About Mac Walter, MD

Assistant Professor
Department of Medicine
Division of Pulmonary and Critical Care Medicine
Northwestern University Feinberg School of Medicine

ECMO for ARDS: Key Pearls for Emergency Physicians from the EOLIA Trial

The role of extracorporeal membrane oxygenation (ECMO) in the management of acute respiratory distress syndrome (ARDS) has been a source of debate within the critical care community.¹ The use of ECMO has steadily increased over the past decade;² however, evidence to support the widespread adoption of this expensive and invasive technology is limited. As advances in ECMO technology have rapidly outpaced evidence, clinicians have been left to speculate as to ECMO’s true value. Is ECMO a promising tool to advance the care of patients with respiratory failure³ or an expensive distraction that has inappropriately supplanted evidence-based strategies?⁴

All who care for patients with ARDS have been eagerly awaiting the results of the Extracorporeal Membrane Oxygenation for Severe Acute Respiratory Distress Syndrome (EOLIA) trial which were recently published in May 2018’s New England Journal of Medicine.⁵

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By Mac Walter, MD|2018-05-31T07:46:14-07:00May 31, 2018|Critical Care/ Resus, Pulmonary|

Lactic Acidosis and Beta Agonist Therapy in Asthma

A 45 y/o male with moderate persistent asthma presents with wheezing and cough following a viral URI. He is tachypneic and has diffuse wheezing. PEFR is 250 (>50% below his normal). Initial ABG is 7.46/33/70 on room air with a lactate of 2.0 mmol/L. He receives IV steroids and 4 rounds of albuterol nebulizers. On repeat evaluation, his work of breathing and wheezing have improved and his PEFR is now >300. He is completed alert and oriented with a BP of 118/70 and a HR of 110. Repeat ABG shows 7.35/35/100 on room air; however, his lactate is now 7 mmol/L.

Clinical Question

Is the rise in his lactate expected following beta-agonist therapy?
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By Mac Walter, MD|2018-05-31T06:31:12-07:00Dec 18, 2013|Pulmonary, Tox & Medications|