Saving Lives Podcast: Critical Care w/eddyjoemd
By Eddy Joe Gutierrez, MD
In each episode, Dr. Gutierrez discusses the latest research and best practices in Intensive Care Medicine. He also shares his own insights and experiences as an Intensivist/Critical Care physician.
The podcast is designed for healthcare professionals who want to stay up-to-date with evidence-based medicine.
Saving Lives Podcast: Critical Care w/eddyjoemdDec 11, 2020
Advance Directives in the ICU: Challenges and Challenges
In this episode of The Saving Lives Podcast, we delve into the intricate subject of advance directives in the intensive care setting. Titled "Deciphering the Complex World of Advance Directives in ICU Care: Challenges and Solutions," the episode explores the historical background, implementation challenges, and the impact of advance directives on patient care within ICUs. Let's highlight the practical difficulties healthcare professionals face in honoring patients' wishes and the varied effectiveness of advance directives across different regions. This episode aims to shed light on the importance of advance directives in ensuring patient autonomy and improving the quality of end-of-life care in critical settings.
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Citation: Baumann SM, Kruse NJ, Kliem PSC, Amacher SA, Hunziker S, Dittrich TD, Renetseder F, Grzonka P, Sutter R. Translation of patients' advance directives in intensive care units: are we there yet? J Intensive Care. 2023 Nov 15;11(1):53. doi: 10.1186/s40560-023-00705-z. PMID: 37968692; PMCID: PMC10648602.
Mitraclip Complications to Watch Out For
In this episode of The Saving Lives Podcast, we explore the innovative MitraClip system, a less invasive treatment for mitral regurgitation. The discussion covers the device's evolution, its impact on patient outcomes, and the challenges and complications associated with its use.
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Citation: Schnitzler K, Hell M, Geyer M, Kreidel F, MĆ¼nzel T, von Bardeleben RS. Complications Following MitraClip Implantation. Curr Cardiol Rep. 2021 Aug 13;23(9):131. doi: 10.1007/s11886-021-01553-9. PMID: 34387748; PMCID: PMC8363549.
Rethinking Physical Restraints: Unveiling ICU Practices and Patient Care
In this episode of The Saving Lives Podcast, we delve into the compelling findings of a recent review on the adverse effects of physical restraint use in ICUs. We discuss the paradoxical nature of restraints, designed for patient safety but linked to significant complications, including skin injuries, delirium, PTSD, and more. Understanding the limitations of our current system, we explore how this research urges a shift towards more compassionate, patient-centered care and the critical need for alternative practices.
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Citation: Sebastian Berger, Pascale Grzonka, Simon A. Amacher, Sabina Hunziker, Anja I. Frei, Raoul Sutter, Adverse events related to physical restraint use in intensive care units: A review of the literature, Journal of Intensive Medicine, 2023,ISSN 2667-100X,
Hyperdynamic LV Function in Septic Patients: Does It Matter?
In this episode of The Saving Lives Podcast, we dive into a compelling study from the Annals of Intensive Care, exploring the prevalence and impact of hyperdynamic left ventricular systolic function in septic patients. Unpacking the findings, we discuss how this condition influences mortality rates and what it means for clinical practice in intensive care units.
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Citation: Sato R, Sanfilippo F, Hasegawa D, Prasitlumkum N, Duggal A, Dugar S. Prevalence and prognosis of hyperdynamic left ventricular systolic function in septic patients: a systematic review and meta-analysis. Ann Intensive Care. 2024 Feb 3;14(1):22. doi: 10.1186/s13613-024-01255-9. PMID: 38308701.
New 2024 Guidelines: Corticosteroids in Sepsis, ARDS, and CAP
This episode delves into the 2024 update on corticosteroid guidelines for critically ill patients with sepsis, ARDS, and community-acquired pneumonia. We break down the recommendations, evidence, and clinical implications of this crucial guidance for healthcare providers.
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Citation: Chaudhuri D, Nei AM, Rochwerg B, Balk RA, Asehnoune K, Cadena RS, Carcillo JA, Correa R, Drover K, Esper AM, Gershengorn HB, Hammond NE, Jayaprakash N, Menon K, Nazer L, Pitre T, Qasim ZA, Russell JA, Santos AP, Sarwal A, Spencer-Segal J, Tilouche N, Annane D, Pastores SM. Executive Summary: Guidelines on Use of Corticosteroids in Critically Ill Patients With Sepsis, Acute Respiratory Distress Syndrome, and Community-Acquired Pneumonia Focused Update 2024. Crit Care Med. 2024 Jan 19. doi: 10.1097/CCM.0000000000006171. Epub ahead of print. PMID: 38240490.
Exploring the Potential of Therapeutic Plasma Exchange in Sepsis
In this episode, we delve into the groundbreaking study "Influence of therapeutic plasma exchange treatment on short-term mortality of critically ill adult patients with sepsis-induced organ dysfunction." We explore how Therapeutic Plasma Exchange (TPE) could revolutionize the treatment of sepsis, a condition notoriously difficult to manage. The episode breaks down the study's methods, results, and significant implications for future clinical practice, highlighting the urgent need for further research in this promising area.
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Citation: Kuklin V, Sovershaev M, Bjerner J, Keith P, Scott LK, Thomas OMT, Szpirt W, Rock G, Stegmayr B. Influence of therapeutic plasma exchange treatment on short-term mortality of critically ill adult patients with sepsis-induced organ dysfunction: a systematic review and meta-analysis. Crit Care. 2024 Jan 4;28(1):12. doi: 10.1186/s13054-023-04795-x. PMID: 38178170; PMCID: PMC10768220.
Integrating Palliative Care in the ICU: Enhancing Quality of Life
In this episode of The Saving Lives Podcast, "Integrating Palliative Care in the ICU: Enhancing Quality of Life," host EddyJoe discusses the article 'Palliative Care in Intensive Care' from 'Intensive Care Medicine.' The episode examines how palliative care improves patient quality of life and reduces ICU stays, highlighting its role beyond end-of-life care. It emphasizes the need for training and changing perceptions among healthcare professionals. Essential for medical practitioners, this episode offers insights into incorporating palliative care into ICU practices for better patient outcomes.
