Episode 53: Insights into Modern Critical Care with Dr. Jean-Louis Vincent: Part II

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 Support the show