Osler Podcasts: Recent Episodes
Todd Fraser
This podcast is dedicated to the hard-working doctors, nurses and allied health professionals striving for excellence
CPD Homes will be introduced to Australian-registered doctors in 2024, but what are they for, and what do they mean for you?
Chair of the Medical Board of Australia, Dr Anne Tonkin, joins Todd to talk about what lies ahead.
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Mechanical ventilation is indeed a lifesaving intervention. However, it is clear that positive pressure ventilation itself has the potential to cause harm. Novel approaches to ventilation aim to minimise this risk, and one such strategy is the incorporation of oesophageal pressure monitoring.
Tai Pham is a staff intensivist in Paris and an assistant professor at Paris Saclay university. He completed a PhD in public health where he focussed on respiratory physiology and mechanical ventilation, and is a member of the executive committees for Lung Safe and Wean Safe studies.
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If you’ve worked in ICU for very long, you’ll recognise the scenario where a patient who is weaning from mechanical ventilation goes into pulmonary oedema. This syndrome is referred to as weaning induced pulmonary oedema, or WIPO.
Dr Rui Shi currently works as an intensivist in the surgical ICU of the First Affiliated Hospital at Sun Yet Sen University in China.
Rui has a strong interest in haemodynamic monitoring in critical care in which she has done a PhD, and she joins Todd to talk about this fascinating clinical problem.
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The ultimate outcome for patients who are resuscitated from cardiac arrest depends heavily on the neurological damage that results from a low flow state. Prevention of further damage during this phase is one of the core goals of post resuscitation care.
In recent years, a multitude of research papers have been produced which examine various aspects of this approach, including oxygenation and blood pressure targets.
One alternative strategy may be to increase cerebral blood flow by allowing mild therapeutic hypercapnoea, an approach studied in the recently released TAME trial. Principle investigator of the study, Glenn Eastwood, joins Todd on the podcast to discuss the key features and results from this important trial.
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This podcast comes to you from the 2023 ANZICS Clinical Trials Group Noosa meeting.
ECMO (extracorporeal membrane oxygenation) is steadily embedding itself into modern critical care medicine.
Does it have a role in pre-hospital setting for patients with refractory cardiac arrest?
In this podcast, we are joined by Aidan Burrell to talk about the SHERPA trial.
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Non invasive ventilation is steadily establishing itself as a crucial component of the critical care armoury. While many patients can tolerate it, some require sedation.
Wisam Al-Bassam is a staff specialist at Monash Medical center and Victorian Heart hospital. Wisam is passionate about education and research, and his research interests include mechanical ventilation and sedation in ICU. He joins Todd to talk about the role of dexmedetomidine in patients on non invasive ventilation in the ICU
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DKA causes a serious disturbance of fluid and electrolyte balance.
However, it is said that more complications are caused by our management than by the disease itself. This is no more apparent than in our management of the patient's fluids.
Professor Bala Venkatesh is a world renowned intensive care researcher and he joins Todd to discuss the BEST-DKA trial
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Sometimes the failing heart needs support, and inotropic agents are often instituted ahead of other measures such as ECMO
But is there a best agent?
Antoine Kimmoun is a professor of Critical Care Medicine at the University of Lorraine, France, and he joins Todd to discuss these important agents.
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This podcast comes to you from the 2022 LIVES Conference in Paris
Disseminiated intravascular coagulation is the endpoint of a range of different conditions, including sepsis. How does this important clinical condition evolve, and what can we do about it?
Mirjam Bachler is a senior post doc researcher in surgery at the Department of Anaesthesiology and Intensive care Medicine at Innsbruck, Austria. Her key interests are coagulation in critical care, particularly after inflammatory diseases.
She joins Todd to talk about DIC in sepsis.
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Cardiac arrest causes neurological injury through a sustained period of hypoxia and ischaemia. It has long been thought that avoiding further hypoxia could save vulnerable brain tissue, leading to the common practice of deliberate hyperoxygenation.
However, recent research has suggested this approach may in fact be harmful.
Paul Young is an Intensivist and critical care researcher from Wellington in New Zealand, and he joins me to discuss an upcoming study which will further explore this issue, LOGICAL
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This podcast comes to you from the 25th Annual Noosa meeting of the ANZICS Clinical Trials Group.
It is now well recognised that mechanical ventilation, while potentially lifesaving, also causes damage to the lung in its own right. Careful setting of the ventilator is crucial to avoiding lung injury. While plateau pressure ceilings have been recommended for many years, research attention is now turning towards driving pressure.
Neil Ferguson is the head of critical care at the University Health Network and Mt Sinai Health Systems in Toronto, and has an extensive research history in critical care ventilation
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This podcast comes to you from the 2022 LIVES Conference in Paris
Sudden cardiac arrest in the community has historically had a poor prognosis. Improvements in prehospital care and post resuscitation interventions have raised hopes that overall survival has improved.
But has it?
Tommaso Scquizzato is a researcher in the fields of cardiac arrest and resuscitation science at San Raffaele Hospital in Milan, Italy and member of the European resuscitation council BLS Science and Education Committee
You can follow Tommaso on twitter too - @tscquizzato
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Managing bleeding in a patient with severe trauma is a complex process, with multiple interventions occurring in parallel.
Derek Kleinveld is an intensivist and researcher from the Department of Intensive Care Medicine at the University Medical Centre in Amsterdam, Netherlands, and he joins me to discuss haemostatic resuscitation in trauma.
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There has been an intense focus on the nutritional needs of ICU patients in recent years, but what happens to them when they go to the wards?
This important question is now the subject of interest for highly regarded critical care dietitians and researchers Lee-anne Chapple and Emma Ridley.
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It is well known that critical illness often features a pro-catabolic state, which can lead to muscle atropy and long term functional deficits. Early mobilisation has been thought to slow the rate of muscle loss, and potentially improve these outcomes.
Professor Carol Hodgson is Head of the Division of Clinical Trials and Cohort Studies, School of Public Health and Preventive Medicine, at Monash University in Melbourne, Australia.