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Citation: Neukirchen M, Metaxa V, Schaefer MS. Palliative care in intensive care. Intensive Care Med. 2023 Dec;49(12):1538-1540. doi: 10.1007/s00134-023-07260-z. Epub 2023 Nov 27. PMID: 38010381; PMCID: PMC10709230.
The Impact of Microcirculation Assessment in ICU Shock Patients: Insights from the DAMIS Trial
In this episode, we delve into the groundbreaking DAMIS trial, exploring the impact of sublingual microcirculation assessment on treatment decisions for ICU patients with shock. We discuss the methodology, findings, and implications of this extensive multicenter study, offering insights into how real-time microcirculatory data influences clinical outcomes in critical care. Join us for an in-depth analysis and expert opinions on this pivotal topic in intensive care medicine.
Show Notes: https://eddyjoemd.com/damis-trial-microcirculation/
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Citation: Bruno RR, Wollborn J, Fengler K, Flick M, Wunder C, AllgƤuer S, Thiele H, Schemmelmann M, Hornemann J, Moecke HME, Demirtas F, Palici L, Franz M, Saugel B, Kattan E, De Backer D, Bakker J, Hernandez G, Kelm M, Jung C. Direct assessment of microcirculation in shock: a randomized-controlled multicenter study. Intensive Care Med. 2023 Jun;49(6):645-655. doi: 10.1007/s00134-023-07098-5. Epub 2023 Jun 6. Erratum in: Intensive Care Med. 2023 Oct;49(10):1279. PMID: 37278760; PMCID: PMC10242221.
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Should We Go Searching for Asymptomatic Catheter-Related Thrombosis?
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Show Notes: eddyjoemd.com/asymptomatic-catheter-related-thrombosis/
Explore the often-overlooked issue of asymptomatic catheter-related thrombosis (CRT) in ICU patients on The Saving Lives Podcast. This episode delves into a revealing study published in the Annals of Intensive Care, uncovering the incidence, risk factors, and implications of asymptomatic CRT. Join us for a thought-provoking discussion that challenges traditional beliefs and sheds light on crucial aspects of catheter management in critical care.
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Citation: Abbruzzese C, Guzzardella A, Consonni D, Turconi G, Bonetti C, Brioni M, Panigada M, Grasselli G. Incidence of asymptomatic catheter-related thrombosis in intensive care unit patients: a prospective cohort study. Ann Intensive Care. 2023 Oct 19;13(1):106. doi: 10.1186/s13613-023-01206-w. PMID: 37858003; PMCID: PMC10587047. Link to Article
Haloperidol in ICU Delirium: Insights from the EuRIDICE Trial
This episode delves into the pivotal EuRIDICE randomized clinical trial published in Critical Care in 2023. This episode provides an in-depth analysis of the trial's findings on using haloperidol in managing delirium among critically ill adults in the ICU. We'll explore the implications of these results for clinicians and the broader healthcare community, discussing whether haloperidol truly impacts the duration of delirium and coma in ICU patients. This discussion is essential for medical professionals, from students to board-certified physicians, seeking to stay informed on the latest in critical care medicine. Tune in to gain valuable insights and broaden your understanding of ICU delirium management.
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I'm Writing a Book!
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Direct (DL) vs Video Laryngoscopy (VL) for Intubation? DEVICE Trial
In this podcast I break down the DEVICE trial looking at using video laryngoscopy (VL) or direct laryngoscopy (DL) for intubation. Show Notes: https://eddyjoemd.com/vl-dl-intubation/ This Video was Editing Using Descript: https://www.descript.com?lmref=BGOxjQ
TrueLearn Link:Ā ā ā ā https://truelearn.referralrock.com/l/EDDYJOEMD25/ā ā ā Ā Discount code:Ā EDDYJOEMD25 Citation: Prekker ME, Driver BE, Trent SA, Resnick-Ault D, Seitz KP, Russell DW, Gaillard JP, Latimer AJ, Ghamande SA, Gibbs KW, Vonderhaar DJ, Whitson MR, Barnes CR, Walco JP, Douglas IS, Krishnamoorthy V, Dagan A, Bastman JJ, Lloyd BD, Gandotra S, Goranson JK, Mitchell SH, White HD, Palakshappa JA, Espinera A, Page DB, Joffe A, Hansen SJ, Hughes CG, George T, Herbert JT, Shapiro NI, Schauer SG, Long BJ, Imhoff B, Wang L, Rhoads JP, Womack KN, Janz DR, Self WH, Rice TW, Ginde AA, Casey JD, Semler MW; DEVICE Investigators and the Pragmatic Critical Care Research Group. Video versus Direct Laryngoscopy for Tracheal Intubation of Critically Ill Adults. N Engl J Med. 2023 Jun 16. doi: 10.1056/NEJMoa2301601. Epub ahead of print. PMID: 37326325.
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Aortic Pulsatility Index (API): Optimizing Cardiogenic Shock Management
First of all, I apologize for the bad audio. This episode was lost until my buddy Haney Mallemat (@criticalcarenow) saved it.
Aortic pulsatility index (API) is a hemodynamic measurement being studied to predict clinical outcomes in heart failure & cardiogenic shock.
Show Notes: https://eddyjoemd.com/aortic-pulsatility-index/
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IV Thiamine: Can it Help Critically Ill Septic Shock Patients?
IV Thiamine may be helpful to improve the outcomes of critically ill (ICU) patients who have sepsis or septic shock.
Show Notes: https://eddyjoemd.com/iv-thiamine
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Hydrocortisone for Severe Community-Acquired Pneumonia (CAP)
Show Notes: https://eddyjoemd.com/hydrocortisone-cap/
In this episode of the podcast, I discuss a new study that found that hydrocortisone can save lives in patients with severe community-acquired pneumonia (CAP). I discuss the findings and what they mean for the treatment of CAP. In addition I also discuss the risks and benefits of using hydrocortisone, and who should be considered for treatment.
CAP is a common and potentially life-threatening infection of the lungs. It is caused by bacteria that are inhaled into the lungs, and it can affect people of all ages. The most common symptoms of CAP are fever, cough, shortness of breath, and chest pain. In severe cases, CAP can lead to pneumonia, sepsis, and death.
The study that we discuss in this episode was a randomized controlled trial that looked at the effect of hydrocortisone on mortality in patients with severe CAP. The study found that patients who received hydrocortisone were less likely to die than those who did not receive hydrocortisone. This finding is significant because it suggests that hydrocortisone may be a life-saving treatment for patients with severe CAP.
