What’s optimal PEEP for your patients with an increased BMI? Our study showed a simple equation you can use: PEEP = BMI/3 There’s variability, but BMI/3 approximates the mean optimal PEEP (by esophageal manometry) from BMI 25 to > 40 #EMIMCC #medsky www.sciencedirect.com/science/arti...

Identifying optimal positive end-expiratory pressure by body mass index does not account for natural physiologic variability in pleural pressure

Mechanical ventilation and selecting optimal positive end-expiratory pressure (PEEP) in patients across a wide range of body mass indexes (BMI) is cha…

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What’s the best site for chest compressions? Probably mid-LV Guideline recommended location overlies the LV in the minority of cases TTE may be a good tool to better localize mid LV and thus optimal compression location (esp if TEE unavailable) #foamcc www.sciencedirect.com/science/arti...

Transthoracic Echocardiography is Superior to AHA Guidelines Location in Identifying the Left Ventricle for Chest Compressions

Standard CPR guidelines recommend chest compressions over the lower half of the sternum; however, this often results in compressions over the left ven…

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Can you allow a MAP of < 65 in your patients with septic shock? Yes! Maybe as low as MAP of 50 But you must examine to make sure they are perfused -capillary refill < 3 seconds, warm extremities without mottling -adequate urine output -clearing lactate #EMIMCC journals.lww.com/ccmjournal/a...

Individualized PEEP: Can you estimate optimal PEEP in any BMI with the simple equation of BMI/3? Maybe! Our new paper comparing esophageal pressure base transpulmonary pressure estimates of optimal PEEP (tPP of 0 +\-2) vs BMI/3 in OR patients www.sciencedirect.com/science/arti...

Identifying Optimal Positive End-Expiratory Pressure by Body Mass Index Does Not Account for Natural Physiologic Variability in Pleural Pressure

Mechanical ventilation and selecting optimal positive end-expiratory pressure (PEEP) in patients across a wide range of body mass indexes (BMI) is cha…

sciencedirect.com

How do you stop hydrocortisone once septic shock has resolved? I tend to be an abrupt discontinuation kind of person, stop as soon as the pressors are off rather than taper (unless it’s been a prolonged course) Restrospective evidence 👇 journals.lww.com/ccejournal/f...

Evaluation of Hydrocortisone Discontinuation Strategies in... : Critical Care Explorations

ility differ among patients with septic shock undergoing abrupt hydrocortisone discontinuation compared with gradual tapering. DESIGN, SETTING, AND PARTICIPANTS: A retrospective cohort study conduc...

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Which has a higher mortality? 1. Patient with EF 30% BP 80/56 with lactic acid 1.8, normal LFTs, and warm extremities OR 2. Patient with EF 30% BP 100/70 with lactic acid 3.8, elevated LFTs and cool distal extremities

Excited to share our updated review of ECMO for the emergency clinician! Grateful for my excellent co-authors who shared their extensive expertise & time: @skylerlentz.bsky.social, Cameron Upchurch, Jenelle Badulak, Brit Long, and @mgottliebmd.bsky.social authors.elsevier.com/a/1lFOI2dHVQ...

What in critical care medicine do you think makes the patient look better in the short term but is actually worse in the longer term? 25 yrs ago we might have said look my patient with ARDS and 12 ml/kg tidal volume is oxygenating better, so it must be superior to 6 ml/kg

Intensivists and Respiratory Therapists: 🫁 What’s your go to tidal volume for the patient without ARDS and why? 6 ml/kg PBW 8 ml/kg PBW 10 ml/kg PBW Something else?

What’s the highest IPAP you’ll use with NIV in a patient with COPD and respiratory failure? Before this trial I’d stop at ~ 20 cmH20, and think about intubating if not improving After this trial: Now up to 30 cmH20 may safely avoid intubation jamanetwork.com/journals/jam...

Effect of Noninvasive Positive Pressure Ventilation on the Need for Endotracheal Intubation in COPD

This randomized clinical trial compares the effect of high-intensity noninvasive positive pressure ventilation (NPPV) vs low-intensity NPPV on the need for endotracheal intubation in patients with an ...

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What’s the role of the osm gap in identifying toxic alcohol poisoning? The con: We say it’s limited and all about the history and clinical course www.sciencedirect.com/science/arti...

The Osmolal Gap Has a Limited Role in the Evaluation of Possible Toxic Alcohol Poisoning

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What’s the highest temperature you’ve seen in clinical practice and what was the cause?

🫀What happens when epinephrine is given before defibrillation in VT/VF arrest journals.lww.com/ccmjournal/a...

a fire with the words way to add fuel written below it

ALT: a fire with the words way to add fuel written below it

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Failed extubation? I like to think of it as an intubation vacation