She joins Todd on the podcast to talk about the recently released TEAM trial.
This is another great interview from the 2022 ANZICS CTG meeting in Noosa
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How important is AKI in trauma? Can we predict which patients will be affected? What can we do to stop it?
These questions and many more have troubled intensive care clinicians as they care for patients after severe trauma. Dr Anatole Harrois joins Todd on the podcast to talk all-things AKI in trauma
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In traumatic brain injury, the lung and the brain are caught in a complex interplay, where the challenges of managing one can affect the other.
Chiara Robba is a consultant in Neuro and General Intensive Care at Policlinico San Martino, Genova. She has a PhD in neuroscience and is the current chair of the NeuroICU section of the ESICM. Chiara joins Todd to discuss her thoughts on this important issue.
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Ventilation is known to cause injury to the lungs in its own right, but now it is becoming clear that the respiratory effort of the patient may also contribute to ongoing pulmonary damage.
Antonio Pesenti joins Todd to discuss what we know, and the future of research in this area.
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The SuDDICU trial is now in print. This long awaited trial explored the merits of Selective Digestive Decontamination (SDD), and in parallel studied its potential impact on the local microbiology resistance patterns.
After over 15 years of work, principle investigator Ian Seppelt joins Todd on the podcast to discuss the trial, the results, and what it all means
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COVID-19 is a multisystem disease, and cardiac injury has been identified as a major contributor to the pathology.
Antoine Vieillard-Baron is an intensivist and researcher from Boulogne in France, and he joins the podcast to talk about key echocardiographic patterns of disease found in COVID-19
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Thrombotic microangiopathies are uncommon disorders, and can result in significant patient morbidity. With the introduction of effective new therapies, the outlook for those suffering from these diseases is increasingly optimistic.
Elie Azoulay is a professor of medicine, intensivist and board member of the French National Reference Centre for Thrombotic Microangiopathies.
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Surgical site infections are a dreaded complication of all surgery, no more so than in cardiothoracics. Antibiotics at the time of surgery has an established role in the prevention of infections, but the duration of therapy remains contentious.
The CALIPSO trial will explore different approaches to this question, and chief investigator Trisha Peel joins Todd on the podcast to discuss the issue.
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Does my patient need bolus IV crystalloid fluids?
This is a conundrum faced on a daily basis for clinicians working in the ICU. As time goes by, more evidence of the harm fluids do becomes available, so how can we be sure the fluids we give benefit our patients?
Xavier Monnet is an intensivist and fluids researcher, and he joins Todd on the podcast to discuss fluid responsiveness.
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The development of antimicrobial agents is one of the most influential achievements of modern medicine. However, where once we thought the days of sepsis deaths could be numbered, antimicrobial resistance has given us pause for pessimism.
Professor Jan De Waele is a surgery-trained intensivist and clinical researcher from Ghent, Belgium, working on several aspects of optimizing antimicrobial use in the ICU, including Antimicrobial Stewardship.
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The pathophysiology of ARDS is complex and remains incompletely understood. However, it is clear that ARDS is not simply a disease of the alveoli.
Understanding the pathological basis of ARDS will assist in the development of new therapies for this potentially fatal disease.
One such avenue is the role of thrombolysis. Professor Anders Aneman and Dr Lucy Coupland are leaders of a new program of research looking at this potential intervention.
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The impact of resuscitation strategies on the gut is often neglected, as attention to circulatory and respiratory support takes priority.
Leading ICU dietitian Varsha Asrani joins Todd to chat about the implications of gut ischaemia for the longterm recovery of our patients.
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Healthcare is a difficult industry to advance in. Many of us are time-poor and there is little structure to training and learning outside formal college training programs.
Many clinicians are therefore turning to coaching and mentoring for answers. These concepts are familiar to many in business, but they are only now working their way into mainstream healthcare.
In this podcast, Rita Holland joins Todd to discuss the potential benefits of coaching in healthcare
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Traumatic brain injury is a significant problem, affecting patients of all ages across the globe. Despite this, relatively little hard evidence supports the interventions commonly used in practice.
Research in this area remains challenging, with many barriers to the traditional large-scale randomised controlled trial. Perhaps alternative sources of evidence are required.
In this podcast from the 24th annual ANZICS-CTG meeting in Noosa, Toby Jeffcote joins Todd to discuss these limitations, and how "big data" may provide the solution.
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In 2002, the critical care world was rocked by a pair of studies released simultaneously in the New England Journal of Medicine, which found that therapeutic hypothermia improved neurological outcomes for unconscious survivors of cardiac arrest.
In the almost 20 years that have followed, several trials have produced conflicting results, culminating in the TTM-2 trial released in 2021, which seems to have finally put the issue to rest – cooling to 33 degrees Celsius is no better for patients than 37.5.
Niklas Nielsen is Prof Anaes / CC at Lund University in Sweden, and the principle investigator of the TTM-2 trial, and he joins me on the podcast to discuss what’s next for hypothermia research.
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Plasmapheresis can be a life saving intervention in a number of ICU conditions. Two potential methods are available – centrifugal plasmapheresis and membrane therapeutic plasma exchange. But what do we know about the applicability, utilisation and complications of the latter?
On this episode, Todd is joined by Mitul Chavda and Alpesh Patel, who recently published 6 years worth of prospective data from their service, run from the Flinders Medical Centre in South Australia.
Baxter Healthcare has provided an educational grant to sponsor this podcast. The content was developed independently of Baxter Healthcare and opinions expressed are those of the presenting healthcare professionals.
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In this episode of the Careers in Health podcast, Todd chats to Rheumatologist Graeme Jones
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Part 2 of this interview with CLIP-2 chief investigator Michael Reade explores the structure of CLIP-2, some of the challenges the project has had to overcome, and the workings of a non-inferiority trial.
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Platelets are a critical component of haemostatic resuscitation, but there are significant challenges involved in their use, most notably, their short shelf life.
