eCritCare Podcast: Recent Episodes
Swapnil Pawar
The landscape of Intensive care is changing. In the era of evidence based medicine, we try to make best possible decision for our patients based on best available evidence. Every fortnight, Dr Swapnil Pawar & Dr Jose Chacko will bring you one hot topic in Critical care. If you want to stay up to date with recent evidence or learn how to critically evaluate the literature in critical care, this podcast is for you.
In this episode, we discuss the recently published SWITCH trial which compared the efficacy of decompressive craniectomy with best medical treatment vs best medical treatment alone for deep intra-cerebral hemorrhage.
In this episode, we discuss the etiology of diaphragmatic dysfunction, its management and strategies for prevention.
In this episode, we discuss the recently published RCT AMIKINHAL, which tested the efficacy of inhaled amikacin in preventing VAP in ICU patients who were ventilated for> 72 hours. Although, this trail demonstrated reduced incidence of VAP in intervention arm, it's premature to adopt these practices widely in intensive care.
In this episode, we discuss recently published RCT in JAMA "NICO trial", which evaluated the role of GCS based intubation vs non-invasive airway management. It is important to understand the nuances before generalising the conclusion of this trial.
In this episode, we discuss the recently published RCT in NEJM, which challenged the current dogma regarding the role of IV thyroxine in potential organ donor patient population.
In this episode, we discuss the recently published RCT "ECLS-Shock" trial in NEJM. This trial tested the benefit of instituting early extra-corporeal support in cardiogenic shock and suggested more harm in intervention arm compared to control arm.
In this episode, we discuss recently published landmark RCT which compared the timing for initiation of oral anticoagulation in patients who presented with ischaemic stroke with rapid AF.
In this episode, we discuss the controversy surrounding the usage of steroids in Community-acquired pneumonia. This controversy arose after the CAPE-COD trial was published recently in NEJM. We discuss the pros and cons of administering steroids as a blanket treatment. We recommend caution and suggest considering the external validity of this trial before changing your practices.
In this episode, we discuss recently published RCT "MERCY Trial" which evaluated the efficacy of continuous infusion vs intermittent dosing strategy of Meropenem.
In this episode, we discuss the recently published RCT "PATCH Trial", which evaluated the efficacy of pre-hospital tranexamic acid in patients with severe trauma. This trial confirmed the results of CRASH-2 trial, which demonstrated 28-day mortality benefit with the use of tranexaic acid in trauma if administered in < 3 hours. However, it failed to demonstrate any significant benefit with favourable neurological output at 6 months. This highlights the importance of Post-ICU care which at this stage is not standardised and varies across the globe.
In this episode, we discuss recenetly published RCT, which compared the role of craniotomy vs decompressive craniectomy in managing acute SDH.
In this episode, we discuss the recently published non-inferiority RCT "PACER Trial", which evaluated the efficacy of prophylactic platelet transfusion in thrombocytopenic patients requiring CVC insertion.
In this episode, Prof Ian Seppelt, one of the lead investigators of SuDDICU, shares his insights and talks about the rationale for SDD in ICU. He also explains the reasons behind the failure to change practices despite the evidence of mortality benefit from the recent meta-analysis. He discusses the future of SDD and the strategy for its widespread adaptation.
In this episode, we dive deeper into the controversy surrounding using high-flow nasal cannula vs NIV in high-risk patients to prevent reintubation. The recently published trial raised some crucial questions and forced us to reconsider our overall approach to extubation in this subset of patients.
In this episode, we discuss recently published RCT, which demonstrated the mortality benefit in Community-acquired pneumonia.
In this episode, we discuss the recently published RCT in NEJM, which evaluated the efficacy of ECMO CPR ( eCPR) in patients with OHCA secondary to a shockable rhythm.
In this episode, we discuss the recently published CLOVERs trial, which compared fluid dominant vs vasopressor-dominant resuscitation strategies for patients in septic shock.
In this podcast, we discuss another RCT which evaluated the efficacy of restrictive Vs liberal oxygenation targets in comatose OHCA survivors.
