Critical Matters: Recent Episodes
Sound Physicians
Fluid overload is a common problem in critically ill patients. In this episode, Dr. Sergio Zanotti discuss recognizing and managing fluid overload in the ICU with guest Dr. Michael J. Connor, Jr., a practicing intensivist and nephrologist. Dr. Connor is a Professor and Senior Physician of Critical Care Medicine & Nephrology at the Divisions of Pulmonary, Allergy, Critical Care, and Sleep Medicine and Renal Medicine at Emory University School of Medicine. Additionally, he serves as the director of critical care nephrology at the Emory Critical Care Center at Grady Memorial Hospital.Additional resourcesEuropean Society of Intensive Care Medicine Clinical Practice Guideline on fluid therapy in adult critically ill patients: Part 3- fluid removal at de-escalation phase. Intensive Care Med 2025: https://pubmed.ncbi.nlm.nih.gov/40828463/ Optimizing Fluid Therapy in the Critically Ill. International Fluid Academy website – 2025: https://www.fluidacademy.org/2025/01/17/optimising-fluid-therapy-in-the-critically-ill-introduction-to-7d/ Fluid overload in the ICU: evaluation and management. R. Claure-Del Granado and R. L. Mehta. BMC Nephrology 2016: https://pubmed.ncbi.nlm.nih.gov/27484681/Books and music mentioned in this episode:Think Again: The Power of Knowing What You Don’t Know. By Adam Grant: https://bit.ly/4gZvz9cRUSHMERE. By Mumford & Sons: https://bit.ly/473FzKc
Originally posted in April of 2023, we are sharing this episode of Critical Matters again as Dr. Sergio Zanotti's discussion about the long journey to healing and recovery for those who've survived critical illness in the ICU remains pertinent and important. This conversation features Dr. Margaret Herridge, Professor of Medicine, Senior Scientist in Critical Care and Respiratory Medicine at the University of Toronto. Dr. Herridge is also Director of Critical Care Research. Director of the RECOVER Program, and Clinical Director of the Grace RECOVER Program for Chronic Critical Illness, in the University Health Network, Toronto, Canada.Additional Resources:Outcomes after Critical Illness. M. Herridge and E. Azoulay: https://pubmed.ncbi.nlm.nih.gov/36884324/Neuropsychological sequelae and impaired health status in survivors of severe acute respiratory distress syndrome. Hopkins RO, et al: https://pubmed.ncbi.nlm.nih.gov/10390379/One-year outcomes in survivors of the acute respiratory distress syndrome. Herridge m, et al: https://pubmed.ncbi.nlm.nih.gov/12594312/Long-term cognitive impairment after critical illness. Pandharipande PP, et al: https://pubmed.ncbi.nlm.nih.gov/24088092/The RECOVER Program: disability risk groups and 1-year outcome after 7 or more days of mechanical ventilation. Herridge M, et al: https://pubmed.ncbi.nlm.nih.gov/26974173/Determinants of long-term outcome in ICU survivors: results from the FROG-ICU study. Gayat E, et al: https://pubmed.ncbi.nlm.nih.gov/29347987/Symptoms of anxiety and depression in family members of intensive care unit patients. Pochard F, et al: https://pubmed.ncbi.nlm.nih.gov/11588447/Books Mentioned in this Episode:Bel Canto. By Ann Patchett: bit.ly/3nWs7VpCommonwealth. By Ann Patchett: bit.ly/43pWSCt
In this episode, Dr. Sergio Zanotti discusses ECPR–Extracorporeal Cardiopulmonary Resuscitation. ECPR is still be considered a niche therapy, but its relevance and availability are increasing. He is joined by Dr. Adam Green, a practicing intensivist at Cooper University Health Care and an Associate Professor of Medicine at Cooper Medical School of Rowan University (CMSRU). Dr. Green is the director of research for the division of Critical Care and has authored over 50 peer-reviewed publications. He has been part of the ECMO team at Cooper since its inception. Additional resources:Extracorporeal cardiopulmonary resuscitation for refractory cardiac arrest. The Lancet Respiratory Medicine 2025: https://www.sciencedirect.com/science/article/pii/S2213260025001225 Effect of Intra-arrest Transport, Extracorporeal Cardiopulmonary Resuscitation, and Immediate Invasive Assessment and Treatment on Functional Neurologic Outcome in Refractory Out-of-Hospital Cardiac Arrest. JAMA 2022: https://jamanetwork.com/journals/jama/fullarticle/2789313 Association between increasing institutional experience with ECPR and outcomes in patients with out-of-hospital cardiac arrest: A nationwide multicenter observational study in Japan (the JAAM–OHCA registry) RESUSCITATION 2025: https://www.resuscitationjournal.com/article/S0300-9572(24)00862-1/fulltext Early Extracorporeal CPR for Refractory Out-of-Hospital Cardiac Arrest. N Eng J of Med 2023: https://www.nejm.org/doi/full/10.1056/NEJMoa2204511 Books mentioned in this episode: The Perfect Predator: A Scientist’s Race to Save Her Husband from a Deadly Superbug. By S. Strathdee and T Patterson: https://amzn.to/3Hxjmez
In this episode, Dr. Sergio Zanotti discusses clinical guidelines for the transfusion of platelets and fresh frozen plasma (FFP) in critically ill patients. He is joined by Dr. Angel Coz Yataco, a practicing pulmonary critical care physician. Dr Coz Yataco is on the faculty of the Cleaveland Clinic Main Campus. He is also the lead author of the recently published American College of Chest Physicians Clinical Practice Guidelines on “Transfusion of Fresh Frozen Plasma and Platelets in Critically Ill Adults.”Additional resources:American College of Chest Physicians Clinical Practice Guidelines on Transfusion of Fresh Frozen Plasma and Platelets in Critically Ill Adults. Coz Yataco a, et al. CHEST 2025: https://pubmed.ncbi.nlm.nih.gov/40074060/ Platelet Transfusion 2025 AAB and ICTMG International Clinical Practice Guidelines. JAMA 2025: https://pubmed.ncbi.nlm.nih.gov/40440268/ Platelet Transfusion before CVC Placement in Patients with Thrombocytopenia. Van Baarle LF, et al. New Eng J of Med 2023: https://www.nejm.org/doi/full/10.1056/NEJMoa2214322 Books mentioned in this episode:Think Again: The Power of Knowing What You Don’t Know. By Adam Grant: https://bit.ly/404783f
In this episode, Dr. Sergio Zanotti discusses the different aspects of managing pneumonia in critically ill patients. He covers the initial management of severe pneumonia, management of ventilator-associated pneumonia, and highlights the clinical approach to non-resolving pneumonia in the intensive care unit (ICU). He is joined by Dr. Andre Kalil, a physician specializing in critical care and infectious diseases. Dr. Kalil is a Professor in the Division of Infectious Diseases and Director of Transplant Infectious Diseases at the University of Nebraska Medical Center (UNMC).Additional resources:How to approach a patient hospitalized for pneumonia who is not responding to treatment? Pedro Povoa, et al. Intensive Care Med 2025: https://link.springer.com/article/10.1007/s00134-025-07903-3 Management of Adults With Hospital-acquired and Ventilator-associated Pneumonia: 2016 Clinical Practice Guidelines by the Infectious Diseases Society of America and the American Thoracic Society. Andre Kalil, et al. Clin Infect Dis. 2016: https://pmc.ncbi.nlm.nih.gov/articles/PMC4981759/ Management of Ventilator-Associated Pneumonia: Guidelines. M Metersky and Andre c. Kalil. Infect Dis Clin North Am. 202: https://pubmed.ncbi.nlm.nih.gov/38280768/ Hydrocortisone in Severe Community-Acquired Pneumonia. CAPE-COD Clinical Trial. N Eng J of Med 202: https://www.nejm.org/doi/full/10.1056/NEJMoa2215145 Continuous vs. Intermittent β-Lactam Antibiotic Infusions in Critically Ill Patients with Sepsis. BLING III Clinical Trial. JAMA 2024: https://jamanetwork.com/journals/jama/fullarticle/2819971Music mentioned in this episode: Pat Metheny Group – We Live Here: https://bit.ly/44gt8JlAntonio Carlos Jobin – Terra Basilis: http://bit.ly/4k4Amq1Mahler: Symphony No.9 – Chicago Symphony Orchestra: http://bit.ly/4k9sXWn
In this episode of, Dr. Sergio Zanotti explores the vital role of enteral nutrition in the ICU—a foundational element in the prevention and treatment of disease-related malnutrition among critically ill patients. He is joined by Dr. Leah Gramlich, a distinguished gastroenterologist and physician nutrition specialist from the Royal Alexandra Hospital in Alberta, Canada. Dr. Gramlich is a Professor of Medicine at the University of Alberta and the founding president of the Canadian Nutrition Society. She has also served on the Board of Directors for the American Society for Parenteral and Enteral Nutrition and chaired the Canadian Malnutrition Task Force, bringing deep expertise to this essential topic.Additional resources:Enteral Nutrition in Hospitalized Adults. Lead Gramlich, Peggi Guenter. New Engl J Med 2025: https://pubmed.ncbi.nlm.nih.gov/40239069/ Individualized nutritional support in medical inpatients at nutritional risk: a randomized clinical trial. The EFFORT Clinical Trial. Lancet 2019: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(18)32776-4/abstract Low versus standard calorie and protein feeding in ventilated adults with shock: a randomised, controlled, multicentre, open-label, parallel-group trial (NUTRIREA-3). Lancet Respir Med 2023: https://pubmed.ncbi.nlm.nih.gov/36958363/ The effect of higher protein dosing in critically ill patients with high nutritional risk (EFFORT Protein): an international, multicentre, pragmatic, registry-based randomised trial. Lancet 2023: https://pubmed.ncbi.nlm.nih.gov/36708732/ Books mentioned in this episode:The Overstory: A Novel. By Richard Powers: https://bit.ly/43Drra1
In this episode, Dr. Zanotti discusses the science of hope. He's joined by Dr. Stephen Trzeciak, a physician-scientist, the Edward D. Viner Endowed Chief of Medicine at Cooper University Health Care, and Professor and Chair of Medicine at Cooper Medical School of Rowan University in Camden, New Jersey. Dr. Trzeciak is a practicing intensivist and a clinical researcher with more than 100 publications in the scientific literature. In addition, he is co-author of two excellent books: Wonder Drug: 7 Scientifically Proven Ways That Serving Others Is the Best Medicine for Yourself (2022) and Compassionomics: The Revolutionary Scientific Evidence that Caring Makes a Difference (2019).Additional resources:Recovery Expectations and Long-term Prognosis of Patients with Coronary Heart Disease Barefoot JC, et al. JAMA Internal Medicine 2011: https://pubmed.ncbi.nlm.nih.gov/21357800/ Optimism and Rehospitalization After Coronary Artery Bypass Graft Surgery. Scheler MF, et al. JAMA Int Med 1999: https://pubmed.ncbi.nlm.nih.gov/10219928/ The median is not the message. By Jay Gould: https://journalofethics.ama-assn.org/sites/joedb/files/2018-05/mnar1-1301.pdfBooks mentioned in this episode:Man’s Search for Meaning. By Viktor E. Frankl: https://bit.ly/3SqsNytWonder Drug: 7 Scientifically Proven Ways That Serving Others Is the Best Medicine for Yourself. By Stephen Trzeciak and Anthony Mazzarelli: https://bit.ly/4kiyA5qCompassionomics: The Revolutionary Scientific Evidence that Caring Makes a Difference. By Stephen Trzeciak and Anthony Mazzarelli: https://bit.ly/43ul5IE
In this episode, Dr. Sergio Zanotti focuses on the nuances of mechanical ventilation in patients with severe asthma. Previously, he explored the medical management of acute asthma exacerbations. Today, he takes a deeper dive into ventilatory strategies tailored to this high-risk population. He's joined by Dr. Emily Damuth, a dual-trained emergency medicine and critical care physician. Dr. Damuth is an Assistant Professor of Medicine and Emergency Medicine at Cooper Medical School of Rowan University and practices clinically in both the Emergency Department and Intensive Care Unit at Cooper University Hospital in Camden, New Jersey. She is also an Assistant Program Director for the Critical Care Medicine Fellowship and is actively involved in the ECMO program. A passionate educator, she teaches mechanical ventilation through lectures and simulation and has received multiple teaching awards for her contributions to medical education.Additional resources:Links:Management of Life-Threatening Asthma. O. Garner, et al. CHEST 2022; https://pubmed.ncbi.nlm.nih.gov/35218742/ Extracorporeal Membrane Oxygenation for Refractory Asthma Exacerbations With Respiratory Failure. J. Zakrajsek, et al. CHEST 2023: https://pubmed.ncbi.nlm.nih.gov/36191634/ Ventilator Graphics and Respiratory Mechanics in the Patient With Obstructive Lung Disease. R. Dhand. Respiratory Care 2005: https://pubmed.ncbi.nlm.nih.gov/15691394/ Books mentioned in this episode:Seabiscuit: An American Legend. By Laura Hillenbrand: https://bit.ly/3EY24pJPisto: The Life of Pete Maravich. By Mark Kriegel: https://bit.ly/3GIarq6Good Inside: A Practical Guide to Resilient Parenting Prioritizing Connection Over Correction. By Becky Kennedy: https://bit.ly/4iSTnes
In this episode, Dr. Zanotti discussed the Society of Critical Care Medicine “Focused Update on the Clinical Guidelines for the Prevention and Management of Pain, Anxiety. Agitation/Sedation. Delirium, Immobility, and Sleep Disruption in Adult Patients in the ICU." This is also known as the PADIS Guidelines. He is joined by Joanna L. Stollings, PharmD, a Board-Certified Pharmacotherapy Specialist and a Board-Certified Critical Care Pharmacotherapy Specialist. Joanna is the Medical Intensive Care Unit (MICU) Clinical Pharmacy Specialist at the Vanderbilt University Medical Center. She also served as vice chair for the PADIS Guideline Focused Update and co-authored the guidelines.Additional resources:Society of Critical Care Medicine Focused Update on the Clinical Guidelines for the Prevention and Management of Pain, Anxiety. Agitation/Sedation. Delirium, Immobility, and Sleep Disruption in Adult Patients in the ICU. PADIS 2025 Update: https://pubmed.ncbi.nlm.nih.gov/39982143/ Clinical Practice Guidelines for the Prevention and Management of Pain, Agitation/Sedation, Delirium, Immobility, and Sleep Disruption in Adult Patients in the ICU. PADIS 2018 Guidelines: https://pubmed.ncbi.nlm.nih.gov/30113379/ Link to a previous episode of Critical Matters discussing the PADIS 2018 Guidelines: https://soundphysicians.com/podcast-episode/?podcast_id=342&track_id=635606964 Landing page for the Critical Illness, Brain Dysfunction, and Survivorship (CIBS) Center: https://www.icudelirium.org/ Books mentioned in this episode:The Prophet. By Kahlil Gibran: https://bit.ly/4lA2Jhx
In this episode, Dr. Sergion Zanotti discusses TEE in cardiac arrest and shock. Critical care clinicians commonly utilize transthoracic echocardiography in the ICU as part of their point-of-care-ultrasonography (POCUS) toolkit. However, there is a growing push to train intensivists in using transesophageal echocardiography (TEE) for cardiac arrest and peri-arrest situations in the ICU. Our guest is Dr. Sara Nikravan, a cardiothoracic anesthesia critical care physician with training in advanced perioperative echocardiography. Dr. Nikravan is an Associate Professor of Cardiothoracic Anesthesiology and Critical Care Medicine at the University of Washington Medical School and practices at the UW Medical Center. She is recognized as an expert and master educator in Critical Care, Perioperative echocardiography, and Point of Care Ultrasound. She has authored numerous peer-reviewed papers and is the guidelines co-chair of the Society of Critical Care Medicine Guidelines on Adult Critical Care Ultrasonography: Focused Update 2024, recently published in Critical Care Medicine. Additional links:Society of Critical Care Medicine Guidelines on Adult Critical Care Ultrasonography: Focused Update 2024, Crit Care Med 2025: https://pubmed.ncbi.nlm.nih.gov/39982182/ Focused Transesophageal Echocardiography During Cardiac Arrest Resuscitation: JACC Review Topic of the Week. JACC 2020: https://pubmed.ncbi.nlm.nih.gov/32762909/ Landing page for the Resuscitative TEE Project website: https://www.resuscitativetee.com/ Books mentioned in this episode:The Prophet. By Kahlil Gibran: https://www.amazon.com/dp/998247037X?psc=1&smid=ATVPDKIKX0DER&ref_=chk_typ_imgToDp
In this episode, Dr. Sergio Zanotti explores one of medicine's fastest-evolving frontiers: artificial intelligence (AI). From predictive analytics to decision-support tools, AI is beginning to influence how we deliver critical care — but what does that actually mean for frontline clinicians? Dr. Zanotti is joined by Dr. Sharad Patel, a critical care physician with additional board certification in nephrology and Echocardiography. He is a Critical Care Intensivist at Cooper University Health Care, the assistant program Director for the Internal Medicine Residency Program, and an Assistant Professor of Medicine at Cooper Medical School of Rowan University. Dr. Patel is deeply interested in applying artificial intelligence and technology at the bedside.Additional resources:Landing page for New England Journal of Medicine – AI in Medicine section. A multitude of articles and resources on the topic: https://www.nejm.org/ai-in-medicine Attention Is All You Need. A Vaswani et al. NIPS 2017: https://proceedings.neurips.cc/paper_files/paper/2017/file/3f5ee243547dee91fbd053c1c4a845aa-Paper.pdf Artificial Intelligence Courses Online: https://www.coursera.org/courses?query=artificial%20intelligence UDEMY landing page for AI courses. https://www.udemy.com/AI Books mentioned in this episode:Meditations. By Marcus Aurelius (Author), Gregory Hayes (Translator): https://amzn.to/4iLvfLAThinking Fast and Slow. By Daniel Kahneman: https://bit.ly/4c6pANu
In a previous episode, Dr. Sergio Zanotti explored the importance of challenging dogma, particularly when the supporting evidence is weak or absent. Today, he continues that discussion by examining critical care practices that persist despite a lack of strong scientific validation. He's joined by Dr. Mervyn Singer, an internationally recognized leader in critical care medicine. Dr. Singer is a professor of intensive care medicine at University College London and a distinguished clinician, researcher, and educator. Through his research, publications, and dynamic presentations, he has inspired Dr. Zanotti — and countless intensivists worldwide — to think critically, challenge conventions, and push the boundaries of our field.Additional resources:Challenging management dogma where evidence is non-existent, weak, or outdated: part II. DA Hofmaennner and M. Singer. Intensive Care Med2024: https://pubmed.ncbi.nlm.nih.go Challenging management dogma where evidence is non-existent, weak, or outdated. DA Hofmaennner and M. Singer. Intensive Care Med 2022: https://pubmed.ncbi.nlm.nih.gov/35303116/ Biomarker-Guided Antibiotic Duration for Hospitalized Patients with Suspected Sepsis. The ADAPT-Sepsis Randomized Clinical Trial. JAMA 2025: https://pubmed.ncbi.nlm.nih.gov/39652885/ Hyperglycemic Crises in Adults with Diabetes: A Consensus Report. Diabetes Care 2024: https://pubmed.ncbi.nlm.nih.gov/38907161/ Books and music mentioned in this episode.Influenza: The Hundred-Year Hunt to Cure the 1918 Spanish Flu Pandemic. By. Jeremy Brown: https://amzn.to/3Ftb0mOBeethoven: 9 Symphonies / Karajan 1963: https://amzn.to/3R1M9ZO
Due to advancements in medical and surgical care, the survival of patients with congenital conditions into adulthood has dramatically increased. However, as these individuals transition to adulthood, their unique physiology, chronic complications, and evolving care needs create significant challenges for their management when they are admitted to adult intensive care units (ICUs). This episode will discuss adult congenital disease in the ICU. Dr. Zanotti is joined by Dr. Cameron Dezfulian, a pediatric and adult critical care physician. He is the director of the Adult Congenital Heart Disease Program Development for the Section of Critical Care at Texas Children's Hospital and a faculty member at Cardiothoracic Critical Care at Baylor St. Luke's Medical Center. He is also a Senior Faculty member at Baylor College of Medicine in Houston, Texas. Additional resources:ACC/AHA 2008 Guidelines for the Management of Adults With Congenital Heart Disease. Circulation 2008: https://www.ahajournals.org/doi/pdf/10.1161/CIRCULATIONAHA.108.190690 Special Considerations in Critical of the Congenital Heart Disease Patient. E Neethling, et al. Can J Cardiol. 2023: https://pubmed.ncbi.nlm.nih.gov/36682483/ Management of the Critically Ill Adult with Congenital Heart Disease. WB Kratzert, et al. J Cardiothorac Vasc Anesth 2018: https://pubmed.ncbi.nlm.nih.gov/29500124/ Adults with childhood-onset chronic conditions admitted to US pediatric and adult intensive care units. J Edwards, et al. J Crit Care 2015: https://pubmed.ncbi.nlm.nih.gov/25466316/Down Syndrome. MJ Bull. N Eng J Med 2020. https://www.nejm.org/doi/full/10.1056/NEJMra1706537 Books and Music mentioned in this episode:The Bible: https://bit.ly/3EK4LL6
February 7-14 marks the observance of Congenital Heart Disease Awareness Week. In this podcast episode, Dr. Sergio Zanotti provides a unique perspective on adult congenital heart disease, drawing from his journey as a lifelong patient. He offers reflections shaped by his own experiences with complex adult congenital heart disease, including insights gained from a recent medical procedure that granted him a firsthand view of patient care in the ICU. Additional resources:ACC/AHA 2008 Guidelines for the Management of Adults With Congenital Heart Disease. Circulation 2008: https://www.ahajournals.org/doi/pdf/10.1161/CIRCULATIONAHA.108.190690 The Bell Curve. By Atul Gawande. The New Yorker 2004: https://www.newyorker.com/magazine/2004/12/06/the-bell-curve Website for the Adult Congenital Heart Association: https://www.achaheart.org/ Books and music mentioned in this episode:Montaigne. By Stefan Zweig: https://bit.ly/4gEOVP2The Heart. A Novel. By Maylis De Kerangal: https://bit.ly/41ehqinThe Essays: A Selection (Penguin Classics). By. Michel de Montaigne: https://bit.ly/3EvFwvW
Acute kidney injury is a frequent complication of critical illness, and a subgroup of these patients will require renal replacement therapy. In this episode. Dr. Sergio Zanotti discusses optimizing renal replacement therapy in the ICU. He is joined by Dr. Michael J. Connor, Jr., a practicing intensivist and nephrologist. He is a professor and senior physician of critical care medicine and nephrology at the Divisions of Pulmonary, Allergy, Critical Care, & Sleep Medicine and Renal Medicine at Emory University School of Medicine. In addition, he is the director of critical care nephrology at the Emory Critical Care Center at Grady Memorial Hospital.Additional resources:Delivering optimal renal replacement therapy to critically ill patients with acute kidney injury. Wald R, et al. Intensive Care Med 2022: https://pubmed.ncbi.nlm.nih.gov/36066597/ Initiation Strategies for Renal-Replacement Therapy in the Intensive Care Unit. AKIKI Study Group. N Engl J Med 2016: https://pubmed.ncbi.nlm.nih.gov/27181456/ Effect of Early vs Delayed Initiation of Renal Replacement Therapy on Mortality in Critically Ill Patients with Acute Kidney Injury. ELAIN Trial. JAMA 2016: https://pubmed.ncbi.nlm.nih.gov/27209269/ Timing of Renal-Replacement Therapy in Patients with Acute Kidney Injury and Sepsis. IDEAL-ICU Investigators. N Eng J Med 2018: https://pubmed.ncbi.nlm.nih.gov/30304656/ Timing of Initiation of Renal-Replacement Therapy in Acute Kidney Injury. STARRT-AKI Investigators. N Engl J Med 2020: https://pubmed.ncbi.nlm.nih.gov/32668114/ Comparison of two delayed strategies for renal therapy initiation for severe acute kidney injury. AKIKI 2 Trial. Lancet 2021: https://pubmed.ncbi.nlm.nih.gov/33812488/ Books and Music mentioned in this episode:The Invisible Life of Addie LaRue. By V.E. Schwab: The Invisible-Life-Addie-LaRue Moon Music. By Coldplay: Moon-Music-Coldplay