Could frozen platelets be the answer?
Michael Reade is an anaesthetist, intensivist and clinical researcher from the University of Queensland and the Australian Defence Force, and he joins Todd to discuss his research program in this area, known as CLIP
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Ketamine is regarded as a bit of a wonder drug in emergency and critical care areas, but is it all that it’s cracked up to be.
Andrew Casamento is an Intensivist / Emergency Physician at the Northern, Austin, Warringal Private and Bendigo Hospitals in Victoria, and is the author of a recent review of the role of ketamine in mechanically ventilated ICU patients. He joins Todd on the podcast to discuss some of the important points.
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Bronchiolitis is a considerable portion of the workload of paediatric ICUs. As an inflammatory disease process, treatment with corticosteroids may have benefit, and the alpha effects of adrenaline may reduce secretions. However, evidence remains sparse, while international guidelines are conflicting.
Ben Gelbart is a paediatric intensivist from the Royal Children's Hospital in Melbourne, and he joins the podcast to chat about a recently released paper on which he was the lead author, which explore the role of these two agents.
This is the second interview from our podcast series from the 2022 Noosa meeting of the ANZICS CTG
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Our guest on this podcast is Dr Emma Ridley, Manager of the ICU Nutrition Program at the Monash University ANZICS Research Centre. She joins me Todd to chat about her survey of nutritional practice in Australasian ICUs, known as Nutrients, presented at the 2022 ANZICS-CTG conference in Noosa.
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Delirium and sleep deprivation are known to go hand in hand in the ICU.
Could melatonin, a readily available, safe and cheap hormonal therapy, improve sleep, and thereby delirium, in a general population of ICU patients?
Lead investigator of the recently released ProMEDIC study Dr Brad Wibrow joins Todd to discuss the results of his study.
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In this Careers in Health podcast, Todd chats to Ear, Nose and Throat surgeon, Dr David McIntosh
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Interstitial Lung Disease is like a black box for many intensivists. The complexity of the pathology seems to be only matched by the complexity of the diagnostic classification, and the drug names used to treat them.
James Lindstrom is a dual trained intensivist and respiratory physician in Geelong, Australia, and he joins me to explore some of the issues related to ILD in the ICU
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It has been said that more people suffer harm from our management of diabetic ketoacidosis than those that do from the disease itself.
So how do we avoid these pitfalls in the emergency department?
Adan Atriham is an emergency physician from Houston, Texas
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Unstable patients with tachyarrhythmias may need urgent cardioversion in the emergency department.
Dr Eleni Salakidou is a specialist in emergency medicine at the University General Hospital of Heraklion, and she joins Todd on the podcast to share her tips for safe and successful cardioversion.
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Necrotising fasciitis is a scary disease for even the most experienced of emergency physicians.
Dr Michael Gleenberg is an emergency physician and Residency Director at the Assuta Ashdod University Hospital in Israel, and he joins Todd to discuss the identification and management of this important disease process
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In this episode of the Careers in Health podcast, Todd chats to ophthalmologist, Dr Madeleine Adams
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Medication errors are a significant challenge to the safety of patients. Pre-filled syringes represent an opportunity to prevent errors related to medication preparation, and may have additional cost and efficiency savings.
Dr Rhys Thomas is an anaesthetist and the Quality and Safety Fellow at John Hunter Hospital in New South Wales. He joins Todd to share his experiences with pre-filled syringes
Baxter Healthcare has provided an educational grant to sponsor this podcast. The content was developed independently of Baxter Healthcare and opinions expressed are those of the presenting healthcare professional.
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Many doctors will take leadership positions during their careers, but the skills required to succeed in these roles do not come naturally to all.
Hash Abdeen is the Chair of the Council of Doctors in Training for the Australian Medical Association. He joins Todd on the podcast to chat about his experience in leadership positions, how junior doctors can enhance their skills, and what the AMA CDT is doing to support this.
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In this episode of the Careers in Health podcast, Todd interviews Dr Sophia Velosa, an endocrinologist with a special interest in Obstetric Medicine
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The stress of exams, clinical practice, finances and major life events takes a toll on junior doctors. The added burden of COVID-19 has pushed many to the edge.
Tahnee Bridson is an inspiring young doctor who saw an opportunity to help by establishing a peer-to-peer support group, known as Hand 'n' Hand.
She joins Todd on the podcast to chat about the project
If you would like to access the serviced provided by Hand 'n' Hand, or are interested in becoming a support facilitator, follow the link below
https://www.handnhand.org.au/join
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The critically ill bleeding patient who is taking novel oral anticoagulant medications is a difficult clinical challenge.
Dr Barbra Backus is an emergency physician from The Netherlands, and she joins Todd to discuss some of the important issues in managing this problem.
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In this episode, Todd chats to geriatrician Dr John Endacott
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Acute cardiogenic pulmonary oedema is a common presenting complaint in the emergency department.
Dr Roberto Cosentini is an emergency physician from Bergamo in Italy. He joins Todd to discuss the use of NIV in the management of these patients.
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Transcutaneous pacing is an important emergency skill. In this podcast, senior emergency medicine trainee Dr Tim Balfour joins Todd to discuss the indications for pacing, describe the process of applying and adjusting it, and share some tips and tricks for its use.
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Dr Stuart Collins is a urologist on the Sunshine Coast in Queensland, Australia.
He joins Todd on the podcast to chat about the highs and lows of his specialty.
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As Indirect Calorimetry becomes more practical at the bedside, how will it influence nutritional prescription?
Oana Tatucu is a senior ICU dietitian and a research fellow at the ANZICS Research Centre. She joins Todd on the podcast to discuss the role of IC now and into the future.
Baxter Healthcare has provided an educational grant to sponsor this podcast. The content was developed independently of Baxter Healthcare and opinions expressed are those of the presenting healthcare professional.
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Patients with chronic pulmonary hypertension can present to hospital acutely unwell. What are the principles of managing these patients?
