Anesthesia and Critical Care Reviews and Commentary
In this 119th episode I welcome Dr. Robert Sawyer to the show. Dr. Sawyer was the PI on the STOP-IT trial comparing a short course of antibiotics versus a longer course for complicated intraabdominal infections. We discuss the trial, the outcomes, and what the future of antimicrobial management in the surgical ICU may look like.
Reference:
STOP-IT Trial: https://www.nejm.org/doi/full/10.1056/NEJMoa1411162
In this 106th episode I welcome Dr. Marius Fassbinder to the show to discuss the use of hydroxyethyl starches.
References:
1. Woodcock, T. E. & Woodcock, T. M. Revised Starling equation and the glycocalyx model of transvascular fluid exchange: an
improved paradigm for prescribing intravenous fluid therapy. British Journal of Anaesthesia 108, 384–394 (2012).
2. Westphal, M. et al. Hydroxyethyl starches: different products–different effects. Anesthesiology 111, 187–202 (2009).
3. Brunkhorst, F. M. et al. Intensive insulin therapy and pentastarch resuscitation in severe sepsis. N. Engl. J. Med. 358, 125–139
(2008).
4. Perner, A. et al. Hydroxyethyl Starch 130/0.42 versus Ringer’s Acetate in Severe Sepsis. N. Engl. J. Med. 367, 124–134 (2012).
6. Myburgh, J. A. et al. Hydroxyethyl Starch or Saline for Fluid Resuscitation in Intensive Care. N. Engl. J. Med. 367, 1901–1911
(2012).
7. Annane, D. et al. Effects of fluid resuscitation with colloids vs crystalloids on mortality in critically ill patients presenting with
hypovolemic shock: the CRISTAL randomized trial. JAMA 310, 1809–1817 (2013).
8. Joosten, A. et al. Crystalloid versus Colloid for Intraoperative Goal-directed Fluid Therapy Using a Closed-loop System: A
Randomized, Double-blinded, Controlled Trial in Major Abdominal Surgery. Anesthesiology 128, 55–66 (2018).
9. Gillies, M. A. et al. Incidence of postoperative death and acute kidney injury associated with 6% hydroxyethyl starch use: systematic review and meta-analysis. British Journal of Anaesthesia 112, 25–34 (2014).
In this 105th episode, which will be the first part in a series on blood management, I turn over the mic to Dr. Stephanie Cha who interviews Dr. Steve Frank about blood management in cardiac surgery and how to do “bloodless” surgery for patients who refuse blood transfusions.
References:
In this 104th episode I welcome Dr. Pam Lipsett to the show to discuss the diagnosis and treatment of sepsis.
References:
Sepsis-3 guidelines from JAMA: https://jamanetwork.com/journals/jama/fullarticle/2492881
Marik Sepsis cocktail: Marik PE et al. Hydrocortisone, Vitamin C, and Thiamine for the Treatment of Severe Sepsis and Septic Shock. 2017: 151(6);1229–1238.
ADRENAL trial: https://www.nejm.org/doi/full/10.1056/NEJMoa1705835
APROCCHSS Trial: https://www.nejm.org/doi/10.1056/NEJMoa1705716
SEPSISPAM Trial: https://www.nejm.org/doi/full/10.1056/NEJMoa1312173
In this episode, episode 86, I welcome Dr. Bob Sikorski back to the show to discuss thromboelastography (TEG) and thromboelastometry (ROTEM). We discuss how they work, what they tell us and how we can use them.
Example TEG:
In this episode, Episode 69, I welcome Dr. Bob Sikorski, director of trauma anesthesiology at Johns Hopkins, to the show to discuss a general overview of trauma anesthesia. We discuss prehospital, ER and OR management and key things to keep in mind when caring for trauma patients.
References: Trauma references list
TEG diagram:
In this episode, episode 37, I go over crises that can happen in the OR, when to suspect them, and what to do about them. I draw from two excellent sets of OR crisis checklists that are available for free. The Stanford Anesthesia Cognitive Aid Group’s lists and the Ariadne Labs/Brigham/Harvard School of Public Health lists.
The Stanford checklists can be downloaded for free here: http://emergencymanual.stanford.edu
The Harvard checklists can be downloaded for free here: http://www.projectcheck.org/crisis-checklist-download.html
In this episode, episode 31, I welcome one of our amazing chief residents to the show, Dr. Stephen Freiberg. Stephen has taken an interest in massive transfusion and he goes over the highlights of when to do it, how to do it, what complications you see from it and how to manage those complications.
In this episode, episode 29, I welcome to the show Dr. Glenn Whitman. Dr. Whitman is a cardiac surgeon and intensivist and runs the cardiac surgical ICU here at Johns Hopkins. I interview Dr. Whitman about PA catheters. We discuss when to place them, when not to place them, how to use them and when to take them out.
In this episode I discuss the use of IV fluids for perioperative use including how to decide when to give fluid, the downsides of over resuscitation, whether to use crystalloid or colloid, and whether to use saline or a balanced salt solution such as LR.
Slides to go along with this episode are here: IV Fluids slides