In this episode, I’ll discuss why warfarin needs overlap with another anticoagulant when treating VTE. Subscribe on iTunes, Android, or Stitcher The CHEST guidelines state: It is now standard practice to start anticoagulant treatment after VTE with a heparin (unfractionated or low molecular weight) together with a VKA, overlap the two drugs for at least […]

In this episode, I’ll discuss the incidence of anaphylaxis to sugammadex. Subscribe on iTunes, Android, or Stitcher Concerns over the rate of anaphylaxis to sugammadex delayed the US approval of the drug, with the FDA issuing a not approvable letter in 2008 citing in part concerns about allergic reactions. When sugammadex was approved in 2015 […]

In this episode, I’ll discuss whether using haloperidol for ICU delirium reduces mortality. Subscribe on iTunes, Android, or Stitcher While many pharmacologic therapies have been studied to treat ICU delirium, the recommendations from the latest SCCM PADIS guidelines is: We suggest not routinely using haloperidol, an atypical antipsychotic, or a HMG-CoA reductase inhibitor (i.e., a […]

In this episode, I’ll discuss the prediction of hypotension from propofol when used as an ICU sedative. Subscribe on iTunes, Android, or Stitcher Hypotension from ICU sedatives like propofol and dexmedetomidine can complicate patient management.  I discussed predicting hypotension from dexmedetomidine back in Episode 563. Hypotension from propofol in the ICU can also be reasonably […]

In this episode, I’ll discuss the mechanism of interaction between ACE inhibitors and angiotension II. Subscribe on iTunes, Android, or Stitcher Shout out to Academy member JCR for inspiring this episode! The vasopressor angiotensin II carries a warning in the prescribing information that “ACE inhibitors may increase response to angiotensin II”. No information on why […]

In this episode, I’ll discuss an article that compares mortality in COVID-19 patients who received enoxaparin vs those who received unfractionated heparin. Subscribe on iTunes, Android, or Stitcher Managing coagulopathies in patients hospitalized with COVID-19 is one of the more challenging aspects of care for these patients. While prospective trials are ongoing, a retrospective analysis […]

In this episode, I’ll discuss a review article that identifies the most significant rifamycin-opioid interactions. Subscribe on iTunes, Android, or Stitcher Opioids have a narrow therapeutic index and many undergo metabolism by the CYP450 enzyme system. Rifamycins such as rifampin and rifabutin have the potential to induce CYP450 enzymes are thereby interfere with the therapeutic […]

In this episode, I’ll discuss an article about hypotension from ketamine for rapid sequence intubation. Subscribe on iTunes, Android, or Stitcher Hypotension is an undesirable effect of rapid sequence intubation, and can occur from the medications used to facilitate intubation or from decreased venous return due to positive pressure ventilation. Because ketamine has a side effect profile […]

In this episode, I’ll discuss an article about TOF monitoring vs clinical assessment only in ARDS patients on NMBAs. Subscribe on iTunes, Android, or Stitcher The SCCM Guidelines for Sustained Neuromuscular Blockade in the Adult Critically Ill Patients give a weak recommendation that peripheral nerve stimulators with train-of-four monitoring may be a useful tool for monitoring […]

In this episode, I’ll discuss the optimal sedation strategy in patients with ARDS who receive NMBAs. Subscribe on iTunes, Android, or Stitcher The two large trials regarding neuromuscular blocking agents (NMBAs) in patients with acute respiratory distress syndrome (ARDS) (ACURASYS and ROSE) produced ambiguous results regarding the utility of NMBAs in these patients. One possibility […]

In this episode, I’ll discuss whether the sugammadex-contraceptive interaction is being adequately considered in practice. Subscribe on iTunes, Android, or Stitcher Sugammadex is a γ-cyclodextrin that was designed to bind rocuronium and vecuronium for the purpose of reversing paralysis from these neuromuscular blocking medications. The prescribing information includes information that sugammadex may interfere with the […]

In this episode, I’ll discuss whether diuretics are safe to reduce fluid balance in critically ill patients. Subscribe on iTunes, Android, or Stitcher Interest in fluid balance and the associated adverse effects in ICU patients has grown considerably over the last decade. The general practice of reducing fluid balance, sometimes referred to as deresuscitation, is […]