Cardiologist Dr Kavitha Muthiah joins Todd on the podcast to discuss the underlying causes, precipitants, management and rescue options for these patients.
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Bronchopleural fistula is an important diagnosis to consider in patients with persistent and high volume pneumothoraces.
Dr Izzy Seneviratne is a dual trained Intensivist and Respiratory Physician who joins Todd on the podcast to talk about the diagnosis and management of this important condition.
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Targeted temperature management has become a mainstay of treatment for resuscitated patients following cardiac arrest.
Manoj Saxena is an intensivist and clinician researcher from Sydney, Australia, and was part of the team that delivered the TTM-2 trial earlier in 2021. He joins Todd on the podcast to discuss the premise of TTM-2, the results and what comes next.
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As the world wrestles with the COVID-19 pandemic, it’s clear that much depends on our ability to vaccinate a large proportion of the population.
Like all medications, vaccines have their side effects, and the most notable at present is an unusual syndrome of intravascular clotting associated with thrombocytopaenia.
Dr Tim Brighton is a consultant haematologist with New South Wales Health, and a participant in a recent working party that developed guidelines for the detection and management of this important condition, known as Vaccine Induced Thrombotic Thrombocytopaenia, or VITT.
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The importance of adequate antibiotic dosing in sepsis and pneumonia is well known. However, changes in the pharmacokinetics and dynamics of antibiotics makes it challenging to ensure the appropriate doses are given.
Dr Jason Roberts is an internationally renowned ICU pharmacist and researcher, and he joins Todd to discuss these important issues, and some potential solutions.
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Manipulating the ventilator to protect the critically ill ARDS patient from harm, while simultaneously improving their condition, is one of the dark arts of intensive care practice.
Airway Pressure Release Ventilation is a somewhat novel mode of mechanical ventilation which seeks to enhance lung recruitment while reducing lung injury. Ed Litton is an Intensivist and researcher from the Fiona Stanley Hospital in Perth, Australia, and he joins Todd to chat about his approach to APRV
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Join host Dr Todd Fraser for this fascinating exploration of life, both professional and personal, for those lucky enough to practice in a regional or remote ICU.
Guests include Penny Stewart, Rob Bevan, Paul Secombe, Claire Corrigan and Lauren Cox
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Traditionally we’ve measured the performance of the health system machine on hard endpoints such as mortality, and this is particularly so in ICU.
In recent years however, we’ve begun to focus more on the patient experience, including their functional outcomes. Narrative and qualitative research has provided us with a better understanding of the emotional, psychological and physical trauma imposed by critical illness.
Kali Dayton is a nurse practitioner in ICU, and through her podcast “Walking Home from the ICU”, has helped shine the spotlight on this important issue through a series of interviews with survivors of critical illness. She joins Todd on the podcast to share what she's learned.
You can find Kali's podcast here : https://anchor.fm/restoringlife
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Extracorporeal membrane oxygenation (ECMO) is an increasingly available therapy, though it remains restricted to tertiary centres. So what does this mean for smaller peripheral units?
Dr Sara Allen is an intensivist and anaesthetist from the Auckland City Hospital in New Zealand, and she joins Todd to discuss referrals for ECMO.
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The intravenous cannula may be the most common procedure performed in healthcare. You probably perform several of them a day, without thinking twice.
However, without attention to detail, it’s possible the humble cannula could cause your patient harm.
Gillian Ray-Barruel is an experienced nurse researcher at Griffith University in Australia. Among her numerous research interests, Gillian has extensive experience in prevention of indwelling device-related patient complications.
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Large and persistent bronchopleural fistulae are one of the more challenging problems to manage in ICU practice.
In this enlightening interview, Intensivist and Respiratory Physician Dr Michael Putt discusses the principles of management, and the role of bronchoscope intervention.
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Up to a quarter of emergency services calls relate to behavioural disturbance or mental health issues. For many patients, these calls end up in transportation to the emergency department, where the service struggles to meet the patient's needs.
David Hardstaff is an experienced paramedic who is part of a novel approach to this problem, a prehospital response team aiming to manage patients predominantly in their own homes. He joins Todd to talk about the prehospital issues surrounding mental health, and the Co-Responder program.
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While mechanical ventilation can be life saving, it can also cause its fair share of complications.
Dr Kiran Shekar is an intensivist at The Prince Charles Hospital in Brisbane, Australia. He heads a program of research exploring a range of therapies that may minimise these risks, including the subject of today's discussion, Extracorporeal CO2 removal (ECCOR)
Baxter Healthcare has provided an educational grant to sponsor this podcast. The content was developed independently of Baxter Healthcare and opinions expressed are those of the presenting healthcare professional.
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We focus a lot on energy and protein delivery in ICU. But what happens to patients and their nutrition when they get to the wards?
Could it be that an intensive approach to feeding throughout the patient's hospital stay is the key to enhancing functional recovery?
Eliza Miller is the project manager for the INTENT trial, and she joins us to discuss this important study.
Baxter Healthcare has provided an educational grant to sponsor this podcast. The content was developed independently of Baxter Healthcare and opinions expressed are those of the presenting healthcare professional.
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While sepsis research in adults has gathered pace in recent years, similar work in paediatrics is lacking.
Among those looking for the elusive "magic bullet" are researchers Sainath Raman and Luregn Schlapbach. In this fascinating podcast, they discuss the limitations of research in paediatric sepsis, the current evidence landscape, and their upcoming RESPOND trial.
Baxter Healthcare has provided an educational grant to sponsor this podcast. The content was developed independently of Baxter Healthcare and opinions expressed are those of the presenting healthcare professional.
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Resuscitation of hypotensive patients with sepsis traditionally involves up to several litres of crystalloid fluids before vasopressors are initiated. While this forms the basis for many sepsis management guidelines, the dogma is being challenged.
In this latest podcast from the 2021 ANZICS CTG meeting in Noosa, Stephen McDonald joins Todd to talk about the ARISE FLUIDS 2 trial, which aims to provide more detail on the prioritisation of these two key interventions.