The trial showed no difference between the two groups w.r.t 90-day mortality or discharge from hospital
In this episode, we discuss the recently published DOSE VF trial, which evaluated the efficacy of early double sequential defibrillation strategy over vector change and standard defibrillation strategies.
This trial has demonstrated that this innovative strategy has the potential to improve mortality and is likely to change our practices.
In this episode, we discuss the recently published RCT "TEAM trial", which evaluated the role of early mobilisation in mechanically ventilated intensive care patients.
In this episode, we discuss the SETPOINT 2 trial, which evaluated the controversy around the timing of tracheostomy.
In this episode, we discuss a recently published randomised controlled trial evaluating the role of aggressive fluid resuscitation strategy in mild acute pancreatitis.
Join us in this episode to discuss the evidence behind the use of tranexamic acid for various indications in intensive care.
In our landmark 100th episode, we discuss the controversy around one of the most commonly used drugs in intensive care, i.e. Oxygen. In this episode, we dive deeper into the available evidence and recommend our approach for using oxygen in critically ill patients.
In this episode, we discuss the role of therapeutic hypothermia and targeted temperature management in severe TBI. We dive deeper into the available literature on this topic and share our recommendations on this controversy.
In this episode, we discuss the controversies around the definitions, diagnostic criteria, investigations and management of ventilator-associated pneumonia.
In this episode, we discuss the recently published trial evaluating the efficacy of liberal vs restrictive fluid resuscitation strategy in patients with septic shock.
In this episode, we discuss the recently published RCT evaluating the role of IV Vitamin C in patients with septic shock. This trial has given us a clear answer on the future of vitamin C in these patients. We discuss the available evidence on this topic so far and suggest our approach to this toopic.
In this episode, we discuss the evidence behind each target used in resuscitating a patient with septic shock.
In this episode, we discuss the landmark trial published in JAMA, which evaluated the efficacy of eCPR over standard strategy. We believe although a well-conducted trial, it's still not enough evidence to decide one way or the other w.r.t performing eCPR in patients with out of hospital cardiac arrest.
In this episode, we discuss the evidence behind the choice of adrenaline vs noradrenaline in patients who achieved ROSC (return of spontaneous circulation) after OHCA(out of hospital cardiac arrest).
In this episode, we discuss the controversy surrounding the use of NIV in hypoxemic respiratory failure in severe COVID-19. The results of the RECOVERY-RS trial has provided us with significant evidence on this topic.
In this episode, we discuss the recently published trial on long term outcomes in COVID patients.
In this episode, we discuss a recently published PLUS study comparing saline solution with Plasmalyte-148. This study demonstrated no significant mortality difference between the saline group and the plasmalyte-148 group.
In this episode, we discuss the recently published RCT evaluating the role of extended thromboprophylaxis in COVID-19.
In this episode, we discuss the challenges faced by healthcare systems and the patterns emerging from the current COVID-19 pandemic wave caused by the Omicron variant.
In this episode, we discuss a recently published trial comparing conventional oxygen therapy and high flow nasal oxygen therapy.
In this podcast, we discuss the controversy surrounding glycemic control in intensive care. We discuss the target range, the ideal amount of time spent in the target range and the utility of continuous glycemic monitoring in critically ill patients.
In this episode, we discuss the CONTROLLING study which compared the novel strategy of individualised glycemic control vs conventional glucose control.
In this episode, we dive deeper into the controversy around the timing of initiation of RRT in Intensive Care.
The controversy around the dose of steroid dose in COVID-19 still exists. In this podcast, we discuss the recently published RCT COVID Steroid 2 and dive deeper into this controversy.
In this episode, we discuss some of the key recommendations and the rationale behind them from recently published SSCG 2021.
Hyperventilation has been used to control raised ICP for decades. However, the evidence behind it is very weak. In this podcast, we discuss the recently published study by CENTRE-TBI to address this controversy.
In this episode, we discuss the evidence behind the dogmatic practice of routinely using ICP monitoring in patients with traumatic brain injury admitted to ICU.
The debate over low vs high oxygenation targets continue. In this podcast, we discuss the recently published trial in JAMA which evaluates the effect of high oxygenation on organ failure scores.
