Sepsis care keeps evolving but not always in ways that feel clean or universally agreed upon.

In this episode, I break down the latest Surviving Sepsis Campaign guidelines what actually changed, what didn’t, and what matters at the bedside when the patient in front of you is crashing.

We focus on two of the most debated areas right now:

• Prehospital antibiotics: Are we truly helping patients or just moving the needle earlier without improving outcomes
• Blood cultures before antibiotics: Dogma vs reality when time, access, and patient stability are working against you

This isn’t a guideline summary. It’s a practical discussion about where the evidence is strong, where it’s weak, and where clinicians are still forced to make judgment calls in real time.

If you’ve ever wondered whether you’re practicing evidence-based medicine or just following momentum, this episode is for you.

My approach to ventilating severe metabolic acidosis! Often needing to balance harm of the acidosis with harm of the ventilator and creating a balance of these 2 forces while we fix the underlying pathophysiology!

Spontaneous Breathing Trials aren’t just a checkbox before extubation.

They’re one of the most nuanced and most misunderstood checklists in critical care.

In this episode, we unpack why SBTs are not simply “pass or fail.”

A patient can “pass” the numbers and still fail at the bedside. They can “fail” and still be extubatable.

We dive into:

• Why the RSBI isn’t about extubatability
• How anxiety, pain, sedation washout, and cardiac function distort the data
• The hidden hemodynamics of liberation
• Why diaphragm performance matters more than a single respiratory rate
• And how over-reliance on protocol can blind us to physiology

Because at the end of the day, extubation is not decided by a spreadsheet. It’s decided at the bedside.

By watching the patient. By reading subtle cues. By integrating ventilator data with work of breathing, mental status, secretion burden, airway protection, and trajectory.

SBTs are a test of physiology — but they’re also a test of clinical judgment.

Dont fall into the trap of : "better luck tomorrow"

#floatingventguy

IG: @pulmtoilet

If your PEEP strategy is:
“ARDSnet table + hope for the best”
…it’s time for an upgrade.
This webinar walks through how to personalize PEEP in ARDS using compliance, stress index, PV curves, and bedside clues you can use on your next shift.

#floatingventguy

Podcast I did with Escola de Intensiva about vent management in the obese ARDS patient and COPD!

First 45 min of the PC webinar!!!

Response to a reel that Kali Dayton posted about a nurse who is burned out in the ICU due to poor A-F bundle implementation.

TLDR: We need to do better

Triggering the ventilator is how the ventilator knows to go from expiration to inspiration.

Theres a few ways we can trigger the breath and some dssynchronies associated with it.

In this episode, I go over these concepts!

Positive Pressure & the Failing Heart 

Positive pressure ventilation is one of the most powerful tools we use at the bedside.

In this episode, I sit down with critical care cardiologist Willard Appelfeld, MD to unpack how positive pressure ventilation interacts with the failing heart. We break down preload, afterload, venous return, RV–LV interactions, and why CPAP, BiPAP, and invasive ventilation can dramatically improve patients with acute decompensated heart failure.

We move beyond dogma and into physiology—connecting ventilator settings to pulmonary edema. If you’ve ever wondered why positive NIPPV settings to flash pulmonary edema and how PPV affects the RV and LV.

 Cardiac mechanics Positive pressure as therapy Real ICU decision-making

When we are aiming for a lung protective strategy, it's important to note what exactly we mean when we say lung protective. Its also important that we follow the ventilator waveforms to ensure we are protecting the lungs with the settings we provide. You can call a vent strategy lung protective… but the alveoli will be the judge. We dive into the importance of reading waveforms and being able to spot if we are violating our goals.