Baxter Healthcare has provided an educational grant to sponsor the following podcast. The content was developed independently of Baxter Healthcare and opinions expressed are those of the presenting healthcare professional.
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Many patients undergoing Continuous Renal Replacement Therapy in ICU require fluid removal.
But how fast can you remove it?
Dr Emily See is a Nephrologist and senior ICU fellow at the Austin Hospital in Melbourne Australia. She joins Todd on this edition of the podcast from the 2021 ANZICS CTG meeting in Noosa to talk about the concept of Net Ultrafiltration Rate, and the upcoming NEPTUNE study.
Baxter Healthcare has provided an educational grant to sponsor the following podcast. The content was developed independently of Baxter Healthcare and opinions expressed are those of the presenting healthcare professional.
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Limiting tidal volumes to prevent lung injury has been a core plank of ICU care for the past 20 years.
However, is it that simple? Dr Ewan Goligher joins us to discuss how using the driving pressure to set Vt may help tailor ventilation to the patient's needs.
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While it remains an uncommon event, some patients with cancer require ICU level care.
Dr Tamishta Hensman is a senior ICU fellow at the Royal Darwin Hospital, and holds a Diploma of Palliative Care Medicine. Following her presentation at the recent CICM Annual Scientific Meeting, she joins Todd to discuss the latest data on survival, some common presentations, and some tips for talking to families.
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Lung ultrasound is gradually establishing itself as an invaluable point-of-care investigation in ICU and emergency medicine.
Dr Robert Arntfield is an intensivist and traumatologist from London, Ontario, and he joins Todd to describe how it fits into his clinical practice.
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Despite the incredible burden of COVID-19, ICU researchers have somehow been able to produce practice changing research at an unprecedented rate.
ICU nutrition researchers Lee-anne Chapple and Emma Ridley join Todd on the podcast to discuss their findings regarding the nutritional status and issues for COVID-19 patients admitted to ICU
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Despite increasing focus and the development of international clinical guidelines, delirium in ICU remains an under-recognised issue.
Melissa Ankravs is a senior ICU pharmacist, and she joins Todd on the podcast to discuss the results of a point prevalence study in Australia / New Zealand
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Aidan Burrell joins the podcast to update our listeners with the progress of the SPRINT SARI project - designed to collect real time data on the COVID-19 pandemic in Australasia.
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One of the fundamentals of therapy for severe Diabetic Ketoacidosis (DKA) is fluids. However, it is well known that aggressive fluid replacement with Normal Saline commonly results in a non-anion gap metabolic acidosis as the underlying condition improves.
Does this acidosis cause harm? Can it be avoided?
In this edition of the podcast, Todd chats to intensivist Dr Mahesh Ramanan about his recently completed study, SCOPE, which compared the effects of buffered solution Plasmalyte 148 with normal saline in these patients.
This is another great podcast interview from the 2021ANZICS Clinical Trials Group meeting in Noosa
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COVID 19 has ravaged many parts of the world, leaving some patients with persistent symptoms known as "Long COVID".
But what about survivors of critical illness due to COVID-19? How do they compare with other ICU survivors?
Professor Carol Hodgson is the Head of the Division of Clinical Trials and Cohort Studies, School of Public Health and Preventive Medicine, Monash University. Carol's major area of research interest is functional outcomes for survivors of ICU, and she joins Todd to chat about the COVID-RECOVERY study
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Professor David Tuxen has had a long and distinguished career as an Intensivist, Director and researcher. Decades of research into mechanical ventilation have given David a unique perspective into trial interpretation, and he has recently raised his concerns about research outcomes in ventilation trials.
He joins Todd on the latest podcast from the 2021 ANZICS CTG Noosa meeting to discuss these issues.
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Hypofibrinogenaemia is an independent risk factor for mortality after severe trauma. How though should we manage it?
Dr James Winearls is an Intensivist and researcher from the Gold Coast University Hospital. In this special edition podcast from the 2021 Noosa ANZICS CTG meeting, he joins Todd to chat about the issue, and the FIESTY 2 study he leads
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Looking for a specialty that combines procedural work with consultation, private practice and in-patient care? Need something with a seemingly endless array of options for subspecialisation?
Gastroenterology may well be just what you're looking for. Dr Simone Kaye joins Todd on the Careers in Health podcast to find out what it's really like
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Extracorporeal membrane oxygenation (ECMO) has an established role as a rescue therapy in severe respiratory failure.
But could there be benefit in using it earlier, to avoid the potential complications associated with mechanical ventilation?
Dr Aidan Burrell is an intensivist and researcher from The Alfred Hospital in Melbourne, Australia, and he joins Todd on the first podcast from the 2021 Noosa ANZICS CTG meeting.
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The marvel that is modern Intensive Care has the capacity to save lives, and help survivors live long and satisfying lives. But it comes at a cost, both in terms of patient experience and cost.
Anecdotally, the number of patients with life-limiting illnesses are being referred for management in the ICU. This trend has given some clinicians pause to consider whether traditional ICU is the best place for their care.
Dr Matt Maiden led a team who studied the incidence of life limiting illness in ICU patients, and he joins Todd on the podcast to discuss the results and their implications.
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As the COVID-19 pandemic continues unabated, the search for meaningful therapies is being led by clinical researchers.
Dr Lise Estcourt is a consultant haematologist who has led major studies into the role of convalescent plasma in the treatment of COVID-19.
She joins Todd on the podcast to summarise the data so far.
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Can you cut it?
Being a surgeon is as much a way of life as it is a profession. In this podcast, Felicity Adams joins Todd to chat about her experiences in training to become, and then being, a surgeon.
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James Cox is a Queensland-trained orthopaedic surgeon with subspecialty interests in hip, knee and pelvic trauma.
He joins Todd on the podcast to describe his path to specialty, and what life is like as an Orthopaedic Surgeon
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Intensive Care Medicine is a highly exciting and variable specialty, but it also carries with it the stress of caring for patients and their families under enormous duress.