In this episode, Dr. Sergio Zanotti discusses rational fluid therapy. He is joined by Dr. Adrian Wong, a practicing intensive care medicine and anesthesia physician. Dr. Wong is a consultant and clinical lead at King’s College Hospital, London. He also serves as a committee member for the Intensive Care Society FUSIC, examiner for the European Diploma of Intensive Care Medicine, on the executive committee of the International Fluid Academy. Additional resources:Intravenous fluid therapy in the perioperative and critical care setting” Executive summary of the International Fluid Academy (IFA). Malbrain ML, et al. Ann. Intensive Care 2020: https://pubmed.ncbi.nlm.nih.gov/32449147/ Multidisciplinary expert panel report on fluid stewardship: perspectives and practice. Malbrain ML, et al. Annals of Intensive Care 2023: https://pubmed.ncbi.nlm.nih.gov/37747558/ The emerging concept of fluid tolerance: A position paper. Kattan E, et al. Journal of Critical Care 2022: https://pubmed.ncbi.nlm.nih.gov/35660844/ Everything you need to know about derescuscitation. Malbrain ML, et al. Intensive Care Med 2022: https://pubmed.ncbi.nlm.nih.gov/35932335/ Start with Why. TED Talk presented by Simon Sinek: https://simonsinek.com/videos/ted-talks/Books mentioned in this episode:Thinking Fast and Slow. By Daniel Kahneman: https://amzn.to/4hicUojStart with Why: How Great Leaders Inspire Everybody to Take Action. By Simon Sinek: https://bit.ly/42hzt8n
This episode of Critical Matters will close 2024 with a year in review. Dr. Sergio Zanotti is going solo and will discuss a couple of relevant clinical guidelines and review five clinical trials. To close, he'll share some of his favorite books for 2024.Additional Resources:Critical Care Management of Patients Post Cardiac Arrest (AHA/NCS): Hirsch KG, Abella BS, Amorim E, et al. Critical Care Management of Patients After Cardiac Arrest: A Scientific Statement from the American Heart Association and Neurocritical Care Society. Neurocrit Care. 2024;40(1):1-37: https://bit.ly/4087o1w2024 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations: Summary From the Basic Life Support; Advanced Life Support; Pediatric Life Support: Neonatal Life Support; Education, Implementation, and Teams; and First Aid Task Forces. Circulation 2024: https://bit.ly/4fD4o1RPREOXI Trial. Gibbs KW, Semler MW, Driver BE, et al. Noninvasive Ventilation for Preoxygenation during Emergency Intubation. N Engl J Med. 2024;390(23):2165-2177. doi:10.1056/NEJMoa2313680: https://bit.ly/4fD4pCXAMIKINHAL Trial. Ehrmann S, Barbier F, Demiselle J, et al. Inhaled Amikacin to Prevent Ventilator-Associated Pneumonia. N Engl J Med. 2023;389(22):2052-2062. doi:10.1056/NEJMoa2310307: https://bit.ly/4iQQvzUREVISE Trial. Cook D, Deane A, Lauzier F, et al. Stress Ulcer Prophylaxis during Invasive Mechanical Ventilation. N Engl J Med. 2024;391(1):9-20. doi:10.1056/NEJMoa2404245: https://bit.ly/3Pc4nqHTIGHT K Trial. O'Brien B, Campbell NG, Allen E, et al. Potassium Supplementation and Prevention of Atrial Fibrillation After Cardiac Surgery: The TIGHT K Randomized Clinical Trial. JAMA. 2024;332(12):979-988. doi:10.1001/jama.2024.17888: https://jamanetwork.com/journals/jama/fullarticle/2823246BALANCE Trial. Daneman N, Rishu A, et al. Antibiotic Treatment for 7 versus 14 Days in Patients with Bloodstream Infections. N Engl J Med. Published online November 20, 2024. doi:10.1056/NEJMoa2404991: https://www.nejm.org/doi/abs/10.1056/NEJMoa2404991CMD Study. Bodien YG, Allanson J, Cardone P, et al. Cognitive Motor Dissociation in Disorders of Consciousness. N Engl J Med. 2024;391(7):598-608. doi:10.1056/NEJMoa2400645: https://www.nejm.org/doi/full/10.1056/NEJMoa2400645Books Mentioned in this Episode:Slow Productivity: The Lost Art of Accomplishment Without Burnout. By Cal New Port: https://amzn.to/4gTbkJ2Meditations for Mortals: Four Weeks to Embrace Your Limitations and Make Time for What Counts. By Oliver Burkeman: https://bit.ly/4gURU6NKnife: Meditations After an Attempted Murder. By Salman Rushdie: https://bit.ly/3ZPsAIt
In this episode Dr. Zanotti discusses the current role of pulmonary artery catheters in critical care medicine. He is joined by Dr. Steven Hollenberg a critical care and cardiology physician. Dr. Hollenberg is a professor of medicine at Emory University School of Medicine and director of cardiac intensive care at the Emory Heart & Vascular Center.Additional resources:Pulmonary Artery Catheter Use and Risk of In-hospital Death in Heart Failure Cardiogenic Shock.Kanwar MK, et al. J Card Fail. 2023 Sep;29(9):1234-1244: https://pubmed.ncbi.nlm.nih.gov/37187230/ Pulmonary Artery Catheter Use and Mortality in the Cardiac Intensive Care Unit. Bernard S Kadosh, et al. JACC Heart Failure 2023: https://pubmed.ncbi.nlm.nih.gov/37318422/ Complete Hemodynamic Profiling With Pulmonary Artery Catheters in Cardiogenic Shock Is Associated With Lower In-Hospital Mortality. A Reshad Garan, et al. JACC Heart Failure 2020: https://pubmed.ncbi.nlm.nih.gov/33121702/ Right Heart Catheterization in Cardiogenic Shock Is Associated With Improved Outcomes: Insights From the Nationwide Readmissions Database. Sagar Ranka, et al. J Am Heart Assoc 2021: https://pubmed.ncbi.nlm.nih.gov/34423652/ Books mentioned in this episode:I Contain Multitudes: The Microbes Within Us and a Grander View of Life. By Ed Yong: https://www.amazon.com/Contain-Multitudes-Microbes-Within-Grander/dp/0062368605/ref=sr_1_1?crid=1EVOY6OVQZ437&dib=eyJ2IjoiMSJ9.Na-UJShWq7ngsH9dxvSV2Q.Ob-k26_k01p5WzKzo4CWnsvD4Jjq9RU1krhQhmUi9u4&dib_tag=se&keywords=I+contain+platitudes&qid=1732299607&sprefix=i+contain+platitudes%2Caps%2C132&sr=8-1Kind of Blue. Miles Davis: https://www.amazon.com/Kind-Blue-Vinyl-Miles-Davis/dp/B0041TM5OU/ref=sr_1_2?crid=E6F0PBPV33BG&dib=eyJ2IjoiMSJ9.4Kk2sCHn8DAOl9j_qadqsZPMVZPlOuKNXg9vv_NTPEYrl10vHYNIC5-wrGJeFpn9K8rSS8aspG9zhJHjAyDqiIUiC9VKvvHjzQsAGmr4wP9VWUPWumInjcS72CDmoaEYr3h2Uoiy8yt-YfYFHm7Y-6XoPecnwju8_zumwohrrhYWC0X6rR8Ui3Xhp6ILDU3sBNb50TJ6iq_fjataiHX7X6fBL1YnUo3X-uBcnQVfKtc.v-zGaYaLVvE7BGxS1c-2_Brbwsq1kAxVKEuxqsaBci8&dib_tag=se&keywords=Miles+Davis+Kind+of+Blue&qid=1732299762&sprefix=miles+davis+kind+of+blue%2Caps%2C139&sr=8-2Brahms: Ein Deutsches Requiem. Sir Simon Rattle: https://www.amazon.com/Brahms-Ein-Deutsches-Requiem-German/dp/B000MTEDIE/ref=sr_1_5?crid=2UCHLINLHSETV&dib=eyJ2IjoiMSJ9.aDG2ZKyB5OnEgO3Z6_VOsNplIVSXmtXffLy2Jrylq4vgaRHEYDyBsz_4YG1fE_88IJxJ2ScnxhBvvDkVZjauoazwhTEMef0o_nJN25zUb_7oXFNkPMo_U4WBLhgK5njVOkm2ae67weI5roWsx-KbokunvjgAf-tXngA30o2xDQxh0-9y0kJbJRdKtVY63PcPv3yp9YdOrpgo2PO-gpspQsio7uJ-dgz5SY1vX1je3U4.aMm-IxbuxnZSIacaIBGZWc36GYliQP4r-9f9-SBq5tQ&dib_tag=se&keywords=Brahms+requiem&qid=1732299866&sprefix=brahms+requiem%2Caps%2C142&sr=8-5e
In this episode, Dr. Sergio Zanotti discusses the application of behavioral economics to clinical practice, specifically choice framing in ICU goals-of-care Meetings. He is joined by Dr. Joanna Hart, a pulmonary critical care physician and assistant professor of medicine at the Perelman School of Medicine at the University of Pennsylvania in Philadelphia. She is also a core faculty member of the Palliative and Advanced Illness Research Center and is affiliated with the Center for Health Incentives and Behavioral Economics.Additional Resources:Clinician’s Use of Choice Framing in ICU Family Meetings. Joanna L Hart et al. Crit Care Med 2024: https://pubmed.ncbi.nlm.nih.gov/38912880/ Using Default Options and Other Nudges to Improve Critical Care. Scott Halpern. Crit Care Med 2019: https://pmc.ncbi.nlm.nih.gov/articles/PMC5826616/ Books mentioned in this episode:Demon Copperhead. By Barbara Kingsolver: https://bit.ly/4hYCqQvThinking Fast and Slow. By Daniel Kahneman: https://bit.ly/4i3eknKNudge. By Richard H. Thaler, et al.: https://bit.ly/3YUqxlG
In this episode, Dr. Sergio Zanotti discusses the management of critically ill patients after cardiac surgery, focusing on the clinical management of two important complications: hemorrhage and cardiac arrest. He is joined by Dr. Christopher Noel, a critical care attending at Cooper University Healthcare. Dr. Noel is also an assistant professor of medicine at Cooper Medical School of Rowan University and associate program director for the Critical Care Medicine Fellowship and the Clerkship Director for Critical Care Medicine Clerkships for Medical Students.Additional resources:American Association for Thoracic Surgery (AATS) TSRA Primer- Critical Care:https://www.aats.org/tsra-primer-post-operative-bleeding https://www.aats.org/tsra-primer-cardiac-arrest-post-cardiotomy The Society of Thoracic Surgeons Expert Consensus for the Resuscitation of Patients Who Arrest After Cardiac Surgery. Ann Thorac Surg 2017: https://pubmed.ncbi.nlm.nih.gov/28122680/ Society of Cardiovascular Anesthesiologists clinical practice improvement advisory for the management of perioperative bleeding and hemostasis in cardiac surgery patients. J of Cardiothoracic and Vascular Anesthesia 2019: https://pubmed.ncbi.nlm.nih.gov/31613811/Music mentioned in this episode:The Outsiders. By Eric Church: https://bit.ly/4fHvxkpCollective Soul. By Collective Soul: https://bit.ly/3AzLcUd
In this episode, Dr. Sergio Zanotti discuss the management of critically ill patients undergoing hyperglycemic emergencies. He is joined by Dr. George Willis, a practicing emergency medicine physician. Dr. Willis is an Associate Professor and Associate Program Director for Emergency Medicine at the University of Texas Health Science Center in San Antonio, where he also serves as Vice Chair of Faculty Affairs. A recognized clinical educator, he holds a particular interest in endocrine emergencies, vascular emergencies, procedural education, and medical education. Additional resources:Hyperglycemic Crises in Adults with Diabetes: A Consensus Report. GE Umpierez, et al. Diabetes Care 2024: https://diabetesjournals.org/care/article/47/8/1257/156808/Hyperglycemic-Crises-in-Adults-With-Diabetes-A Clinical Effects of Balanced Crystalloids vs Saline in Adults With Diabetic Ketoacidosis. WH Self, et al. JAMA 2020: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7670314/ Evaluation and Management of the Critically Ill Adult with Diabetic Ketoacidosis. B Long, GC Willis, S Lentz, et al. J Emerg Med 2020: https://pubmed.ncbi.nlm.nih.gov/32763063/ The SQuID protocol (subcutaneous insulin in diabetic ketoacidosis) Impacts on ED operational Metrics. Acad Emerg Med 2023: https://pubmed.ncbi.nlm.nih.gov/36775281/Books mentioned in this episode:Kintsugi: Finding Strength in Imperfection. By Celine Santini: https://bit.ly/3NCdAYB
This episode, Dr. Sergio Zanotti discusses music and critical illness and explores the topic through the lens of his guest – Andrew Schulman. Andrew is the first musician to be accepted as a professional Society of Critical Care Medicine (SCCM) member. He is a member of the SCCM ICU Liberation Committee, where he met and had the opportunity to work with Dr. Zanotti. Andrew and his wife Wendy, are the subjects of Josh Aronson's documentary film Andrew & Wendy (2015), which has aired multiple times on PBS-TV. He is the author of Waking The Spirit: A Musician’s Journey Healing Body, Mind, and Soul. Since its release in the U.S. in August 2016, Waking the Spirit has been chosen as an Oliver Sacks Foundation Best Book of the Year Selection, Finalist for the Books for a Better Life Award, and a People Magazine Pick in Nonfiction.Additional Resources:Andrew Schulman’s Website https://andrewschulmanmusic.com/about Books and Albums mentioned in this episode:Waking The Spirit: A Musicians’s Journey Healing Body, Mind and Soul. By Andrew Schulman: https://us.macmillan.com/books/9781250132222Musicophilia: A Tale of Music and the Brain. By Oliver Sacks: https://bit.ly/4dCTjwvSt. Matthew Passion – Johann Sebastian Bach (Composer), Leonard Bernstein (Conductor): https://amzn.to/4eZmgE5Lute Sonatas Nos. 30 & 39 & 96: 11 Silvius Leopold Weiss (Composer), Robert Barto (Performer): https://bit.ly/3YfXha2
In this episode of Critical Matters, Dr. Zanotti discusses the use of intravenous albumin in critical care. He is joined by D. Jeannie Callum, Director of Transfusion Medicine and Professor of Pathology and Molecular Medicine at Queens University in Ontario, Canada. Dr. Callum’s research focuses on blood utilization, hemostasis in the bleeding patient, and transfusion-related errors. She has received numerous awards and published extensively. Dr. Callum is the lead author of “Use of Intravenous Albumin: A Guidelines from the International Collaboration for Transfusion Medicine Guidelines,” published earlier this year in CHEST.Additional Resources:Use of Intravenous Albumin. A Guideline from the International Collaboration for Transfusion Medicine Guidelines. CHEST 2024: https://journal.chestnet.org/article/S0012-3692(24)00285-X/fulltext International Collaboration for Transfusion Medicine Guidelines Website: https://www.ictmg.org/ Ten myths about albumin. M Joannidis, et al. Intensive Care Med 2022: https://pubmed.ncbi.nlm.nih.gov/35247060/ A comparison of albumin and saline for fluid resuscitation in the intensive care unit. SAFE Study Investigators. N Engl J Med 2004: https://pubmed.ncbi.nlm.nih.gov/15163774/ Albumin Replacement in Patients with Severe Sepsis or Septic Shock. ALBIOS Study Investigators. N Engl J .Med 2014: https://www.nejm.org/doi/full/10.1056/NEJMoa1305727 Books mentioned in this episode:Ending Medical Reversal: Improving Outcomes, Saving Lives. By Vinayak K. Prasad: https://bit.ly/4dAimRaThe Time Machine. By H.G. Wells: https://amzn.to/4eK4apG
Much attention has been paid to targeted temperature management (TTM) in post-cardiac arrest patients. The evidence for this practice continues to evolve, and previous episodes of Critical Matters have covered this topic. In this episode, Dr. Zanotti focuses on other aspects of Neurological Support in the ICU for post-cardiac arrest patients. He is joined by Dr. Edilberto Amorin, a neurologist with subspecialty training in critical care and epilepsy. He has expertise in neurological intensive care, telemedicine, and multimodal brain monitoring with EEG. Dr Amorin is an Assistant Professor of Neurology at UCSF Weill Institute for Neurosciences and directs the Epilepsy and Clinical Neurophysiology Service at the Zuckerberg San Francisco General Hospital.Additional resources:Critical Care Management of Patients After Cardiac Arrest: A Scientific Statement From the American Heart Association and Neurocritical Care Society. Circulation 2024: https://pubmed.ncbi.nlm.nih.gov/38040992/ Treating Rhythmic and Periodic EEG Patterns in Comatose Survivors of Cardiac Arrest.TELSTAR Investigators. N Engl J Med 2022: https://www.nejm.org/doi/full/10.1056/NEJMoa2115998 Improving Outcomes After Post-Cardiac Arrest Brain Injury: A Scientific Statement from the International Liaison Committee on Resuscitation. ILCOR 2024: https://www.ilcor.org/news/improving-outcomes-after-post-cardiac-arrest-brain-injuryBooks mentioned in this episode:As Real as it Gets: The Life of a Hospital at the Center of the AIDS Epidemic. By Carol Pogash: https://bit.ly/4d4xHZCC. Miller Fisher: Stroke in the 2oth Century. By LR Caplan: https://bit.ly/3XFw3Jw
Hypotension and shock are both recognized as complications post-cardiac surgery. Some patients may develop more severe shock refractory to fluids and catecholamines. This response is also known as today's podcast episode, topic: vasoplegia after cardiac surgery. For this discussion, Dr. Zanotti is joined by Dr. Iqbal Ratnani, an intensivist who practices at the DeBakey Heart & Vascular Center and the Center for Critical Care at Houston Methodist Hospital. Dr. Ratnani is an Associate Professor of Clinical Anesthesiology & Critical Care for the Department of Anesthesiology and Critical Care at Weill Cornell Medical College. In addition, Dr. Ratnani is the Director of Critical Care Education at the Center for Critical Care.Additional resources:Vasoplegia: A Review. Igbal Ratnani, et al. Methodist DeBakey Cardiovascular Journal 2023: https://pubmed.ncbi.nlm.nih.gov/37547893/ Vasoplegic Syndrome after Cardiopulmonary Bypass in Cardiovascular Surgery: Pathophysiology and Management in Critical Care. Zied Ltaief, et al. Journal of Clinical Medicine 2022: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9658078/Books mentioned in this episode:Marino’s The ICU Book. By Paul Marino: https://bit.ly/3XmWPGAEvery Deep-Drawn Breath. By Wes Ely: https://bit.ly/4cODkeqIn Shock: My Journey from Death to Recovery to Redemption. By Rana Awdish: https://bit.ly/3Z4mC7z
We pulled out another favorite out this week - Dr. Zanotti's deep-dive on tracheostomy emergencies. Tracheostomies are common in ICU patients. Every intensivist should be capable of recognizing and providing initial management to potentially serious complications associated with tracheostomies. Dr. Zanotti is joined by Drs. Laura Bontempo and Sara Manning, emergency physicians and educators with a special interest in the topic. Dr. Laura Bontempo is an associate professor of emergency medicine and serves as Assistant Director for Faculty Development & Resident Education in the Department of Emergency Medicine at the University of Maryland Medical School. Dr. Sara Manning is an Assistant Professor of Clinical Emergency Medicine, in the Department of Emergency Medicine at the Indiana University School of Medicine.Additional Resources:Tracheostomy Emergencies. LJ Bontempo and SL Manning. Emerg Med Clin N Am 2019: pubmed.ncbi.nlm.nih.gov/30454773/Link to Onepager on Tracheostomy Emergencies: onepagericu.com/trach-emergenciesBleeding Tracheostomy. Kenji Inaba MD. Presented at Essentials of EM: www.facebook.com/EssentialsofEM/v…163679590380038/Book Recommendations:Who Moved my Cheese?: An A-Mazing Way to Deal with Change in Your Work and in Your Life. By Spencer Johnson, et al: amzn.to/3pq0CkRWhere the Red Fern Grows. By Wilson Rawls: amzn.to/3AawH6a
Today, we are revisiting one of our favorite episodes from last year - The Forgotten Patient. Dr. Zanotti focuses on the loved ones and families of critically ill patients and explores the topic through the lens of a cardiac arrest co-survivor. His guest is Kristin Flanary, a cognitive neuroscientist and social psychologist. Kristin is a co-survivor of cancer(twice) and a co-survivor of sudden cardiac arrest. She is also known for her social media alter ego – Lady Glaucomflecken. In 2022 Kristin co-founded Glaucomflecken LLC, where she works to advocate for caregivers and co-survivors of medical trauma and critical illness, community CPR and AED use, and sudden cardiac arrest survivorship. She has written about her experience as a co-survivor in medical journals and has received an EMS Cardiac Arrest Save Challenge Coin, the Citizen CPR Foundation’s '40 Under 40' award, and the American Heart Association’s Resuscitation Champion award.Additional Resources:The Quiet Place. K. Flanary. Journal of Cardiac Failure, 2021: www.onlinejcf.com/article/S1071-91…00403-6/fulltextRoger. K Flanary. CHEST. 2022: journal.chestnet.org/article/S0012-…029-6/fulltextLife after Cardiac Arrest: The importance of engaging with the “forgotten patient.” K Haywood & K Dainty. Resuscitation, 2018: www.resuscitationjournal.com/article/S0…0195-3/pdfLink to the Glaucomflecken’s website: glaucomflecken.com/Books Mentioned in this Episode:In Shock. By Rana Awdish: bit.ly/441b0Cx
In this episode, Dr. Zanotti covers temporary pacing in the ICU. he is joined by Dr. Christopher Noel, a Critical Care Attending at Cooper University Healthcare, and an Assistant Professor of Medicine at Cooper Medical School of Rowan University. In addition, Dr. Noel is the Associate Program Director for the Critical Care Medicine Fellowship and the Director of the Medical Student Critical Care Clerkship.Additional resources:Temporary Epicardial Pacing After Cardiac Surgery. Cronin b, et al. Journal of Cardiothoracic and Vascular Anesthesia 2022: https://pubmed.ncbi.nlm.nih.gov/36180288/ Temporary epicardial pacing after cardiac surgery: a practical review. Part 1: General considerations in the management of epicardial pacing. M.C. Reade. Anesthesia 2007: https://pubmed.ncbi.nlm.nih.gov/17300304/ Temporary epicardial pacing after cardiac surgery: a practical review. Part 2: Selection of epicardial pacing modes and troubleshooting. M.C. Reade. Anesthesia 2007: https://pubmed.ncbi.nlm.nih.gov/17381573/ Medtronic Educational Resources on Temporary Pacemakers: https://www.medtronic.com/us-en/healthcare-professionals/products/cardiac-rhythm/pacemakers/temporary-external-pacemakers.html Books mentioned in this episode:Crucial Conversations: Tools for Talking When Stakes are High. By Joseph Grenny, et al.: https://bit.ly/3XWFo0dThe Mutiny on the Bounty. By Peter FitzSimons: https://bit.ly/4cwGkNb
Disturbances in neurological function due to primary neurological disorders or organ failure from critical illness are common in patients admitted to the ICU. In this episode, Dr. Zanotti discusses the neurological physical exam in the ICU. He is joined by Dr. Adam Rizvi, a neurologist with Neurocritical care and vascular neurology fellowship training who currently practices critical care, neurocritical care, and tele-neurology/tele-stroke in several hospitals in California. In addition to his clinical work, Dr. Rizvi is an accomplished educator and researcher.Additional Resources:Neurological examination of critically ill patients: a pragmatic approach: Report of an ESICM expert panel. Intensive Care Med 2014. https://pubmed.ncbi.nlm.nih.gov/24522878/Critical Matters Podcast episode: Brain Death / Death by Neurological Criteria. Host: S. Zanotti. Guest: D. Greer: https://soundphysicians.com/podcast-episode/?podcast_id=342&track_id=1677810255Clinical Neuroanatomy Made Ridiculously Simple. Edition 6. Stephan Goldberg, MD: https://amzn.to/4cC34uZBooks mention in the episode:Meditations. By Marcus Aurelius. Translation by Gregory Hayes: https://amzn.to/4eBxK1d
This is the second part in our series discussing temporary mechanical circulatory support (tMCS). Part one, covered different types of devices for tMCS, pathophysiology of shock, clinical indications, and general considerations for critical care clinicians. In Part 2, Dr. Zanotti covers a more detailed discussion of medical management and troubleshooting of patients on tMCS. He is again joined by Bindu Akkanti, MD, an associate professor in the Division of Pulmonary, Critical Care, and Sleep Medicine at UTHealth Houston. Dr. Akkanti is the Medical Director of the Heart Failure ICU and the Director of Critical Care for the Heart & Vascular Institute at Memorial Hermann Texas Medical Center.Additional Resources:More about Dr. Akkanti: https://med.uth.edu/internalmedicine/2022/11/17/bindu-akkanti-md/Mechanical Circulatory Support Part 1 - Critical Matters Podcast. https://soundphysicians.com/podcast-episode/?podcast_id=342&track_id=1828006629 A Comprehensive Review of Mechanical Circulatory Support Devices. V Atti, et al. Heart Intl. 2022. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9524665/ American Society of Artificial Internal Organs website. https://asaio.org/ IABP: Hemodynamics, troubleshooting, technical tips. https://www.youtube.com/watch?v=ULgjuhBgP9U Composer and Musician A.R. Rahman. https://www.arrahman.com/
In the first part of this two-part series, Dr. Zanotti is joined by Bindu Akkanti, MD, an associate professor in the Division of Pulmonary, Critical Care, and Sleep Medicine at UTHealth Houston. Together, they discuss temporary mechanical circulatory support, an increasingly vital modality in treating cardiogenic shock and other subsets of critically ill patients in shock. Dr. Akkanti is the Medical Director of the Heart Failure ICU and the Director of Critical Care for the Heart & Vascular Institute at Memorial Hermann Texas Medical Center.Additional Resources:More about Dr. Bindu Akkanti: https://med.uth.edu/internalmedicine/2022/11/17/bindu-akkanti-md/Review of Pathophysiology of Cardiogenic Shock and Escalation of Mechanical Circulatory Support Devices. Pahuja M, et al. Curr Cardiol Rep 2023: https://pubmed.ncbi.nlm.nih.gov/36847990/ Temporary mechanical circulatory support devices: practical considerations for all stakeholders. Salter BS, et al. Nature Reviews Cardiology 2023: https://www.nature.com/articles/s41569-022-00796-5 Microaxial Flow Pump or Standard Care in Infarct-Related Cardiogenic Shock. Moller JE, et al. N Engl J Med 2024: https://www.nejm.org/doi/full/10.1056/NEJMoa2312572 Books Mentioned in this Episode:The Alchemist. By Paulo Coelho: https://bit.ly/3yv4Zmt
