The venous-to-arterial carbon dioxide difference (PCO₂ gap), defined as PcvCO₂ (taken from a central line blood gas) – PaCO₂ (taken from an arterial blood gas), answers a question that neither lactate nor ScvO₂ can typically answer directly. Whereas ScvO₂ focuses on the balance between oxygen delivery and consumption, the pCO₂…
Procalcitonin is a peptide precursor of calcitonin that becomes detectable in the setting of systemic bacterial infection, driven by cytokines and endotoxin released throughout the body rather than from the thyroid alone. Levels rise over 12-24 hours with bacterial sepsis and fall as the inflammatory signal resolves. This time course,…
This video walks through how I approach extubation for many of my postoperative patients in the CVICU, drawing directly from the same physiologic framework I use as a cardiac anesthesiologist in the operating room. View this post on Instagram A post shared by Rishi Kumar, MD | RK.MD (@rishimd)
“Thiamine before glucose” is a bedside teaching that started with a sound physiologic concept and slowly hardened into dogma when dealing with patients with alcohol use disorder. Thiamine deficiency underlies Wernicke encephalopathy, a preventable but often missed neurologic emergency most commonly seen in alcohol use disorder, malnutrition, prolonged vomiting, and…
Olanzapine (Zyprexa) and quetiapine (Seroquel) are often discussed as if they are interchangeable sedating antipsychotics used to help with addressing facets of delirium (insomnia, emotional lability, etc.). It often feels like dealer’s choice when deciding which one to use. Here are some of my considerations as an intensivist. Olanzapine is…
Andexanet alfa (Andexxa) will leave the US market on December 22, 2025, after AstraZeneca withdrew its biologics license application for commercial reasons. For a drug that costs as much as a car (~$25-50K per dose) and carries meaningful safety concerns… good riddance! Andexanet entered practice as the only FDA-approved reversal…
Candida auris (C. auris) has become a significant challenge in critical care across the country. It spreads across surfaces, equipment, and even skin, allowing outbreaks to take hold long before they are detected. These infections tend to appear in patients with comorbidities like advanced age, diabetes, kidney disease, malignancy, dialysis…
The NxStage System One continuous renal replacement therapy (CRRT) system provides convective and diffusive clearance through a simplified cartridge system. It has an interface centered on three large, color-coded numeric fields that offer the most essential information for therapy. When I’m rounding in the CVICU, I often look at these…
As a cardiac anesthesiologist and intensivist, vasoplegia following cardiopulmonary bypass is an issue I often face in the OR and ICU. This distributive shock phenotype is characterized by low systemic vascular resistance, despite preserved or elevated cardiac output, primarily driven by dysregulated nitric oxide (NO) and guanylate cyclase signaling, which…
B-lines are a vertical “comet-tail” artifact seen on lung ultrasound. They represent interstitial edema or increased lung water in thickened subpleural interlobular septa. In other words, B-lines represent fluid in the lungs (e.g., pulmonary edema, heart failure, etc.). When performing lung ultrasound, I use a high-frequency linear probe and begin…