Dr Rob Bevan is an Intensivist and supervisor of training at Middlemore Hospital in Auckland, New Zealand, and the current vice president of the Australia New Zealand College of Intensive Care Medicine
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Sudden cardiac arrest is a common event. Rarely though, it can be a feature of acute Subarachnoid Haemorrhage.
What impact does this have on the patient's prognosis?
A recent review of a binational ICU patient registry set out to explore this question, and one of the authors, Professor Andrew Udy, joins Todd on the podcast to discuss their findings
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Despite increased focus on gender inequities in healthcare in recent years, female doctors still experience the effects of systemic discrimination. Rather than teaching them how to cope with discrimination, proactive strategies such as enhanced negotiations skills may help to level the playing field.
Fiona McKenzie is a management consultant and mediator, and she has developed a framework for teaching negotiation skills to female doctors, helping them achieve their goals and progress their careers.
She joins Todd on the podcast to discuss her program
More information about Sustainable Negotiation can be found at www.resolvingmatters.com.au
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Dr Craig Mitchell has spent nearly 20 years providing general anaesthesia and critical care services. His career encompasses private and public work, routine and emergency cases, critically ill patients and rural practice. Somehow, he's also found time to explore non-medial business interests to, as a co-founder of a boutique winery and wine bar.
His story serves as an example of the wide and varied opportunities available to medical graduates
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Malnutrition is common in ICU, and it stands to reason that it should impact on functional recovery.
Lee-anne Chapple is a senior dietician in critical care at the Royal Adelaide Hospital, and an NHMRC Early Career Fellow at the University of Adelaide. She joins Todd on the podcast to discuss her work in protein metabolism in critically ill patients
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Traditionally, anaesthetists have ventilated patients undergoing prolonged surgery with supra physiological tidal volumes to prevent collapse and improve oxygenation. But is this safe? Evidence from the critical care sphere suggests ventilator induced lung injury may be minimised with a more conservative approach.
Dharshi Karalapillai is an Intensivist-Anaesthetist from Melbourne's Austin Hospital, and is lead author of a paper which explored the role of a low volume ventilation strategy.
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So what makes a cardiologist tick?
Professor Christian Hamilton-Craig has experienced the full spectrum of cardiology, from academia and research to bedside clinician, taking the good with the bad along the way.
In this absorbing interview he describes the path his career has taken, the options available to those interested in cardiology, and the enjoyment he derives from it to this day.
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Does metabolic acidosis cause harm to critically ill patients? Or is it just an epiphenomenon of severe illness?
In this podcast, lead investigator of the VITAMINS trial, Tomoko Fujii, joins Todd to discuss her latest program of research, the SODIBIC trial.
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Colin McArthur is an Intensivist and director of research at Auckland City Hospital in New Zealand, and is the Co-lead for the Australia-New Zealand arm of the REMAP-CAP study, which today releases the results of its first domain study, corticosteroids.
Colin joins Todd on the podcast to discuss the results of this important trial
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David Cooksley is an experienced Emergency and Retrieval Physician who currently works in the Emergency Department at the Sunshine Coast University Hospital and for LifeFlight Retrieval Medicine at their Maroochydore helicopter base. He has worked for four different retrieval services including twice with the London’s Air Ambulance, which is widely regarded as the world’s best pre-hospital trauma service. He is also a Wing Commander in the RAAF Specialist Reserve and is the Air Force’s Principal military critical care aeromedical transport team instructor and has successfully completed overseas training in military pre-hospital combat critical care.
Today David joins Todd on the podcast to share his experiences in retrieval medicine.
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Transporting the ventilated patient is one of the highest risk processes critically ill patients will face
Lina Bergman is a critical care nurse and researcher from Gothenberg in Sweden, and she joins Todd on the podcast to discuss her research into this delicate process.
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As the COVID-19 pandemic surges ahead, researchers are desperately seeking evidence to support a range of potential disease modifying treatments.
On this episode, Prof Tony Gordon from Imperial Hospitals in London joins me to discuss one such potential therapy, convalescent serum. Tony is a prominent intensivist researcher and is the UK chief investigator for the REMAP-CAP study.
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On this episode of the Careers in Health Podcast, Todd is joined by General Practitioner Dr Anita Holland. Originally from the UK, Anita has settled on the Sunshine Coast in Queensland, Australia, and has specialised interests in obstetrics, paediatrics and women's health.
In this fabulous interview, Anita chats about the highs and lows of general practice, and how the flexibility it affords has allowed her to explore her other passions.
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Critical illness can have an overwhelming effect on the long term quality of life of survivors of ICU.
On this thought provoking interview, Professor Carol Hodgson joins Todd on the podcast to discuss the latest publication in her research program, the PREDICT trial, which was presented at the 2020 ANZICS Clinical Trials Group meeting in Noosa.
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The unfolding COVID-19 pandemic has seen an unprecedented sharing of information to support clinicians in making clinical decisions at the coal-face. But has this pressure to publish data come at the cost of lower standards of governance?
Colin McArthur, co-lead of the ANZ arm of the REMAP-CAP study joins Todd on the podcast to discuss the trials and tribulations of hydroxychloroquine, and THAT observational study.
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So what's life like as an Infectious Diseases Physician?
Dr Keat Choong is the Director of Infectious Diseases at the Sunshine Coast University Hospital in Queensland, Australia.
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Research in the past decade has helped clarify dosing and indications for renal replacement therapy. But what about the management of volume status in a critically ill patient with acute anuric renal failure?
Professor Rinaldo Bellomo is one of the world's leading critical care nephrologists and researchers, and he presented his thoughts on this issue at the most recent Australia-New Zealand Intensive Care Society (ANZICS) Clinical Trials Group meeting in Noosa. He joins Todd to discuss the concept, and his plan for a research program to answer these questions.
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Chronic pain in survivors of ICU is remarkably frequent, yet remains poorly researched and managed. Dr Ben Moran is an anaesthetist and intensivist from New South Wales in Australia, and a PhD candidate at the George Institute in Sydney. He joins Todd on the podcast to discuss his research.