We hope that you find this episode of the podcast informative and helpful. If you have any questions or comments, please feel free to contact me.
Citation:
Dequin PF, Meziani F, Quenot JP, Kamel T, Ricard JD, Badie J, Reignier J, Heming N, PlantefĆØve G, Souweine B, Voiriot G, Colin G, Frat JP, Mira JP, Barbarot N, FranƧois B, Louis G, Gibot S, Guitton C, Giacardi C, Hraiech S, Vimeux S, L'Her E, Faure H, Herbrecht JE, Bouisse C, Joret A, Terzi N, Gacouin A, Quentin C, Jourdain M, Leclerc M, Coffre C, Bourgoin H, LengellĆ© C, Caille-FĆ©nĆ©rol C, Giraudeau B, Le Gouge A; CRICS-TriGGERSep Network. Hydrocortisone in Severe Community-Acquired Pneumonia. N Engl J Med. 2023 Mar 21. doi: 10.1056/NEJMoa2215145. Epub ahead of print. PMID: 36942789.
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Methylene Blue for Septic Shock?
Show Notes: https://eddyjoemd.com/methylene-blue-septic-shock/ Link to Lactic Acid Post: https://eddyjoemd.com/lactic-acid-sepsis/
In this episode, we discuss the use of methylene blue as a potential treatment for septic shock. We explore the science behind how methylene blue can help improve circulation and reduce inflammation in patients experiencing septic shock, and share a new study that was recently published in Critical Care. We break down the study and address common concerns and misconceptions about the use of methylene blue in this context, and discuss how we need additional research regarding its effectiveness and safety. If you're interested in learning more about cutting-edge treatments for sepsis and other critical illnesses, this episode is not to be missed.
Citation:
Ibarra-Estrada M, Kattan E, Aguilera-GonzĆ”lez P, Sandoval-Plascencia L, Rico-Jauregui U, GĆ³mez-Partida CA, Ortiz-MacĆas IX, LĆ³pez-PulgarĆn JA, ChĆ”vez-PeƱa Q, Mijangos-MĆ©ndez JC, Aguirre-Avalos G, HernĆ”ndez G. Early adjunctive methylene blue in patients with septic shock: a randomized controlled trial. Crit Care. 2023 Mar 13;27(1):110. doi: 10.1186/s13054-023-04397-7. PMID: 36915146; PMCID: PMC10010212.
Although great care has been taken to ensure that the information in this podcast are accurate, eddyjoe, LLC shall not be held responsible or in any way liable for the continued accuracy of the information, or for any errors, omissions or inaccuracies, or for any consequences arising therefrom.
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Vitamin B12 for Septic Shock?
In this episode, Dr. Eddy Joe explores the crucial role of Vitamin B12, hydroxocobalamin, can be potentially used in septic shock. He discusses the indications using evidence based medicine of how hydroxocobalamin can potentially be helpful in septic shock and how Vitamin B12 can help in treating this life-threatening condition. This informative and engaging episode is a must-listen for anyone interested in understanding the connection between vitamin B12 and septic shock.
Show Notes: https://eddyjoemd.com/b12-septic-shock/
Citation:
Patel JJ, Willoughby R, Peterson J, Carver T, Zelten J, Markiewicz A, Spiegelhoff K, Hipp LA, Canales B, Szabo A, Heyland DK, Stoppe C, Zielonka J, Freed JK. High-Dose IV Hydroxocobalamin (Vitamin B12) in Septic Shock: A Double-Blind, Allocation-Concealed, Placebo-Controlled Single-Center Pilot Randomized Controlled Trial (The Intravenous Hydroxocobalamin in Septic Shock Trial). Chest. 2023 Feb;163(2):303-312. doi: 10.1016/j.chest.2022.09.021. Epub 2022 Sep 26. PMID: 36174744.
Although great care has been taken to ensure that the information in this podcast are accurate, eddyjoe, LLC shall not be held responsible or in any way liable for the continued accuracy of the information, or for any errors, omissions or inaccuracies, or for any consequences arising therefrom. Ā Ā
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Appreciating Our Nurses: The Role of the ICU Physician
Show Notes: eddyjoemd.com/appreciating-nurses/
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Citation: Vincent JL, Boulanger C, van Mol MMC, Hawryluck L, Azoulay E. Ten areas for ICU clinicians to be aware of to help retain nurses in the ICU. Crit Care. 2022 Oct 13;26(1):310. doi: 10.1186/s13054-022-04182-y. PMID: 36229859.
Although great care has been taken to ensure that the information in this podcast are accurate, eddyjoe, LLC shall not be held responsible or in any way liable for the continued accuracy of the information, or for any errors, omissions or inaccuracies, or for any consequences arising therefrom. Ā Ā
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More Fluids vs. Vasopressors During the First 24 Hours of Septic Shock (CLOVERS Trial)
Show Notes: eddyjoemd.com/clovers/
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Citation:
National Heart, Lung, and Blood Institute Prevention and Early Treatment of Acute Lung Injury Clinical Trials Network; Shapiro NI, Douglas IS, Brower RG, Brown SM, Exline MC, Ginde AA, Gong MN, Grissom CK, Hayden D, Hough CL, Huang W, Iwashyna TJ, Jones AE, Khan A, Lai P, Liu KD, Miller CD, Oldmixon K, Park PK, Rice TW, Ringwood N, Semler MW, Steingrub JS, Talmor D, Thompson BT, Yealy DM, Self WH. Early Restrictive or Liberal Fluid Management for Sepsis-Induced Hypotension. N Engl J Med. 2023 Jan 21. doi: 10.1056/NEJMoa2212663. Epub ahead of print. PMID: 36688507.
Goodbye, 2022. Hello, 2023!
Show Notes: eddyjoemd.com/hello-2023/
Cardiogenic Shock: Part 3
Evaluation of patients with Cardiogenic Shock. Why do we need a swan, introduction to CPO, PAPi and survival rates in these critically ill patients
Show Notes: https://eddyjoemd.com/cardiogenic-shock-mcs/
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Cardiogenic Shock: Part 2
Evaluation of patients with Cardiogenic Shock. Part two of who knows how many episodes I will create on this topic. In this episode I discuss the stages and prognosis based on the staging.
