October 29, 2020

Background: ICU discharge is often delayed due to intravenous vasopressor requirements to maintain clinically indicated blood pressure goals. In some patients without impairment of tissue oxygenation, the use of oral agents could facilitate weaning from IV vasopressors and lead to earlier ICU discharge. Midodrine is an oral alpha1 adrenergic agonist that may facilitate liberation from IV vasopressors. Evidence for this is mostly observational without randomized clinical trials (See PulmCrit).

October 18, 2020

The Novel Coronavirus 2019, was first reported on in Wuhan, China in late December 2019.  The outbreak was declared a public health emergency of international concern in January 2020 and on March 11th, 2020, the outbreak was declared a global pandemic.  The spread of this virus is now global with lots of media attention.  The virus has been named SARS-CoV-2 and the disease it causes has become known as coronavirus disease 2019 (COVID-19).  This new outbreak has been producing lots of hysteria and false truths being spread, however the data surrounding the biology, epidemiology, and clinical characteristics are growing daily, making this a moving target.  Below are two videos I created discussing 10 topics on COVID-19 (Both videos were recorded on Oct 13th, 2020).

October 12, 2020

Background: The only well-established treatments for sepsis and septic shock are antibiotic therapy and source control.  Septic shock, the most severe form of sepsis, is characterized by circulatory and cellular metabolism abnormalities.  There have been a host of randomized controlled trials evaluating the use of vitamin C, thiamine, and corticosteroids (i.e. metabolic cocktail) to help mitigate dysregulated host responses in the hopes of improving patient-oriented outcomes. Thus far none of the randomized trials have shown improvements in mortality and shown mixed results with shock reversal (see tables below).

October 10, 2020

From Oct 6th – 8th, 2020, Haney Mallemat (@CriticalCareNow) and his team put on an absolutely amazing online critical care conference called ResusX Rewired.  ResusX is a conference designed by resuscitationists to provide clinicians with the most up to date skills and knowledge to help make a difference in your patients' lives.  Haney and his crew made a combination of short-format, high-yield lectures, and completely customizable small group sessions with procedural demos seem easy.  There were so many high-quality speakers and pearls that I learned from this conference that I wanted to archive them here in one post for reference and to share with our readers/followers.

October 5, 2020

Background: The CRASH-2 trial, published in 2010, showed a survival benefit for patients with traumatic hemorrhage who received TXA compared to placebo.  TXA has become standard practice in many settings as a result of this data. However, patients with significant head injury were excluded in this study and, it was unclear of the effect of TXA in this group. In 2019, CRASH-3 examined the use of TXA in traumatic brain injury (TBI) and found the overall effect size of TXA on ICH was not statistically significant compared to placebo.  Subgroup analysis demonstrated that certain patients (<3hrs, GCS 9 – 15, and ICH on baseline CT) showed benefit with TXA. However, this data was hypothesis generating only: not the primary outcome of the trial and with wide confidence intervals.  Further data is clearly needed to elucidate the role of TXA in those with TBI.