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High flow nasal oxygen therapy is rapidly establishing itself as a low cost, low side effect treatment option in respiratory failure.
In this, another great podcast from the 22nd Annual Meeting of the Australia-New Zealand Intensive Care Society (ANZICS) Clinical Trials Group in Noosa, Australia, Todd is joined by Dr Ed Litton to talk about the upcoming NOTACS trial, an international study exploring its role in preventing complications post cardiothoracic surgery.
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As the COVID-19 outbreak unfolds, increasing experience with the disease has allowed much to be learned.
Dr Mark Nichols joins Todd on the podcast to discuss the updated COVID-19 guidelines from the Australia-New Zealand Intensive Care Society (ANZICS).
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As the pandemic crisis grows, there is considerable anxiety among clinicians who may be required to make difficult decisions about the management of an overwhelming number of patients.
Former ANZICS president Stephen Warrilow chaired a working group which developed consistent guidelines to support these decisions and he joins Todd to discuss them in this essential podcast.
The guidelines can be found here
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One of the most daunting tasks during the COVID-19 outbreak is intubation. Not only are the patients extremely sick and fragile, but the risks to staff and the strategies employed to prevent them add extra complexity.
Associate Professor David Brewster is an intensivist and anaesthetist and Melbourne's Cabrini Hospital, and a board member of the Safe Airway Society. He joins Todd to chat about the recently released SAS guideline for intubation of the COVID-19 patient.
The guidelines can be found here -
https://www.mja.com.au/journal/2020/consensus-statement-safe-airway-society-principles-airway-management-and-tracheal
During the interview David refers to the Intubate COVID study, which can be found here - http://bit.ly/intubatecovid
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In the midst of the COVID-19 pandemic, researchers are working overtime to provide data to clinicians at the bedside. Among them is Professor Steve Webb from Monash University's School of Public Health and Preventative Medicine. Steve is the principal investigator of the REMAP-CAP study, a multi-factorial research program designed to provide meaningful results on potential interventions in real time.
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In these uncertain early phases of the pandemic, it is critical that clinicians and policy makers alike have access to data to inform decisions. SPRINT SARI, established after the 2009 H1N1 outbreak, will collect demographic and management data from COVID-19 patients admitted to over 50 ICUs.
Aidan Burrell is an intensivist at Melbourne's Alfred Hospital, and is an Adjunct Senior Lecturer at Monash University. He joins Todd to share more on the SPRINT-SARI study
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As the COVID-19 pandemic gathers pace, the Australia New Zealand Intensive Care Society has released guidelines for preparation, resource allocation and management of patients with COVID-19
In this special edition podcast, Anthony joins Todd to discuss the guidelines, which can be found here
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Emma Ridley is the Manager of the ICU Nutrition Program at the Monash University ANZICS Research Centre. She joins Todd on the podcast to chat about another role she fills, as chair of the ANZICS CTG Novice Investigators Group
You can find more information about the group here
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In this Osler special edition podcast from the 22nd annual Australia New Zealand Intensive Care Society (ANZICS) Clinical Trials Group meeting from Noosa, Todd chats to TAME-Cardiac Arrest lead investigator Glenn Eastwood about therapeutic permissive hypercapnoea in resuscitated cardiac arrest patients.
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In this latest Osler podcast from the 22nd annual ANZICS Clinical Trials Group meeting from Noosa, Shailesh Bihari chats with Todd about his work with 20% albumin in sepsis resuscitation
Shailesh is an Associate Professor at Flinders University in Adelaide, and an NHMRC Early Career Fellow
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In this special edition Osler podcast, live from the 22nd annual ANZICS Clinical Trials Group meeting in Noosa, Australia, renowned critical care trials Todd Rice joins us to chat about Pragmatic Clinical Trials.
Todd is an Associate Professor of Medicine in the Division of Allergy, Pulmonary and Critical Care Medicine at Vanderbilt University in Nashville, Tennessee
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Violence in healthcare staff is anecdotally increasing. A recently released paper casts further light on this important issue, and explores whether the National E Admission Target (NEAT) is a new factor in triggering such episodes against ICU staff.
Authors Albertina Pol and Stephane Bouchoucha join Todd on the podcast to discuss their findings
The reference for the paper discussed in this podcast is found here:
Pol, Albertina & Bouchoucha, Stephane & Carter, Melody. (2018). Violence and aggression in the intensive care unit: What is the impact of Australian National Emergency Access Target?. Australian Critical Care.
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Patients with acute liver failure are relatively rare, but they can be spectacularly unwell.
In this enlightening interview, Dr Stephen Warrilow from Melbourne's Austin Hospital joins Todd to discuss the outcomes and management of this important group of patients.
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Paul Secombe is an intensive care physician at the Alice Springs Hospital in Australia. He is the lead author of a recent review of the presentation, resource needs and outcomes of indigenous Australians admitted to an intensive care unit.
He joins Todd on the podcast to explore the findings of this review, and what it means for the care of his patients.
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Amy Neilson has spent the best part of her career working in austere and hazardous environments with a range of humanitarian organisations. She joins Todd on this podcast to share some of her amazing experiences.
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Dr Jocelyn Lowinger initially trained as a GP before working in health, where she first came into contact with professional coaching. Fascinated by the idea, she undertook further training, and now offers this service across the healthcare industry.
She joins Todd on the podcast to discuss coaching and how it applies to the modern health paradigm.
Interested listeners can find more information at Jocelyn's website : https://coachgp.com.au/
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Bethany Boulton is an emergency physician from Queensland. She joins Todd on the Careers in Health podcast to chat about what it's really like to be at the cutting edge of emergency medicine
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Is hyperoxia harmful in ICU patients? Does a restrictive approach to prescription of FiO2 in ventilated patients improve patient centred outcomes?
These questions have led to the ICU-ROX trial, which was recently released at the World Congress of Intensive Care in Melbourne, Australia. Principle investigator Dr Paul Young presented the paper, and joins Todd on the podcast to discuss the results, and where we go from here.
