Today, I continue a discussion on the evidence for the use of angiotensin II in vasodilatory shock. Click here to see my summary of the ATHOS 3 trial 

Today's episode will look at the use and utility of lactate clearance in sepsis.

Click to see a list of short summaries covering some of the best published literature on lactate clearance in sepsis. 

You can see a summary of the SMART and Salt ED trials at the links below

SMART trial

SaltED trial

Today, I start an overview of the use of angiotensin II (ATII) in shock. Specifically, I look at some of the first published uses of ATII in the literature. In the next episode I review the more recent randomized controlled trial (ATHOS 3) which studied the use ATII in vasodilatory shock.

Click to see a narrative summary of today's podcast 

You can see a summary of today's discussion at the following link:

https://www.evernote.com/l/AhaQSrLXu7xCuJ-uuWUKwcaw41Up6kdC_jE/

Relevant Articles:

1. The Coagulopathy of Chronic Liver Disease: this is the article Brian used for his research
2. How I Treated Disseminated Coagulopathy of Liver Disease: This article contains a great review of DIC and a very useful scoring tool 
3. TEG for Cirrhotic Coagulopathy: Time for Implementation? this is a great review on the concept of thromboelastograms (TEG studies)
4. Bleeding and Coagulopathies in Critical Care: this is a great review article on coagulopathies in general and our history of using blood products 

Take-Home Points:

1. INR correlates poorly with bleeding risk in cirrhosis.
2. While an increased tendency to bleed is certainly present, it may have more to do with altered hemodynamics (elevated portal pressures), endothelial dysfunction, uremia, platelet count/dysfunction, and bacterial infections rather than elevations in traditional markers of coagulation (PT/INR, aPTT) 
3. Distinguishing between DIC and Accelerated Intra-vascular Coagulation and Fibrinolysis (AICF) is difficult. Some helpful adjuncts include factor VIII levels, TEG studies, blood smears, and a DIC score

Remember to have fun...and never stop reading!

Cheers,

Sam Konkol