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...

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...

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...

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...

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...

Failed extubation?

I like to think of it as an intubation vacation