December 20, 2020

Background: Despite continued focus on equity in healthcare, it has yet to be realized in the United States. Healthcare can be considered a microcosm of society where resources are not allocated fairly among the population.  A recent editorial in the NEJM demonstrates that even equipment designed to give objective information can harbor important biases.  Pulse oximetry is a diagnostic tool that is ubiquitous in hospitals.  Triage and oxygen therapy administration decisions are made based on the readings from pulse oximetry. The development and validation of this tool was not performed in racially diverse populations but how this impacts the obtained information is unknown.

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.

August 3, 2020

 Background Information:

The care and management of patients with acute respiratory distress syndrome (ARDS) is complex and follows an inciting injury to the lungs. This constellation of symptoms is characterized by hypoxemia, diffuse lung inflammation, decreased lung compliance and noncardiogenic pulmonary edema typically seen as bilateral opacities on radiographical imaging.1  Slow progress has been made in developing effective ARDS treatments, among them are low tidal volumes which have been shown to improve mortality.2 Over time the development of guidelines such as the ARDSnet protocol have also helped provide a stepwise framework to treatment. However, there are a subset of patients who continue to remain hypoxic and refractory hypoxemia accounts for 10-15% of deaths in ARDS patients.3   The therapies typically implemented to correct refractory hypoxia include proning, inhaled pulmonary vasodilators, extracorporeal membranous oxygenation (ECMO), paralysis, recruitment maneuvers, unconventional ventilator modes and more.4–8 The following post and included infographics focus on the following therapies: Proning, Paralytics and (lung) Protection. It is important to note that regardless of the therapy, specializing care on an individual basis with a risk-benefit analysis is required to give patients the best possible chance at survival.

June 29, 2020

Background: In patients with acute respiratory distress syndrome (ARDS) the National Heart, Lung, and Blood Institute ARDS clinical trials network recommends a target partial pressure of arterial oxygen (Pao2) between 55 and 80 mmHg. Goals of arterial oxygenation are not based on robust experimental data and prior evidence has shown the feasibility of targeting a lower partial pressure of arterial oxygen in patients with ARDS. The authors of this trial, aptly named the study, LOCO2 (Liberal Oxygenation vs Conservative Oxygenation). They sought to determine whether a lower oxygen strategy was safe in patients with ARDS.

May 31, 2020

I am fortunate to work in a hospital system that is very forward thinking.  We have a phenomenal relationship with our intensivists, and I have been fortunate enough to have several discussions with them about how we are managing COVID-19 in our ICUs.  For full transparency, I don’t work up in the ICU, but had the opportunity to discuss what we are doing in our ICUs with one of our intensivists (ECMO, steroids, Remdesivir, etc...).  We are doing something different in San Antonio that I thought was worth discussing on this podcast that may be a feasible option for some institutions and some patients, but not all. If there is one thing this disease has taught me, that is one size does not fit all.
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