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Associate Professor Daryl Jones is an intensivist from The Austin Hospital in Melbourne, Australia. He joins Todd on the podcast to discuss the nature of in-hospital cardiac arrest in the era of a modern Rapid Response Team.
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In this episode of the Career Paths podcast Todd talks to Dr Sonia Fullerton, a palliative care physician with an interest in symptom management, end of life care and advanced care planning. Sonia also has interests in physician wellbeing and the healthcare needs of asylum seekers.
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Managing acute pain is a common task faced by all junior doctors. With a range of analgesics available, and a seemingly endless variety of conditions to apply them to, this task can become quite complex.
In this podcast, Todd chats with Dr Nellie Dick, an anaesthetist with a special interest in the management of acute pain.
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Ensuring patients get the right treatment at the right time is a core ambition of a modern healthcare system, and there is no better example of this than the early administration of antibiotics in patients with severe sepsis.
Daniel Cudini is an Intensive Care Paramedic and Clinical Support Officer with Ambulance Victoria, and is a noted prehospital researcher. He joins Todd on the podcast to chat about the PASS study - Paramedic Antibiotic administration in Severe Sepsis.
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Dr Rob Dickson is a 6th year trainee of the Australian College of Remote and Rural Medicine in the tiny Tasmanian hamlet of Queenstown, and recently ventured to the Southernmost continent as an Antarctic Medical Practitioner.
He joins Todd on the podcast today to chat about the appeal of remote and rural medicine, and his time practicing medicine in the world's most isolated practice.
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Dr Andrew Casamento is an emergency medicine and intensive care physician from Melbourne, Australia. He joins Todd to discuss the use of 2 commonly used narcotic infusions in critically ill patients, fentanyl and morphine, and challenges the research community to investigate this surprisingly evidence-free zone.
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Sepsis is usually associated with fever. This highly conserved response has a range of theoretical benefits, including enhanced immune functioning and increased microbial response to antibiotics.
But what happens when patients are hypothermic on presentation? Professor Andrew Udy joins Todd on the podcast to discuss the impact of hypothermia in sepsis, and the results of a recent review of such patients at Melbourne's Alfred Hospital.
The review can be found here
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Traumatic cardiac arrest is associated with a terrible prognosis - or is it?
In this fabulous Osler Podcast, Todd is joined by ED, Pre-hospital and ICU physician Dr Adam Holyoak to talk about the presentation, outcomes and management of patients who arrest after trauma.
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Blood is a precious commodity at the best of times, but no where more so than on the African continent.
The incidence of children presenting with sepsis and critical anaemia is frightening, and overwhelms the availability of blood. There is some contention that adherence to the World Health Organisation guidelines may ultimately waste this scarce resource.
Kath Maitland, author of the renowned FEAST trial, led her research group in trying to determine whether or not a highly restrictive approach to transfusion in this group compared with the WHO standard was safe in a trial known as TRACT.
Kath joined Todd to discuss the results and implications of this extremely important trial.
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Is the capacity to train new Intensivist reaching a tipping point? What is the capacity of the current system to train ICU trainees?
Professor Bala Venkatesh is a former president of the College of Intensive Care Medicine of Australia / New Zealand, and recently published the results of a binational survey of Directors of ICU, Supervisors of Training and CICM trainees.
He joins Todd on the podcast to discuss the findings, and how they potentially impact on the future training program.
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The role of vitamin C and thiamine in the management of vasoplegic septic shock has been a highly controversial and topical issue in modern critical care in the past 2-3 years.
Tomoko Fujii, research fellow at the Monash-ANZICS Research Centre and clinical intensivist, joins Todd in this fascinating podcast to discuss the ongoing VITAMINS trial, a feasibility study seeking to set the ground work for a major trial in this area.
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Michael Toolis is an ICU fellow at St Vincent's Hospital in Melbourne. He recently published a survey of Australasian intensivists, aimed at exploring the variation in intubation practice, and the need for regional guidelines and refresher training.
He joined Todd on the podcast to review the survey, and the current guidelines on managing intubation in critically ill patients.
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On this week's episode, Dr Jai Darvall, an intensivist and anaesthetist from the Royal Melbourne Hospital, joins Todd to talk about his area of interest, persistent critical illness.
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Professor Ravi Tiruvoipati is an intensivist and director of research at Peninsula Health Service in Melbourne, Australia. Ravi has extensive research experience with extracorporeal therapies in ICU, and is currently completing his PhD in carbon dioxide physiology.
Ravi joins Todd on the podcast to discuss the role of hypercapnoea in sepsis, and whether it might eventually play a therapeutic role.
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Attending a call for a patient in palliative care is an increasingly common experience for paramedics. In this fantastic interview, Tony Hucker joins Todd to discuss the reasons for these calls, some tips on how to deal with them, and the barriers to providing quality palliative care.
Tony is a Critical Care Paramedic with over 4 decades of experience in a number of Australian ambulance jurisdictions. Tony is a Senior Medical Educator with the Royal Australian College of General Practitioners and teaches advanced resuscitation programs nationally. His current full time role is with the Queensland Ambulance Service as the Director of Clinical Quality and Patient Safety.
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Professor Sandy Peake is an intensivist and researcher from the Queen Elizabeth Hospital and the University of Adelaide, and is one of the principle investigators of the recently released TARGET trial.
In this fascinating interview, Sandy chats to Todd about energy delivery in ICU patients, the TARGET trial and how the results impact on our practice today.
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Tranexamic acid is an old drug with a new purpose, and is increasingly found in the drug kits of prehospital providers.
Dr Dan Bodnar, Deputy Medical Director of Queensland Ambulance Service, joins Todd on the podcast to discuss the uses, evidence base and administration of Tranexamic acid.
Dan is a Brisbane based Emergency Physician. His work life between the Royal Brisbane and Women's Hospital, the Queensland Ambulance Service and the Queensland Children's Hospital.
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