With over 700 modes of mechanical ventilation available today, it can be overwhelming to find the best application of technology at the bedside. Focused on goal-directed mechanical ventilation, this discussion covers the taxonomy of mechanical ventilation modes and provides a framework for a rational approach at the bedside. Dr. Zanotti is joined by Dr. Eduardo Mireles-Cabodevila, Director of the Medical Intensive Care Unit and the Simulation and Advanced Skills Center at the Cleveland Clinic. In addition, Dr. Mireles-Cabodevila is the Vice-Chair of the Division of Critical Care Medicine, Department of Pulmonary and Critical Care, within the Integrated Hospital-Care Institute at the Cleveland Clinic.Additional Resources:How do I ventilate patients with ARDS: Goal-directed mode selection. E. Mireles-Cabodevila. Med Intensiva 2022: https://pubmed.ncbi.nlm.nih.gov/36220727/ A Rational Framework for Selecting Modes of Ventilation. E. Mireles-Cabodevila, et al. Respir Care 2013: https://pubmed.ncbi.nlm.nih.gov/22710796/ Closing the Gap in Patient-Ventilator Discordance Recognition. A. Liendo and E. Mireles-Cabodevila. Respir Care 2024: https://pubmed.ncbi.nlm.nih.gov/38267228/ Standardized Education for Ventilatory Assistance (SEVA) resources page; https://my.clevelandclinic.org/departments/respiratory/medical-professionals/seva#seva-resources-tabMechanical Ventilation Mode Taxonomy App:iPhone: https://apps.apple.com/us/app/ventilator-mode-map/id1508307955Android: https://play.google.com/store/apps/details?id=org.ccf.vmm&hl=en_USBooks mentioned in this episode:Solito: A Memoir. By Javier Zamora: https://bit.ly/4b6hPG8
In this episode, Dr. Zanotti discusses the management of acute life-threatening asthma exacerbations in the ICU with this guest, Dr. Haney Mallemat, a physician trained in EM/IM and Critical Care. Dr. Mallemat is currently an Associate Professor of Emergency Medicine and Internal Medicine at the Cooper Medical School at Rowan University.Additional Resources:How Not to Kill an Asthmatic – Presented at CODA Change by Haney Mallemat: https://codachange.org/severe-asthma Management of Acute Life-Threatening Asthma Exacerbations in the Intensive Care Unit. Talbot T, et al. Appl. Sci 2024: https://www.mdpi.com/2076-3417/14/2/693 ResusX,- a medical resuscitation conference created by Dr. Mallemat: https://www.resusx.comLast Week Now! - A curated newsletter by ResusX: https://www.resusx.com/newsletterKeynotable – a course for beginners and seasoned speakers: https://www.keynotable.netBooks mentioned in this episode:How to Win Friends and Influence People. By Dale Carnegie: https://bit.ly/49WlcOd
In this episode, Dr. Zanotti is joined by Dr. Stephen Pastores to discuss the 2024 Focused Update: Guidelines on Use of Corticosteroids in Sepsis, Acute Respiratory Distress Syndrome, and Community-Acquired Pneumonia, published by the Society of Critical Care Medicine. Dr. Pastores is Program Director for Critical Care Medicine and Vice-Chair of Education for the Department of Anesthesiology and Critical Care Medicine at Memorial Sloan Kettering Cancer Center. In addition, Dr. Pastores is a professor of anesthesiology and medicine at Weill Cornell Medical College in New York, NY.Additional resources:2024 Focused Update: Guidelines on Use of Corticosteroids in Sepsis, Acute Respiratory Distress Syndrome, and Community-Acquired Pneumonia. Crit Care Medicine 2024: https://journals.lww.com/ccmjournal/pages/articleviewer.aspx?year=9900&issue=00000&article=00275&type=FulltextAdjunctive Glucocorticoid Therapy in Patients with Septic Shock. ADRENAL Trial. N Engl J Med 2018. https://www.nejm.org/doi/full/10.1056/NEJMoa1705835 Hydrocortisone plus Fludrocortisone for Adults with Septic Shock. APROCCHSS Clinical Trial. N Engl J of Med 2018: https://www.nejm.org/doi/full/10.1056/NEJMoa1705716 Dexamethasone treatment for the acute respiratory distress syndrome: a multicentre, randomized controlled trial. The Lancet 2020: https://www.thelancet.com/journals/lanres/article/PIIS2213-2600(19)30417-5/abstract Hydrocortisone in Severe Community-Acquired Pneumonia. CAPE-COD Trial. N Eng J Med 2023: https://www.nejm.org/doi/full/10.1056/NEJMoa2215145Books mentioned in this episode:Elon Musk. By Walter Isaacson: https://bit.ly/3PVXWsGThe Autumn Ghost: How the Battle Against a Polio Epidemic Revolutionized Modern Medical Care. By Hannah Wunsch: https://bit.ly/4avevns
In this episode, Dr. Zanotti discusses the delicate balance of conflict resolution in healthcare. Conflict is common in our daily work in the ICU. Many clinicians avoid conflict and have negative feelings towards it. However, conflict, when managed appropriately, can lead to significant benefits for our patients and teams. Dr. Zanotti's discussion is based on a webinar he presented earlier this month as part of Sound Critical Care Leadership Week.Additional Resources:Watch the full webinar: https://youtu.be/R3wz29W3C4gConflict Management in the ICU. Previous Critical Matters podcast episode with Dr. Joshua Kayser. https://soundphysicians.com/podcast-episode/?podcast_id=342&track_id=1378454077Books Mentioned in this Episode:Nonviolent Communication. By Marshal B. Rosenberg: https://bit.ly/4a8h0fpGetting to YES: Negotiating Agreement Without Giving In. By Roger Fisher and William Ury: https://bit.ly/3TSD5J3Possible: How We Survive (and Thrive) in an Age of Conflict. By William Ury: https://bit.ly/4aauFCKCrucial Conversations: Tools For Talking When Stakes are High. By Joseph Grenny, et al: https://bit.ly/43AU6LaThe Anatomy of Peace: Resolving the Heart of Conflict. By the Arbinger Institute: https://bit.ly/4a1v0HL
In this episode, Dr. Zanotti is joined by Dr. Craig Rackley to discuss the role of ECMO – extracorporeal membrane oxygenation in supporting patients with acute respiratory failure. Dr. Rackley is a practicing pulmonary critical care physician and an associate professor of Medicine at Duke University School of Medicine. He is the medical director of Adult ECMO in the Duke Division of Pulmonary, Allergy, and Critical Care Medicine. Dr. Rackley is also a recognized clinician, educator, and researcher interested in respiratory failure, ARDS, and ECMO.Additional ResourcesEfficacy and economic assessment of conventional ventilatory support versus extracorporeal membrane oxygenation for severe adult respiratory failure (CESAR): a multicentre randomised controlled trial. The CESAR Trial. Lancet 2009: https://pubmed.ncbi.nlm.nih.gov/19762075/ Extracorporeal Membrane Oxygenation for Severe Acute Respiratory Distress Syndrome. The EOLIA Trial. N Eng J of Med 2018: https://www.nejm.org/doi/full/10.1056/NEJMoa1800385 Bertini P, Guarracino F, Falcone M, et al. ECMO in COVID-19 Patients: A Systematic Review and Meta-analysis. J Cardiothorac Vasc Anesth 2022: https://pubmed.ncbi.nlm.nih.gov/34906383/Books mentioned in this episodeEndurance: Shackleton’s Incredible Voyage. By Alfred Lansing: https://bit.ly/43g71C1South!: The Story of Shackleton’s Last Expedition 1914-1917. By Ernest Shackleton: https://bit.ly/49NyJbU
In this episode, we will discuss critical care management of acute neuromuscular disorders. We will focus on the Guillain-Barre Syndrome and Myasthenia Gravis. My guest is Dr. Kamran Athar, who is trained in critical care medicine and neurocritical care. He is a practicing neurointensivist at the Farber Institute for Neuroscience in Philadelphia. Dr. Athar is an assistant professor of Medicine and Neurology at the Jefferson School of Medicine in Philadelphia.Additional Resources:Neuromuscular Disorders in the Intensive Care Unit. T B Birch. American Academy of Neurology 2021: https://pubmed.ncbi.nlm.nih.gov/34618763/ The clinical management of neuromuscular disorders in intensive care. M S Damian and EFM Wijdicks. Neuromuscular Disorders 2019: https://www.sciencedirect.com/science/article/abs/pii/S0960896618304231Books Mentioned in this Epsiode:When Breath Becomes Air. By Paul Kalanithi: https://www.amazon.com/When-Breath-Becomes-Kalanithi-Paul/dp/1784701998/ref=tmm_pap_swatch_0?_encoding=UTF8&qid=1706814212&sr=8-1
In this episode, Dr. Zanotti is joined by Dr. Eddy Fan for a discussion about Respiratory Support in ARDS. Dr. Fan is an associate professor in the Interdepartmental Division of Critical Care Medicine and the Institute of Health Policy, Management, and Evaluation at the University of Toronto. He is also a staff intensivist at the University Health Network/Mount Sinai Hospital. Dr. Fan is currently the Medical Director of the Extracorporeal Life Support Program at the Toronto General Hospital and the Director of Critical Care Research at the University Health Network/Mount Sinai Hospital. Dr. Fan’s research has focused on advanced life support for acute respiratory failure and patient outcomes from critical illness. He is a co-author of the ESICM ARDS Clinical Guidelines.Additional Resources:ESICM guidelines on acute respiratory distress syndrome: definition, phenotyping, and respiratory support strategies. Intensive Care Med 2023: https://pubmed.ncbi.nlm.nih.gov/37326646/An Update on Management of Adult Patients with ARDS. Official ATS Clinical Practice Guideline. Am J Respir Crit Care Med 2024; https://www.atsjournals.org/doi/full/10.1164/rccm.202311-2011STProne Positioning in Severe Acute Respiratory Distress Syndrome. PROSEVA Clinical Trial. N Engl J of Med 2013: https://www.nejm.org/doi/full/10.1056/nejmoa1214103Extracorporeal Membrane Oxygenation for Severe Acute Respiratory Distress Syndrome. The EOLIA Trial. N Eng J of Med 2018: https://www.nejm.org/doi/full/10.1056/NEJMoa1800385Books mentioned in this episode:A Portrait of the Artist as a Young Man. By James Joyce: https://bit.ly/49kzmtn
In this episode, we discuss the management of seizures in the intensive care unit. Our guest is Dr. Brandon Foreman – an internist and neurologist with fellowship training in epilepsy and Neurocritical care. Dr. Foreman is an Associate Professor of Neurology at the University of Cincinnati Medical College. He is the Associate Director for Neurocritical Care Research. An excellent clinician, researcher, and educator focusing on Clinical Neurophysiology and Neurocritical care.Additional Resources:Seizure Management in the Intensive Care Unit. Boggs JG. Curr Treat Options Neurol 2021: https://pubmed.ncbi.nlm.nih.gov/34697528/ American Epilepsy Society – Website with multiple clinical Guideline: https://pubmed.ncbi.nlm.nih.gov/34697528/ Treating Rhythmic and Periodic EEG Patterns in Comatose Survivors of Cardiac Arrest. Ruijter BJ, et al. N Engl J Med 2022: https://pubmed.ncbi.nlm.nih.gov/35196426/ Books mentioned in this episode: Siddhartha: A Novel. By Hermann Hesse: https://www.amazon.com/Siddhartha-Novel-Hermann-Hesse Netflix- Reference Guide on Our Freedom and Responsibility Culture https://igormroz.com/documents/netflix_culture.pdf
In this episode, we discuss the evaluation of fever in the adult ICU patient. We discuss updates from the recently published Society of Critical Care Medicine and Infectious Diseases Society of America clinical guidelines. My guest is Dr. Andre Kalil, a critical care and infectious disease physician. Dr. Kalil is a Professor in the Division of Infectious Disease and Director of Transplant Infectious Disease at the University of Nebraska Medical Center (UNMC). A renowned clinician, educator, and researcher, Dr. Kalil has received many distinctions, including the 2021 Scientist Laureate Award at UNMC. Dr. Kalil is an author of the 2023 Society of Critical Care Medicine and The Infectious Disease Society of America Guidelines for Evaluating New Fever in Adult Patients in the ICU.Additional Resources:Society of Critical Care Medicine and the Infectious Diseases Society of America guidelines for Evaluation New Fever in Adult Patients in the ICU. Crit Care Medicine 2023. https://pubmed.ncbi.nlm.nih.gov/37902340/Executive Summary: Guidelines for Evaluating New Fever in Adult Patients in the ICU. Crit Care Medicine 2023. https://pubmed.ncbi.nlm.nih.gov/37902339/Guidelines for the evaluation of new fever in critically ill adult patients: 2008 Update. Crit Care Medicine 2008/ https://pubmed.ncbi.nlm.nih.gov/18379262/Books mentioned in this episode: Splendid Solution: Jonas Salk and the Conquest of Polio. By Jeffrey Klugerhttps://www.amazon.com/Splendid-Solution-Jonas-Conquest-Polio/dp/0425205703/ref=tmm_pap_swatch_0?_encoding=UTF8&qid=1702571365&sr=8-2
In this episode, we discuss the topic of Brain Death / Death by Neurologic Criteria. We discuss updates from the recently published American Academy of Neurology, American Academy of Pediatrics, Child Neurology Society, and Society of Critical Care Medicine clinical guidelines. Our Guest is Dr. David Greer. Dr. Greer is a neurologist with additional vascular neurology and neurocritical care training. He is the Chair of the Boston University School of Medicine Department of Neurology. Dr. Greer is a renowned clinician, educator, and researcher. He has an extensive list of publications and awards. He is the first author of the “Pediatric and Adult Brain Death/Death by Neurologic Criteria Consensus Guideline” we will discuss today.Additional Resources:Pediatric and Adult Brain Death / Death by Neurologic Criteria Consensus Guideline. David Greer, et al. Neurology 2023: https://n.neurology.org/content/early/2023/09/13/WNL.0000000000207740 Determination of Brain Death / Death by Neurologic Criteria. The World Brain Death Project. D. Greer et al. JAMA 2020 https://pubmed.ncbi.nlm.nih.gov/32761206/ Determination of Brain Death / Death by Neurologic Criteria. The World Brain Death Project. VIDEO: https://edhub.ama-assn.org/jn-learning/video-player/18529668 Controversies in Brain Death Declaration: Legal and Ethical Implications in the ICU. S Biel, et al: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7223748/ Books mentioned in this episode: The Boys in the Boat. By Daniel J. Brown: https://www.amazon.com/Boys-BoatTeam of Rivals: The Political Genius of Abraham Lincoln. By Doris Kearns Goodwin: https://t.ly/7F1MyNine Stories. By JD Salinger: https://t.ly/qM5w_
In this episode, we will discuss Central Line-Associated Bloodstream Infections (CLABSI). My guest is Dr. Naomi O’Grady, a critical care and infectious disease physician at the National Institutes of Health. She is Chief of the Internal Medicine Service and an attending physician in the Clinical Center's Critical Care Medicine Department (CCMD). Her research focuses on strategies to reduce the incidence of antimicrobial-resistant pathogens in the ICU and catheter-related bloodstream infections.Additional Resources:Prevention of Central Line-Associated Bloodstream Infections. N. O’Grady. New Engl J Med 2023: https://pubmed.ncbi.nlm.nih.gov/37733310/ Sustaining reductions in central line-associated bloodstream infections in Michigan intensive care units: a 10-year analysis. P Pronovost, et al. Am J Med Qual 2016: https://pubmed.ncbi.nlm.nih.gov/25609646/ Bloodstream infection event (central line-associated bloodstream infection and non central-line associated bloodstream infection.) National Healthcare Safety Network: https://www.cdc.gov/nhsn/pdfs/pscmanual/4psc_clabscurrent.pdf Books Mentioned in this Episode:Nancy Drew Book Series. By Carolyn Keene. Nancy Drew Books: https://tinyurl.com/4rjx6st8The Checklist Manifesto. By Atul Gawande The Checklist Manifesto- Atul Gawande: https://tinyurl.com/5pccn98p
To err is human. In today’s episode, we will discuss the science behind learning to fail, in other words: “failing well”. We will discuss our flawed relationship to failure, how to better understand failure, and how to learn from failure. I am joined by Amy Edmondson, the Novartis Professor of Leadership and Management at the Harvard Business School. For the last 2 decades, she has studied the elements of high-performing teams in complex environments. She has coined the term “psychological safety” and has made critical insights into teaming, learning from failure, and innovation. She is the author of several books and multiple academic papers and a regular contributor to the Harvard Business Review. Her latest book “Right Kind of Wrong: The Science of Failing Well”, was released in September of this year on hardback.Additional Resource:Right Kind of Wrong. The Science of Failing Well. By Amy Edmondson: https://www.amazon.com/Right-Kind-Wrong-Science-Failing-ebook/dp/B0BTZT9CXV#:~:text=In%20Right%20Kind%20of%20Wrong,from%20flubs%20of%20all%20stripes Critical Matters podcast episode – The Fearless ICU, a discussion with Amy Edmondson on Psychological safety and teaming: https://soundphysicians.com/podcast-episode/?podcast_id=342&track_id=1220843524 Faculty page for Amy Edmondson. A great jumping point to her vast body of work: https://www.hbs.edu/faculty/AmyEdmondsonStrategies for Learning from Failure. By A. Edmondson. Harvard Business Review 2011: https://hbr.org/2011/04/strategies-for-learning-from-failureBooks Mentioned in this Episode:Adapt: Why Success Always Starts with Failure. By Tim Hartford: https://shorturl.at/mpQU1Being Wrong: Adventures in the Margin of Error. By Kathryn Shulz: https://shorturl.at/qAHJ0Principles: Life and Work. By Ray Dalio: https://shorturl.at/JRSZ1
Organ transplantation has proven to be life-saving for thousands of patients and a growing number of disease processes. However, the gap between available organs for transplant and patients on organ transplant waiting lists continues to grow. In this episode, we will discuss the ICU management of the organ donor. Our guest is Dr. George Williams. He is a Professor of Anesthesiology, Critical Care and Pain Medicine, and Vice Chair for Critical Care Medicine at the McGovern Medical School of the University of Texas in Houston. Dr. Williams is also Medical Co-Director of the Surgical Intensive Care Unit at Lyndon B. Johnson General Hospital, and Executive Medical Director, for the Donor Specialty Care Unit- Memorial Hermann Hospital TMC. He is an Immediate Past-President of the Texas Society of Anesthesiologists and currently serves as Chair, for the American Society of Anesthesiologists Committee on Critical Care Medicine. Additional Resources:Management of the Potential Organ Donor in the ICU. A clinical guideline published by the Society of Critical Care Medicine: https://www.sccm.org/Clinical-Resources/Guidelines/Guidelines/Management-of-the-Potential-Organ-Donor-in-the-ICUWebsite for the United Network for Organ Sharing (UNOS): https://unos.org/Critical Matters podcast episode – Death By Neurological Criteria: https://soundphysicians.com/podcast-episode/?podcast_id=342&track_id=1304762116The rise of organ donation after circulatory death: a narrative review. Gardiner D, et al. ANESTHESIA 2020: https://associationofanaesthetists-publications.onlinelibrary.wiley.com/doi/10.1111/anae.15100Books Mentioned in this Episode:The Holy Bible, KJV: https://shorturl.at/wyLM4
In this episode of the podcast, we will discuss Hospital Sepsis Programs with the recently released CDC Hospital Sepsis Program Core Elements document as an anchor. Our guest is Dr. Hallie Prescott, an Associate Professor in Pulmonary & Critical Care Medicine at the University of Michigan, and a staff physician at the Ann Arbor Veterans Affairs Healthcare System. Dr. Prescott’s primary focus of research has been on sepsis care and outcomes. She serves as co-chair of the international Surviving Sepsis Campaign Guidelines and as lead for the Michigan Hospital Medicine Safety Consortium’s Sepsis Initiative.Additional Resources:CDC Hospital Program Sepsis Program Core Elements: https://www.cdc.gov/sepsis/pdfs/sepsis-core-elements-H.pdf CDC Additional Sepsis Clinical Resources: https://www.cdc.gov/sepsis/core-elements/resources.htmlSCCM Surviving Sepsis Guidelines: https://journals.lww.com/ccmjournal/pages/articleviewer.aspx?year=2021&issue=11000&article=00021&type=FulltextCharacterising an implementation intervention in terms of behaviour change techniques and theory: the ‘Sepsis Six’ clinical care bundle. Steinmo S, et al. Implementation Science 2015: https://implementationscience.biomedcentral.com/articles/10.1186/s13012-015-0300-7Effect of a Multicomponent Sepsis Transition and Recovery Program on Mortality and Readmissions After Sepsis: The Improving Morbidity During Post-Acute Care Transitions for Sepsis Randomized Clinical Trial. Crit Care Medicine 2022: https://escholarship.org/content/qt4j222757/qt4j222757_noSplash_ad94a5b7db24a75b6176198a51129f5a.pdfBooks mentioned in this episode:The Autumn Ghost: How the Battle Against a Polio Epidemic Revolutionized Modern Medical Care. By Hannah Wunsch: https://www.amazon.com/Autumn-Ghost-Against-Epidemic-Revolutionized/dp/1771649453/ref=sr_1_1?crid=K1OFKS5NTQM4&keywords=the+autumn+ghost+hannah+wunsch&qid=1694808152&sprefix=autumn+ghosts%2Caps%2C108&sr=8-1
In this episode, Dr. Zanotti discusses advances in the management of cardiogenic shock. His guest is Dr. Jacob Jentzer, a cardiac intensivist trained in both Cardiology and Critical Care Medicine who practices full-time in the Cardiac Intensive Care Unit at Mayo Clinic in Rochester, MN. As the Director of Cardiac Intensive Care Unit Research at Mayo Clinic, he is active in Intensive Care Unit patient outcomes research, with a particular focus on the outcomes of patients with cardiogenic shock and cardiac arrest.Additional ResourcesConcise Definitive Review: Advances in the Management of Cardiogenic Shock. Jentzer JC et al. Crit Care Medicine 2023: https://pubmed.ncbi.nlm.nih.gov/37184336/SCAI clinical expert consensus statement on the classification of cardiogenic shock. Baran DA, et al.: https://www.ncbi.nlm.nih.gov/pubmed/31104355SCAI stages of cardiogenic shock stratify mortality risk. Jentzer JC et al.: https://www.ncbi.nlm.nih.gov/pubmed/?term=SCAI+stages+of+cardiogenic+shock+stratify+mortality+riskAdvances in the Staging and Phenotyping of Cardiogenic Shock: Part 1. Jentzer JC, et al. JACC Advances 2022: https://www.jacc.org/doi/10.1016/j.jacadv.2022.100120Machine Learning Approaches for Phenotyping in Cardiogenic Shock and Critical Illness: Part 2. Jentzer JC, et al. JACC Advances 2023: https://www.jacc.org/doi/10.1016/j.jacadv.2022.100126Extracorporeal Life Support in Infarct-Related Cardiogenic Shock. ECLS-SHOCK Investigators. New Eng J of Med 2023: https://pubmed.ncbi.nlm.nih.gov/37634145/Book Recommendations:The Hobbit by JRR Tolkien: https://bit.ly/44S0tZDThe Lord of the Rings Trilogy by JRR Tolkien: https://bit.ly/45Q9NP0The House of God. By Samuel Shem: https://bit.ly/48gnusc
In this episode, Dr. Zanotti discusses the management of acute-on-chronic liver failure (ACLF) in the ICU. He is joined by Dr. Nanchal, a practicing critical care physician with an interest in liver disease. He is a Professor in the Division of Pulmonary and Critical Care Medicine, at the Medical College of Wisconsin, in Milwaukee. Dr. Nanchal is also the lead author of the Society of Critical Care Medicine’s Guideline for the Management of Adult Acute and Acute-on-Chronic Liver Failure in the ICU.Additional ResourcesExecutive Summary for Guideline for the Management of Adult Acute and Acute-on-Chronic Liver Failure in the ICU: Neurology, Peri-transplant Medicine, Infectious Disease, and Gastroenterology Considerations: https://journals.lww.com/ccmjournal/pages/articleviewer.aspx?year=2023&issue=05000&article=00010&type=FulltextGuideline for the Management of Adult Acute and Acute-on-Chronic Liver Failure in the ICU: Neurology, Peri-transplant Medicine, Infectious Disease, and Gastroenterology Considerations: https://journals.lww.com/ccmjournal/pages/articleviewer.aspx?year=2023&issue=05000&article=00011&type=FulltextGuideline for the Management of Adult Acute and Acute-on-Chronic Liver Failure in the ICU: Cardiovascular, Endocrine, Hematologic, Pulmonary, and Renal Considerations: https://journals.lww.com/ccmjournal/Fulltext/2020/03000/Guidelines_for_the_Management_of_Adult_Acute_and.29.aspxPrevious Episodes of Critical Matters on the Topic of Acute-on-Chronic Liver Failure:https://soundphysicians.com/podcast-episode/?podcast_id=342&track_id=953807698https://soundphysicians.com/podcast-episode/?podcast_id=342&track_id=965563996Books Mentioned in this Episode:Noise: A Flaw in Human Judgement. By Daniel Kahneman, et al: https://bit.ly/3sqfRinSeven Brief Lessons on Physics. By Carlo Rovelli: https://bit.ly/45jv82NAnaximander: And the Birth of Science. By Carlo Rovelli: https://bit.ly/3sqgqbZ
