I finished State of the Art Management of ARDS! 🚀

I finished Advanced Mechanical Ventilation Course! 🚀

I finished Evidence-based Management of Sepsis & Septic Shock! 🚀

In their recent article, “Stepwise Liberation from High-Flow Nasal Cannula in Acute Respiratory Failure,” published in CHEST, the authors highlight that high-flow nasal cannula (HFNC) has become a first-line therapy for patients with acute respiratory failure. They note that despite widespread use—especially since the COVID-19 pandemic—high-quality evidence guiding HFNC discontinuation remains scarce. Decisions regarding when and how to reduce flow rate, FiO₂, or both, are often left to clinicians’ discretion in the absence of standardized protocols. Prolonged HFNC support when no longer needed may result in longer ICU and hospital stays, higher healthcare costs, and reduced availability of critical resources. To address this gap, the article proposes a standardized, physiology-based stepwise approach to HFNC liberation, analogous to spontaneous breathing trials in mechanically ventilated patients, with the aim of improving care efficiency and resource utilization in hospitalized patients with acute respiratory failure. High-Flow Nasal Cannula Liberation - CHEST

I finished Critical Care Crash Course! 🚀

From the echocardiographic images:

• LVOT diameter (D) = 2.56 cm

• LVOT area (A) = π × (D/2)² = 3.14 × (1.28)² ≈ 5.15 cm²

• LVOT VTI = 11.8 cm

In a randomized trial across 18 public hospitals in Kenya involving 2,180 adults with community-acquired pneumonia (CAP), patients received either standard care or standard care plus oral low-dose glucocorticoids for 10 days. By day 30, mortality was 22.6% in the glucocorticoid group and 26.0% in the standard-care group (hazard ratio 0.84; 95% CI, 0.73–0.97; P=0.02). Adverse events were similar between groups. Conclusion: Adjunctive low-dose glucocorticoids reduced mortality without increasing adverse events, even in low-resource settings.

https://www.nejm.org/doi/10.1056/NEJMoa2507100

I got this from one of the ICU physicians and thought to share it with you here as it is interesting, any idea?

A patient with intracranial hemorrhage.