical chicanery
Whether or not you have any interest in bamlanivimab, you should read this post as an amusing example of shoddy statistics being published in top journals. background & general landscape of the two trials The BLAZE-1 trial involved randomizing patients within three days of testing positive for COVID-19 to one of four arms: placebo, 700 […]
IBCC – Revamped COVID chapter focusing on ICU & stepdown management
The COVID chapter has been updated, overhauled, and refocused on the management of the sickest COVID patients (those requiring admission to ICU or stepdown units). The new chapter removes more basic information about COVID that we’re all probably familiar with at this point (but the original, larger chapter is still available here). The goal of […]
IBCC chapter – Disseminated Intravascular Coagulation (DIC)
Disseminated Intravascular Coagulation (DIC) is like the ARDS of the hematological system. It’s not really one disorder, but rather a collection of different disorders with some shared features. The diagnosis and optimal treatment remain elusive. The IBCC chapter is located 👉 here. The podcast & comments are below. Follow us on iTunes
PulmCrit- RCTs don’t justify using convalescent plasma or antibody cocktails
Passive immunity refers to the infusion of antibodies (either polyclonal antibodies in the form of convalescent plasma, or engineered monoclonal antibodies). The goal is to neutralize viral particles, reduce viral replication, and thereby improve clinical outcomes. This is a promising theory, but it requires evidentiary support in the form of randomized controlled trials. So far, […]
PulmCrit – Six RCTs to answer one question: what is the role of tocilizumab in COVID-19?
The REMAP-CAP trial recently detected mortality benefit from tocilizumab in patients with COVID-19. However, several other RCTs have failed to find substantial benefit from tocilizumab. This begs the question: Has REMAP-CAP discovered a uniquely beneficial way to use tocilizumab, or is this simply a statistical outlier? evidence roundup: RCTs on tocilizumab Let’s review the trials. […]
IBCC – Purpura Fulminans
Purpura fulminans is a rare form of disseminated intravascular coagulation which requires specific management. Most commonly it is seen as a complication of septic shock with multi-organ failure. Unfortunately, purpura fulminans is often treated simply with a generic approach for septic shock. The IBCC chapter is located 👉 here. The podcast & comments are below. […]
PulmCrit – Baricitinib for COVID-19: The rise of the jakinibs
Background: JAK-inhibitors (jakinibs) in the greater context Much of the harm from infections is mediated by hyperactive inflammatory reactions. To date, most research has focused on two classes of medications to treat this: Corticosteroids have the advantage of being cheap, widely available, and often effective. The disadvantage is that corticosteroids modulate innumerable molecular pathways, thereby […]
PulmCrit – Dismantling the systemic racism of pulse oximetry
Oximetry is fundamental to critical care. Consequently, even small biases in pulse oximetry measurements could have real clinical impact (especially when leveraged across innumerable measurements among thousands of patients). Racial bias in pulse oximetry was the subject of two studies in 2005 and 2007. The topic was then largely ignored over the past 13 years. […]
PulmCrit – I’m upset about the RELAX trial
Some studies have reported a gradual upwards trend in the PEEP being used for intubated patients without ARDS (e.g., from 5 cm to 7 cm). Is this good or bad? That is the question which the RELAX trial embarked upon answering. It’s a complex question which probably doesn’t have a binary answer… but never mind – let’s get to the study.
IBCC chapter & cast – Massive Transfusion Protocol (MTP)
Massive Transfusion Protocols have attracted substantial attention over the past several years, so most folks will be familiar with the general concepts. This chapter reviews a variety of details which may be essential to the success of an MTP – yet can easily get lost in the chaos. The IBCC chapter is located 👉 here. […]
PulmCrit – Does Remdesivir reduce length of stay? SOLIDARITY vs. ACTT-1.
With the publication of the SOLIDARITY trial, there is increasing consensus that remdesivir doesn’t affect mortality. However, there continues to be debate about whether remdesivir affects hospital length of stay. Let’s dig into the data here to try to reconcile differences between ACTT-1 and SOLIDARITY. Did ACTT-1 actually show that remdesivir reduces the hospital length […]
PulmCrit – Want to help stop COVID? Be quiet.
The closed mouth catches no flies Benjamin Franklin, Poor Richard’s Almanac, 1742 We’re hopefully nearing the end of the COVID pandemic, with vaccines coming soon. Unfortunately, vaccines won’t be able to bail us out this winter. Neither will fancy designer pharmaceuticals. The main interventions necessary to keep us safe for now are basic public health […]
PulmCrit – I’m so confused about bamlanivimab
2020 has been a weird year by any standard. So, I shouldn’t be surprised that the bamlanivimab story is so weird. But still. Anyhow, if you’re ready to go down the rabbit hole, here we go… derivation and early testing The story begins with Eli Lilly designing a monoclonal anti-spike antibody to neutralize COVID-19. The […]
PulmCrit – Oscar awards for the best COVID prognostic models
We are continually tasked with triaging COVID patients, a situation which will become more complex as the numbers continue to rise. This involves making educated guesses about which patients are most likely to deteriorate, and which patients may benefit most from critical care. That’s enormously difficult. At this point, we’re quite familiar with individual risk […]
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