Show Notes: https://eddyjoemd.com/cardiogenic-shock-mcs/
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Cardiogenic Shock: Part 1
Evaluation of patients with Cardiogenic Shock. Part one of who knows how many episodes I will create on this topic. Definition, Clinical Manifestations, Phenotypes and an Introduction to Management Strategies
Show Notes: https://eddyjoemd.com/cardiogenic-shock-mcs/
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Acute Pancreatitis Resuscitation: No Need to Overdo It
How should we provide IV fluids to patient with acute pancreatitis? Let's look at a recent paper in the NEJM that helps with rate & duration. In this episode, we discuss the resuscitation of acute pancreatitis and why it's important not to overdo it. Acute pancreatitis is a common condition that can be associated with significant morbidity and mortality. Fluid resuscitation is a key component of the management of these patients, but recent evidence suggests that excessive fluid administration may actually do more harm than good. We review the latest NEJM paper and evidence on fluid resuscitation in acute pancreatitis. Whether you're a seasoned critical care clinician or just starting out, this episode will provide valuable insights into the resuscitation of acute pancreatitis.
Show Notes: http://eddyjoemd.com/fluids-pancreatitis/
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Citation:
de-Madaria E, Buxbaum JL, Maisonneuve P, GarcĆa GarcĆa de Paredes A, Zapater P, Guilabert L, Vaillo-Rocamora A, RodrĆguez-GandĆa MĆ, Donate-Ortega J, Lozada-HernĆ”ndez EE, Collazo Moreno AJR, Lira-Aguilar A, Llovet LP, Mehta R, Tandel R, Navarro P, SĆ”nchez-Pardo AM, SĆ”nchez-Marin C, Cobreros M, FernĆ”ndez-Cabrera I, Casals-Seoane F, Casas Deza D, Lauret-BraƱa E, MartĆ-MarquĆ©s E, Camacho-MontaƱo LM, Ubieto V, Ganuza M, Bolado F; ERICA Consortium. Aggressive or Moderate Fluid Resuscitation in Acute Pancreatitis. N Engl J Med. 2022 Sep 15;387(11):989-1000. doi: 10.1056/NEJMoa2202884. PMID: 36103415.
Milrinone vs. Dobutamine in Cardiogenic Shock: Which is Better?
Should we use milrinone or dobutamine in patients in cardiogenic shock? NEJM published data providing us with the answer.
In this episode, we explore the topic of cardiogenic shock and the use of two common medications, milrinone and dobutamine, in treating it. We examine the mechanisms of action, potential side effects, and clinical outcomes associated with each drug to determine which may be the better option for patients. Join us as we delve into this complex and important topic in critical care medicine.
Show Notes: https://eddyjoemd.com/milrinone-dobutamine/
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Citation: Mathew R, Di Santo P, Jung RG, Marbach JA, Hutson J, Simard T, Ramirez FD, Harnett DT, Merdad A, Almufleh A, Weng W, Abdel-Razek O, Fernando SM, Kyeremanteng K, Bernick J, Wells GA, Chan V, Froeschl M, Labinaz M, Le May MR, Russo JJ, Hibbert B. Milrinone as Compared with Dobutamine in the Treatment of Cardiogenic Shock. N Engl J Med. 2021 Aug 5;385(6):516-525. doi: 10.1056/NEJMoa2026845. PMID: 34347952.
Do Cardiogenic Shock Patients Need a Swan-Ganz/Pulmonary Artery Catheter?
Do Cardiogenic Shock Pts Need a Swan-Ganz/Pulmonary Artery Catheter? Let's look at the data. Let's also look at the devices such as pulse-contour analysis and bioreactance to see if they could replace the PA catheter in the management of cardiogenic shock.
Show Notes: https://eddyjoemd.com/cardiogenic-shock-swan/
Mechanical Circulatory Support Notes: https://eddyjoemd.com/cardiogenic-shock-mcs/
Pulmonary Artery Pulsatility Index (PAPi)
Pulmonary Artery Pulsatility Index (PAPi) is a hemodynamic parameter with prognostic value in pts w/right heart failure & cardiogenic shock.
Show Notes: https://eddyjoemd.com/papi/
Citations:
Lim HS, Gustafsson F. Pulmonary artery pulsatility index: physiological basis and clinical application. Eur J Heart Fail. 2020 Jan;22(1):32-38. doi: 10.1002/ejhf.1679. Epub 2019 Nov 28. PMID: 31782244.
Å kulec R, Parizek T, Stadlerova B, Bilska M, Cerny V. Subcostal TAPSE measured by anatomical M-mode: prospective reliability clinical study in critically ill patients. Minerva Anestesiol. 2021 Nov;87(11):1200-1208. doi: 10.23736/S0375-9393.21.15464-1. Epub 2021 May 13. PMID: 33982987.
Modin D, MĆøgelvang R, Andersen DM, Biering-SĆørensen T. Right Ventricular Function Evaluated by Tricuspid Annular PlaneĀ Systolic Excursion Predicts Cardiovascular Death in the GeneralĀ Population. J Am Heart Assoc. 2019 May 21;8(10):e012197. doi: 10.1161/JAHA.119.012197. PMID: 31088196; PMCID: PMC6585329.
Korabathina R, Heffernan KS, Paruchuri V, Patel AR, Mudd JO, Prutkin JM, Orr NM, Weintraub A, Kimmelstiel CD, Kapur NK. The pulmonary artery pulsatility index identifies severe right ventricular dysfunction in acute inferior myocardial infarction. Catheter Cardiovasc Interv. 2012 Oct 1;80(4):593-600. doi: 10.1002/ccd.23309. Epub 2012 Jan 10. PMID: 21954053.
Morine KJ, Kiernan MS, Pham DT, Paruchuri V, Denofrio D, Kapur NK. Pulmonary Artery Pulsatility Index Is Associated With Right Ventricular Failure After Left Ventricular Assist Device Surgery. J Card Fail. 2016 Feb;22(2):110-6. doi: 10.1016/j.cardfail.2015.10.019. Epub 2015 Nov 10. PMID: 26564619.