In this episode, we discuss the controversies around the long term sequelae of COVID-19. We dive deeper into the available evidence and suggest the next steps to address this very significant issue.
In this podcast, we discuss another landmark study called BASIC, which evaluated the superiority of balanced salt solution over 0.9% saline in critically ill patients admitted to Brazilian intensive care units.
The evidence for the use of Remdesivir in COVID-19 is conflicting. Different guidelines have suggested contradictory recommendations on its use in COVID-19. Tocilizumab, although demonstrated mortality benefit in conjunction with steroids, we do not have data on its long term outcomes including quality of life. In this episode, we revisit the controversy surrounding the use of these agents in COVID-19.
No standard protocol exists to decrease or eliminate preoperative fasting times for adult ICU patients with cuffed endotracheal tubes; however, multiple intensive care units across the globe have implemented their own protocols with adjusted times for the intubated patient. This has led to significant variability in practices along with potential harm to ICU patients. In this podcast, we challenge this another dogmatic practice in the Intensive care unit and dive deeper into available evidence.
In this episode, we talk about the novel concept called mechanical power in ventilating patients with ARDS. This concept has led to a new debate as to whether we should move away from the dogmatic approach of fixed tidal volume ventilation to an individualised ventilation strategy for patients with ARDS.
In this episode, we discuss the recently published landmark RCT -TTM2. This trial has answered the important question and forced us to reconsider our management practices around post-out of hospital cardiac arrest management.
The recent study published by Golligher et al have challenged the dogma of setting 6-8 ml/kg Vt for all patients with ARDS. In this study, the authors demonstrated that the mortality in ARDS is related to driving pressure and baseline elastance and there is no correlation between mortality and plateau pressure or P/F ratio. In this episode, we discuss how this study will impact the future of mechanical ventilation in ARDS.
Oxygen is a precious commodity. COVID-19 pandemic has reminded us of the significance of Oxygen and we need to be mindful that Oxygen is a drug. It has its own side effects and thus warrants cautious use. In this podcast, we discuss controversial but thought-provoking COAST trial in-depth.
COVID-19 pandemic continues to be a major problem across the globe. Various treatment options are emerging and we are desperate to achieve some normalcy in our lives. The recent addition is the use of monoclonal antibodies, which constitute a form of passive immunotherapy. In this podcast, we dive deeper into the available evidence on this novel treatment option.
Recently published RCTs and various guidelines have given us conflicting results w.r.t optimal dose of thromboprophylaxis in patients with COVID-19. In this episode, we dive deeper into the available evidence on this topic and suggest the rational approach in selecting the dose of thromboprophylaxis in COVID-19 patients.
Different Vaccines were developed during the COVID-19 pandemic at unprecedented speed using different platforms. However, recent reports raised concerns regarding thrombotic complications and thrombocytopenia after certain vaccines. In this episode, we discuss the pathophysiology and the treatment of this newly described syndrome.
In this episode, we discuss another landmark trial that has answered the very relevant question regarding the use of anti-fibrinolytic treatment in subarachnoid hemorrhage.
The use of neuromuscular blockade is not uncommon however, it's associated with many complications such as the increased risk of ICU acquired weakness, prolonged length of ICU stay along with the increased risk of corneal ulceration and VTE. In this episode, we discuss various indications for the use of NMB agents in ICU and review the available evidence on this topic.
Restrictive Vs Liberal transfusion strategy debate has come to the surface after the publication of the REALITY trial. In this podcast, we dive deeper into proposed transfusion thresholds in intensive care in various subgroups and the evidence behind them.
Hemoglobin targets in patients with myocardial infarction are still debatable. In this episode, we discuss the landmark REALITY trial, which explores the non-inferiority of a restrictive transfusion strategy over a liberal transfusion strategy.
In this episode, we discuss recently published practice-changing trials RECOVERY and REMAP-CAP. These trials have clearly demonstrated the difference in mortality with the use of Tocilizumab in severe COVID-19.
Join us to dive deeper into the recent controversy around oxygen therapy and its proposed targets in ICU patients. In this episode, we compare 3 landmark trials namely ICU-ROX, LOCO2 and HOT-ICU along with recently published meta-analyses to fully understand the nature of this controversy and discuss our recommendations for the future.