In this episode of Critical Matters, Dr. Zanotti is joined by Dr. Nitin Puri. As a critical care physician, Dr. Puri is the Division Head for Critical Care Medicine, and Co-Director for the Center for Critical Care Medicine at Cooper University Health System. He is an Associate Professor of Medicine at Cooper Medical School of Rowan University, in Camden, New Jersey. Together, they discuss medical errors in healthcare.Additional Resources:“To Err is Human: Building a Safer Health System.” The landmark publication y the Institute of Medicine highlighting medical errors as a critical cause of deaths in the US healthcare system: https://www.ncbi.nlm.nih.gov/pubmed/25077248Medical error – the third leading cause of death in the US: https://www.ncbi.nlm.nih.gov/pubmed/27143499The Safety of Inpatient Health Care. New England Journal of Medicine 2023; https://www.nejm.org/doi/full/10.1056/NEJMsa2206117The Communication and Optimal Resolution (CANDOR) toolkit from the Agency for Healthcare Research and Quality (AHRQ). CANDOR is a process that health care institutions and providers can use to respond in a timely, thorough and fair way when medical errors occur and cause patient’s harm: https://www.ahrq.gov/professionals/quality-patient-safety/patient-safety-resources/resources/candor/introduction.htmlA powerful video on to topic of disclosure of medical errors. Worth a view: https://www.youtube.com/watch?time_continue=4&v=xeMWizTodYwBooks Mentioned in this Episode:The Fearless Organization: Creating Psychological Safety in the Workplace for Learning, Innovation, and Growth. By Amy Edmondson: https://bit.ly/3OQe1zVPachinko. By Min Lee Jee: https://bit.ly/3DNJegK
In this episode of the podcast, we will discuss oncologic emergencies. Dr. Zanotti is joined by Dr. R Scott Stephens, a pulmonary/critical care physician and associate professor of medicine and oncology at the Johns Hopkins University School of Medicine. He is the Director of Oncology and Bone Marrow Transplant Critical Care at Johns Hopkins Hospital and the Sidney Kimmel Comprehensive Cancer Center. A recognized clinician, educator, and researcher Dr. Stephens has expertise and interest in ARDS, ECMO, and oncologic critical care.Additional Resources:Oncologic Emergencies for the Intensivist – the Old, the New, and the Deadly. Thandra K, et al. J Intensive Care Med 2020: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6886674/Oncologic Emergencies – Traditional and Contemporary. Spring J, and Munshi L. Crit Care Clin 2020: https://pubmed.ncbi.nlm.nih.gov/33190777/ Critically Ill Patients with Cancer: A Clinical Perspective. Martos-Benitez F, et al. World J clin Onco 2020: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7643188/ Management of Febrile Neutropenia: ESMO Clinical Practice Guidelines. Annals of Oncology 2016: https://www.annalsofoncology.org/article/S0923-7534(19)31643-6/pdf Books Mentioned in this Episode:The Elements of Style. By William Strunk and EB White: https://amzn.to/3KddG7CThe Structure of Scientific Revolutions: By William Kuhn: https://bit.ly/43HkS34The Physicists: The History of a Scientific Community in Modern America. By Daniel Kevles: https://bit.ly/477Z8jOAmerican Prometheus: The Triumph and Tragedy of j. Robert Oppenheimer. By Kai Bird and Martin Sherwin: https://bit.ly/479AEqn
In this episode, we will discuss the evaluation and initial management of acute disorders of consciousness in the ICU. Our guest is Dr. Cherylee Chang, a practicing neuro intensivist, a Professor of Neurology, and the Division Chief of Neurocritical Care, in the Department of Neurology, at Duke University, in Durham, North Carolina. Additional ResourcesState-of-the-Art Evaluation of Acute Adult Disorders of Consciousness for the General Intensivist. Chang C, et al. Critical Care Medicine 2023: https://pubmed.ncbi.nlm.nih.gov/37070819/ Neurocritical Care Society Curing Coma Campaign. Provencio J, et al. Neurocrit Care 2020: https://pubmed.ncbi.nlm.nih.gov/32578124/NIH Stroke Scale: https://www.ninds.nih.gov/health-information/public-education/know-stroke/health-professionals/nih-stroke-scaleUpdated nomenclature of delirium and acute encephalopathy: statement of ten Societies. Intensive Care Med 2020: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7210231/Critical Matters podcast episode on CNS Infections: https://soundphysicians.com/podcast-episode/?podcast_id=342&track_id=1533382963Books mentioned in this episode:Bed Number Ten. By Sue Baier and Mary Zimmeth Schomaker: amzn.to/3O8FmgpThe Diving Bell and the Butterfly. By Jean-Dominique Bauby: bit.ly/44HxhonClinical Neuroanatomy Made Ridiculously Simple. By Stephen Goldberg: https://amzn.to/3PUF7Xu
In this episode, we will discuss prone position ventilation in adult respiratory distress syndrome (ARDS). Despite clinical trials demonstrating a benefit on mortality, the adoption of prone position ventilation has been challenging. We will discuss the impact the COVID-19 pandemic had on the use of prone position ventilation and lessons learned that can help increase the proper use of this treatment modality moving forward. Our guest is Dr. Chad Hochberg, a member of the Division of Pulmonary and Critical Care Medicine, Department of Medicine, at John Hopkins University Medical School in Baltimore, Maryland.Additional ResourcesFactors Influencing the Implementation of Prone Positioning during the COVID-19 Pandemic. Hochberg C, et al. Ann Am Thorac Soc, 2023; https://pubmed.ncbi.nlm.nih.gov/35947776/Declining Use of Prone Positioning After High Initial Uptake in COVID-19 Adult Respiratory Distress Syndrome. Hochberg C, et al. Crit Care Med 2023: https://pubmed.ncbi.nlm.nih.gov/37294144/ESICM Guidelines on ARDS 2023. Intensive Care Medicine 2023: https://link.springer.com/article/10.1007/s00134-023-07050-7ATS/ESICM/SCCM Clinical Practice Guideline: Mechanical Ventilation in Adult Patients with Acute Respiratory Distress Syndrome: https://www.atsjournals.org/doi/10.1164/rccm.201703-0548SProne Position for Acute Respiratory Distress Syndrome: A Systematic Review and Meta-Analysis. Munshi L, et al. Ann Am Thorac Soc 2017: https://pubmed.ncbi.nlm.nih.gov/29068269/Prone Positioning in Severe Acute Respiratory Distress Syndrome. Guerin C. Et al. PROSEVA Trial. New Eng J Med 2013: https://www.nejm.org/doi/full/10.1056/nejmoa1214103Books Mentioned in this EpisodesThe Omnivore’s Dilemma: A Natural History of Four Meals, By Michael Pollan: https://bit.ly/42FpndS
In this episode of Critical Matters, we discuss Central Nervous System (CNS) Infections. Our discussion focuses on the management of meningitis and encephalitis in the ICU. My guest is Dr. Catherine Albin, a neuro intensivist at the Emory Healthcare System in Atlanta, Georgia. Dr. Albin holds a faculty position as Assistant Professor of Neurology and Neurosurgery, in the Division of Neurocritical Care of Emory University School of Medicine.Additional ResourcesInfectious Meningitis and Encephalitis. R Bystritsky and F Chow: https://pubmed.ncbi.nlm.nih.gov/34798976/Critical care management of meningitis and encephalitis: an update. M Thy, et al.: https://pubmed.ncbi.nlm.nih.gov/35975963/Infectious Disease Society of America’s Clinical Practice Guidelines for Healthcare-Associated Ventriculitis and Meningitis: https://pubmed.ncbi.nlm.nih.gov/28203777/ Books Mentioned in this EpisodeThe Acute Neurology Survival Guide. By Catherine Albin and Sahar Zafar :bit.ly/45TtfuoWhy We Sleep: Unlocking the Power of Sleep and Dreams. By Matt Walker: https://bit.ly/3MNoWs0
There is increased recognition of the right ventricle's pivotal role in health and disease. In this episode, we will discuss Right Ventricular Failure in the context of critical illness. Our guest is Dr. Ryan Tedford, a practicing cardiologist focusing on heart failure. Dr. Tedford is the Dr. Peter C. Gaze Endowed Chair in Heart Failure. He is a Professor of Medicine and Cardiology, Section Chief for Heart Failure, Medical Director of Cardiac Transplantation, and Director of the Advanced Heart Failure & Transplant Fellowship Training Program at the Medical University of South Carolina.Additional ResourcesRight Ventricular Failure. Houston B, Britain EL, and Tedford R. N Engl J of Med 2023: https://pubmed.ncbi.nlm.nih.gov/36947468/ Diuretic versus placebo in intermediate-risk acute pulmonary embolism: a randomized clinical trial. Lim P, et al. Eur Heart J Acute Cardiovasc Care 2022: https://pubmed.ncbi.nlm.nih.gov/34632490/ Multimodality Imaging of Right Heart Function. Hahn R, et al. JACC 2023: https://pubmed.ncbi.nlm.nih.gov/37164529/ Ventricular dilation is associated with improved cardiovascular performance and survival in sepsis. Zanotti, s et al. CHEST 2010: https://pubmed.ncbi.nlm.nih.gov/20651022/ Link to recent podcast on Acute Pulmonary Embolism: https://soundphysicians.com/podcast-episode/?podcast_id=342&track_id=1463000353 Books Mentioned in this Episode:The Right Ventricle in Health and Disease. N Voelkel and D Schranz, Editors: https://bit.ly/436iROd The Code Breaker: Jennifer Doudna, Gene Editing, and the Future of the Human Race. By W Isaacson: https://bit.ly/3IDUL5a
May is National Critical Care Awareness and Recognition Month, a time to celebrate our ICU teams and honor our patients. In this episode of the podcast, we will focus on the forgotten patient – the loved ones and families of critically ill patients. We will explore the topic through the lens of a cardiac arrest co-survivor. Our guest is Kristin Flanary, a cognitive neuroscientist and social psychologist. Kristin is a co-survivor of cancer(twice) and a co-survivor of sudden cardiac arrest. She is also known for her social media alter ego – Lady Glaucomflecken. In 2022 Kristin co-founded Glaucomflecken LLC, where she works to advocate for caregivers and co-survivors of medical trauma and critical illness, community CPR and AED use, and sudden cardiac arrest survivorship. She has written about her experience as a co-survivor in medical journals and has received an EMS Cardiac Arrest Save Challenge Coin, the Citizen CPR Foundation’s '40 Under 40' award, and the American Heart Association’s Resuscitation Champion award.Additional Resources:The Quiet Place. K. Flanary. Journal of Cardiac Failure, 2021: https://www.onlinejcf.com/article/S1071-9164(21)00403-6/fulltext Roger. K Flanary. CHEST. 2022: https://journal.chestnet.org/article/S0012-3692(22)04029-6/fulltext Life after Cardiac Arrest: The importance of engaging with the “forgotten patient.” K Haywood & K Dainty. Resuscitation, 2018: https://www.resuscitationjournal.com/article/S0300-9572(18)30195-3/pdf Link to the Glaucomflecken’s website: https://glaucomflecken.com/Books Mentioned in this Episode:In Shock. By Rana Awdish: https://bit.ly/441b0Cx
Transitions of care during a patient’s hospitalization are points of vulnerability with a high potential for harm. In this episode, we will discuss transitions of care from the ICU to the wards. We will explore the ICU-PAUSE framework and how it can be implemented to improve this critical process of care delivery in the ICU. Our guest is Dr. Lekshmi Santhosh, a practicing pulmonary critical care physician at UCSF Health. She is an Associate Professor of Medicine in the Divisions of Pulmonary/Critical Care Medicine & Hospital Medicine at the University of California San Francisco. Dr. Santosh is one of the creators and leaders of the ICU-PAUSE initiative.Additional ResourcesAmerican Thoracic Society (ATS) ICU-PAUSE initiative. https://www.thoracic.org/professionals/education/ats-icu-pause-initiative.php Creating the ICU-PAUSE Tool for Intensive Care Unit-Ward Transitions. L Santosh et al. ATS Scholar 2022. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9341494/ Characterizing ICU-ward handoffs at three academic medical centres: process and perceptions. L Santosh, et al. BMJQS 2018. https://pubmed.ncbi.nlm.nih.gov/30636201/ Implementation of the I-PASS handoff program in diverse clinical environments: A multicenter prospective effectiveness implementation study. A Starmer, et al. J Hosp Med 2023. https://pubmed.ncbi.nlm.nih.gov/36326255/ Books Mentioned in this EpisodeIn Shock. By Rana Awdish: bit.ly/441b0CxEvery Deep Drawn Breath. By Wes Ely: bit.ly/3Aqt4ICMom Milestones. By Grace Farris: bit.ly/3ArT06zDare to Lead. By Brene Brown: bit.ly/3n3N54OQuiet. By Susan Cain: bit.ly/3HcuHxkThe Credibility Code (Speech Skills). By Cara Hale Alter: bit.ly/40ErQE8
Despite all the advances developed in critical illness, survivors of the ICU have a long journey to healing and recovery. In this episode of the podcast, we will discuss outcomes after critical illness. Our guest is Dr. Margaret Herridge, Professor of Medicine, Senior Scientist in Critical Care and Respiratory Medicine at the University of Toronto. Dr. Herridge is also Director of Critical Care Research. Director of the RECOVER Program, and Clinical Director of the Grace RECOVER Program for Chronic Critical Illness, in the University Health Network, Toronto, Canada.Additional Resources:Outcomes after Critical Illness. M. Herridge and E. Azoulay: https://pubmed.ncbi.nlm.nih.gov/36884324/ Neuropsychological sequelae and impaired health status in survivors of severe acute respiratory distress syndrome. Hopkins RO, et al: https://pubmed.ncbi.nlm.nih.gov/10390379/ One-year outcomes in survivors of the acute respiratory distress syndrome. Herridge m, et al: https://pubmed.ncbi.nlm.nih.gov/12594312/ Long-term cognitive impairment after critical illness. Pandharipande PP, et al: https://pubmed.ncbi.nlm.nih.gov/24088092/ The RECOVER Program: disability risk groups and 1-year outcome after 7 or more days of mechanical ventilation. Herridge M, et al: https://pubmed.ncbi.nlm.nih.gov/26974173/ Determinants of long-term outcome in ICU survivors: results from the FROG-ICU study. Gayat E, et al: https://pubmed.ncbi.nlm.nih.gov/29347987/ Symptoms of anxiety and depression in family members of intensive care unit patients. Pochard F, et al: https://pubmed.ncbi.nlm.nih.gov/11588447/ Books Mentioned in this Episode:Bel Canto. By Ann Patchett: bit.ly/3nWs7VpCommonwealth. By Ann Patchett: bit.ly/43pWSCt
In this episode, we will discuss Mechanical Power and ventilator induced lung injury (VILI). Our guest is Dr. Jason Bartock, a practicing intensivist at Cooper Medical System in Camden, New Jersey. Dr. Bartock is faculty and Program Director of the Critical Care Medicine Fellowship at Cooper Medical School of Rowan University, Camden, New Jersey.Additional Resources:Mechanical power: meaning, uses and limitations. L Gattinoni, et al: https://pubmed.ncbi.nlm.nih.gov/36884050/ Mechanical Power: A New Concept in Mechanical Ventilation Poudel, et al: https://pubmed.ncbi.nlm.nih.gov/34597688/ Mechanical power at a glance: a simple surrogate for volume-controlled ventilation. L Giosa, et al: https://pubmed.ncbi.nlm.nih.gov/31773328/ The future of driving pressure: a primary goal for mechanical ventilation? H. Aoyama, et al. https://pubmed.ncbi.nlm.nih.gov/30305906/Seminal clinical trial comparing low tidal volumes to traditional tidal volumes in ARDS. ARDS Network: https://www.nejm.org/doi/full/10.1056/nejm200005043421801 Educational website with mechanical ventilation content: https://www.criticalcareatcooper.com/masterin-mechanical-ventilationBooks Mentioned in this Episode:Crucial Conversations: Tools for Talking When Stakes are High. By Joseph Grenny, et al: https://bit.ly/3FL4Xr9Critical Maters Podcast – Interrupting the VILI Vortex. Guest J. Marini, MD: https://soundphysicians.com/podcast-episode/?podcast_id=342&track_id=819824731Critical Matters Podcast- Initial Management of ARDS. Guest R.P. Dellinger, MD: https://soundphysicians.com/podcast-episode/?podcast_id=342&track_id=635607780
In this episode of the podcast, we will discuss the current management of Acute Pulmonary Embolism. Our guest is Dr. Belinda Rivera-Lebron, a pulmonary critical care physician who practices at the University of Pittsburgh Medical System. She is an Associate Professor of Medicine and is the Director of the UPMC Acute Pulmonary Embolus (PE) Program and the UPMC Chronic Thromboembolic Pulmonary Hypertension (CTEPH) Program. Dr. Rivera-Lebron’s areas of interest include pulmonary embolism and pulmonary hypertension.Additional ResourcesDiagnosis, Treatment and Follow Up of Acute Pulmonary Embolism: Consensus Practice from the PERT Consortium.: https://pubmed.ncbi.nlm.nih.gov/31185730/ AHA Scientific Statement. Surgical Management and Mechanical Circulatory Support in High-Risk Pulmonary Embolisms: https://pubmed.ncbi.nlm.nih.gov/36688837/ PERT Consortium website: https://pertconsortium.org/Books Mentioned in this Episode:The Trusted Advisor. By David H. Meister, et al: bit.ly/3mq9Oap
In this episode of the podcast, we will discuss Fluid Management for Sepsis through the lens of the recently published CLOVERS clinical trial. Our guest is Dr. Nathan Shapiro, Professor of Emergency Medicine at Harvard Medical School, and an attending physician in the Department of Emergency Medicine at Beth Israel Deaconess Medical Center. Dr. Shapiro is the Vice Chairman of Research for the Emergency Department. Dr. Shapiro is a lead author and investigator for the recently published CLOVERS clinical trial.Additional ResourcesEarly Restrictive or Liberal Fluid Management for Sepsis-Induced Hypotension. CLOVERS clinical trial: https://www.nejm.org/doi/full/10.1056/NEJMoa2212663Restriction of Intravenous Fluids in ICU Patients with Septic Shock. CLASSIC clinical trial: https://www.nejm.org/doi/full/10.1056/NEJMoa2202707Surviving Sepsis Campaign: Guidelines 2021: https://www.sccm.org/Surviving-Sepsis-Guidelines-2021Early Goal-Directed Therapy in the Treatment of Severe Sepsis and Septic Shock: https://www.nejm.org/doi/full/10.1056/nejmoa010307Early, Goal-Directed Therapy for Septic Shock: Metanalysis of the ARISE, ProCESS, and PriMISe clinical trials: https://www.nejm.org/doi/10.1056/nejmoa1701380Books Mentioned in this Episode:Extreme Ownership: How Navy SEALs Lead and Win. By Jocko Willink and Leif Babin: https://bit.ly/3Ktadmk
As we begin a new year with the podcast, I have decided to depart from our customary guest format and usual clinical topics to focus on personal growth and mastery. I am a firm believer that mastery (learning new skills) is the key to an engaged and joyful clinical career. In this episode of the podcast, we will discuss Skills, Super Skills, and Ultra Skills. We will discuss this new framework for understanding and developing skills relevant to our professional and personal growth. Please reach out with comment on Twitter (@sergio_zanotti) or LinkedIn.Books and Podcasts Mentioned in this Episode:The Fearless ICU – Critical Matters Podcast with Amy Edmondson: http://bit.ly/3I7rq3oThe Infinite Game. By Simon Sinek: https://bit.ly/3XhMgBeDrive. By Daniel Pink: https://bit.ly/3XlhFCSDeep Work. By Cal Newport: https://bit.ly/3YyXD99Switch. By Chip Heath & Dan Heath: https://amzn.to/3IaXQdcMindset. By Carol Dweck: https://bit.ly/3XhXS7lLeonardo Da Vinci. By Walter Isaacson: https://bit.ly/40AmwmJRange. By David Epstein: https://bit.ly/3jGZ1roEssentialism. By Greg McKeown: https://bit.ly/3xruX6BMastery. By Robert Greene: https://bit.ly/3RKjiccLinchpin. By Seth Godin: https://bit.ly/3jKBu8U
In this episode of the podcast, we will discuss the first hour of clinical care post return of spontaneous circulation in cardiac arrest survivors. Our guest is Dr. Haney Mallemat a critical care intensivist and emergency medicine clinician at Cooper University Health. He is also an associate professor of medicine and of emergency medicine at Cooper Medical School of Rowan University, in Camden, New Jersey.Additional Resources:Critical Care Now: A site for intensivists and resuscitationists.: https://criticalcarenow.com/RESUS-X: The ultimate resuscitation educational experience: https://www.resusx.com/https://pubmed.ncbi.nlm.nih.gov/25599355/European Resuscitation Council and European Society of Intensive Care Medicine guidelines 2021: post-resuscitation care: https://link.springer.com/article/10.1007/s00134-021-06368-4Oxygen Targets in Comatose Survivors of Cardiac Arrest. BOX Trial: https://www.nejm.org/doi/full/10.1056/NEJMoa2208686Blood-Pressure Targets in Comatose Survivors of Cardiac Arrest. BOX Trial: https://www.nejm.org/doi/full/10.1056/NEJMoa2208687Books Mentioned in this Episode:SmartLess. One of Haney’s favorite podcasts: https://podcasts.apple.com/us/podcast/smartless/id1521578868How to win Friends & Influence People. By Dale Carnegie: bit.ly/3VVlTRQEMRAP. A leading educational platform recommended by Haney: https://www.emrap.org/
In this episode of the podcast, we will discuss the management of Acute Metabolic Encephalopathies. Our guest is Dr. Eelco Wijdicks (@EWijdicks on Twitter) Professor of Neurology at Mayo Clinic College of Medicine and Science. He is an attending Neurointensivist in the Neurosciences Intensive Care Unit at the Saint Mary’s Hospital campus, Rochester, Minn. He currently serves as the chair in the Critical Care and Hospital Neurology Division in the Department of Neurology.Additional Resources:Identifying encephalopathies from acute metabolic derangements. EFM Wijdicks: https://onlinelibrary.wiley.com/doi/full/10.1111/joim.13538Neurocinema: When Film Meets Neurology. By Eelco Wijdicks: bit.ly/3tQfD1tNeurocinema- The Sequel. By Eelco Wijdicks: bit.ly/3GAQ9g4Books Mentioned in this Episode:The Origin of Species. By Charles Darwin: bit.ly/3TY9XgwCharles Darwin: A Biography Vol 1. By Janet Browne: bit.ly/3EoAi1eCharles Darwin: A Biography Vol 2. By Janet Browne: bit.ly/3XriSdmA New Biographical Dictionary of Film: Sixth Edition. By David Thomson: bit.ly/3U4XjMC
In this episode of the podcast, we will discuss the management of conflict in the intensive care unit (ICU). Our guest is Dr. Joshua Kayser. Dr. Kayser is Section Chief for Medical Critical Care Medicine and Medical ICU Director at the VA Medical Center in Philadelphia. He is also Professor of Clinical Medicine and Professor of Medical Ethics and Healthy Policy at the University of Pennsylvania.Additional Resources:Conflict Management in the ICU. JB Kayser and LJ Kaplan: https://pubmed.ncbi.nlm.nih.gov/32618689/How doctors manage conflicts with families of critically ill patients during conversations about end-of-life decisions in neonatal, pediatric, and adult intensive care. AS Spijkers et al.: https://link.springer.com/article/10.1007/s00134-022-06771-5Center to Advance Palliative Care Website – with great resources: https://www.capc.org/Vital Talk website. A great resource for developing communication skills in healthcare: https://www.vitaltalk.org/ Books Mentioned in this Episode:In Shock. By Rana Awdish: https://amzn.to/3UzJtTg
In this episode of the podcast, we discuss the management of Acute Ischemic Stroke (AIS). Our guest is Dr. Fred Rincon, a neurologist and critical care specialist with expertise in the resuscitation and management of acute brain injured patients. He is a Professor of Neurology at Cooper Medical School of Rowan University and Director of the Neuro-ICU at Cooper University Health Care in Camden, New Jersey.