Kang G, Ha R, Banerjee D. Pulmonary artery pulsatility index predicts right ventricular failure after left ventricular assist device implantation. J Heart Lung Transplant. 2016 Jan;35(1):67-73. doi: 10.1016/j.healun.2015.06.009. Epub 2015 Jun 17. Erratum in: J Heart Lung Transplant. 2017 Nov;36(11):1272. PMID: 26212656.
Kapur NK, Esposito ML, Bader Y, Morine KJ, Kiernan MS, Pham DT, Burkhoff D. Mechanical Circulatory Support Devices for Acute Right Ventricular Failure. Circulation. 2017 Jul 18;136(3):314-326. doi: 10.1161/CIRCULATIONAHA.116.025290. PMID: 28716832.
Bicarb in Diabetic Ketoacidosis (DKA): Should You Change Your Practice?
Should we provide our DKA patients with sodium bicarbonate (bicarb) pushes or drips to improve their pH? Let's look at the data.
In this episode, we dive into the controversial topic of using bicarbonate in the management of diabetic ketoacidosis (DKA). Is it beneficial or harmful? We review the current evidence and guidelines to help you make informed decisions on whether to incorporate bicarb into your DKA protocol. Join us as we explore the potential benefits and risks of bicarbonate use, the impact on patient outcomes, and the implications for clinical practice.
Show Notes: https://eddyjoemd.com/bicarb-dka/
Trust the MAP on the Patient Monitor. Not the SBP nor DBP on Patients with a BP Cuff
When you're taking one of those automated blood pressure measurements on an oscillometric device, you should trust the MAP.
Show Notes: https://eddyjoemd.com/oscillometric-map/
High-Flow Nasal Oxygen: Clinical Guidelines by the European Respiratory Society
The European Respiratory Society has provided 8 conditional recommendations for the use of nasal high flow/high flow nasal cannula/high flow oxygen/whatever you want to call it. Here, I review the 8 recommendations and add some commentary on them.Ā
Show Notes: https://eddyjoemd.com/high-flow/
Citation:
Oczkowski S, Ergan B, Bos L, Chatwin M, Ferrer M, Gregoretti C, Heunks L, Frat JP, Longhini F, Nava S, Navalesi P, Ozsancak UÄurlu A, Pisani L, Renda T, Thille AW, Winck JC, Windisch W, Tonia T, Boyd J, Sotgiu G, Scala R. ERS clinical practice guidelines: high-flow nasal cannula in acute respiratory failure. Eur Respir J. 2022 Apr 14;59(4):2101574. doi: 10.1183/13993003.01574-2021. PMID: 34649974.
Intermittent Fasting: Debunked?
Is intermittent fasting (time-restricted-eating) with a calorie restriction better than just a calorie restriction?Ā
Show Notes: https://eddyjoemd.com/intermittent-fasting/
Citation:
Liu D, Huang Y, Huang C, Yang S, Wei X, Zhang P, Guo D, Lin J, Xu B, Li C, He H, He J, Liu S, Shi L, Xue Y, Zhang H. Calorie Restriction with or without Time-Restricted Eating in Weight Loss. N Engl J Med. 2022 Apr 21;386(16):1495-1504. doi: 10.1056/NEJMoa2114833. PMID: 35443107.
Aspirin in COVID-19: Has It Made a Comeback?
Aspirin has been thoroughly studied for patients with COVID-19. This study is a positive trial suggesting benefits to using it. But should we? Let's interpret the data given recent advancements.Ā
Show Notes: https://eddyjoemd.com/aspirin-covid/
Although great care has been taken to ensure that the information in this podcast are accurate, eddyjoe, LLC shall not be held responsible or in any way liable for the continued accuracy of the information, or for any errors, omissions or inaccuracies, or for any consequences arising therefrom.
Citation:
Hawkins K, Jackson AM, Quintana MT, Lankford AS, Keneally RJ, Al-Mashat M, Fisher D, Williams J, Berger JS, Mazzeffi MA, Crandall KA; N3C Consortium and ANCHOR Investigators. Association of Early Aspirin Use With In-Hospital Mortality in Patients With Moderate COVID-19. JAMA Netw Open. 2022 Mar 1;5(3):e223890. doi: 10.1001/jamanetworkopen.2022.3890. PMID: 35323950; PMCID: PMC8948531.
High Flow Nasal Oxygen or NIV in the Immunocompromised?
In patients who are immunocompromised, we must determine whether using high flow oxygen (HFNC/NHF/HFO) or NIV would better serve our patients
Show Notes: https://eddyjoemd.com/high-flow-immunocompromised/
Although great care has been taken to ensure that the information in this podcast are accurate, eddyjoe, LLC shall not be held responsible or in any way liable for the continued accuracy of the information, or for any errors, omissions or inaccuracies, or for any consequences arising therefrom.
Citation:
Bourenne J, Girault C, Vinsonneau C, Dellamonica J, Labro G, Jochmans S, Herbland A, Quenot JP, Devaquet J, Benzekri D, Vivier E, Nseir S, Colin G, Thevenin D, Grasselli G, Bougon D, Assefi M, GuƩrin C, Lherm T, Kouatchet A, Ragot S, Thille AW; FLORALI-IM study group and the REVA Research Network. High-flow nasal oxygen alone or alternating with non-invasive ventilation in critically ill immunocompromised patients with acute respiratory failure: a randomised controlled trial. Lancet Respir Med. 2022 Mar 21:S2213-2600(22)00096-0. doi: 10.1016/S2213-2600(22)00096-0. Epub ahead of print. PMID: 35325620.
tPA for Critically Ill ICU Patients with COVID-19: Does Alteplase Help?
Should we be considering tPA (alteplase) as a last-ditch effort to try to improve oxygenation in our COVID-19 patients?
Show Notes: https://eddyjoemd.com/tpa-covid/
Although great care has been taken to ensure that the information in this podcast are accurate, eddyjoe, LLC shall not be held responsible or in any way liable for the continued accuracy of the information, or for any errors, omissions or inaccuracies, or for any consequences arising therefrom.
