HeyHippocratesShock, the ventilator, sedation — a colleague who cites every call.
Clinical decision support that reasons like an intensivist while you decide: titrate the vasopressor, set the lung-protective vent, target the sedation — with the decision rule and exactly what would change it. Built for verified intensivists.
Watch it think — in intensive care.
Two worked examples, reasoned the way it answers: the relevant clinical checks run, the answer is cited, the decision rule is explicit, and what is missing is flagged.
Septic shock, norepinephrine at 0.5 µg/kg/min, MAP still 58, lactate rising to 6, adequately volume-resuscitated — next step?
This is escalating vasopressor-refractory septic shock. Add vasopressin (0.03 U/min) as the second agent, and start hydrocortisone (about 200 mg/day) once escalating catecholamines are needed. Re-confirm the patient is truly fluid-replete, chase source control, and get an echo — if there is cardiac dysfunction, add an inotrope (dobutamine or epinephrine).
Decision ruleNorepinephrine first; MAP still <65 → add vasopressin; escalating pressors → hydrocortisone; reassess volume, source and cardiac function (echo → inotrope if needed).
Not established from this alone — true volume status, the source, cardiac function and steroid response change the plan.
Intubated, PaO₂/FiO₂ 110, bilateral infiltrates, not cardiogenic — how should I set the ventilator?
This is moderate ARDS. Ventilate lung-protectively: tidal volume 6 mL/kg predicted body weight, plateau pressure ≤30 cmH₂O, keep driving pressure low, titrate PEEP to the FiO₂, and accept permissive hypercapnia. With P/F <150, prone for ≥16 hours a day and consider neuromuscular blockade; escalate to VV-ECMO for refractory hypoxemia.
Decision ruleARDS → 6 mL/kg PBW, plateau ≤30, low driving pressure, PEEP-to-FiO₂; P/F <150 → prone ≥16 h/day; refractory → VV-ECMO.
Not established from this alone — plateau and driving pressure, compliance, hemodynamics and the P/F trend change the settings.
Illustrative simulations. The physician always decides.
The answers intensivists actually look up.
The exact questions your field searches for — answered in the format the knowledge base speaks: the answer, the decision rule, what's missing, and the source.
Refractory septic shock — vasopressors and steroids?
Norepinephrine is first-line to a MAP ≥65 mmHg. When it is inadequate, add vasopressin (0.03 U/min) rather than escalating norepinephrine alone, and give IV hydrocortisone (about 200 mg/day) once ongoing escalation is needed. Confirm volume status, pursue source control, and echo for cardiac dysfunction — add an inotrope if present. Angiotensin II is an option in refractory cases.Surviving Sepsis
Decision ruleNorepinephrine → MAP ≥65; still low → add vasopressin; escalating pressors → hydrocortisone; echo → inotrope for cardiac dysfunction.
Missing data: true volume status, source control, cardiac function and steroid responsiveness change the strategy.
ARDS — lung-protective ventilation settings?
Set a tidal volume of 6 mL/kg predicted body weight, keep the plateau pressure ≤30 cmH₂O and the driving pressure low, and titrate PEEP against FiO₂. Permissive hypercapnia is accepted to protect the lung. For P/F <150, prone positioning ≥16 hours a day reduces mortality; neuromuscular blockade and VV-ECMO are reserved for severe, refractory hypoxemia.ARDSNet · guideline
Decision rule6 mL/kg PBW, plateau ≤30, minimize driving pressure, PEEP-to-FiO₂; P/F <150 → prone; refractory → VV-ECMO.
Missing data: plateau and driving pressure, compliance, CO₂ and hemodynamics tune the settings.
Sedation and delirium — what should I target?
Aim for light sedation — a RASS of −2 to 0 — with an analgesia-first (analgosedation) approach and daily spontaneous awakening and breathing trials. Prefer propofol or dexmedetomidine over benzodiazepines, which drive delirium. Screen with CAM-ICU, treat pain and remove precipitants, and use the ABCDEF bundle with early mobility.PADIS · guideline
Decision ruleLight sedation (RASS −2 to 0), analgesia-first, daily awakening/breathing trials, avoid benzodiazepines, CAM-ICU screen, ABCDEF bundle.
Missing data: the indication for sedation, hemodynamics, organ function and delirium risk change the agent and depth.
Refractory hypoxemia in ARDS — prone positioning and ECMO?
For moderate-to-severe ARDS with P/F <150 despite lung-protective settings, early prone positioning for ≥16 hours a day improves survival (PROSEVA). If hypoxemia stays refractory — roughly P/F <80, or uncompensated hypercapnia despite optimization — VV-ECMO at an experienced center is the next step (EOLIA). Optimize PEEP, neuromuscular blockade and fluid balance first.PROSEVA · EOLIA
Decision ruleP/F <150 → prone ≥16 h/day; refractory (P/F <80 / uncompensated hypercapnia) → VV-ECMO after optimization.
Missing data: the response to prone, PEEP and paralysis, plus center capability, drive the ECMO decision.
What it knows in intensive care
Your whole practice, one specialist brain — grounded in specialist-written, cited knowledge.
A generalist intensivist colleague across respiratory failure, shock, sedation, renal, neuro-critical care and sepsis — cited, non-directive, always with the decision rule.
Deep specialist agents for cardiac ICU, neuro-critical care, ECMO & mechanical support and respiratory failure — each its own specialist voice and knowledge base — plus your own uploaded materials.
Why not just use OpenEvidence or ChatGPT?
A large language model answers any clinical question with total confidence and no idea whether it is right. A search engine finds papers. HeyHippocrates reasons inside your specialty from a knowledge base a specialist in your field wrote and signed, and tells you the decision rule and what is missing.
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Questions intensivists ask
It reasons in the targets you use — MAP, lactate clearance, vasopressor escalation and steroid thresholds — and always shows the reasoning, the decision rule and what would change it. The decision always stays your call.
Both. Fellows use it to pressure-test a plan and learn the decision rule; attendings use it as a fast, cited second opinion on rounds and at the bedside. Access is gated to verified physicians.
Cardiac ICU, neuro-critical care, ECMO & mechanical support and respiratory failure each have their own deep specialist agent on the Pro plan, on top of the full general critical-care scope on Basic.
No. It is physician-facing clinical decision support — a cited thinking partner. It does not diagnose, does not treat, and gives no patient-facing advice. The decision always stays with you.
Every answer is grounded only in specialist-written, cited critical-care knowledge — traceable to a named source — and always states the decision rule plus what data is missing, instead of a confident guess.