The RECOVERY trial just released a preprint demonstrating benefit from tocilizumab in COVID-19. As with the prior RECOVERY studies, this is a multicenter, open-label, pragmatic trial. A robust mortality benefit was detected (the fragility index calculates to 17, which isn’t too shabby). Several important secondary endpoints were positive as well (e.g., reduced intubation rate, reduced […]
EMCrit 291 – For Frak’s Sake, Ketamine is at least as Hemodynamically Stable as Etomidate!
Ketamine IS AT LEAST as hemodynamically stable as ETOMIDATE!!!
IBCC chapter & cast – Atrial Fibrillation in critical illness
Most available data on atrial fibrillation pertains to chronic outpatient management or atrial fibrillation following cardiac surgery. This data may not apply perfectly to most critically ill patients. Extrapolation of available data to the management of critically ill patient is challenging, with much left to clinical judgement. The IBCC chapter is located 👉 here. The […]
PulmCrit Wee – MENDS2: Fentanyl or fentanyl for sedation in mechanically ventilated adults with sepsis
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 […]
EMCrit 290 – Decompensated Hypothyroidism and Myxedema with Dr. Arti Bhan
Thyroid storm’s boring brother is still a life threat–you need to know it!
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, […]
EMCrit 289 – Ketamine Only Intubation Paper with Brian Driver
A discussion of 3-recent NEAR database publications
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 […]
EMCrit 288 – Neurogenic Shock & Should we be Using Vasopressors for Hemorrhagic Shock?
Neurogenic Shock and Vasopressors for Hemorrhagic Shock
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. […]
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