In this podcast, we discuss the challenges and the evidence behind different technological platforms used to produce COVID-19 vaccines.
The year 2020 has been a challenging year for most of us. We all are eagerly waiting to get out of this pandemic. Recently published trial on COVID-19 vaccine has offered some hope, however its too soon to predict the outcome.
High lactate levels are uniformly associated with poor clinical outcomes, including mortality. However, there is considerable interest and conflict of opinion regarding the clinical value of using lactate levels to guide resuscitation in critically ill patients. In this episode, we dive deeper into this long-standing controversy.
Join us in this episode, where we discuss the recently published trial in JAMA. This trial explores the efficacy of regional citrate anticoagulation over systemic heparin anticoagulation for CRRT. This is the largest randomised controlled trial on this topic and has provided very valuable answers on this topic.
In this episode, we discuss some of the controversial recommendations from surviving sepsis guidelines and talk about the rational approach in adopting these guidelines.
In this episode, we discuss what the importance of guidelines is, how they are formed and what does GRADE methodology involve.
In this episode, we dive deeper to understand how to interpret a meta-analysis, which is usually situated at the top of the pyramid of Evidence-based medicine.
In this podcast, we discuss how one should interpret an RCT, which is considered as the gold standard while practising evidence-based medicine.
The role of steroids in COVID-19 has been endorsed after the publication of RECOVERY trial. However, whether we should change our practices based on just one trial was heavily debated. In this podcast, we discuss the role of steroid in COVID-19 in-depth and weigh all the available evidence on this topic.
Prone positioning was first proposed in the 1970s as a method to improve gas exchange in ARDS. Subsequent observations of dramatic improvement in oxygenation with simple patient rotation motivated the next several decades of research. During COVID -19 pandemic, the debate on the utility of proning has been resurfaced. In this podcast, we dive deeper to discuss the physiology and evidence behind the role of proning in ARDS.
In this podcast, we discuss a recently published landmark trial START-AKI trial. This trial explores the benefit of accelerated renal replacement strategy compared to standard strategy.
Join us in our Golden jubilee episode, where we discuss top 10 trials published in last two decades that helped to change the practices in Intensive care.
The cytokine storm, arising from a dysregulated host response, has captivated mainstream and scientific media in recent times with its possible role leading to poor outcomes in COVID-19. It is characterized by the release of mediators, including chemokines, interleukins, interferons, and tumor necrosis factors. In this podcast, we discuss the available evidence on this topic.
Tranexamic acid has been thought to be the wonder drug for stopping the active bleeding and has recently been proven life-saving in certain subgroups of patients. HALT_IT is another landmark trial that has evaluated the benefit of tranexamic acid in patients with acute GI bleeding. In this podcast, we discuss the implications of this landmark trial.
Recently published RCT in NEJM has raised more questions on the use of HCQ for post-exposure prophylaxis in COVID-19. This trial is more provocative than definitive. In this podcast, we discuss this trial in-depth and present our views on this topic.
The majority of guidelines for COVID-19 recommended against the use of steroids. However, RECOVERY trial has challenged this opinion by proving that low dose dexamethasone can actually improve the outcomes by both decreasing the mortality and facilitating early discharge from the hospital. In this podcast, we discuss the implications of this landmark trial on the future of this deadly pandemic.
The routine use of Vit D in critically ill patients is debatable. The VIOLET trial published in NEJM in December 2019 has given us some clear answers on this topic. In this podcast, we discuss this trial in-depth to outline future directions on this topic.
Management of ARDS comprises of multi-modal approach that includes pharmacological and non-pharmacological interventions. The evidence on non-pharmacologic interventions is consistent. However, the benefit of pharmacological interventions is still debatable. In this podcast, we critically evaluate the role of neuromuscular blockade in ARDS.
The recently published trial in JAMA has suggested that the treatment with convalescent plasma in COVID-19 is feasible and can be used as a potential treatment option in this devastating pandemic.
In this episode, we discuss another landmark trial published in NEJM on the use of Remdesivir in COVID-19. This trial has raised more questions than providing answers.
