Do you think it should be used like to a D-Dimer, Bayesian logic into decision making. Low pretest probability, undetectable CRP quite reassuring. However your pt in multi-organ failure I don’t care what the CRP is just like I don’t care what the Dimer is in the RV dilated, tachy, post op pt? 🤷‍♂️

Volume control with decelerating flow or pressure control volume guarantee? Early cycling? I’d try increasing I-time or switching to PSV if the patients sedation could be lightened to point of triggering

I think most of us have! I just think the dogma that the LP causes the herniation is based on fear and not reality. LPs are performed in cryptococcal meningitis for high ICP… i suspect we aren’t inducing any herniation with LPs but I doubt we will ever have good evidence

Or said another way “people who look like they are going to herniate, herniate”. Who knows if the LP precipitated it or if it would have happened anyway 🤷‍♂️

Built in second provider in case of things falling apart and FoN access, what could be better! 👌

Amazing case as always!