Citation:
Barrett CD, Moore HB, Moore EE, Wang J, Hajizadeh N, Biffl WL, Lottenberg L, Patel PR, Truitt MS, McIntyre RC Jr, Bull TM, Ammons LA, Ghasabyan A, Chandler J, Douglas IS, Schmidt EP, Moore PK, Wright FL, Ramdeo R, Borrego R, Rueda M, Dhupa A, McCaul DS, Dandan T, Sarkar PK, Khan B, Sreevidya C, McDaniel C, Grossman Verner HM, Pearcy C, Anez-Bustillos L, Baedorf-Kassis EN, Jhunjhunwala R, Shaefi S, Capers K, Banner-Goodspeed V, Talmor DS, Sauaia A, Yaffe MB. Study of Alteplase for Respiratory Failure in SARS-CoV-2 COVID-19: A Vanguard Multicenter, Rapidly Adaptive, Pragmatic, Randomized Controlled Trial. Chest. 2022 Mar;161(3):710-727. doi: 10.1016/j.chest.2021.09.024. Epub 2021 Sep 27. PMID: 34592318; PMCID: PMC8474873.
Rapid Shallow Breathing Index (RSBI): Does it Predict A Successful Extubation?
Should we use rapid shallow breathing index (RSBI) in isolation or in conjunction with other parameters to predict extubation success?
In this episode, we discuss the use of Rapid Shallow Breathing Index (RSBI) as a predictor of successful extubation in critically ill patients. We review the significance of the RSBI, and the factors that affect its accuracy. We also explore the evidence behind the use of RSBI in clinical practice and its limitations. Join us as we dive into this topic and examine how RSBI can be used in the management of mechanically ventilated patients.
Show Notes: https://eddyjoemd.com/rsbi/
GoodRx Link: https://goodrx.onelink.me/1153955910/x52sjptq
Although great care has been taken to ensure that the information in this podcast are accurate, eddyjoe, LLC shall not be held responsible or in any way liable for the continued accuracy of the information, or for any errors, omissions or inaccuracies, or for any consequences arising therefrom.
Citations:
Trivedi V, Chaudhuri D, Jinah R, Piticaru J, Agarwal A, Liu K, McArthur E, Sklar MC, Friedrich JO, Rochwerg B, Burns KEA. The Usefulness of the Rapid Shallow Breathing Index in Predicting Successful Extubation: A Systematic Review and Meta-analysis. Chest. 2022 Jan;161(1):97-111. doi: 10.1016/j.chest.2021.06.030. Epub 2021 Jun 26. PMID: 34181953.
Ouellette DR. The Decision to Liberate From the Ventilator: More Than Just a Number. Chest. 2022 Jan;161(1):6-7. doi: 10.1016/j.chest.2021.07.016. PMID: 35000708.
VTE Prophylaxis or Full Anticoagulation in COVID: Visiting the Guidelines
Reviewing the data and guidelines to provide anticoagulation or VTE prophylaxis to our patients with COVID-19.
Show Notes: https://eddyjoemd.com/anticoagulation-covid/
Although great care has been taken to ensure that the information in this podcast are accurate, eddyjoe, LLC shall not be held responsible or in any way liable for the continued accuracy of the information, or for any errors, omissions or inaccuracies, or for any consequences arising therefrom.
Website: www.eddyjoemd.com
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Podcast: https://anchor.fm/eddyjoemd
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Citation: Moores LK, Tritschler T, Brosnahan S, Carrier M, Collen JF, Doerschug K, Holley AB, Iaccarino J, Jimenez D, LeGal G, Rali P, Wells P, Thromboprophylaxis in Patients with COVID-19. A Brief Update to the CHEST Guideline and Expert Panel Report,Ā CHESTĀ (2022), doi:https://doi.org/10.1016/j.chest.2022.02.006.
When to Perform a Tracheostomy on a COVID-19 Patient
Show Notes: https://eddyjoemd.com/expectations/
Although great care has been taken to ensure that the information in this podcast are accurate, eddyjoe, LLC shall not be held responsible or in any way liable for the continued accuracy of the information, or for any errors, omissions or inaccuracies, or for any consequences arising therefrom.
Website: www.eddyjoemd.com
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Citation: Ji Y, Fang Y, Cheng B, Li L, Fang X. Tracheostomy timing and clinical outcomes in ventilated COVID-19 patients: a systematic review and meta-analysis. Crit Care. 2022 Feb 8;26(1):40. doi: 10.1186/s13054-022-03904-6. PMID: 35135597; PMCID: PMC8822732.
Why Do We Order Two Sets of Blood Cultures?
Are you annoyed when the clinician orders two sets of blood cultures for your patient? Let's look at why you have to do two and 20ml's. In this episode, we explore the reasons behind ordering two sets of blood cultures when a patient presents with a suspected infection. We discuss the importance of obtaining accurate and reliable results, how the two sets of cultures increase the chances of identifying the causative agent, and why it is essential to obtain the cultures before administering antibiotics. We also touch upon the risks of false positives and false negatives and how they can impact patient care. Join us as we delve into the rationale behind one of the most commonly ordered diagnostic tests in healthcare.
Show Notes: https://eddyjoemd.com/blood-cultures/
Although great care has been taken to ensure that the information in this podcast are accurate, eddyjoe, LLC shall not be held responsible or in any way liable for the continued accuracy of the information, or for any errors, omissions or inaccuracies, or for any consequences arising therefrom.
Website: www.eddyjoemd.com
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Podcast: https://anchor.fm/eddyjoemd
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Lactate/Lactic Acid: Why Do We Check It and Why Do We Trend it?
In this podcast I cover lactate levels (aka lactic acid levels) sorting out the original data as to why we check it on every patient with sepsis or septic shock upon arrival to the ED, how it is associated with mortality, and how trending it could provide insight to the prognosis of our patients. In this episode, we explore the importance of lactate/lactic acid levels in critically ill patients. Why do we check lactate levels? What do they tell us about a patient's clinical status? How do we interpret trends in lactate levels over time? We'll discuss the physiology behind lactate production, its role in sepsis and shock, and how it can help guide our resuscitation efforts. Join us as we dive into the world of lactate and its crucial role in critical care.
Show Notes: https://eddyjoemd.com/lactic-acid-sepsis/
Although great care has been taken to ensure that the information in this podcast are accurate, eddyjoe, LLC shall not be held responsible or in any way liable for the continued accuracy of the information, or for any errors, omissions or inaccuracies, or for any consequences arising therefrom.