Additional Resources Management of Acute Ischemic Stroke. F. Herpich and F. Rincon: https://pubmed.ncbi.nlm.nih.gov/32947473/ AHA Guidelines for the Management of Acute Ischemic Stroke (2019): https://pubmed.ncbi.nlm.nih.gov/31662037/ Link to NIHSS Certification Course: https://www.nihstrokescale.org/ The intensive care management of acute ischemic stroke. D. Sharma and M. Smith: https://pubmed.ncbi.nlm.nih.gov/35034076/ Association of Neurocritical Care Services with Mortality and Functional Outcomes for Adults With Brain Injury. Meta-analysis. JAMA Neurology 2022: https://pubmed.ncbi.nlm.nih.gov/36036899/
Book Recommendations: The Servant: A Simple Story of About the True Essence of Leadership. By James C. Hunter: https://amzn.to/3U6u6SI How to Be a Leader: An Ancient Guide to Wise Leadership. By Plutarch: https://amzn.to/3eMBxhU
In this episode of the podcast, we will discuss tracheostomy emergencies. Tracheostomies are common in ICU patients. Every intensivist should be capable of recognizing and providing initial management to potentially serious complications associated with tracheostomies. Our guests are Drs. Laura Bontempo and Sara Manning, emergency physicians and educators with a special interest in the topic. Dr. Laura Bontempo is an associate professor of emergency medicine, and serves as Assistant Director for Faculty Development & Resident Education, in the Department of Emergency Medicine at the University of Maryland Medical School. Dr. Sara Manning is an Assistant Professor of Clinical Emergency Medicine, in the Department of Emergency Medicine at the Indiana University School of Medicine.
Additional Resources: Tracheostomy Emergencies. LJ Bontempo and SL Manning. Emerg Med Clin N Am 2019: https://pubmed.ncbi.nlm.nih.gov/30454773/
Link to Onepager on Tracheostomy Emergencies: https://onepagericu.com/trach-emergencies
Bleeding Tracheostomy. Kenji Inaba MD. Presented at Essentials of EM: https://www.facebook.com/EssentialsofEM/videos/1163679590380038/
Book Recommendations: Who Moved my Cheese?: An A-Mazing Way to Deal with Change in Your Work and in Your Life. By Spencer Johnson, et al: https://amzn.to/3pq0CkR
Where the Red Fern Grows. By Wilson Rawls: https://amzn.to/3AawH6a
In this episode of the podcast, we will discuss dogma in critical care medicine. How do we fight dogma when the evidence is weak? Our guest is Dr. Mervyn Singer, an internationally recognized critical care clinician, investigator, and educator. Dr. Singer is professor of intensive care medicine at University College London.
Additional Resources: Challenging management dogma where evidence is non-existent, weak, or outdated. By D. A Hofmaenner and M. Singer https://link.springer.com/article/10.1007/s00134-022-06659-4
Link to Gapminder, an independent educational non-profit fighting global misconceptions https://www.gapminder.org/
Think Again: The Power of Knowing What You Don’t Know. By Adam Grant https://amzn.to/3bceyLu
Books Mentioned in this Episode: Factfulness: Ten Reasons We're Wrong About the World--and Why Things Are Better Than You Think. By Hans Rosling https://amzn.to/3S4kWFj
In this episode, we will discuss Brain Death / Death by Neurologic Criteria. Brain Death remains an important topic within the practice of critical care medicine. However, there are still inconsistencies in the concept, criteria, practice, and documentation of brain death. Today we will discuss this topic through the lens of "The World Brain Death Project." Our Guest is Dr. David Greer, Chair of the Department of Neurology at the Boston University School of Medicine. Dr. Greer is a renowned clinician, educator, and researcher.
Additional Resources Determination of Brain Death / Death by Neurologic Criteria. The World Brain Death Project. D. Greer et al. JAMA 2020 https://pubmed.ncbi.nlm.nih.gov/32761206/ Determination of Brain Death / Death by Neurologic Criteria. The World Brain Death Project. VIDEO https://edhub.ama-assn.org/jn-learning/video-player/18529668 Controversies in Brain Death Declaration: Legal and Ethical Implications in the ICU. S Biel, et al. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7223748/
Books Mentioned in this Episode The Boys in the Boat. By Daniel J. Brown https://www.amazon.com/Boys-Boat
Brain Death. By Eelco Wijdicks https://www.amazon.com/Brain-Death-Eelco-F-M-Wijdicks/
In this episode of the podcast, we will discuss tracheal intubation-associated hypotension. Endotracheal intubation is a common procedure in the clinical care of critically ill patients. Tracheal intubation in the ICU is often associated with cardiovascular complications that can include hypotension, cardiac arrest, or death. A recently published clinical trial evaluating the impact of a 500ml- bolus of crystalloid solution intravenously on cardiovascular complications post-intubation is the catalyst for our discussion.
Additional Resources Effect of Fluid Bolus Administration on Cardiovascular Collapse Among Critically Ill Patients Undergoing Tracheal Intubation. A Randomized Clinical Trial. The PREPARE II Investigators. https://jamanetwork.com/journals/jama/fullarticle/2793545
Effect of a fluid bolus on cardiovascular collapse among critically ill adults undergoing tracheal intubation (PREPARE) a randomized controlled trial. The PREPARE Investigators. https://pubmed.ncbi.nlm.nih.gov/31585796/ Previous episodes of Critical Matters discussing other Intravenous Fluid topics. Critical Matters_Fluid Responsiveness: https://bit.ly/3bBTOg7 Critical Matters_Fluid BaSICS: https://bit.ly/3y99S0j
Link to REBELEM post on Post Intubation Hypotension: The AH SHITE mnemonic. https://rebelem.com/post-intubation-hypotension-the-ah-shite-mnemonic/
Link to PulmCrit Blog on PREPARE clinical trial. https://emcrit.org/pulmcrit/prepare/
Books mentioned in this episode: Leonardo Da Vinci. By Walter Isaacson. https://amzn.to/3Nw0PfG
Benjamin Franklin. By Walter Isaacson. https://amzn.to/3OM3N0C
In this episode of the podcast, we will discuss the science behind the benefits of being Other-Focused and of having a Live-to-Give attitude. Our guest is Dr. Stephen Trzeciak, a practicing intensivist, physician scientist, professor, and chair of medicine at Cooper Medical School of Rowan University in Camden, New Jersey. Dr. Trzeciak is the co-author of “Wonder Drug: 7 Scientifically Proven Ways That Serving Others Is the Best Medicine for Yourself”, a wonderful book soon to be published and the focus of our conversation today.
Additional Resources Website for the book: Wonder Drug: 7 Scientifically Proven Ways That Serving Others Is the Best Medicine for Yourself: https://www.wonderdrugbook.com/ Link to previous podcast episode with Dr. Trzeciak on Compassionomics: https://bit.ly/3tqBdJU Curricula for empathy and compassion training in medical education: A systematic Review. Patel s, et al: https://pubmed.ncbi.nlm.nih.gov/31437225/ Need for compassion in prehospital and emergency care: A qualitative study on bus crash survivor’s experiences. Doohan I, et al: https://pubmed.ncbi.nlm.nih.gov/25257225/ “Unsung Hero” a beautifully executed commercial of what it means to be Live to Giver: https://www.youtube.com/watch?v=uaWA2GbcnJU
Books Mentioned in this Episode: Man’s Search for Meaning. By Viktor Frankl: https://amzn.to/3xv9n1J Against Empathy: The Case for Rational Compassion. By Paul Bloom: https://amzn.to/3MtzXg1
We are taking a short break from recording new episodes this month. I hope you enjoy this previously released episode on Toxicology in the ICU. This is part two of a two part series. Today’s episode will focus on specific toxic ingestions and their management. Our guest is Dr. Jerrold B. Leikin. Dr. Leikin is the Director of Medical Toxicology at North Shore University Health System-OMEGA which includes several hospitals in Illinois. In addition, he is a Clinical Professor of Medicine at the Pritzker School of Medicine (University of Chicago) and Professor of Medicine and Pharmacology at Rush Medical College.
Additional Resources: Link to the website for the American Association of Poison Control Centers: https://aapcc.org/ A three part review series published in CHEST on Toxicology in the ICU: https://www.ncbi.nlm.nih.gov/pubmed/21896525 https://www.ncbi.nlm.nih.gov/pubmed/21972388 https://www.ncbi.nlm.nih.gov/pubmed/22045882
Albums Mentioned in this Episode: The Beatles Live at the BBC: Dr. Leikin’s recommendation for the one album he would take on a deserted island: https://amzn.to/2vIrX5M
We are taking a short break from recording new episodes this month. I hope you enjoy this previously released episode on Toxicology in the ICU. This is part one of a two part series. Today’s episode will focus on an overview of toxic ingestions and their general management. Our guest is Dr. Jerrold B. Leikin. Dr. Leikin is the Director of Medical Toxicology at North Shore University Health System-OMEGA which includes several hospitals in Illinois. In addition, he is a Clinical Professor of Medicine at the Pritzker School of Medicine (University of Chicago) and Professor of Medicine and Pharmacology at Rush Medical College.
Additional Resources: Link to the website for the American Association of Poison Control Centers: https://aapcc.org/ A three-part review series published in CHEST on Toxicology in the ICU. https://www.ncbi.nlm.nih.gov/pubmed/21896525 https://www.ncbi.nlm.nih.gov/pubmed/21972388 https://www.ncbi.nlm.nih.gov/pubmed/22045882
Books mentioned in this episode: Biographies on Louis Armstrong: https://amzn.to/3wsdT0z https://amzn.to/38DfEP5 Albums by Louis Armstrong: https://amzn.to/3Pt40qO
Patients who survive a cardiac arrest often sustain a severe anoxic brain injury. Determining their neurological prognosis is a critical component of post-cardiac arrest care. In this episode of the podcast, we will discuss best practices for Neuroprognostication after Cardiac Arrest. Our guest is Dr. Neha Dangayach, a neurocritical care physician at Mt. Sinai Medical Center in New York. Dr. Dangayach is an Assistant Professor of Neurology and Neurosurgery at the Icahn School of Medicine at Mt. Sinai.
Additional Resources: Predicting outcome from hypoxic-ischemic coma. Levy DE, et al. JAMA 1985: https://pubmed.ncbi.nlm.nih.gov/3968772/ Prediction of poor neurological outcome in comatose survivors of cardiac arrest: a systematic review. Sandroni C et al. Intensive Care Medicine 2020: https://pubmed.ncbi.nlm.nih.gov/32915254/
Books Mentioned in this Episode: How to Win Friends & Influence People. By Dale Carnegie: https://amzn.to/3Lk9rpn Dare to Lead. By Brene Brown: https://amzn.to/3vi1dse Think Again. By Adam Grant: https://amzn.to/3OB3l6a
This is an encore for a previous episode of Critical Matters. One in five US residents receives ICU care at the end of life. In this episode, we discuss different aspects of end of life care in the ICU. Our guest is Dr. BJ Miller, a physician, author, and speaker. He is a practicing hospice and palliative medicine physician and is best known for his 2015 TED Talk, "What Really Matters at the End of Life." BJ has been on the teaching faculty at UCSF School of Medicine since 2007. He is a powerful advocate for the role of our senses, community, and presence in delivering palliative care and for ushering in a new perspective on living with death.
Additional Resources: What really matters at the end of life, BJ Miller presented at TED 2015: https://bit.ly/3EcOslB Clinician-Family Communication About Patients' Values and Preferences in Intensive Care Units. Scheunemann LP et al, JAMA Internal Medicine, 2019: https://bit.ly/3jzNqqD A Beginner's Guide to the End: Practical Advice for Living Life and Facing Death. BJ Miller and Shoshana Berger: https://amzn.to/3rpl6LM Vital Talk courses, a set of online and in person courses designed to equip clinicians with the tools to have difficult conversations with patients and families: https://www.vitaltalk.org/courses/
Books Mentioned in this Episode: Man’s Search for Meaning. Viktor Frankl: https://amzn.to/37l3Mk9 Mortally Wounded: Stories of Soul Pain, Death and Healing. Michael Kearney: https://amzn.to/3xsyAKI Bering Mortal: Medicine and What Matters in the End. Atul Gawande: https://amzn.to/3Jz3OlG The Denial of Death. Ernest Becker: https://amzn.to/3vfQ22e
This is a previously released episode that I thought would be of great interest to our listeners. As we move forward post 24 months of COVID-19 reconnecting with our purpose and core values is more important than ever. In this episode, we discuss the practice of respect in the intensive care unit. Our guest is Samuel M. Brown, MD, MS, a practicing intensivist and Director of the Center for Humanizing Critical Care, at Intermountain Medical Center in Murray, Utah. Dr. Brown holds an academic appointment as Associate Professor of Medicine at the University Of Utah School Of Medicine, Murray UT. He is a prolific investigator and author with a wide range of interests including complexity in critical illness, echocardiography, and ethics. Our conversation covers topics such as dignity, respect, compassion, and burnout. Join us in a fascinating discussion with a thought leader in bringing humanism to critical care.
Additional Resources: Recent article co-authored by Dr. Brown and colleagues reviewing important aspects of the practice of respect in critical care medicine: https://bit.ly/3uFLou8 The Center for Humanizing Critical Care works with researchers and clinicians with the goal of helping patients and family members make it through critical illness with their humanity intact: https://bit.ly/3JTxfjp Speak, Memory: An autobiography revisited. By Vladimir Nabokov: https://amzn.to/3iKaXVc
In a recent episode of the podcast, we had a wonderful conversation with Amy Edmondson (Twitter: @ AmyCEdmondson), on the elements of high-performing teams in complex environments. In this episode of the podcast, we examine psychological safety, teaming, and learning from failure within the context of building better ICU teams. The episode is a recording of a webinar I recently presented entitled “The Fearless ICU: Building a Culture of Healing and Transformation.”
Additional Resources: Critical Matters podcast episode with Amy Edmondson – The Fearless ICU: https://bit.ly/365bjmv Webinar- The Fearless ICU: Building a Culture of Healing and Transformation: https://bit.ly/3u2zlXs What Google Learned in its Quest to Build the Perfect Team. New York Times: https://nyti.ms/3p84qHk Implementing New Practices: An Empirical Study of Organizational Learning in Hospital Intensive Care Units. A. Edmondson et al. Management Science 2007: https://bit.ly/3JJXisP
The last 24 months have pushed ICU teams around the world to their limits. As we move forward, we need to heal and rebuild our critical care teams. Healthcare more than ever will require ICU teams to perform at the highest levels and to continuously innovate to deliver high-value care to the sickest of the sick. In today’s episode of the podcast, we will discuss the elements of The Fearless ICU. Our guest is Amy Edmondson (@AmyCEdmondson), the Novartis Professor of Leadership and Management at the Harvard Business School. For the last two decades, she has studied the elements of high-performing teams in complex environments.
Additional Resources: Faculty page for Amy Edmondson. A great jumping point to her vast body of work: https://www.hbs.edu/faculty/AmyEdmondson How to turn a group of strangers into a team. TED Talk by Amy Edmondson: https://bit.ly/3vaKwzA The Fearless Organization. By Amy Edmondson: https://amzn.to/3v7JzrJ What Google Learned in its Quest to Build the Perfect Team. New York Times: https://nyti.ms/3p84qHk Implementing New Practices: An Empirical Study of Organizational Learning in Hospital Intensive Care Units. A. Edmondson et al. Management Science 2007: https://bit.ly/3JJXisP
Books Mentioned in this Episode: Get Rid of the Performance Review! By Samuel Culbert: https://amzn.to/354mYl3 Mindset. By Carol Dweck: https://amzn.to/3LRR2B8
In today’s episode, we will discuss the management of severe alcohol withdrawal in the intensive care unit. Our guest is Dr. Nick Mark (@nickmmark), a critical care physician practicing in Seattle, Washington. Dr. Mark is the founder and creator of www.onepagerICU.com - a wonderful resource that provides regularly updated comprehensive and practical one-page summaries on various critical care topics.
Additional Resources: Link to the onepager on Alcohol Withdrawal. -https://onepagericu.com/ A statement on research needs for inpatient management of severe alcohol withdrawal from the American Thoracic Society. - https://www.atsjournals.org/doi/10.1164/rccm.202108-1845ST Guidelines for clinical management of alcohol withdrawal from American Society of Addiction Medicine (ASAM). - https://bit.ly/3GIRkq6
Books mentioned in this episode: Surely You’re Joking, Mr. Feynman! By Richard Feynman. - https://amzn.to/34IZBgs Sapiens: A Brief History of Humankind. By Yuval Noah Harari. - https://amzn.to/3HGqsbE
Fluid resuscitation is a cornerstone of our treatment for circulatory failure and is often quite challenging to get right. In today’s episode of the podcast, we will discuss the prediction of fluid responsiveness. Our guest is Dr. Haney Mallemat, a critical care intensivist and emergency medicine clinician at Cooper University Health. He is also an associate professor of medicine and of emergency medicine at Cooper Medical School of Rowan University, in Camden, New Jersey.
Additional Resources: Critical Care Now: A site for intensivists and resuscitationists. - https://criticalcarenow.com/ RESUS-X: The ultimate resuscitation educational experience. - https://bit.ly/3nXtWih Prediction of fluid responsiveness: a review. Enev R, et al. 2021. - https://bit.ly/33NNHBT Prediction of fluid responsiveness: an update. Monnet X, et al. 2016. - https://bit.ly/3H2R6ew Predictors of fluid responsiveness in critically ill patients mechanically ventilated at low tidal volumes: systematic review and metanalysis. Alvarado Sanchez JI, et al. 2021 - https://bit.ly/3KJ6D5l
Music and Podcasts mentioned in this episode: Haney’s musical recommendation – listen to the band Wilco. - https://wilcoworld.net/ 99% Invisible. One of Haney’s favorite podcasts. Open access. - https://99percentinvisible.org/ The Joe Rogan Experience. Popular podcast on Spotify. - https://open.spotify.com/show/4rOoJ6Egrf8K2IrywzwOMk EMRAP. A leading educational platform recommended by Haney. - https://www.emrap.org/
As we start a new year, we look forward with the hope to grow and improve critical care medicine. In today’s episode of the podcast, we will discuss a path forward focused on healing, recovery, and transformation.
Our guest is Dr. Wes Ely, professor of medicine at Vanderbilt University School of Medicine and co-director of the Center for Critical Illness, Brain dysfunction, and Survivorship (CIBS Center). Dr. Ely is the author of Every Deep-Drawn Breath – a wonderful book that will guide our discussion in this episode.
Additional Resources: Link to the CIBS Center website, which contains a wealth of resources for intensivists on the topic of delirium: https://www.icudelirium.org Kaleidoscope by Wes Ely: https://pubmed.ncbi.nlm.nih.gov/25599355/ Don’t give COVID-19 long-haulers the Silent Treatment by Wes Ely: https://bit.ly/3GfgJbC ABCDEF Bundle and Supportive ICU Practices for Patients with Coronavirus Disease 2019 Infection - An International Point Prevalence Study. K Liu, et al. Critical Care Explorations 2021: https://bit.ly/3qepqgS Caring for Critically Ill Patients with the ABCDEF Bundle - Results of the ICU Liberation Collaborative in Over 15,000 Adults: https://bit.ly/3FeX0Hw
Books Mentioned in this Episode: Every Deep-Drawn Breath by Wes Ely: https://www.icudelirium.org/every-deep-drawn-breath In Shock by Rana Awdish: https://amzn.to/3JY9p6n Arrowsmith by Sinclair Lewis: https://amzn.to/339MJ2m East of Eden by John Steinbeck: https://amzn.to/3JXpRDN
In today’s podcast episode, we will discuss Point of Care Ultrasonography (POCUS). We examine key trends in technology, the relationship of POCUS to consultative ultrasonography, growing clinical applications, and challenges with POCUS.
Our guest is Dr. Jose Luis Diaz-Gomez. Dr. Diaz- Gomez is the Chief of Transplant, Cardiovascular, and Mechanical Support Critical Care, and Director of Critical Care Echocardiography at Baylor, St. Luke’s Medical Center in Houston, Texas. He is a Senior Faculty in Cardiovascular Anesthesia and Critical Care at Baylor College of Medicine.
Additional Resources: Point of Care Ultrasonography. By J.L. Diaz-Gomez et al. New England Journal of Medicine 2021: https://bit.ly/3JftVPt Multi-organ point of care ultrasound for COVID-19 (PoCUS4COVID). Expert Consensus: https://bit.ly/3mrXvaF Society of Critical Care Medicine Resources for critical care ultrasound: https://bit.ly/3yZsW1m Point of care ultrasonography Certification – CHEST: https://bit.ly/32bZfyd
Books Mentioned in this Episode: The Myth of Artificial Intelligence: Why Computers Can’t Think the Way We Do. By Erik Larson: https://amzn.to/3ySWDRm Essentialism: The Disciplined Pursuit of Less. By Greg McKeown: https://amzn.to/3EfVeFT
In this episode of Critical Matters, we will discuss the Surviving Sepsis Campaign Guidelines 2021 update.
Our guest is Dr. Laura Evans. Dr. Evans is the medical director for critical care and professor in the division of pulmonary, critical care and sleep medicine at the University of Washington Medical Center. She is the current Surviving Sepsis Campaign guidelines co-chair and the lead author for the 2021 Surviving Sepsis Campaign Guidelines.
Additional Resources: Surviving Sepsis Campaign Guidelines 2021: https://journals.lww.com/ccmjournal/Fulltext/2021/11000/Surviving_SepExecutive Summary: Surviving Sepsis Campaign Guidelines 2021: https://journals.lww.com/ccmjournal/Fulltext/2021/11000/Executive_Summary__Surviving_Sepsis_Campaign_.14.aspx Society of Critical Care Medicine Resources for SSC: https://www.sccm.org/SurvivingSepsisCampaign/Home Hanlon's Razor: https://thedecisionlab.com/reference-guide/philosophy/hanlons-razor/
Books Mentioned in this Episode: Good Night Stories for Rebel Girls: 100 Tales of Extraordinary Women by Elena Favilli and Francesca Vallo: https://www.amazon.com/Good-Night-Stories-Rebel-Girls/dp/0997895810/ref=sr_1_1?crid=13KK590LSPF64&keywords=good+night+stories+for+rebel+girls&qid=1638473265&sprefix=good+night+%2Caps%2C182&sr=8-1
In this episode of Critical Matters, we discuss the management of severe acute pancreatitis.
