In this episode, we talk all things critical care the one and only, Dr. Jean-Louis Vincent aka. JLV. This episode is a MUST listen. We touch upon the evolution of early goal directed therapy, measures of fluid responsiveness, optimizing oxygen delivery, and the importance of integrating data points versus examining them in isolation when caring for our critically ill and injured patients. This and MUCH MUCH more in arguably one of my favorite episodes to date!!
Timestamps
00:00 Introduction
01:21 What happened to SG catheters and should we use them?
04:05 What decreases mortality in critical care patients?
05:30 When to transfuse critical care patient? Use your brain!
08:55 Measures of tissue perfusion and fluid responsiveness
09:36 JLV breaks down the Rivers trial
10:36 Recent EGDT papers
10:54 How to optimize O2 delivery? Late ScVO2, dob challenge, and fluid challenges
13:21 Dynamic measures of fluid responsiveness
13:46 CVP as a relative value
15:14 Passive leg raising (PLR) as a measure of fluid responsiveness
21:20 JLV's take on therapeutic nihilism
24:45 Don’t isolate; integrate!
26:46 Navigating the future of critical care – JLV’s thoughts on AI in the ICU
29:55 Rapid fire hot topics in the ICU – Yes or No
-Metabolic cocktail
-Corticosteroids for septic shock
-Albumin and Lasix or Lasix alone
PCT/CRP and sepsis/Abx
Resources:
International Symposium on Intensive Care and Emergency Medicine (ISICEM):
https://www.isicem.org
ISICEM Chats Platform:
https://www.isicem.org/e-chat/index.asp
Articles:
Passive leg raising:five rules, not a drop of fluid! https://ccforum.biomedcentral.com/articles/10.1186/s13054-014-0708-5
The fluid challenge
https://ccforum.biomedcentral.com/articles/10.1186/s13054-020-03443-y
Blood lactate levels in sepsis: 8 questions
Vincent JL, Bakker J. Blood lactate levels in sepsis: in 8 questions. Curr Opin Crit Care. 2021 Jun 1;27(3):298-302. doi: 10.1097/MCC.0000000000000824. PMID: 33852499.
We should avoid the term "fluid overload"
https://ccforum.biomedcentral.com/articles/10.1186/s13054-018-2141-7
EGDT in the Treatment of Severe Sepsis and Septic Shock
https://www.nejm.org/doi/full/10.1056/nejmoa010307
A Randomized Trial of Protocol-Based Care for Early Septic Shock
https://www.nejm.org/doi/full/10.1056/nejmoa1401602