Next Sira debate

This is a bit of a bumper month but it seemed sensible to cohort these similar topics than split them over the next two months.
This month’s questions:
1. In patients on escalating doses of vasopressors (and/or inotropes) should we routinely be inserting a femoral arterial line to correlate with radial arterial pressures, and if so and they differ which pressure do we target? Is anyone doing this already
2. Is there ever any benefit in using inotropes as part of the management of septic shock? Do they do more harm than good? Should we instead restrict ourselves to vasopressors and fluid optimisation?
This month’s papers:
I don’t have a clever German word that could articulate the medical version of “the kitchen sink”, I do however have an extraordinary article (20 mins of reading tops) that does just that. Think heroic medicine, think I’m not sure if this should be in the Christmas BMJ, think I’m not sure I would be brave enough to admit to this, think…… I’ll let you make your own minds up:
And an oldy but a goody from NEJM (particularly relevant for those of us that dabble in cardiac ICU…..) Paper :

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