Our guest is Dr. Marc G Besselink (@MarcBesselink). He is Professor of pancreatic and hepatobiliary(HPB) surgery, at Amsterdam University Medical Centers in the Netherlands. Dr. Besselink is a member of the Dutch Pancreatitis Study Group and is the senior investigator of the POINTER clinical trial (recently published in the New England Journal of Medicine).
Additional Resources: Acute Pancreatitis: https://bit.ly/3D6kONK POINTER Clinical Trial - Immediate Versus Postponed Intervention for Infected Necrotizing Pancreatitis: https://bit.ly/3wxRLQN PYTHON Clinical Trial - Early Versus On-demand Nasoenteric Tube Feeding in Acute Pancreatitis: https://bit.ly/3km1STK APEC Clinical Trial - Urgent Versus Conservative ERCP for Acute Pancreatitis: https://bit.ly/3qlVK1I
Books Mentioned in this Episode: The House of God by Samuel Shem: https://amzn.to/3wy8Lq2
In this episode of Critical Matters, we will discuss two important clinical questions regarding intravenous fluids. First: Does the composition of intravenous fluids impact patient outcomes? Second: Does the mode of administration (rapid bolus vs. slower infusion) matter?
Our guest is Michael J. Connor, Jr., MD, a practicing intensivist and nephrologist. He is an Associate Professor & Senior Physician of Critical Care Medicine & Nephrology at the Division of Pulmonary, Allergy, Critical Care, & Sleep Medicine, Emory University School of Medicine. In addition, Dr. Connor is the Director for Critical Care Nephrology at the Emory Critical Care Center at Grady Memorial Hospital.
Additional Resources: Does Crystalloid Composition or Rate of Fluid Administration Make a Difference When Resuscitating Patients in the ICU?: https://bit.ly/DDtMOT BaSICS Trial – Balanced Solutions vs. 0.9 % Saline: https://bit.ly/3pH7Q51 BaSICS Trial – Slower vs, Faster Intravenous Fluid Bolus Rates: https://bit.ly/2ZvYSgy The SPLIT Randomized Clinical Trial: https://bit.ly/3El5op1 The SMART Clinical Trial: https://bit.ly/DGMDQb
Books Mentioned in this Episode: Quiet: The Power of Introverts in a World that Can’t Stop Talking by Susan Cain: https://amzn.to/AZza5g Talk Like TED: The 9 Public-Speaking Secrets of the World’s Top Minds by Carmine Gallo: https://amzn.to/3pG0e2V
In this episode of Critical Matters, we will discuss Ivermectin as a potential treatment for COVID-19. During the COVID-19 Delta surge, we have seen a sharp increase in the noise surrounding the use of Ivermectin. A record number of prescriptions have been filled during the last months and numerous news stories report families suing hospitals refusing to provide Ivermectin to patients. We will discuss the available evidence and the role of misinformation in this phenomenon.
Additional Resources: The FDA approved drug Ivermectin inhibits replications of SARS-CoV2 in vitro: https://bit.ly/3ayUhvE Ivermectin to prevent hospitalizations in patients with COVID-19 (IVER-COVID 19): https://bit.ly/3DCOwJZ Effect of Ivermectin on Time to Resolution of Symptoms among Adults with Mild COVID-19: https://bit.ly/3v8QaQw Ivermectin for Prevention and Treatment of COVID-19 Infection: A Systematic Review, Meta-analysis, and Trial Sequential Analysis to Inform Clinical Guidelines: https://bit.ly/3lB7rPh Ivermectin for the Treatment of Coronavirus Disease 2019: A Systematic Review and Meta-analysis: https://bit.ly/3mU9s8w Ivermectin for preventing and treating COVID-19: Review: https://bit.ly/30dDzQD
Books Mentioned in this Episode: Think Again: The Power of Knowing What You Don’t Know by Adam Grant: https://amzn.to/3j1CrGy
In this episode of Critical Matters, we will discuss the results of the recently published TTM2 clinical trial and the current state of evidence for Targeted Temperature Management in the post cardiac arrest patient.
Our guest is Dr. Niklas Nielsen. Dr. Nielsen is an associate professor at the Department of Clinical Sciences at Helsingborg, Lund University, and consultant in Anesthesiology and Intensive Care at Helsingborg Hospital. He was the principal investigator for the TTM1 and TTM 2 clinical trials.
Additional Resources: The International Cardiac Arrest Registry (INTCAR): https://bit.ly/2Xbe0yt Hypothermia versus Normothermia after Out-of-Hospital Cardiac Arrest: https://bit.ly/3nad5Jo Targeted Temperature Management at 33C versus 36C after Cardiac Arrest: https://bit.ly/38THRO9 Targeted Temperature Management for Cardiac Arrest with Nonshockable Rhythm: https://bit.ly/2X19aUj 2020 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care: https://bit.ly/3z0k7T3
Books Mentioned in this Episode: Oxygen: The Molecule that Made the World by Nick Lane: https://amzn.to/2WYMmVz Anna Karenina by Leo Tolstoy: https://amzn.to/3yVao0v
In this episode of Critical Matters, we will explore the Choosing Wisely for Critical Care. These are evidenced-based best practices to avoid waste and promote value in the practice of critical care medicine.
We are fortunate to have with us today three of the authors of the recently published guidelines for critical care medicine – Choosing Wisely for Critical Care: The Next Five. Our guests are Jerry Zimmerman, Pamela Smithburger, and Anita Reddy. Jerry Zimmerman is a physician from the Department of Pediatrics, Seattle Children’s Hospital, Harborview Medical Center, University of Washington School of Medicine, in Seattle. Pamela Smithburger is a doctor in clinical pharmacy from the University Of Pittsburgh School Of Pharmacy, in Pittsburgh. Anita Reddy is a physician from the Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Cleveland Clinic, in Cleveland.
Additional Resources: Choosing Wisely For Critical Care: The NEXT Five. Critical Care Medicine 2021: https://bit.ly/3hQFkbx Medicine’s Ethical Responsibility for Health Care Reform- The Top Five List: https://bit.ly/36nDhGI The Choosing Wisely Website – ABIM: https://bit.ly/3hLdsWt Society of Critical Care Medicine – Choosing Wisely Website: https://bit.ly/3yG4TTN Society of Critical Care Medicine – Knowledge and Education Group (KEG): https://bit.ly/36tKvJb
Books Mentioned in this Episode: Pediatric Critical Care Medicine 6th Edition by Jerry Zimmerman Alexandre T. Rotta: https://amzn.to/3ADJk82 One Hundred Years of Solitude by Gabriel Garcia Marquez: https://amzn.to/3ARKJYS Love in the Times of Cholera by Gabriel Garcia Marquez: https://amzn.to/3jXWsyL
In this episode of Critical Matters, we will discuss the management of the difficult airway.
Our guest is Dr. Thomas Heidegger. Dr. Heidegger practices anesthesia and intensive care medicine. He is a Professor in the Department of Anesthesia, Spital Grabs, in Grabs and the Department of Anesthesiology, and Pain Medicine, Bern University Hospital, University of Bern, in Bern – both in Switzerland.
Additional Resources: Management of the Difficult Airway: https://bit.ly/2T0mXsj Major Complications of Airway Management - Fourth National Audit Project (NAP4): https://bit.ly/2UwJZHT Understanding Sensitivity and Specificity with the Right Side of the Brain: https://bit.ly/3gOqF1h Canadian Airway Focus Group Updates Consensus-Based Recommendations for Management of Difficult Airways: https://bit.ly/3h0tkUt Video - Face Mask Ventilation - Two-Handed Technique: https://bit.ly/3w0RNPj Video - Emergent Surgical Airway (Cricothyrotomy): https://bit.ly/3zPsAKx
Books Mentioned in this Episode: West Pulmonary Physiology: The Essentials: by John B. West and Andrew M. Luks; https://amzn.to/3gOdfm8 Thinking Fast and Slow by Daniel Kahneman: https://amzn.to/3d4bnTN Noise: A Flaw in Human Judgment by Daniel Kahneman: https://amzn.to/35KpdXJ
In this episode of Critical Matters, we will discuss the critical care management of the patient with anaphylaxis.
Our guest is Dr. Guha Krishnaswamy. Dr. Krishnaswamy is a Professor of Medicine in the Section of Pulmonary, Critical Care, Allergy and Immunology and the Section of Infectious Diseases in the Wake Forest School of Medicine. He is also chief, of the Section of Allergy, Asthma and Immunology at the Bill Hefner VA Hospital and Affiliated Clinics in Salisbury, NC.
Additional Resources: Critical Care Management of the Patient with Anaphylaxis: A Concise Definitive Review: https://bit.ly/3zfkA58 Anaphylaxis- Practice Parameter Update: https://bit.ly/3ctbGaG American College of Allergy, Asthma and Immunology Website: https://bit.ly/3zcKvL6 Hereditary Alpha-Tryptasemia: A Commonly Inherited Modifier of Anaphylaxis: https://bit.ly/3w5tJLZ
Books Mentioned in this Episode: Everyday Zen: Love and Work by CJ Beck: https://amzn.to/3g5U9Ye Jonathan Livingston Seagull by Richard Bach: https://amzn.to/3w9FCjR The Wasteland by TS Elliot: https://amzn.to/3gjcDDA
May is Mental Health Awareness Month, a time to reflect on important aspects of mental health, work to alleviate its burden, and reduce the stigma associated with mental health problems. After an unprecedented year in critical care with the COVID-19 pandemic, these topics are more relevant than ever.
In this episode of Critical Matters, we will discuss the topic of clinician well-being. We will discuss the impact of COVID-19 on clinician well-being, the relationship of burnout with mental health, and end with a focus on some actionable steps within our control to promote clinician well-being.
Additional Resources: Coronavirus Disease 2019 Immediately Increases Burnout Symptoms in ICU Professionals: A Longitudinal Cohort Study: https://journals.lww.com/ccmjournal/ One More Time: How Do You Motivate Employees?: https://hbr.org/2003/01/one-more-time-how-do-you-motivate-employees An Official Critical Care Societies Collaborative Statement-Burnout Syndrome in Critical Care Health-care Professionals: A Call for Action: https://pubmed.ncbi.nlm.nih.gov/27396776/ Out of the Straitjacket: https://pubmed.ncbi.nlm.nih.gov/29490178/ National Suicide Prevention Lifeline (1-800-273-8255): https://suicidepreventionlifeline.org/ Physician Support Line (1-888-409-0141): https://www.physiciansupportline.com/ The Emotional PPE Project: https://www.emotionalppe.org/ Talk Space:https://www.talkspace.com/ How Will You Measure Your Life?: https://hbr.org/2010/07/how-will-you-measure-your-life Time for Happiness: https://hbr.org/2019/01/time-for-happiness Taking Action Against Clinician Burnout: https://www.nap.edu/catalog/25521/taking-action-against-clinician-burnout-a-systems-approach-to-professional
Books Mentioned in this Episode: The Echiridion by Epitectus: https://www.amazon.com/Enchiridion-Adapted-Contemporary-Reader/dp/1521308861/ref=sr_1_2_sspa Why We Sleep by M Walker: https://www.amazon.com/Why-We-Sleep-Science-Dreams/dp/0141983760/ref=tmm_pap_swatch_0
In this episode of Critical Matters, we will discuss judgment under uncertainty and how to make better decisions. The episode is based on a recent webinar I had the opportunity to present as part of Sound Critical Care’s Leadership Week. During this episode I will discuss judgments in the context of the COVID-19 pandemic, explore the science behind how we make decisions and finally share some thoughts on tools we can utilize to improve our decision process under uncertain conditions.
Additional Resources: Judgment Under Uncertainty Webinar: https://bit.ly/2RLwp1S2 An Organization-Wide Approach to Good Decision Making: https://bit.ly/3uVgywc Noise: How to Overcome the High, Hidden Cost of Inconsistent Decision Making: https://bit.ly/3w1vXLH Performing a Project Premortem: https://bit.ly/3odxJH1 Sensible Medicine—Balancing Intervention and Inaction During the COVID-19 Pandemic: https://bit.ly/33DgQfh
Books Mentioned in this Episode: Thinking, Fast and Slow by Daniel Kahneman: https://amzn.to/3hjzot1
In this episode of Critical Matters, we will discuss ICU Liberation and the A-F Bundles during the COVID-19 pandemic.
Our guest is Dr. Wesley Ely (@WesElyMD), professor of medicine at Vanderbilt University School of Medicine. He is the co-director of the Center for Critical Illness, Brain dysfunction, and Survivorship (CIBS Center), which has enrolled thousands of patients into clinical trials, answering vital questions about ICU acquired brain disease and other components of ICU survivorship.
Additional Resources: Prevalence and risk factors for delirium in critically ill patients with COVID-19 (COVID-D): a multicentre cohort study: https://www.thelancet.com/action/showPdf?pii=S2213-2600%2820%2930552-X Strategies to Optimize ICU Liberation (A to F) Bundle Performance in Critically Ill Adults With Coronavirus Disease 2019: https://journals.lww.com/ccejournal/pages/articleviewer.aspx?year=2020&issue=06000&article=00016&type=Fulltext ABCDEF Bundle and Supportive ICU Practices for Patients With Coronavirus Disease 2019 Infection: An International Point Prevalence Study: https://journals.lww.com/ccejournal/fulltext/2021/03000/abcdef_bundle_and_supportive_icu_practices_for.12.aspx Link to the CIBS Center website, which contains a wealth of resources for intensivists on the topic of delirium: https://www.icudelirium.org Caring for Critically Ill Patients with the ABCDEF Bundle: Results of the ICU Liberation Collaborative in Over 15,000 Adults: https://www.ncbi.nlm.nih.gov/pubmed/?term=Caring+for+Critically+Ill+Patients+with+the+ABCDEF+Bundle%3A+Results+of+the+ICU+Liberation+Collaborative+in+Over+15%2C000+Adults
Books Mentioned in this Episode: Arrowsmith by Sinclair Lewis: https://www.amazon.com/Arrowsmith-Sinclair-Lewis/dp/B08VYFJVC7/ref=sr_1_3_sspa?crid=D2EL30QJYDN9&dchild=1&keywords=lewis+sinclair&qid=1619044221&sprefix=lewis+sin%2Caps%2C158&sr=8-3-spons&psc=1&spLa=ZW5jcnlwdGVkUXVhbGlmaWVyPUEyMlBCNlBVUkI0RjI1JmVuY3J5cHRlZElkPUEwOTQwMTcyMTE3UVZGRVlDSjhDRyZlbmNyeXB0ZWRBZElkPUExMDI5MDI2M0VBREtVSEFQNE5OViZ3aWRnZXROYW1lPXNwX2F0ZiZhY3Rpb249Y2xpY2tSZWRpcmVjdCZkb05vdExvZ0NsaWNrPXRydWU East of Eden by John Steinbeck: https://www.amazon.com/East-Eden-John-Steinbeck-ebook/dp/B08YLXQ2BC/ref=sr_1_1?dchild=1&keywords=east+of+eden&qid=1619044327&sr=8-1 Extreme Measures by Jessica Nutik Zitter: https://www.amazon.com/Extreme-Measures-Finding-Better-Path-ebook/dp/B01KGZVQOM/ref=sr_1_1?dchild=1&keywords=extreme+measures&qid=1619044537&s=books&sr=1-1 Knocking on Heaven's Door by Katy Butler: https://www.amazon.com/Knocking-Heavens-Door-Better-Death-ebook/dp/B00A285OF6/ref=sr_1_1?dchild=1&keywords=knocking+on+heavens+door&qid=1619044674&s=books&sr=1-1
In this episode of Critical Matters, we will discuss the evidence-based management of severe and fulminant Clostridioides difficile infection(CDI) in the intensive care unit.
Our guest is Dr. Max W. Adelman, a member of the Division of Infectious Diseases and the Department of Medicine, at Emory University School of Medicine in Atlanta.
Additional Resources: Critical Care Management of the Patient with Clostridioides difficile: https://pubmed.ncbi.nlm.nih.gov/33156122/ CDI Guidelines from IIDSA: https://www.idsociety.org/practice-guideline/clostridium-difficile/ Systematic Review with Meta-Analysis: Fecal Microbiota Transplantation for Severe or Fulminant Clostridioides difficile: https://link.springer.com/article/10.1007/s10620-021-06908-4
Books Mentioned in this Episode: The Hot Zone: The Terrifying True Story of the Origins of the Ebola Virus by Richard Preston: https://www.amazon.com/Hot-Zone The Great Influenza: The Story of the Deadliest Pandemic in History by John M. Barry: https://www.amazon.com/Great-Influenza
In today's episode of Critical Matters, we will discuss the use of Extracorporeal Life Support (ECLS) in the form of extracorporeal membrane oxygenation (ECMO) for the treatment of the sickest patients with COVID-19 induced ARDS.
Our guest is Dr. Jenelle Badulak. Dr. Badulak is an emergency physician and intensivist caring for patients in the Emergency Department, Cardiothoracic Intensive Care Unit, Medical Intensive Care Unit and Trauma Intensive Care Unit at the University of Washington Medical Center and Harborview Medical Center. She is a clinician-educator who specializes in curriculum development and assessment with a focus on graduate medical education and Extracorporeal Life Support/Extracorporeal Membrane Oxygenation (ECMO).
Additional Resources: Extracorporeal Membrane Oxygenation Support in COVID-19: An International Cohort Study of the Extracorporeal Life Support Organization Registry: https://www.thelancet.com/article/S0140-6736(20)32008-0/fulltext Extracorporeal Life Support Organization(ELSO) COVID-19 Dashboard and Website: https://www.elso.org/Registry/FullCOVID19RegistryDashboard.aspx Extracorporeal Membrane Oxygenation for Severe Acute Respiratory Distress Syndrome Associated with COVID-19: A Retrospective Cohort Study: https://www.thelancet.com/journals/lanres/article/PIIS2213-2600(20)30328-3/fulltext Extracorporeal Membrane Oxygenation for Severe Acute Respiratory Distress Syndrome: https://www.nejm.org/doi/full/10.1056/NEJMoa1800385
Books Mentioned in this Episode: Extracorporeal Life Support: The ELSO Red Book: https://www.elso.org/Publications/RedBook5thEdition.aspx
Burnout is a major problem in critical care medicine. The COVID-19 pandemic has exacerbated this problem. However, we as clinicians should aspire to more from our careers than the mere elimination or mitigation of burnout. In today's episode of the podcast, we will explore some ideas that go beyond burnout. This is a recent talk given by Dr. Zanotti entitled, “Finding Joy in our Work, The Path to Professional Transcendence”.
Additional Resources: Video - Professional Transcendence: https://spaces.hightail.com/space/oOIGXeROd7/files/fi-68608c75-317c-4c74-a067-9b5fe8897866/fv-30bff5a8-1deb-4579-ad57-4fff440edf40/Finding Joy in Work_ The Path to Professional Transcendence .mp4
Books Mentioned in this Episode: The Enchiridion by Epictetus: https://www.amazon.com/Enchiridion-Epictetus/dp/1503226948/ref=tmm_pap_swatch_0?_encoding=UTF8&qid=1611795176&sr=8-6 Man’s Search for Meaning by Viktor E. Frankl: https://www.amazon.com/Mans-Search-Meaning-Viktor-Frankl/dp/0807014273/ref=tmm_pap_swatch_0?_encoding=UTF8&qid=1611795263&sr=8-1 Deep Work by Cal Newport: https://www.amazon.com/Deep-Work-Focused-Success-Distracted/dp/0349411905/ref=tmm_pap_swatch_0?_encoding=UTF8&qid=1611795325&sr=8-1
In this episode of Critical Matters, we will continue our discussion on the management of acute-on-chronic liver failure (ACLF) in the ICU. Part 2 will cover pulmonary, rena,l and endocrine recommendations for ACLF patients. In a previous episode (Management of ACLF: Part 1) we covered an introduction to ACLF, cardiovascular, and hematology management recommendations.
Our guest is Dr. Nanchal, a practicing critical care physician with an interest in liver disease. He is a Professor in the Division of Pulmonary and Critical Care Medicine, at the Medical College of Wisconsin, in Milwaukee. Dr. Nanchal is the lead author of the Society of Critical Care Medicine’s Guideline for the Management of Adult Acute and Acute-on-Chronic Liver Failure in the ICU.
Additional Resources: Executive Summary for Guideline for the Management of Adult Acute and Acute-on-Chronic Liver Failure in the ICU: journals.lww.com/ccmjournal/Fullt…cute_and.17.aspx Guideline for the Management of Adult Acute and Acute-on-Chronic Liver Failure in the ICU: journals.lww.com/ccmjournal/Fullt…cute_and.29.aspx SCCM Liver Guidelines: www.sccm.org/getattachment/Rese…s-Table-Part-1.pdf
Books Mentioned in this Episode: Thinking Fast and Slow by Daniel Kahneman: www.amazon.com/Thinking-Fast-Slow-Daniel-Kahneman
In this episode of Critical Matters, we will discuss the management of acute-on-chronic liver failure (ACLF) in the ICU.
Our guest is Dr. Nanchal, a practicing critical care physician with an interest in liver disease. He is a professor in the Division of Pulmonary and Critical Care Medicine at the Medical College of Wisconsin in Milwaukee. Dr. Nanchal is the lead author of the Society of Critical Care Medicine’s Guideline for the Management of Adult Acute and Acute-on-Chronic Liver Failure in the ICU.
This episode is part of a two-part series focused on ACLF. Part 1 will cover an introduction to ACLF, cardiovascular, and hematology. Part 2 will cover pulmonary, renal, and endocrine recommendations for ACLF patients.
Additional Resources: Executive Summary for Guideline for the Management of Adult Acute and Acute-on-Chronic Liver Failure in the ICU: https://journals.lww.com/ccmjournal/Fulltext/2020/03000/Guidelines_for_the_Management_of_Adult_Acute_and.17.aspx Guideline for the Management of Adult Acute and Acute-on-Chronic Liver Failure in the ICU: https://journals.lww.com/ccmjournal/Fulltext/2020/03000/Guidelines_for_the_Management_of_Adult_Acute_and.29.aspx SCCM Liver Guidelines: https://www.sccm.org/getattachment/Research/Guidelines/Guidelines/Guidelines-for-the-Management-of-Adult-Acute-and-A/SCCM-Liver-Guidelines-Table-Part-1.pdf
Books Mentioned in this Episode: Thinking Fast and Slow by Daniel Kahneman: https://www.amazon.com/Thinking-Fast-Slow-Daniel-Kahneman
In this episode of Critical Matters, we will discuss thrombosis in COVID-19. We will discuss the pathophysiology, diagnosis, and management of arterial and venous thrombosis in COVID-19.
Our guest is Dr. Gregory Piazza, a cardiovascular medicine specialist at Brigham and Women’s Hospital in Boston. Dr. Piazza is the Director of the Vascular Medicine Section, in the Division of Cardiovascular Medicine, and Associate Professor of Medicine, at Harvard Medical School.
Additional Resources: Diagnosis, Management, and Pathophysiology of Arterial and Venous Thrombosis in COVID-19: https://jamanetwork.com/journals/jama/fullarticle/2773516 Registry of Arterial and Venous Thromboembolic Complications in Patients with COVID-19: https://www.jacc.org/doi/full/10.1016/j.jacc.2020.08.070 ACCP Guidelines for Management Thromboembolism in COVID-19: https://journal.chestnet.org/article/S0012-3692(20)31625-1/fulltext ISTH Guidelines for Management of Thromboembolism in COVID-19: https://onlinelibrary.wiley.com/doi/10.1111/jth.14929
Books Mentioned in this Episode: Dune by Frank Herbert: https://www.amazon.com/Dune-Frank-Herbert
In this episode of Critical Matters, we will discuss how to make teams better. Teams are ubiquitous in the practice of critical care medicine. Understanding the elements that are required for a high functioning team is essential in our quest to deliver high-value critical care. This episode is based on a presentation given by Dr. Zanotti during the latest Sound Critical Care Leadership Week.
Additional Resources: Video - "Above Average: How to Make Teams Better": https://comms.soundphysicians.com/PoliteMail/default.aspx?page=T_URXujah06Y_lZQ2A3mwA&ref_id=Elw9rkGRI0iH80DrpDyi4w The Firm Specificity of Individual Performance: Evidence from Cardiac Surgery: https://pubsonline.informs.org/doi/10.1287/mnsc.1050.0464 Evidence for a Collective Intelligence Factor in the Performance of Human Groups: https://pubmed.ncbi.nlm.nih.gov/20929725/ The Global Study of Engagement: https://www.adp.com/Global_Study_Engagement Learning New Technical and Interpersonal Routines in Operating Room Teams: https://www.emerald.com/insight/content/doi/10.1016/S1534-0856(00)03003-6/full/html Previous Episode - “Circle Up”: https://soundphysicians.com/podcast-critical-matters/?episode=circle-up
In this episode of Critical Matters, we will discuss brain death by neurologic criteria. Brain death remains an important topic within the practice of critical care medicine. However, there are still inconsistencies in concept, criteria, practice, and documentation of brain death. Today we will discuss this topic through the lens of "The World Brain Death Project."
