CCC Update 010

The LITFL Critical Care Compendium is my ongoing obsession, a living resource that covers the spectrum of critical care, including the knowledge base for the FCICM and much, much more. There are now over 1,500 entries built into the LITFL backend

Airway exchange catheter

  • If the bougie is my first love, the Aintree catheter is close second. Other airway exchange catheters are discussed here too: when and how to use them, tips, tricks and complications. Good videos too!

Chloride in Critical Illness

Can I call it hysteria? The FOAMcc world (especially) seems convinced that chloride is a poison. I still have equipoise, the evidence that normal saline fluid therapy causes clinically significant harm is very, very weak. The much heralded Yunos et al, 2012 study in JAMA is critically flawed – as the authors themselves acknowledged in the paper (it can be viewed as a study of harms from “gelofusine-rich” fluid as much as a study of “chloride rich” fluids). Paul Young spoke about this topic at SMACC Chicago and we are all eagerly awaiting the publication of his SPLIT trial: plasmalyte versus normal saline for fluid therapy in ICU. Churchill would no doubt say that chloride is a riddle, wrapped in a mystery, inside an enigma… I’d agree with him.

De-resuscitation and positive fluid balance

Positive fluid balance is decidedly negative if you’re an ICU patient (though how much of fluid excess is confounded by chloride excess…? Now, there’s a thought). Paul Marik has a delicious term for this, ‘iatrogenic salt water drowning’ – though as he said at SMACC Chicago, he doesn’t have a strong opinion on the matter. If fluid excess is the question, then ‘de-resuscitation’ is the answer – it is perhaps one of the dark arts of intensive care medicine. Do I sense a ‘Mind of the De-resuscitationist’ podcast in the works?

FEAST and paediatric fluid resuscitation

John Myburgh said that Kath Maitland should get the Nobel Prize for FEAST. Who am I to disagree with John Myburgh? (even if #myburghcanthandlethetruth was briefly trending at SMACC Chicago). FEAST is a mind-blowing trial – in its conception, its execution and in its findings. Is it time for an adult FEAST?

Fluid bolus therapy

Is there any therapy more ubiquitous in the arsenal of the resucitationist? As you’d expect for such a sacrosanct intervention there is a mountain of evidence supporting its use and a bullet proof physiological rationale (especially in sepsis). Incidentally, I heard an American attendee at SMACC say to Karim Brohi after he apparently gave a talk rubbishing tranexamic acid in trauma, “you realise that Americans don’t get irony?”… Read into that what you will.

Lemierre syndrome

There is so much to love about this. It sounds exotic – anyone else have visions of a Perrier drinking Lemur? The causative organism sounds seriously badass: Fusobacterium necrophorum. Anyone who diagnoses it gets to be king for a day. The disease itself – thrombophlebitis of the internal jugular (IJ) vein and bacteraemia caused by primarily anaerobic organisms, following a recent oropharyngeal infection – we could all do without.

Lemierre syndrome

Transpulmonary pressure and oesophageal manometry

Transpulmonary pressure (TPP) is the net distending pressure applied to the lung by contraction of the inspiratory muscles or by positive-pressure ventilation. Perhaps we should be using oesophageal manometers in mechanically ventilated patients so that we can measure TPP. Perhaps not…

Unplanned extubation

Sometimes things don’t always go to plan… sometimes this is good, sometimes not so good. Risk factors, prevention, management and complications. It is all here.

CCC 700 6

Critical Care


Chris is an Intensivist and ECMO specialist at the Alfred ICU in Melbourne. He is also a Clinical Adjunct Associate Professor at Monash University. He is a co-founder of the Australia and New Zealand Clinician Educator Network (ANZCEN) and is the Lead for the ANZCEN Clinician Educator Incubator programme. He is on the Board of Directors for the Intensive Care Foundation and is a First Part Examiner for the College of Intensive Care Medicine. He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives.

After finishing his medical degree at the University of Auckland, he continued post-graduate training in New Zealand as well as Australia’s Northern Territory, Perth and Melbourne. He has completed fellowship training in both intensive care medicine and emergency medicine, as well as post-graduate training in biochemistry, clinical toxicology, clinical epidemiology, and health professional education.

He is actively involved in in using translational simulation to improve patient care and the design of processes and systems at Alfred Health. He coordinates the Alfred ICU’s education and simulation programmes and runs the unit’s education website, INTENSIVE.  He created the ‘Critically Ill Airway’ course and teaches on numerous courses around the world. He is one of the founders of the FOAM movement (Free Open-Access Medical education) and is co-creator of litfl.com, the RAGE podcast, the Resuscitology course, and the SMACC conference.

His one great achievement is being the father of three amazing children.

On Twitter, he is @precordialthump.

| INTENSIVE | RAGE | Resuscitology | SMACC

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