In this podcast, we discuss multi-national registry data on the efficacy of chloroquine, hydroxychloroquine with or without macrolides in COVID-19 patients. This study has added significant information to our understanding of COVID-19 and has warned us against the use of the combination of HCQ and macrolides.
COVID-19 pandemic has posed a very difficult challenge to the entire ICU community i.e. how to prevent transmission to health care workers while performing routine interventions in critically ill patients. This has forced us to unlearn the traditional ways and learn new ways of performing certain interventions in ICU. In this podcast, we discuss specific modifications that every ICU staff need to be aware of while caring for COVID-19 patient.
Remdesisvir has thought to be the new CURE for COVID-19. In this podcast, we discuss the recent evidence available on the efficacy of Remdesivir in COVID-19.
The literature published from various countries has helped us to understand the disease pattern in COVID-19 pandemic. In this podcast, we discuss the key literature from New York, Italy, China and the UK.
In this episode, we summarise the key literature published in last week w.r.t novel therapies in COVID-19.
In this podcast, we discuss current controversies w.r.t treatment of COVID -19 patients and summarise the literature available till date.
In this podcast, we discuss how to manage critically ill patient diagnosed with COVID-19. This podcast based on current recommendations from various societies and the expressed views may change as recommendations change over time.
Vasopressor administration to maintain higher map in patients >65 years of age has become a dogma. In this podcast, we discuss recently published 65 trial which not only challenges this dogma but will definitely change our practices.
Oxygen is the most commonly used drug in Intensive care. However, the targets for oxygen therapy titration are arbitrary. In this podcast, we discuss the significance of hyperoxemia in intensive care patients.
Sedation in ICU is practised so commonly that thinking of any mechanically ventilated patient without sedation is impossible. This trial published in NEJM has challenged that dogma and showed us that Non-sedation in mechanically ventilated patients is feasible.
The accumulation of a positive fluid balance is a frequent occurrence in critically ill patients. As Paracelsus said, " All things are poisons, nothing is without poison. Only the dose permits something not to be poisonous." Like other drugs, it is the dose of fluids which makes them poisonous. In this podcast, we discuss the significance of de-resuscitation in ICU.
This Randomised controlled trial explored the role of HAT therapy in patients with septic shock admitted to ICU.
Lung protective ventilation has become the cornerstone of the management of ARDS patient. As a consequence, hypercapnia is inevitable. However, permissive hypercapnia is not without its own problems. In this podcast, we discuss this dogma and challenge traditional practices.
In this podcast, we discuss the landmark PEPTIC study, which compared PPIs vs H2 Receptor antagonists in mechanically ventilated patients.
Recently there has been a growing interest in driving pressure as a significant parameter for titration in mechanical ventilation for ARDS patients. It has challenged our dogma of 6-8 mls/kg tidal volume ventilation. In this podcast, we discuss the current evidence and future of mechanical ventilation in ARDS.
The malnutrition in hospitalised patients has a potentially severe impact on their overall outcomes. EFFORT trial, published in Lancet explored whether early intervention in medical inpatients is feasible and whether it alters the outcomes by commencing early individualised nutritional therapy.
The role of thrombolysis in submassive PE remains controversial to date. In this podcast, Dr Chacko & I dive deeper to explore the current evidence on this topic.
Liberating high-risk patients from mechanical ventilation poses a unique challenge to all intensive care physicians. The use of high flow has increased over the last decade, however, combination of high flow nasal oxygen and NIV has not been tested so far. The present study published in JAMA tries to answer this dilemma.
The use of IV albumin is not uncommon in the Intensive care unit. However, the evidence for its routine use is conflicting. In this podcast, Dr Chacko and I critically appraise the available evidence to inform the Intensive care community on the role of IV albumin in the intensive care unit.
Status epilepticus poses a significant challenge to intensive care physicians. There is lots of uncertainty about the treatment options and correct dosing. In this podcast, we discuss the landmark ESETT trial published in NEJM which explores this dilemma but rather helping to solve the problem, asks more questions.