Our guest is Dr. David Greer, Chair of the Department of Neurology at the Boston University School of Medicine. Dr. Greer is a renowned clinician, educator, and researcher.
Additional Resources: Determination of Brain Death/Death by Neurologic Criteria: The World Brain Death Project: https://pubmed.ncbi.nlm.nih.gov/32761206/ Determination of Brain Death/Death by Neurologic Criteria - The World Brain Death Project (Video): https://edhub.ama-assn.org/jn-learning/video-player/18529668 Controversies in Brain Death Declaration: Legal and Ethical Implications in the ICU: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7223748/
Books Mentioned in this Episode: The Boys in the Boat by Daniel J. Brown: https://www.amazon.com/Boys-Boat Brain Death by Eelco Wijdicks: https://www.amazon.com/Brain-Death-Eelco-F-M-Wijdicks/
In this episode of Critical Matters, we will discuss innovation in care through the lens of process and workflow. Over the last several months, we have discussed new drugs, novel therapeutic approaches, and ventilator management strategies. However, the most vital source of innovation and success has been adapting to COVID-19 with new ICU workflows.
Our guest is Dr. Laura Rock, a pulmonary and critical care physician at Beth Israel Deaconess Medical Center in Boston. Dr. Rock is also faculty at Harvard Medical School, at the Center for Medical Simulation and is a trained Vital Talk instructor. She shares with us the concept of "Circle Up".
Additional Resources: "Circle Up": Workflow Adaptation and Psychological Support via Briefing, Debriefing, and Peer Support: https://catalyst.nejm.org/doi/full/10.1056/CAT.20.0240 Emotions and COVID-19: GIVE to Connect, Understand, and Support: https://litfl.com/emotions-and-covid-19-give-to-connect-understand-and-support/ Don't Answer Feelings with Facts: https://blogs.bmj.com/bmj/2020/04/13/laura-k-rock-dont-answer-feelings-with-facts/ An excellent resource to learn more about "Circle Up": https://harvardmedsim.org/circleup/ VitalTalk - Resource for Patient/Family Communication: https://www.vitaltalk.org/resources/
Books Mentioned in this Episode: In Shock by Rana Awdish: https://www.amazon.com/Shock-Journey-Death-Recovery-Redemptive/ What Doctors Feel by Daniel Ofri: https://www.amazon.com/What-Doctors-Feel/ Being Mortal by Atul Gawande: https://www.amazon.com/Being-Mortal-Medicine-What-Matters/ Humble Inquiry by Edgar Shein: https://www.amazon.com/Humble-Inquiry-Gentle-Instead-Telling/
In this episode of Critical Matters, we will discuss mechanical ventilation.
Our guest is Dr. Eduardo Mireles-Cabodevila, a practicing pulmonary critical care physician and Director of the Medical Intensive Care Unit at the Cleveland Clinic. His areas of clinical interest are critical care medicine, application of mechanical ventilation, acute and chronic respiratory failure, and extracorporeal life support. Our conversation covers general concepts related to liberation from mechanical ventilation, weaning from mechanical ventilation, and also examines how these concepts may apply to COVID-19 patients.
Additional Resources: Liberation From Mechanical Ventilation in Critically Ill Adults: An Official American College of Chest Physicians/American Thoracic Society Clinical Practice Guideline: Inspiratory Pressure Augmentation During Spontaneous Breathing Trials, Protocols Minimizing Sedation, and Noninvasive Ventilation Immediately After Extubation: https://pubmed.ncbi.nlm.nih.gov/27818331/ An Official American Thoracic Society/American College of Chest Physicians Clinical Practice Guideline: Liberation from Mechanical Ventilation in Critically Ill Adults. Rehabilitation Protocols, Ventilator Liberation Protocols, and Cuff Leak Tests: https://pubmed.ncbi.nlm.nih.gov/27762595/ Tracheostomy in the COVID-19 Era: Global and Multidisciplinary Guidance: https://pubmed.ncbi.nlm.nih.gov/32422180/ Lung Ultrasound Allows the Diagnosis of Weaning-Induced Pulmonary Edema: https://pubmed.ncbi.nlm.nih.gov/30863935/ Previous episode of Critical Matters on Prolonged Mechanical Ventilation: https://critical-matters/outliers-and-super-users:-targeting-prolonged-use-of-mv-in-the-icu
Books Mentioned in this Episode: William Osler: A Life in Medicine by Michael Bliss: https://www.amazon.com/William-Osler
In this episode of Critical Matters, we will take a deep dive into the topic of corticosteroids in COVID-19 ARDS.
Our guest is Todd Rice, MD, an Associate Professor of Medicine in the Division of Allergy, Pulmonary and Critical Care Medicine at Vanderbilt University. Dr. Rice is an accomplished physician-scientist focused on research in patients with sepsis, ARDS, and acute respiratory failure. He recently co-authored an editorial published in JAMA; “Corticosteroids in COVID-19 ARDS: Evidence and Hope During the Pandemic.”
Additional Resources: Corticosteroids in COVID-19 ARDS: https://bit.ly/3bFbFig PROSPERO Meta Analysis: https://bit.ly/3m69rgD RECOVERY Clinical Trial: https://bit.ly/35t59Ka REMAP-CAP Clinical Trial: https://bit.ly/3m2Hkz3 CODEX Clinical Trial: https://bit.ly/3bJQdbU CAPE-COVID Clinical Trial: https://bit.ly/3it8Xz7
Books Mentioned in this Episode: When Breath Becomes Air by Paul Kalanithi: https://amzn.to/2ZlVZeX
In this episode of Critical Matters, we will discuss hypotension and new data on Angiotensin II within the context of our path towards personalized vasopressor support.
Our guest is Dr. Ashish K. Khanna. Dr. Khanna is an anesthesia and critical care practicing physician. He is Associate Professor, and Section Head for Research, in the Department of Anesthesiology, Section on Critical Care Medicine of the Wake Forest School of Medicine, in Winston-Salem, North Carolina. He is a prolific author and researcher and was the lead author of the ATHOS-3 study in the New England Journal of Medicine. The results of which led to the approval of Angiotensin II as a vasopressor for the treatment of refractory hypotension in adults with septic or other types of distributive shock.
Links: The Relationship Between ICU Hypotension and In-Hospital Mortality and Morbidity in Septic Patients: https://bit.ly/2D1epJQ Association between Mean Arterial Pressure and Acute Kidney Injury and a Composite of Myocardial Injury and Mortality in Postoperative Critically Ill Patients: A Retrospective Cohort Analysis: https://bit.ly/2QuyStz Angiotensin II for the Treatment of Vasodilatory Shock (ATHOS-3 Trial): https://bit.ly/2G27hhB Survival After Shock Requiring High-Dose Vasopressor Therapy: https://bit.ly/2EkLm4P Renin as a Marker of Tissue-Perfusion and Prognosis in Critically Ill Patients: https://bit.ly/3jiKT1L Renin and Survival in Patients Given Angiotensin II for Catecholamine-Resistant Vasodilatory Shock: https://bit.ly/2G1tZGB
Additional Content Related to Angiotensin II: Angiotensin II for Vasodilatory Shock: 2019 Update: https://bit.ly/3hvVkyA Personalization of Vasopressor Therapy in the Treatment of Vasodilatory Shock: https://bit.ly/3hy7wyD
In this episode of Critical Matters, we will discuss racism in healthcare.
Our guest is Dr. Gregory R. Johnson. Dr. Johnson is Chief Medical Officer of Hospital Medicine for Sound Physicians. In his role as CMO for Hospital Medicine, he has clinical leadership responsibility for over 200 hospital medicine programs and thousands of clinicians that care for millions of patients every year. Dr. Johnson is a thought leader within his field and a champion for diversity, inclusion, and belonging within medicine.
Additional Resources: The Distribution of Suffering, Relief, and Greed in the Pandemic: https://bit.ly/30Tlzcl COVID-19 and African Americans: https://jamanetwork.com/journals/jama/fullarticle/2764789 Diagnosing and Treating Systemic Racism: https://bit.ly/30QGixp Unequal Treatment: https://bit.ly/3kEXTAd Tuskegee Syphilis Study: https://bit.ly/3fUU46q
Books Mentioned in this Episode: Just Medicine: A Cure for Racial Inequality in American Health Care by Dayna B. Mathew: https://amzn.to/3amBTVU The Immortal Life of Henrietta Lacks by Rebecca Skloot: https://amzn.to/2POH3kd
In this episode of Critical Matters, we discuss the management of COVID induced ARDS.
Our guest is Dr. Eddy Fan, an associate Professor in the Interdepartmental Division of Critical Care Medicine and the Institute of Health Policy, Management and Evaluation at the University of Toronto and a Staff Intensivist at the University Health Network/Mount Sinai Hospital. He is currently the Medical Director of the Extracorporeal Life Support Program at the Toronto General Hospital, and the Director of Critical Care Research at the University Health Network/Mount Sinai Hospital. During our conversation, we discuss phenotypes within ARDS, the best available evidence for the management of ARDS, and other topics.
Additional Resources: COVID-19-Associated Acute Respiratory Distress Syndrome: Is a Different Approach to Management Warranted?: https://bit.ly/3fMkYOp American Thoraic Society - Mechanical Ventilation in Adult Patients with Acute Respiratory Distress Syndrome: https://bit.ly/2CQTIju Management of COVID-19 Respiratory Distress: https://bit.ly/2WuwFCw Previous Episodes of Critical Matters on COVID-19 Induced ARDS/Respiratory Failure: - https://bit.ly/2OGWF8T - https://bit.ly/32yO2p7
Books Mentioned in this Episode: A Portrait of the Artist as a Young Man by James Joyce: https://amzn.to/2OJyiHM
In this episode of Critical Matters, we discuss pregnancy, critical care, and COVID-19.
Our guest is Dr. Cesar Padilla. Dr. Padilla is an attending physician in the Department of Intensive Care and Resuscitation in the Cleveland Clinic in OHIO. He is a practicing anesthesia critical care physician with additional expertise and training in obstetric anesthesia. He is extremely interested in promoting better care of obstetrical patients requiring critical care and has worked in this area extensively from the clinical, educational, and research perspective.
Additional Resources: Articles on Critical Care and Pregnancy by Dr. Padilla: - https://bit.ly/2BTHFkZ - https://bit.ly/2YKBrwH Development of a Comorbidity Index for Use in Obstetric Patients: https://bit.ly/38gtvq1 CDC COVID-19 and Pregnancy Resource Page: https://bit.ly/31v9XwH Articles by Dr. Padillas on KevinMD.com: https://bit.ly/31zIl9M Previous episodes on pregnancy and critical care: - https://bit.ly/2YPjld4 - https://bit.ly/38g5f7k
Books Mentioned in this Episode: Twelve Rules for Life: An Antidote to Chaos by Jordan B. Peterson: https://amzn.to/2Zo8nu2
In this episode of Critical Matters, we discuss challenges related to providing compassionate patient aligned care in the intensive care unit within the frame of COVID-19. We also explore “The Pause”, a simple yet innovative practice with the power to transform our practices.
Our guest is Dr. Silvia Perez Protto, an anesthesia and critical care attending at the Cleveland Clinic. Dr. Perez Protto is a faculty member of the Department of Intensive Care and Resuscitation and is the Medical Director for the End of Life Center at the Cleveland Clinic.
Additional Resources: Empathy: The Human Connection to Patient Care: https://bit.ly/3hiRWHk The Pause (for iPhone: https://apple.co/2zqzGei The Pause (for Android: https://bit.ly/3fislgd The Conversation Project: https://bit.ly/3cRjMaj New York Times - “An Incalculable Lost”: https://nyti.ms/2MOipyQ
Books Mentioned in this Episode: When Breath Becomes Air by Paul Kalanithi: https://amzn.to/2YgjVPe Outliers by Malcolm Gladwell: https://amzn.to/3hdy3l3 The Tipping Point: How Little Things Can Make a Big Difference by Malcolm Gladwell: https://amzn.to/37hJJyC
In this episode of the Critical Matters, we will discuss acute kidney injury (AKI) in patients with COVID-19.
Our guest is Dr. Claudio Ronco, a thought leader in the field of acute kidney injury and nephrology critical care. Dr. Ronco is professor of Nephrology at the University of Padua. Dr. Ronco is also Director of the Department of Nephrology Dialysis & Transplantation and of the International Renal Research Institute (IRRIV) at San Bortolo Hospital in Vicenza, Italy.
Additional Resources: Acute Kidney Injury: https://bit.ly/3daKxaD Management of Acute Kidney Injury in Patients with COVID-19: https://bit.ly/3daKyLJ Extracorporeal Blood Purification and Organ Support in the Critically Ill Patient During COVID-19 Pandemic: Expert Review and Recommendation: https://bit.ly/3c6fxre Video - Cappuccino with Claudio Ronco: https://bit.ly/2B5X3dr
Books Mentioned in this Episode: Carpediem by Claudio Ronco: https://amzn.to/3ekVMxm From Fish to Philosopher by Homer W. Smith: https://amzn.to/3c8j8F9
In this episode of Critical Matters, we continue our exploration and discussion on respiratory support and mechanical ventilation with COVID-19.
Our guest is Dr. John J. Marini, a thought leader in the field of critical care. Dr. Marini is Director of Academic Programs in Research and Education for the Department of Medicine of the Regions Hospital in St. Paul, Minnesota. In most of his research, he has positioned himself at the interface between basic physiology and clinical medicine to develop insights into advancing clinical practice. In this episode, he discusses evolving concepts related to ventilator-induced lung injury and how they apply to respiratory support in patients with COVID-19.
Additional Resources: Management of COVID-19 Respiratory Distress: https://bit.ly/2WuwFCw Time Course of Evolving Ventilator-Induced Lung Injury: https://bit.ly/2YVyEkO Static and Dynamic Contributors to Ventilator-induced Lung Injury in Clinical Practice. Pressure, Energy, and Power: https://bit.ly/360Fmr5
Books Mentioned in this Episode: Nunn's Applied Respiratory Physiology by Andrew B. Lumb: https://amzn.to/2UQLeiX The Discoverers by DJ Boorstin: https://amzn.to/2yTnL8u Why Not Say it Clearly: A Guide to Scientific Writing by LS King.: https://amzn.to/2WV6tzI
In this episode of Critical Matters, we discuss ethical issues related to the COVID-19 pandemic. Our guest is Arthur L. Caplan, Ph.D. Dr. Caplan is the director of the Division of Medical Ethics at New York University Langone Medical Center and School of Medicine. He is the author and editor of 35 books and 750 peer-reviewed articles. Dr. Caplan is a recognized thought leader and expert in the field of medical ethics.
Additional Resources: WHO – Guidance to Managing Ethical Issues in Infectious Disease Outbreaks: https://bit.ly/3bwhqOe Ethics of Outbreaks Position Statement. Part 1: Therapies, Treatment Limitations, and Duty to Treat: https://bit.ly/2Vs8i7G Ethics of Outbreaks Position Statement. Part 2: Family-Centered Care: https://bit.ly/3cQngun Fair Allocation of Scarce Medical Resources in the Time of COVID-19: https://bit.ly/2VRX1fQ
Books Mentioned in this Episode: Plato: Five Dialogues by Plato: https://amzn.to/3bum1Rf Benjamin Franklin: An American Life by W. Isaacson: https://amzn.to/2VOpGTg Poor Richard’s Almanac by B. Franklin: https://amzn.to/2XUQqnK
On this episode of Critical Matters, we will focus on respiratory support and mechanical ventilation with COVID-19. Our guest is Dr. Luciano Gattinoni, a thought leader in the field of critical care. Dr. Gattinoni introduced the concept of lung rest by extracorporeal CO2 removal in acute respiratory failure. He pioneered the use of thoracic CT in ARDS, which culminated in the "baby lung", lung recruitability, and Mechanical Power concepts. His research is focused on the pathophysiology and treatment of acute respiratory failure, including prone positioning, sepsis and acid-based disorders. Dr. Gattinoni has published more than 400 research articles and reviews in peer-reviewed journals.
Additional Resources: COVID-19 Does Not Lead to a “Typical” Acute Respiratory Distress Syndrome: https://bit.ly/3e2cNNw COVID-19 Pneumonia: Different Respiratory Treatment for Different Phenotypes?: https://bit.ly/2URaCFd
Books Mentioned in this Episode: Siddharta by Herman Hess: https://amzn.to/3bXi6vP The Prince by Nicolo Machiaveli: https://amzn.to/2RjyOho Nunn's Applied Respiratory Physiology: https://amzn.to/2UQLeiX The Pathway for Oxygen by M.D. Edwald R. Weibel: https://amzn.to/2yKpNrf Clinical Physiology of Acid-Base and Electrolyte Disorders by Burton Rose and Theodore Post: https://amzn.to/3e2dDdh
In this episode of Critical Matters, we continue to discuss issues related to the COVID- 19 pandemic. The numbers of cases continue to rapidly climb in the US and the world. There are serious concerns for adequate supplies of personal protective equipment for clinicians. In today’s episode we talk about the rational use of personal protective equipment. We try to focus on facts over fear. The discussion is an excerpt from a webinar Dr. Zanotti presented to Sound's national group of clinicians.
Additional Resources: World Health Organization (WHO)- Updated Guidance on PPE for COVID-19: https://bit.ly/3aenLxf; https://bit.ly/3dr1pul Centers for Disease Control (CDC) - Guidance on PPE for COVID-19: https://bit.ly/2UBG1tN COVID-19 and the Risk to Health Care Works: A Case Report: https://bit.ly/3bkcdsm Aerosol and Surface Stability of SARS-CoV-2 as Compared with SARS-CoV-1: https://bit.ly/2WMfLzB Keep the Coronavirus from Infection Health-Care Workers: https://bit.ly/3buvHuj
Books Mentioned in this Episode: Man's Search for Meaning by Victor Frankl: https://amzn.to/3dtoMn0
In this episode of Critical Matters, we provide an update on the COVID-19 epidemic. As the epidemic continues to spread at a rapid pace around the world new information and guidance from health care authorities is coming at a furious pace.
Our guest is Dr. Raquel Nahra, a critical care and infectious disease specialist. Dr. Nahra is faculty at the Cooper Medical School of Rowan University. In addition to her clinical roles, Dr. Nahra is the Hospital Epidemiologist at Cooper University Hospital in Camden NJ.
Additional Resources: World Health Organization (WHO) - Coronavirus Updates: http://bit.ly/2UJKj4b Centers for Disease Control (CDC) - 2019-nCoV Resources and Information: http://bit.ly/2OMGsPO Lancet - Articles and Clinical Information on 2019-nCoV: http://bit.ly/3bxyiEE Johns Hopkins University HUB - Novel Coronavirus Information http://bit.ly/39xETxn
Books Mentioned in this Episode: The Obstacle is the Way: The Timeless Art of Turning Trials Into Triumph by Ryan Holliday: https://amzn.to/3aKSGkE
In this episode of Critical Matters we discuss the outbreak of a novel coronavirus (2019-nCoV), a rapidly evolving epidemic that originated in China and now declared a health care emergency by the World Health Organization (WHO). In this episode, we discuss current understanding regarding the virus and its clinical impact.
Our guest is Dr. Raquel Nahra, a critical care and infectious disease specialist. Dr. Nahra is faculty at the Cooper Medical School of Rowan University. In addition to her clinical roles, Dr. Nahra is the Hospital Epidemiologist at Cooper University Hospital in Camden NJ.
Additional Resources: World Health Organization (WHO) - Coronavirus Status Updates: http://bit.ly/2UJKj4b Centers for Disease Control (CDC)- Resources and Information on 2019-nCoV: http://bit.ly/2OMGsPO Lancet - Articles and Clinical Information on 2019-nCoV: http://bit.ly/3bxyiEE Johns Hopkins University - Novel Coronavirus Information: http://bit.ly/39xETxn Jama Network - Clinical Characteristics of 138 Hospitalized Patients With 2019 Novel Coronavirus–Infected Pneumonia in Wuhan, China: http://bit.ly/2SAKOL8
Books Mentioned in this Episode: Waiting for Godot: A Tragicomedy in Two Acts by Samuel Beckett: https://amzn.to/2HhnUD8
Transfusion of blood product is common in the intensive care unit. Blood product transfusions can be associated with complications and are often given in situations without a clear cut indication. In this episode of Critical Matters, we will discuss current evidence and proper use of blood products in the ICU.
Our guest is Dr. Janice Zimmerman an adjunct Professor of Medicine at Baylor College of Medicine and president of the World Federation of Societies of Intensive and Critical Care Medicine.
Additional Resources: A multicenter, randomized, controlled clinical trial of transfusion requirements in critical care. Transfusion Requirements in Critical Care Investigators, Canadian Critical Care Trials Group: http://bit.ly/37myULa Restrictive or Liberal Red-Cell Transfusion for Cardiac Surgery: http://bit.ly/2Go4NHn Liberal versus restrictive transfusion thresholds for patients with symptomatic coronary artery disease: http://bit.ly/2umO6sK Lower versus higher hemoglobin threshold for transfusion in septic shock: http://bit.ly/38xcoPx Transfusion strategies for acute upper gastrointestinal bleeding: http://bit.ly/37mzbOc Clinical Practice Guidelines From the AABB: Red Blood Cell Transfusion Thresholds and Storage: http://bit.ly/38zoQyB
Books Mentioned in this Episode: Exodus: A Novel of Israel by Leon Uris: https://amzn.to/2Rgeiyh Texas: A Novel by James Michener: https://amzn.to/38qJfWn Oh, the Places You'll Go! by Dr. Seuss: https://amzn.to/30FMPZY
In this episode of Critical Matters, we will discuss the latest evidence, the proper management and potential pitfalls of acute severe hypertension.
Our guest is Dr. Aldo Peixoto. Dr. Peixoto is Professor of Medicine in the Section of Nephrology at the Yale University School of Medicine. He is also Vice Chair for Quality & Safety (Department of Internal Medicine) and Clinical Chief of the Section of Nephrology.
Additional Links: Most recent US guidelines for the diagnosis and treatment of hypertension: http://bit.ly/39XlOFJ European position paper on management of hypertensive emergency: http://bit.ly/35G8eTT Severe Hypertension: http://bit.ly/2shwldW
Books Mentioned in this Episode: Blindness by Jose Saramago: https://amzn.to/30863ak Portuguese Irregular Verbs by Alexander McCall Smith: https://amzn.to/35ARai4
In this episode of Critical Matters, listen to the recording of the Sound Critical Care’s latest webinar, Outliers and Super Users: Targeting Prolonged Use of MV in the ICU. Critically ill patients requiring prolonged mechanical ventilation have poor clinical outcomes and consume a disproportionate amount of resources.
In this webinar, we will discuss outliers and super users in the ICU utilizing prolonged mechanical ventilation as a case study. We will also discuss outcomes for these patients and finally strategies to optimize the care of this difficult patient population.
Watch the video recording: http://bit.ly/2MHL4Ga
Additional Resources: The Hot Spotters by Atul Gawande: http://bit.ly/36lUdvT I-TRACH: Validating A Tool for Predicting Prolonged Mechanical Ventilation: http://bit.ly/2SEcOPy Expectations and outcomes of prolonged mechanical ventilation: http://bit.ly/2QbBDRp Long-term survival of critically ill patients treated with prolonged mechanical ventilation: a systematic review and meta-analysis: http://bit.ly/2tjQgJu Lean Six Sigma to Reduce Intensive Care Unit Length of Stay and Costs in Prolonged Mechanical Ventilation: http://bit.ly/359bYwV
Point-of-care ultrasound continues to grow in availability and is now embedded in many critical care practices. In this episode Critical Matters, we discuss the use of point-of-care ultrasound (POCUS) in the management of hypotension and shock.
Our guest is Dr. Haney Mallemat a recognized educator with a strong interest in POCUS. Dr. Mallemat holds dual academic appointments in Critical Care Medicine and Emergency Medicine at Cooper Medical School of Rowan University.
