Upon first reading the ATHOS-3 trial, I was pleasantly optimistic. Who wouldn't be interested in a shiny new vasopressor? The trial didn't prove much, but it was intriguing. However, it was alarming to hear that the FDA has approved angiotensin II for use based on it. Precious little evidence is available about this drug. With angiotensin II arriving at hospitals soon, some cautions are in order.
Currently there is a lorazepam shortage in the United States. This caused a surge of interest into using phenobarbital for alcohol withdrawal. I've received several e-mails over the past few weeks about this. It's been two years since my last post about phenobarbital, so here's an update focusing on lessons learned in the interim.
Scott Weingart just posted a podcast about management of the hypercapneic, obtunded COPD patient who is failing BiPAP. Do we need to intubate these patients, or could we somehow clear their CO2 noninvasively? This post will start off by exploring respiratory drive as a mediator of disease. With that groundwork, we'll explore the obtunded COPD patient.