Intracranial pressure monitoring is an integral part of Traumatic brain injury(TBI) management in intensive care. In this podcast, we critically appraise the evidence available on this topic to inform ICU clinicians about the current trends.
The role of prophylactic antibiotics in post-cardiac arrest survivors who undergo therapeutic hypothermia management is controversial. This recently published trial raises the question of current clinical practices and forces us to rethink our strategies.
Stress ulcer prophylaxis is routinely used in intensive care. The evidence available is quite conflicting and practices still vary across the globe. In this podcast, we dive deeper into the available evidence to discuss the pros and cons of using SUP in ICU.
Oxygen is a drug and needs to be used cautiously. In this podcast, Dr Chacko & I critically appraise the landmark trial ICU -ROX from ANZICS CTG.
RBC transfusions remain an important treatment for improving tissue oxygenation in the setting of inadequate oxygen-carrying capacity. However, the management of anemia and its impact on critically ill patients has been a matter of debate. In this podcast, Dr. Chacko & I discuss the evidence behind different transfusion thresholds used in critically ill patients.
This podcast is dedicated to all female researchers in Medicine and in particular to Dr Utako Okomoto. CRASH 3 trial is a victory not only for tranexamic acid but also for Utako and her husband's struggle. In this podcast, Dr Chcko & I discuss practice-changing CRASH 3 trial in-depth.
The role of NIV in ARDS is debatable. There is lots of uncertainty amongst the clinicians as to when to initiate NIV in patients with ARDS. In this podcast, Dr Chacko and I critically appraise the evidence on this topic and suggest an approach to deal with this controversy.
In this episode, Dr Chacko & I discuss the recently published trial HYPERION. This trial is about targeted temperature management in patients who had cardiac arrest due to non-shockable rhythm.
In this episode, Dr. Chacko & I discuss the significance of Augmented renal clearance for Intensivist. ARC is often underutilized in ICU and its routine use in ICU may have a significant impact on the outcomes of patients with septic shock and the future of antibiotic resistance.
In this episode, Dr Chacko & I discuss recently published COACT trial. This trial evaluated the role of immediate vs delayed coronary angiography in out hospital cardiac arrest patients who do not have ST-segment elevation on their post-resuscitation ECG.
In this episode, Dr Chacko & I discuss various controversies associated with nutrition in acute pancreatitis.
In this podcast, Dr Chacko & I discuss recent RCT in JAMA in which authours evaluated the efficacy of less demanding weaning strategy vs more demanding strategy.
The use of IABP in cardiogenic shock remains controversial to date. In this podcast, Dr Chacko & I discuss the evidence available on this topic and make recommendations for the future.
In this podcast, Dr Chacko & I discuss newly published RCT discussing the role of vitamin C in the treatment of post-operative vasoplegia after cardiothoracic surgery.
In this podcast, Dr Chacko & I critically evaluate the role of steroids in patients with Septic shock admitted to ICU.
In this podcast, Dr Chacko & I critically appraise the ROSE trial evaluating the efficacy and safety of early NMB in patients with severe ARDS.
In this episode, Dr Chacko & I critically appraise the practices of more fluids vs early commencement of vasopressors in patient with septic shock.
In this podcast, Dr Chacko & I discuss recently published RCT in New England Journal of Medicine.
Although increasingly less frequent, placement of a tracheostomy has become a viable alternative to prolonged endotracheal intubation, with the benefits of improving patient comfort, reducing need for sedation, lowering airway resistance, and allowing for easier airway care. There has been considerable debate on the timing and selection of ICU patients. In this podcast, Dr Chacko and I critically appraise the latest evidence share our preferred approach.
ARDS is a syndrome and not a disease. Our current approach of "One size fits all" for applying various interventions to this beast is not the right approach. In this podcast, Dr Jose Chacko & I critically appraise the latest evidence & propose a modified approach in using this intervention in patients with ARDS.
Decompressive craniectomy is generally performed for the management of refractory ICP in patients with Traumatic brain injury. The evidence available so far warrants careful interpretation. In this podcast, Dr Jose Chacko & I critically evaluate the role this surgery in patients with TBI admitted to the Intensive care unit.