Tobin vs Gattinoni: Infinity Warπ£
Get some more popcorn πΏ
Let's start back at the beginning...
π₯Round #1: Tobin's original editorial casts shade on P-SILI & recommends our usual, conservative approach to intubation (rather than pre-emptive intubation) bit.ly/3h7wx3r
Round #2: Gattinoni replies
π₯3 citations to support existence of P-SILI
π₯claims COVID patients have unusually good compliance based on observing hundreds of patients (no data)
π₯recommends using esophageal pressure swings as a trigger for intubation π€‘ bit.ly/3aAHGaA
Round #3: Tobin strikes back
π₯Major flaws noted in three citations supporting the existence of P-SILI (still hasn't been clearly demonstrated, even in animal models π)
π₯Lack of evidentiary support for esophageal pressure thresholds bit.ly/3aEmUXB
Round #4: Gattinoni hits back weakly
π₯Cites pediatric study on asthma as evidence of P-SILI
Round #5: Tobin strikes back
π₯Pediatric asthma study widely believed to be fabricated data.
π₯Trends show improving mortality correlates with reduced intubation rates.
β’ β’ β’
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how to place a consult: you MUST understand the five stages of consultant grief.
once you can understand this painful and natural process, requesting consults will make a LOT more sense
buckle up, it can be a little roughβ¦
𧡠1/6β¦
stage 1: denial
- You dont need a consult.
- You called the wrong service.
- 18 years old? consult pediatrics
- Iβm not actually on call now
- Everythingβs fine, just walk it offβ¦
stage 2: anger
- you should have consulted us earlier/later
- you should have checked this test before calling us
- youβre a terrible doctor/student/human being
this is much better than MINDS (which contained ~90% hypoactive), but probably still not ideal.
(at this point, does anyone actually think that haloperidol helps with hypoactive delirium ??)
other than dilution of the patient population by patients with hypoactive delirium (who are unlikely to benefit & might conceivably be harmed by over-sedation), the methodology seems pretty solid.
I think it's time for a difficult discussion, folks.
Let's talk about CSF lactate π«£
CSF lactate has been shown to be *superior* to traditional CSF studies in sorting out viral vs. bacterial meningitis in several studies & meta-analyses...
a subset of patients with viral meningitis will initially have a *neutrophilic* pleocytosis.
this can lead to unnecessary admissions & antibiotics