Website: www.eddyjoemd.com
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Podcast: https://anchor.fm/eddyjoemd
My Amazon store for resources you may find helpful: www.amazon.com/shop/eddyjoemd
Citations:
Spiegel R, Gordon D, Marik PE. The origins of the Lacto-Bolo reflex: the mythology of lactate in sepsis. J Thorac Dis. 2020 Feb;12(Suppl 1):S48-S53. doi: 10.21037/jtd.2019.11.48. PMID: 32148925; PMCID: PMC7024759.
Mikkelsen ME, Miltiades AN, Gaieski DF, Goyal M, Fuchs BD, Shah CV, Bellamy SL, Christie JD. Serum lactate is associated with mortality in severe sepsis independent of organ failure and shock. Crit Care Med. 2009 May;37(5):1670-7. doi: 10.1097/CCM.0b013e31819fcf68. PMID: 19325467.
Nguyen HB, Rivers EP, Knoblich BP, Jacobsen G, Muzzin A, Ressler JA, Tomlanovich MC. Early lactate clearance is associated with improved outcome in severe sepsis and septic shock. Crit Care Med. 2004 Aug;32(8):1637-42. doi: 10.1097/01.ccm.0000132904.35713.a7. PMID: 15286537.
The Data on Natural Immunity and Mandates
Are the vaccine mandates that are seen around the world today evidence based? Based on these data, it appears that they are not.Ā
Show Notes: https://eddyjoemd.com/vaccine-mandate/
Although great care has been taken to ensure that the information in this podcast are accurate, eddyjoe, LLC shall not be held responsible or in any way liable for the continued accuracy of the information, or for any errors, omissions or inaccuracies, or for any consequences arising therefrom.
Website: www.eddyjoemd.com
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The Heart and COVID-19 Are Not BFF's
Reviewing a recently published article on Cardiac Injury in COVID-19 that was published in the Intensive Care Medicine Journal by Julie Helms, Alain Combes and Nadia Aissaoui.Ā
Show Notes: https://eddyjoemd.com/foamed
Although great care has been taken to ensure that the information in this podcast are accurate, eddyjoe, LLC shall not be held responsible or in any way liable for the continued accuracy of the information, or for any errors, omissions or inaccuracies, or for any consequences arising therefrom.
Website: www.eddyjoemd.com
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Citation: Helms J, Combes A, Aissaoui N. Cardiac injury in COVID-19. Intensive Care Med. 2022 Jan;48(1):111-113. doi: 10.1007/s00134-021-06555-3. Epub 2021 Nov 2. PMID: 34727214; PMCID: PMC8562019.
How to Stay Up To Date with the Critical Care Literature
Many people often ask me how I stay up to date with the most recent literature in Critical Care Medicine. This podcast will hopefully explain this.
Show Notes: https://eddyjoemd.com/up-to-date-critical-care/
Although great care has been taken to ensure that the information in this podcast are accurate, eddyjoe, LLC shall not be held responsible or in any way liable for the continued accuracy of the information, or for any errors, omissions or inaccuracies, or for any consequences arising therefrom.
Website: www.eddyjoemd.com
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Podcast: https://anchor.fm/eddyjoemd
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Plasma-lyte vs. Saline (0.9% NaCl) in the Critical Ill: Reviewing the PLUS Trial
The PLUS Trial compared plasma-lyte to 0.9% NaCl (aka normal saline) in patients who were critically ill and needed IV fluids. In this episode, we review the PLUS trial that compared Plasma-lyte to Saline (0.9% NaCl) in critically ill patients. We discuss the rationale behind the trial, its design, and the key findings. We also delve into the implications of the study results and explore how this evidence could impact clinical practice. Additionally, we touch on the broader debate surrounding the use of crystalloid solutions in critical care and discuss the limitations of the study. Whether you are a clinician or a student, this episode will provide you with a deeper understanding of the current evidence-based practices regarding the use of fluids in critically ill patients.
Show Notes: https://eddyjoemd.com/plus-trial/
Although great care has been taken to ensure that the information in this podcast are accurate, eddyjoe, LLC shall not be held responsible or in any way liable for the continued accuracy of the information, or for any errors, omissions or inaccuracies, or for any consequences arising therefrom.
Website: www.eddyjoemd.com
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Citation: Finfer S, Micallef S, Hammond N, Navarra L, Bellomo R, Billot L, Delaney A, Gallagher M, Gattas D, Li Q, Mackle D, Mysore J, Saxena M, Taylor C, Young P, Myburgh J; PLUS Study Investigators and the Australian and New Zealand Intensive Care Society Clinical Trials Group. Balanced Multielectrolyte Solution versus Saline in Critically Ill Adults. N Engl J Med. 2022 Jan 18. doi: 10.1056/NEJMoa2114464. Epub ahead of print. PMID: 35041780.
Vasopressin & Methylprednisolone: Time to Add Them to ACLS Protocols?
A new study is showing that we should add vasopressin and methylprednisolone to our ACLS protocols as it helps patients achieve ROSC faster. Should they be standard of care? In this episode, we discuss the use of vasopressin and methylprednisolone in cardiac arrest and their potential benefits. We explore the studies that have examined the use of these medications in ACLS protocols and their mechanisms of action. We also review the controversies surrounding their use, including the lack of strong evidence and potential adverse effects. Join us as we weigh the pros and cons of incorporating these drugs into our resuscitation strategies.
Show Notes: https://eddyjoemd.com/vasopressin-methylprednisolone/
Although great care has been taken to ensure that the information in this podcast are accurate, eddyjoe, LLC shall not be held responsible or in any way liable for the continued accuracy of the information, or for any errors, omissions or inaccuracies, or for any consequences arising therefrom.
