Pulmonology

Critical Care

Questions discussed in this category

Has your management of severe hyponatremia changed after a recent observational study described higher in-hospital mortality for sodium correction of <6 mEq/L compared to 6-10 mEq/L in the first 24 hours?

Seethapathy et al., NEJM

5 Answers available

How do you manage concurrent nonlife-threatening hemoptysis and acute pulmonary embolism?

Estimating blood loss from hemoptysis is not always reliable. The bleeding may be due to the PE itself. Is anticoagulation with any degree of hemoptys...

1 Answer available

Is there a role for repeat surveillance blood cultures in patients with prosthetic valve endocarditis without associated cardiac abscess after a 6 week course of antibiotic treatment without surgical intervention?

1 Answer available

In what clinical scenarios do you utilize post-cardiac arrest targeted temperature management (TTM)?

In the span between the HACA trial and the Targeted Temperature Management in Out-of-Hospital Cardiac Arrest study (Dankiewicz et al., PMID 34133859),...

1 Answer available

Do you routinely use 3% sodium chloride and desmopressin to correct hypovolemic hyponatremia in an asymptomatic patient with serum sodium of less than 120 mEq/L?

3 Answers available

In patients being evaluated for brain death, which abnormal movements are definitively known to still be consistent with brain death and which are possibly consistent with brain death but lack definitive evidence?

What are the sources for this and are they reliable by today’s standards? Numerous case series report various abnormal movements but how reliabl...

1 Answer available

Should checking a urinalysis with reflex to culture be part of the standard work up for fever in an ICU patient with a urinary catheter?

2 Answers available

Do you use absolute random cortisol levels or delta cortisol levels after ACTH stimulation to diagnose adrenal insufficiency in the critically ill?

2 Answers available

What patient factors, if any, would lead you to extubate a patient at high risk of extubation failure to AVAPS rather than BIPAP?

1 Answer available

What factors do you consider while selecting high risk patients for prophylactic NIV after planned extubation?

1 Answer available

Do you use steroids in the management of PJP pneumonia with severe hypoxia in HIV negative patients?

Data on the role of steroids in HIV negative patients with PJP has been conflicting.

1 Answer available

What blood pressure targets do you enforce in the first 24-48 hours in a patient who develops an intracranial hemorrhage after mechanical thrombectomy?

Blood pressure targets for ischemic stroke and intracerebral hemorrhage are described in several guidelines. However, in patients with acute stroke wh...

1 Answer available

What is your preferred mechanism for venting the left ventricle in patients on VA-ECMO?

2 Answers available

What would be your second pressor of choice if patients with LVOT obstruction remain persistently hypotensive on phenylephrine?

1 Answer available

Do you use FVIII levels to differentiate between DIC and coagulopathy of liver disease?

Common thought is that FVIII may be used for differentiating coagulopathy in liver disease (normal to increased, from reduced clearance of VWF/FVIII) ...

4 Answers available

Do you perform PEEP titration while patients are proned?

1 Answer available

Do you add fludrocortisone to hydrocortisone when starting stress dose steroids in a patient with septic shock?

Though there is data to support using both hydrocortisone and fludrocortisone, it seems to be used rarely in clinical practice. A review publishe...

1 Answer available

Does your approach to extubating obese patients differ from your approach in non-obese patients?

1 Answer available

Do you routinely use vasopressin in the management of RV failure leading to shock state in the absence of an obvious treatable cause such as infarction or PE?

2 Answers available

When attempting PEEP titration, how long do you wait after decrements or increments to assess for a change in driving pressure?

1 Answer available

Do you administer calcium to patients with K > 6.5 without EKG changes?

1 Answer available

What are best practices in management of severe acute infusion reaction from infliximab?

Patient became acutely flushed, developed severe and prolonged hypotension with brief loss of consciousness, dizziness, nausea, dry heaves and headach...

1 Answer available

When do you consider the use of corticosteroids in patients diagnosed with EVALI?

1 Answer available

What is your approach to volume resuscitation in patients with obvious septic shock but also with a component of suspected cardiogenic shock?

4 Answers available

Do you increase sedation or consider the use of neuromuscular blockade to prevent potential self-induced lung injury in patients with high respiratory drive?

2 Answers available

Do you attempt more aggressive PEEP titration to improve the P/F ratio prior to proceeding with proning in patients with ARDS and P/F <150?

1 Answer available

Do you discontinue proning due to a perceived lack of response to intervention in a patient with ARDS?

2 Answers available

What strategies do you employ to prevent post-intubation hypotension in a profoundly hypoxic patient given a paralytic for intubation?

1 Answer available

Do you use continuous or intermittent bronchodilator therapy in severe airway obstruction?

1 Answer available

Do you routinely start full dose anticoagulation in new onset atrial fibrillation in the ICU?

2 Answers available

Do you transfuse platelets prior to central line placement in patients with platelet counts less than 50,000?

1 Answer available

What is your approach to PEEP titration in the management of a morbidly obese patient with ARDS?

1 Answer available

Do you routinely use inhaled pulmonary vasodilators in the management of patients with ARDS with refractory hypoxemia?

1 Answer available

Do you start steroid therapy in a patient with pure ARDS without septic shock, or would you only consider steroids only in those with severe community acquired pneumonia?

To help interpret clinical applications of the CAPE COD (2023) and DEXA ARDS (2020) trials.

2 Answers available

What is your threshold to start stress dose steroids in the management of patients with septic shock?

Do you do start therapy at a certain vasopressor requirement?

2 Answers available

What is your perspective on the role of respiratory therapists in managing a patient who is dyssynchronous on their current mode of mechanical ventilation?

Do your respiratory therapists independently adjust ventilator settings without direct physician involvement?

2 Answers available

Do you use steroids in patients with respiratory failure who are infected with both influenza and COVID-19?

How do you approach which risk to accept given that steroids have evidence for use in COVID-19 while is suggestion for harm in using steroids in influ...

1 Answer available

How do you complete brain death testing in patients who cannot tolerate apnea testing and are unable to transport for ancillary testing?

For instance, if the patient doesn’t tolerate apnea testing, is too unstable to go for ancillary testing outside the ICU, and TCDs/EEG are unava...

5 Answers available

What steroid regimen do you employ prior to extubating a patient who does not have a suitable cuff leak?

2 Answers available

What steroid regimen do you use in patients with both septic shock and ARDS?

Do you use hydrocortisone 200 mg/day as studied in ADRENAL/APROCCHSS or dexamethasone 20 mg/day as studied in DEXA-ARDS?

2 Answers available

What are your preferred ventilatory settings/mode(s) for patients with acute hypoxic respiratory failure presenting with severe biventricular dysfunction in cardiogenic shock?

1 Answer available

How would you manage immune check point inhibitor induced capillary leak syndrome refractory to IVIG monotherapy?