I finally caught up with my 8-week backlog of @criticalcarereviews.com emails. I'm unsurprised to say that nothing has changed.
This is totally not a sub-tweet directed at the Andromeda-Shock-2-stans.
This definitely comes with experience and feeling comfortable interpreting the data by yourself.
I always skip the introduction and go straight into the methods, followed by the results, last paragraph of the discussion ± supplement.
Yes. If you're worried about a lung fungus, mica/eraxis ain't it.
People reach for it because it's easy (where as vori/isavu/ampho aren't easy), but it's not useful here.
And if you think you found candida because your BAL said so....no you didn't.
Completely unrelated to any institution I've been affiliated with and/or any current political events:
bsky.app/profile/jona...
What I value most about institutions of higher education is their moral compass, their natural inclination to speak truth to power, and how unflappable they are in the face of changing political winds.
Dexmedetomidine-associated fever happens WAY more often than this, particularly in cardiac surgery patients.
Such an easy way to trick yourself into an unnecessary infectious workup and antibiotic course.
The Hypotension-Prediction Index--a convoluted way of predicting hypotension by...checking whether the MAP is low--fails once again. Shocker.
"HPI-guided hemodynamic therapy did not reduce the incidence of postoperative AKI or overall complications [vs] standard care."
That is totally reasonable, and I don't mean to undermine that point. DL is a safe and effective technique.
I am just always surprised by the intensity of people's convictions on the topic. I am waiting to be convinced that the difference in clinical outcomes justifies such intensity.
I'm just here for the DL/VL drama.
(this is pretty classic confounding by indication)
open.substack.com/pub/sensible...
#EMIMCC #Cardiosky #Medsky
Merry Christmas to everyone except for the people being unnecessarily pedantic about hypoxia and hypoxemia.
1) If you're looking for an excuse to deescalate (i.e., procalcitonin), just deescalate
2) I really want to see us move away from magic numbers (5, 7, 10, 14, etc.) but not sure that fixating on a different magic number is the way to go
The primary outcome is ¯\_(ツ)_/¯.
I mostly see procal being used by people who already want to deescalate and are looking for an excuse to do so. If you're going to order the procal, just stop the antibiotics a day early.
If anything, the potentially increased mortality is more interesting.
“Professional ethics must guide us precisely when we are told that the situation is exceptional. Then there is no such thing as ‘just following orders.’”
~ Timothy Snyder
This is incredibly disturbing.
A patient presented in need of an urgent but relatively minor surgery. Vitally stable.
Surgery goes fine, but ICU is called because their “sat is too low to extubate.”
No prior pulmonary or cardiac conditions.
#emimcc
I'm just waiting for the day when we finally stop teaching people that pressors don’t work in acidotic patients.
I don’t have strong opinions about the result, but this study is grossly underpowered. I would not draw any definitive inferences from it.
Moving from weight based to non weight based was so painful. I'm still doing conversions in my head to get a good grasp on pressor requirements.
I add a couple of people every day but there are many more of you who work with critically ill patients. Drop a comment here and I'll add you! But check to see if you're already on it first 😁 go.bsky.app/NC7iD2K
This is great! Thank you for sharing this!
(Next day, the sodium actually went down)
Renal: "We must keep the correction rate below 12 mEq/day, but to avoid overcorrection/this is a high risk patient, we're going to recommend 8 mEq/day."
Primary team: "Wait—ODS is (really) bad, so we'll do 6 mEq/day."
Maybe this is will be the impetus for some high-quality prospective studies.
Spiciest opinion of the day! Can we still use negative binomial if we don't know how to spell poission though?
This is particularly pronounced when people build their professional identity around being experts in specific techniques, rather than in managing specific problems.
One of the most amusing things in medicine is seeing how people dismiss high-quality evidence when it challenges their preferred practices (e.g., robotic surgery, regional anesthesia, TAVRs, TTM, etc.).
This common belief isn't entirely accurate. In acute blood loss, fluid shifts happen quickly—hemoglobin decreases in < 30 minutes, even without IV fluids.
The levels won't reflect the magnitude of the blood loss, but someone who lost 40% TBV will not have a normal hemoglobin. https://t.co/59
Without exaggeration, the font change on PubMed Central by @NCBI is probably the worst thing to have ever happened to science in the history of science.
Here's your friendly reminder that Plasmalyte is NOT affected by the IV Fluid Shortage, just in case you needed another reason to switch.