Website: www.eddyjoemd.com
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Podcast: https://anchor.fm/eddyjoemd
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Citations:
Andersen LW, Isbye D, KjƦrgaard J, Kristensen CM, Darling S, Zwisler ST, Fisker S, Schmidt JC, Kirkegaard H, Grejs AM, Rossau JRG, Larsen JM, Rasmussen BS, Riddersholm S, Iversen K, Schultz M, Nielsen JL, LĆøfgren B, Lauridsen KG, SĆølling C, PƦlestik K, KjƦrgaard AG, Due-Rasmussen D, Folke F, Charlot MG, Jepsen RMHG, Wiberg S, Donnino M, Kurth T, HĆøybye M, Sindberg B, Holmberg MJ, Granfeldt A. Effect of Vasopressin and Methylprednisolone vs Placebo on Return of Spontaneous Circulation in Patients With In-Hospital Cardiac Arrest: A Randomized Clinical Trial. JAMA. 2021 Oct 26;326(16):1586-1594. doi: 10.1001/jama.2021.16628. PMID: 34587236; PMCID: PMC8482303. Ā
Haukoos J, Douglas IS, Sasson C. Vasopressin and Steroids as Adjunctive Treatment for In-Hospital Cardiac Arrest. JAMA. 2021 Oct 26;326(16):1583-1585. doi: 10.1001/jama.2021.15460. Erratum in: JAMA. 2021 Nov 9;326(18):1874. PMID: 34587235. Ā
Holmberg MJ, Granfeldt A, Mentzelopoulos SD, Andersen LW. Vasopressin and glucocorticoids for in-hospital cardiac arrest: A systematic review and meta-analysis of individual participant data. Resuscitation. 2022 Jan 3;171:48-56. doi: 10.1016/j.resuscitation.2021.12.030. Epub ahead of print. PMID: 34990764.
Atorvastatin for ICU COVID Patients: Not Ready for Prime Time (Journal Club-ish)
Could atorvastatin (lipitor) help improve outcomes in our COVID patients who are in the ICU? Let's review the evidence from this trial.
Show Notes: https://eddyjoemd.com/atorvastatin-covid/
Although great care has been taken to ensure that the information in this podcast are accurate, eddyjoe, LLC shall not be held responsible or in any way liable for the continued accuracy of the information, or for any errors, omissions or inaccuracies, or for any consequences arising therefrom.
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Citation: MJ. 2022 Jan 7;376:e068407. doi: 10.1136/bmj-2021-068407. PMID: 34996756.
Changing ECMO Criteria: Do Days on Vent Prior to Cannulation Matter?
Traditionally, we do not cannulate patients for VV-ECMO if they've been on invasive mechanical ventilation for more than 7 days. These new data say we should allow for a bit more grace.Ā
Show Notes: https://eddyjoemd.com/ecmo/
Although great care has been taken to ensure that the information in this podcast are accurate, eddyjoe, LLC shall not be held responsible or in any way liable for the continued accuracy of the information, or for any errors, omissions or inaccuracies, or for any consequences arising therefrom.
Website: www.eddyjoemd.com
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Citation: Hermann M, Laxar D, Krall C, Hafner C, Herzog O, Kimberger O, Koenig S, Kraft F, Maleczek M, Markstaller K, Robak O, Rƶssler B, Schaden E, Schellongowski P, Schneeweiss-Gleixner M, Staudinger T, Ullrich R, Wiegele M, Willschke H, Zauner C, Hermann A. Duration of invasive mechanical ventilation prior to extracorporeal membrane oxygenation is not associated with survival in acute respiratory distress syndrome caused by coronavirus disease 2019. Ann Intensive Care. 2022 Jan 13;12(1):6. doi: 10.1186/s13613-022-00980-3. PMID: 35024972; PMCID: PMC8755897.
2022 Resolutions: A Fresh-ish Start
The following are my resolutions for the year 2022 with regards to my educational and social media endeavors to bring you all the best.
Show Notes: https://eddyjoemd.com/2022-resolutions/
Although great care has been taken to ensure that the information in this podcast are accurate, eddyjoe, LLC shall not be held responsible or in any way liable for the continued accuracy of the information, or for any errors, omissions or inaccuracies, or for any consequences arising therefrom.
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Obesity in Critical Illness & COVID-19: A Very Bad Combination
Obesity is a risk factor for COVID that we are not hearing enough about. It is a modifiable risk factor that should be addressed.
Show Notes: https://eddyjoemd.com/obesity-covid/
Although great care has been taken to ensure that the information in this podcast are accurate, eddyjoe, LLC shall not be held responsible or in any way liable for the continued accuracy of the information, or for any errors, omissions or inaccuracies, or for any consequences arising therefrom.
Anderson MR, Shashaty MGS. Impact of Obesity in Critical Illness. Chest. 2021 Aug 5;160(6):2135ā45. doi: 10.1016/j.chest.2021.08.001. Epub ahead of print. PMID: 34364868; PMCID: PMC8340548.
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Bicarbonate for Respiratory Acidosis: Not So Fast
When a patient has an acidosis which is respiratory in nature, the right answer should not include using sodium bicarbonate. In this podcast episode, we explore the use of bicarbonate for the treatment of respiratory acidosis. While it is a commonly used therapy, recent studies have suggested that it may not be as effective as previously thought. We discuss the physiology of respiratory acidosis, the rationale for using bicarbonate, and the potential drawbacks and complications associated with its use. We also review the latest evidence and guidelines regarding bicarbonate therapy and offer practical tips for clinicians when managing patients with respiratory acidosis. Tune in to learn more about this important topic and how to optimize your treatment approach.
Show Notes: https://eddyjoemd.com/bicarbonate-respiratory-acidosis/
Although great care has been taken to ensure that the information in this podcast are accurate, eddyjoe, LLC shall not be held responsible or in any way liable for the continued accuracy of the information, or for any errors, omissions or inaccuracies, or for any consequences arising therefrom.
Website: www.eddyjoemd.com Instagram: www.instagram.com/eddyjoemd Twitter: www.twitter.com/eddyjoemd Facebook: www.facebook.com/eddyjoemd Podcast: https://anchor.fm/eddyjoemd My Amazon store for resources you may find helpful: www.amazon.com/shop/eddyjoemd
Fluid Bolus: Pressure Bag vs. 999ml/hr on the IV Pump in Resuscitation
Patient is hypotensive and in need of a fluid bolus resuscitation. Do you place the fluids in a pressure bag or IV Pump?
Show Notes: https://eddyjoemd.com/fluid-bolus/
Although great care has been taken to ensure that the information in this podcast are accurate, eddyjoe, LLC shall not be held responsible or in any way liable for the continued accuracy of the information, or for any errors, omissions or inaccuracies, or for any consequences arising therefrom.
Website: www.eddyjoemd.com
Instagram: www.instagram.com/eddyjoemd
Twitter: www.twitter.com/eddyjoemd
Facebook: www.facebook.com/eddyjoemd
Podcast: https://anchor.fm/eddyjoemd
My Amazon store for resources you may find helpful: www.amazon.com/shop/eddyjoemd