The use of steroids in patients with sepsis and septic shock has been controversial for decades. At present, the Surviving Sepsis Campaign recommends the administration of corticosteroids to patients with persistent shock despite fluid and vasopressor administration. In recent years, several trials have evaluated the addition of fludrocortisone, a potent mineralocorticoid, to hydrocortisone in septic shock.Â In this podcast, we review the latest study that evaluated the combination of hydrocortisone and fludrocortisone in patients with septic shock.Â Should we administer this medication with hydrocortisone for our patients with septic shock?
Should We Administer Steroids in Severe CAP?
In recent years,Â numerous trials have investigated the administration of corticosteroids in patients with pneumonia and have produced mixed results.Â In this podcast, we discuss the latest randomized trial, the CAPE COD trial, that evaluated whether the administration of hydrocortisone to ICU patients with severe CAP reduced mortality.Â Is this a therapy we should look to administer in the ED based on the results of this trial?Â Take a listen and find out…
ECPR for OHCA? – The INCEPTION Trial
In recent years, several single center trials have demonstrated positive outcomes in patients with OHCA randomized to receive ECPR compared with patients who received standard resuscitation.Â Â Not surprisingly, these single center studies have limitations that impact the generalizability of these results.Â Â In the current podcast, we discuss the recently published INCEPTION Trial, which is a multicenter, randomized trial that compared the effect of extracorporeal CPR with conventional CPR in patients with refractory OHCA due to a ventricular arrhythmia.
Should We Use a Liberal or Restrictive Fluid Strategy in Sepsis – The CLOVERS Trial
Intravenous fluid (IVF) administration is a central tenet to the resuscitation of patients with sepsis and sepsis-induced hypotension. At present, the administration of large volumes of IVF is common, though based on low quality of evidence. In this podcast, we review and interpret the recently published CLOVERS Trial, which compared the use of a liberal fluid strategy with a restrictive fluid strategy in patients with sepsis-induced hypotension.
Top Critical Care Articles of 2022
Given the increase in critically ill patients who present to the ED in need of resuscitation, along with the increase in those who board in the ED awaiting an ICU bed, it is imperative that the emergency physician be knowledgeable about recent literature in resuscitation and critical care medicine. In this podcast, we discuss important articles published in 2022 that pertain to care of critically ill ED patients.
Double Sequential External Defibrillation for Refractory Ventricular Fibrillation
More than 350,000 cardiac arrests occur each year in North America.Â Approximately 100,000 of these arrests are due to shockable rhythms.Â Unfortunately, many patients have refractory ventricular fibrillation and do not respond to many attempts at standard defibrillation.Â In this podcast, we discuss a recent study that evaluated double sequential external defibrillation and vector-change defibrillation compared to standard defibrillation in patients with refractory ventricular fibrillation in OHCA.
What is the Optimal SpO2 Target in Vented Patients?
Approximately 3 million critically ill patients are intubated and initiated on mechanical ventilation each year in the United States. A critical component of mechanical ventilation is the adjustment of FiO2 to maintain adequate arterial oxygen saturation.Â Â However, the optimal oxygenation target in critically ill adult patients receiving mechanical ventilation remains uncertain. In this podcast we discuss a recently published study, the PILOT Trial, that evaluated low, intermediate, and high oxygenation targets in critically ill patients.
Does the Timing of Source Control in Sepsis Make a Difference?
The emergency department resuscitation of patients with sepsis focuses on early recognition, timely administration of appropriate antibiotics, appropriate fluid resuscitation, early vasopressor initiation for patients with sepsis-induced hypoperfusion, and hemodynamic monitoring. Source control is also an important component in the resuscitation of patients with sepsis. Though current guidelines identify source control as a “best practice” the optimal timing of source control remains uncertain. In this podcast, we discuss a recent study that evaluated the timing of source control with mortality in patients with community-acquired sepsis.
Does a Restrictive Oxygenation Target Make a Difference in the Post-Arrest Patient?
The care of patients with return of spontaneous circulation following cardiac arrest centers on optimizing oxygenation and ventilation, optimizing hemodynamics, identifying patients that require immediate coronary angiography, detecting seizures, and targeted temperature management.Â Â In recent years, numerous articles have evaluated various components of this post-arrest bundle of care.Â Â In the current podcast, we discuss Part II of the BOX Trial that evaluated a restrictive versus liberal oxygenation target in the post-arrest patient.
Does a Higher MAP in the Post-Arrest Patient Make a Difference?
The care of patients with return of spontaneous circulation following cardiac arrest centers on optimizing oxygenation and ventilation, optimizing hemodynamics, identifying patients that require immediate coronary angiography, detecting seizures, and targeted temperature management.Â Â In recent years, numerous articles have evaluated various components of this post-arrest bundle of care.Â Â In the current podcast, we discuss Part I of the BOX Trial that evaluated mean arterial blood pressures in the post-arrest patient.