Additional Resources: Bedside ultrasound in resuscitation and the rapid ultrasound in shock protocol: http://bit.ly/359RkgX The Society of Point of Care Ultrasound: http://bit.ly/2senLMJ Guidelines for the Appropriate Use of Bedside General and Cardiac Ultrasonography in the Evaluation of Critically Ill Patients—Part II: Cardiac Ultrasonography: http://bit.ly/35b1D4r Does Point-of-Care Ultrasonography Improve Clinical Outcomes in Emergency Department Patients With Undifferentiated Hypotension? An International Randomized Controlled Trial From the SHoC-ED Investigators: http://bit.ly/2Ehzhd3 Rebel Cast Ep 58 - Would you be SHoC-ED if POCUS did not Improve Clinical Outcomes in Patients with Undifferentiated Shock?: http://bit.ly/345uq93 Clinical significance of portal hypertension diagnosed with bedside ultrasound after cardiac surgery: http://bit.ly/2LFJ7sY
Education Conferences: UltraRounds: http://bit.ly/2RAgkdk ResusX: http://bit.ly/2t86q8J
Music Mentioned in this Episode: The Joshua Tree by U2: https://amzn.to/2sYlOnM
Intracerebral hemorrhage (ICH) affects more than one million people annually, worldwide, and is the deadliest and most disabling type of stroke. In this episode of Critical Matters we will discuss the critical care management of ICH.
Our guest is Dr. Sayona John, Associate Professor in the Department of Neurological Sciences at Rush Medical College. She is a practicing neurointensivist and also serves as the Head of the Section of Critical Care Neurology and Medical Director of the Neuroscience Intensive Care Unit & Neuroemergency Transfer programs at Rush University Medical Center in Chicago.
Additional Resources: AHA 2015 Guidelines for the Management of Spontaneous Intracerebral Hemorrhage: http://bit.ly/33ovvZo The ICH score: a simple, reliable grading scale for intracerebral hemorrhage: http://bit.ly/2rsRh0G ICH Score Calculator: http://bit.ly/2OotfNx
Music Mentioned in this Episode: Brother in Arms by Dire Straits: https://amzn.to/34pMxYj Money for Nothing by Dire Straits: http://bit.ly/34pAWZ9
Cardiogenic shock (CS) is a common cause of mortality, and its management remains challenging despite significant advances in treatment options.
In this episode of Critical Matters, we discuss basic concepts, a new proposed classification, and updates on the medical management of patients with cardiogenic shock.
Our guest is Dr. Steve Hollenberg, a practicing cardiologist with dual training in cardiology and critical care medicine. Dr. Hollenberg is a Professor of Medicine at Hackensack Meridian School of Medicine at Seton Hall University and Associate Director of the CTICU at Hackensack Meridian University Hospital.
Additional Resources: The paramedian lumbar puncture: http://bit.ly/2pk8JUw Contemporary Management of Cardiogenic Shock: A Scientific Statement From the American Heart Association: http://bit.ly/2Qdjoey SCAI clinical expert consensus statement on the classification of cardiogenic shock: http://bit.ly/2XdjeWa SCAI stages of cardiogenic shock stratify mortality risk: http://bit.ly/2CCzbf9
Books Mentioned in this Episode: Ulysses by James Joyce: https://amzn.to/2QgIoBW Gravity’s Rainbow by Thomas Pynchon: https://amzn.to/36Vgjps The Elements of Style by E. B. White: https://amzn.to/2QdklUa The Little Prince by Antoine de Saint-Exupéry https://amzn.to/352frOi
In this episode of Critical Matters, we will discuss the recently published CITRIS-ALI clinical trial evaluating the role of high dose Vitamin C in severe sepsis and ARDS.
Our guest is Dr. Emily Brant. Dr. Brant is a practicing intensivist and faculty at the University of Pittsburgh Medical Center. She was the lead author in the JAMA editorial entitled “Is High-Dose Vitamin C Beneficial for Patients with Sepsis?” which was published alongside the CITRIS-ALI Clinical Trial.
Additional Resources: Is High-Dose Vitamin C Beneficial for Patients with Sepsis?: http://bit.ly/2nWKoDp Effect of Vitamin C Infusion on Organ Failure and Biomarkers of Inflammation and Vascular Injury in Patients With Sepsis and Severe Acute Respiratory Failure: The CITRIS-ALI Randomized Clinical Trial: http://bit.ly/31s0QcD Hydrocortisone, Vitamin C, and Thiamine for the Treatment of Severe Sepsis and Septic Shock: A Retrospective Before-After Study: http://bit.ly/2pBs433 Phase I safety trial of intravenous ascorbic acid in patients with severe sepsis: http://bit.ly/2Bl523c
Books Mentioned in this Episode: Becoming by Michelle Obama: https://amzn.to/2MvHRd3
Acute ischemic stroke is a leading cause of morbidity and mortality worldwide. Intensive care management of strokes is focused on reducing complications related to reperfusion treatment and decreasing secondary neurological injury. In this episode of Critical Matters, we will discuss the critical care management of acute ischemic strokes.
Our guest is Dr. Sayona John, Associate Professor in the Department of Neurological Sciences at Rush Medical College. She is a practicing neurointensivist and also serves as the Head of the Section of Critical Care Neurology and Medical Director of the Neuroscience Intensive Care Unit & Neuroemergency Transfer programs at Rush University Medical Center in Chicago.
Additional Resources: AHA 2018 Guidelines for the Early Management of Patients With Acute Ischemic Stroke: http://bit.ly/30TJkxL Educational video on performing the NIH Stroke Scale: http://bit.ly/2opldcZ Link to a pdf document with the NIH Stroke Scale: http://bit.ly/2LVtWMV How to do a four-minute neurological examination: http://bit.ly/328IXRr
Books Mentioned in this Episode: Lincoln's Hundred Days: The Emancipation Proclamation and the War for the Union by Louis P. Masur: https://amzn.to/2VlTTse
Acute abdominal complications developing in critically ill patients in the ICU can be associated with significant morbidity and mortality.
In this episode of Critical Matters, we discuss a variety of acute abdominal complications such as abdominal compartment syndrome, acalculous cholecystitis, toxic megacolon and ischemic bowel.
Our guest is Dr. Samuel Tisherman. Dr. Tisherman is a surgical critical care physician at the R Adams Cowley Shock Trauma Center, University of Maryland Medical Center and a Professor of Surgery at the University of Maryland School of Medicine.
Additional Resources: World Society of Abdominal Compartment Syndrome (WSACS) consensus definitions and recommendations: https://bit.ly/2l9m6EQ Acute Acalculous Cholecystitis: A Review. Huffman J, Schenker S. Clinical Gastroenterology and Hepatology: https://bit.ly/2nfssTL Ogilvie’s Syndrome: Management and Outcomes. Haj, M et al. Medicine: https://bit.ly/2mKLVM5
Books Mentioned in this Episode: Complications: A Surgeon’s Note on an Imperfect Science. By Atul Gawande: https://amzn.to/2laETzB
In this episode of Critical Matters, listen to the recording of Sound Critical Care’s webinar, Personalized Selection of Vasopressors in the Treatment of Shock. Our guest for this episode is Dr. Lakhmir Chawla, Chief Medical Officer of La Jolla Pharmaceutical in San Diego, California.
During this webinar, we discuss lessons learned from the clinical use of the new vasopressor Angiotensin II, as well as personalization of vasopressor therapy in the treatment of vasodilatory shock.
Watch the video recording: https://bit.ly/2jZ1z5h
Hyponatremia and hypernatremia are common in ICU patients and they are associated with increased morbidity and mortality. In this episode of Critical Matters, we discuss the diagnostic approach and treatment of sodium disorders in the ICU.
Our guest is Dr. Lawrence Weisberg, Head of the Division of Nephrology and Deputy Chair of Medicine at Cooper University Health Care. Dr. Weisberg is also Professor of Medicine and Assistant Dean for Curriculum at the Cooper Medical School of Rowan University, in Camden, New Jersey.
Additional Resources: Disorders of Plasma Sodium - Causes, Consequences, and Correction: https://bit.ly/2TT9SNB Rate of Correction of Hypernatremia and Health Outcomes in Critically Ill Patients: https://bit.ly/2P2wxrY Evidence for Managing Hypernatremia: Is It Just Hyponatremia in Reverse?: https://bit.ly/2HjZn0S
Books Mentioned in this Episode: From Fish to Philosopher; the Story of our Internal Environment by Homer William Smith: https://amzn.to/30nrraU Operating Manual for Spaceship Earth by R. Buckminster Fuller: https://amzn.to/2Z6coWt Critical Path by R. Buckminster Fuller: https://amzn.to/2MA9vH9
In this episode of Critical Matters, we will discuss the role of early neuromuscular blockers in the treatment of severe ARDS.
Our guest is Dr. Arthur Slutsky, Professor of Medicine, Surgery and Biomedical Engineering at the University of Toronto. Dr. Slutsky is a world-renowned clinician and investigator with a special interest in ARDS. We will review a recently published clinical trial and discuss its result within the context of available evidence.
Additional Resources: Neuromuscular Blockers in Early Acute Respiratory Distress Syndrome: https://bit.ly/2YwXxnG Neuromuscular Blocking Agents in ARDS: https://bit.ly/2KmMZiA Early Neuromuscular Blockade in the Acute Respiratory Distress Syndrome: https://bit.ly/2ROMJea Early Paralytic Agents for ARDS? Yes, No, and Sometimes: https://bit.ly/2ZONDuB
Books Mentioned in this Episode: Nudge: Improving Decisions About Health, Wealth and Happiness by Richard H. Thaler and Cass R. Sunstein: https://amzn.to/2Kv75pD Misbehaving: The Making of Behavioral Economics by Richard H. Thaler: https://amzn.to/2YRm5Dc Bad Blood: Secrets and Lies in a Silicon Valley Startup by John Carreyrou: https://amzn.to/2MPDjyN
One in five US residents receives ICU care at the end of life. In this episode of Critical Matters, we discuss different aspects of end of life care in the ICU.
Our guest is Dr. BJ Miller, a palliative care physician at the University of California, San Francisco and former Executive Director of Zen Hospice Project. He is a powerful advocate for the role of our senses, community, and presence in delivering palliative care and for ushering in a new perspective on living with death.
Additional Resources: What really matters at the end of life, BJ Miller presented at TED 2015: https://bit.ly/1PlAuNP Clinician-Family Communication About Patients' Values and Preferences in Intensive Care Units. Scheunemann LP et al, JAMA Internal Medicine, 2019: https://bit.ly/2LEH0Y5 A Beginner's Guide to the End: Practical Advice for Living Life and Facing Death. BJ Miller and Shoshana Berger: https://amzn.to/30VVWEV Vital Talk courses, a set of online and in person courses designed to equip clinicians with the tools to have difficult conversations with patients and families:https://bit.ly/30SPrm6
Books Mentioned in this Episode: Man’s Search for Meaning by Viktor Frankl: https://amzn.to/2JPJjFQ Mortally Wounded: Stories of Soul Pain, Death and Healing by Michael Kearney: https://amzn.to/2YkDPuF Bering Mortal: Medicine and What Matters in the End by Atul Gawande: https://amzn.to/2GsTXjH The Denial of Death by Ernest Becker: https://amzn.to/2SyY7LI
In this episode of Critical Matters, we discuss lessons learned from the clinical use of Angiotensin II (GIAPREZA™), which was approved for use in patients with vasodilatory shock a little over a year ago.
Our guest is Dr. Lakhmir S. Chawla, Chief Medical Officer of La Jolla Pharmaceutical in San Diego, California. Dr. Chawla was the designer and lead investigator of the ATHOS (Angiotensin II for the Treatment of High Output Shock) trial which results led to the ATHOS 3 trial, (The Phase 3 clinical trial of angiotensin II, for the treatment of catecholamine-resistant hypotension).
ADDITIONAL RESOURCES:
ATHOS-3 Clinical Trial. Randomized controlled trial evaluating the efficacy of Angiotensin II in raising blood pressure in vasodilatory shock: https://bit.ly/2r5SpG0 Outcomes in Patients with Vasodilatory Shock and Renal Replacement Therapy Treated with Intravenous Angiotensin II: https://bit.ly/2JttWTj Sensitivity to angiotensin II dose in patients with vasodilatory shock: a prespecified analysis of the ATHOS-3 trial: https://bit.ly/2xDVVsr
ALBUMS AND BOOKS MENTIONED IN THIS EPISODE:
The Dark Side of the Moon, Pink Floyd: https://amzn.to/2XZr34x Wish You Were Here, Pink Floyd: https://amzn.to/2Lc2lbb Loonshots: How to Nurture the Crazy Ideas That Win Wars, Cure Diseases, and Transform Industries, Safi Bachall: https://amzn.to/2S4IrPU
In this episode of Critical Matters, we discuss acute neuromuscular disorders in the intensive care unit with Dr. M. Kamran Athar. The discussion focuses on the Guillain-Barre Syndrome and Myasthenia Gravis.
Dr. M. Kamran Athar is a practicing neuro intensivist at the Farber Institute for Neuroscience in Philadelphia. Dr. Athar is an assistant professor of Medicine and of Neurology at the Jefferson School of Medicine in Philadelphia.
Additional Resources:
The clinical management of neuromuscular disorders in intensive care: https://bit.ly/2wWlYe1
Early predictors of mechanical ventilation in Guillain-Barré syndrome: https://bit.ly/2Icb1vi
International consensus guidance for management of myasthenia gravis: https://bit.ly/2Ic2g4I
Books Mentioned in this Episode:
How Doctors Think by Jerome Groopman: https://amzn.to/2ZmHSmV
In this episode, we discuss compassion in the ICU with Dr. Stephen Trzeciak.
Dr. Trzeciak is Chief of Medicine at Cooper University Health Care, and Professor and Chair of Medicine at Cooper Medical School of Rowan University in Camden, New Jersey. He is the co-author of a recently published book “Compassionomics: The Revolutionary Scientific Evidence that Caring Makes a Difference. In addition, Dr. Trzeciak and his research group have published several original research papers focusing on compassion in healthcare.
Additional Resources:
Healthcare provider compassion is associated with lower PTSD symptoms among patients with life-threatening medical emergencies: a prospective cohort study: http://bit.ly/2Wio1re Development and Validation of a Tool to Measure Patient Assessment of Clinical Compassion: http://bit.ly/2JR1ifr For patients, caregiver compassion is essential. The Washington Post: https://wapo.st/30yYtW1
Books and Albums Mentioned in This Episode:
Compassionomics: The Revolutionary Scientific Evidence that Caring Makes a Difference by S. Trzeciak and A. Mazzarelli: https://amzn.to/2JQXv1y The Joshua Tree by U2: https://amzn.to/2JvU4hu The Koln Concert by Keith Jarrett: https://amzn.to/2VVBYMn
In this episode, we discuss Toxicology in the ICU. This is part two of a two-part series. Today’s episode will focus on specific toxic ingestions and their management.
Our guest is Dr. Jerrold B. Leikin. Dr. Leikin is the Director of Medical Toxicology at North Shore University Health System-OMEGA, which includes several hospitals in Illinois. In addition, he is a Clinical Professor of Medicine at the Pritzker School of Medicine (University of Chicago) and Professor of Medicine and Pharmacology at Rush Medical College.
Additional Links:
American Association of Poison Control Centers Website: https://aapcc.org/
A three-part review series published in CHEST on Toxicology in the ICU. Part 1: https://bit.ly/2OhO2k5 Part 2: https://bit.ly/2UuLQY1 Part 3: https://bit.ly/2OiGM7A
Albums Mentioned in this Episode:
Live at the BBCby The Beatles: https://amzn.to/2vIrX5M
In this episode, we discuss toxicology in the ICU. This is part one of a two-part series. Today’s episode will focus on an overview of toxic ingestions and their general management.
Our guest is Dr. Jerrold B. Leikin. Dr. Leikin is the Director of Medical Toxicology at North Shore University Health System-OMEGA, which includes several hospitals in Illinois. In addition, he is a Clinical Professor of Medicine at the Pritzker School of Medicine (University of Chicago) and Professor of Medicine and Pharmacology at Rush Medical College.
Additional Links:
American Association of Poison Control Centers Website: https://aapcc.org/ A three-part review series published in CHEST on Toxicology in the ICU. Part 1: https://bit.ly/2OhO2k5 Part 2: https://bit.ly/2UuLQY1 Part 3: https://bit.ly/2OiGM7A
Books and Albums Mentioned in This Episode:
Pops: A Life of Louis Armstrong by Terry Teachout: https://amzn.to/2IBYB1w Louis Armstrong: An Extravagant Life by Laurence Bergreen: https://amzn.to/2PnkvWC Complete Hot Five & Hot Seven Recordings 2 by Louis Armstrong: https://amzn.to/2Vjvbep
In this episode, we discuss the long term effects of critical illness on cognitive impairment. Our guest is Dr. James Jackson. Dr. Jackson is the Assistant Director of The ICU Recovery Center at Vanderbilt, a Research Associate Professor, and the lead psychologist for the Critical Illness, Brain Dysfunction and Survivorship (CIBS) Center at the Vanderbilt University School of Medicine.
Additional Links:
The BRAIN-ICU Study, a seminal prospective study that established the prevalence of long term cognitive dysfunction in critical illness survivors: https://bit.ly/2InupDw Cognitive outcomes after critical illness. A recent review article on the topic: https://bit.ly/2NLIuR1 Link to the CIBS Center website, which contains a wealth of resources for intensivists: https://bit.ly/2HfdQ0n
Books Mentioned in This Episode:
Fly Fishing Through the Midlife Crisis by Howell Raines: https://amzn.to/2OX9Bqp
For a long time death has been understood as the cessation of cardiopulmonary function. With the advent of mechanical ventilation and life support in the ICU, the concept of brain death emerged. In this episode of Critical Matters, we discuss the determination of death by neurologic criteria. Our guest is Dr. Fred Rincon, Associate Professor of Neurology and Neurological Surgery at Thomas Jefferson University in Philadelphia.
Additional Resources:
The most recent update to the evidence-based guidelines for determining brain death in adults: https://bit.ly/2TXjSZr Web-based toolkit and educational material for clinicians on brain death: https://bit.ly/2FA7KVj Previous episode of Critical Matters with Dr. Rincon where we discussed neuroprognostication after cardiac arrest: https://bit.ly/2JHFZ1q
Books and Albums Mentioned in This Episode:
Meditations by Marcus Aurelius: https://amzn.to/2FD1xIy Nevermind by Nirvana: https://amzn.to/2WmVVYd
n this episode of Critical Matters, we provide a quick recap on five things we learned after attending the annual Society of Critical Care Medicine Critical Care Congress. Four recent clinical studies released ahead of print during the congress are briefly discussed in addition to some thoughts on ECMO.
Additional Resources:
Bag-Mask Ventilation during Tracheal Intubation of Critically Ill Adults: https://bit.ly/2GRFbEH Effect of Titrating Positive End-Expiratory Pressure (PEEP) with Esophageal Pressure-Guided Strategy vs. an Empirical High PEEP-FiO2 Strategy on Death and Days Free From Mechanical Ventilation Among Patients with Acute Respiratory Distress Syndrome: https://bit.ly/2T38pqV Effect of a Resuscitation Strategy Targeting Peripheral Perfusion Status vs Serum Lactate Levels on 28-Day Mortality Among Patients With Septic Shock: https://bit.ly/2UcyoJ3 Adjunctive Intermittent Pneumatic Compression for Venous Thromboprophylaxis: https://bit.ly/2Xx4O35
Books Mentioned in This Episode:
The Art of Living: The Classical Manual on Virtue, Happiness, and Effectiveness. Epictetus by Sharon Lebell: https://amzn.to/2ECiYIp
In this episode of Critical Matters, we discuss what happens to patients who survive the ICU. Our guest is Dr. Carla Sevin, Director for The ICU Recovery Center at the Vanderbilt School of Medicine. Dr. Sevin discusses current concepts regarding the post-intensive care syndrome (PICS) and shares her views on how we can prevent, identify, and treat it.
Additional Resources:
Link to Society of Critical Care Medicine webpage containing a host of resources related to the Post-Intensive Care Syndrome (PICS): https://bit.ly/2S34Xam Link to Understanding Your ICU Stay: Information for Patients and Families booklet: https://bit.ly/2SN6S7u Link to the CIBS Center website, which contains a wealth of resources for intensivists on the topic of ICU liberation and survivorship: https://bit.ly/2HfdQ0n Link to review article, Treatment of the Post-ICU Patient in an Outpatient Setting: https://bit.ly/2UUXkVg
Books Mentioned in This Episode:
In Shock: My Journey from Death to Recovery and Redemptive Power of Hope by Rana Awdish, MD: https://amzn.to/2SOLwX6 A View from the Edge — Creating a Culture of Caring by Rana Awdish, MD: https://bit.ly/2E6t1FF
In this episode of Critical Matters, we take a deep dive in delirium with Wesley Ely, MD. Dr. Ely is a professor of medicine at Vanderbilt University School of Medicine and the co-director of the Center for Critical Illness, Brain dysfunction, and Survivorship (CIBS Center), which has enrolled thousands of patients into clinical trials answering vital questions about ICU acquired brain disease and other components of ICU survivorship. His team developed the CAM-ICU, and he has published extensively on the topic.
Additional Resources:
Link to the CIBS Center website, which contains a wealth of resources for intensivists on the topic of delirium: https://bit.ly/2HfdQ0n The MIND-USA trial evaluated haloperidol and ziprasidone in ICU patients with delirium: https://bit.ly/2OQ5gIE Caring for Critically Ill Patients with the ABCDEF Bundle: Results of the ICU Liberation Collaborative in Over 15,000 Adults: https://bit.ly/2VWLUlm
Books Mentioned in This Episode:
The Boys in the Boat: Nine Americans and Their Epic Quest for Gold at the 1936 Berlin Olympics by Daniel James Brown: https://amzn.to/2RMmcRe Solzhenitsyn: A soul in exile by Joseph Pearce: https://amzn.to/2RPhpi0 Man’s Search for Meaning by Viktor E. Frankl: https://amzn.to/2VZ2ZLb Being Mortal: Medicine and What Matters in the End by Atul Gawande: https://amzn.to/2HfeQ4D
Music Mentioned in This Episode:
The Chronic by Dr. Dre: https://amzn.to/2HffeA7
In this episode of Critical Matters, we discuss burnout in healthcare. Burnout is an increasing problem in critical care that impacts growing numbers of providers, nurses and healthcare professionals working in the intensive care unit. This episode is based on a webinar I presented on the topic followed by a panel discussion with physician leaders.
Additional Resources:
An Official Critical Care Societies Collaborative Statement: Burnout Syndrome in Critical Care Health Care Professionals: A Call for Action: https://bit.ly/2M1PGFq Why Doctors Hate Their Computers by Atul Gawande, MD: https://bit.ly/2JCw1uz Institute for Healthcare Improvement White Paper – Framework for Improving Joy in Work: https://bit.ly/2zHs16F
In this episode of Critical Matters, we discuss the management of critically ill patients with cirrhosis. Our guest is Dr. Ram Subramanian, Medical Director of Liver Transplantation at the Emory School of Medicine in Atlanta. In his dual role as a transplant hepatologist and an intensivist, Dr. Subramanian is involved in the inpatient care of patients before and after liver transplantation and provides a unique perspective on caring for this complex patient population.
ADDITIONAL RESOURCES:
Management of critically ill cirrhotic patients: a multidisciplinary perspective: https://bit.ly/2Et9hN5 A detailed review on ACLF and the impact of scoring systems on prognosis: https://bit.ly/2AcTtev A recent study evaluating the incidence and outcomes for patients with cirrhosis admitted to the ICU with an associated editorial by our guest: https://bit.ly/2BnQaAJ hhttps://bit.ly/2QzuPPc
BOOKS MENTIONED IN THIS EPISODE:
The McKinsey Edge: Success Principles from the World’s Most Powerful Consulting Firm by Shu Hattori: https://amzn.to/2QVVvZW The McKinsey Mind: Understanding and Implementing the Problem-Solving Tools and Management Techniques of the World’s Top Strategic Consulting Firm by Ethan M. Rasiel and Paul N. Friga: https://amzn.to/2Glph6c
In this episode of Critical Matters, we discuss the role of procalcitonin as a biomarker in lower respiratory tract infections and sepsis. Our guest is Dr. David Huang, the primary investigator in the recently published Procalcitonin-Guided Use of Antibiotics for Lower Respiratory Tract Infections (ProACT) clinical trial. He discusses lessons learned from this very important study and offers insight into the use of procalcitonin in clinical practice.
ADDITIONAL RESOURCES:
Procalcitonin-Guided Use of Antibiotics for Lower Respiratory Tract Infections (ProACT) clinical trial: https://bit.ly/2BTZNsf A meta-analysis evaluating the effect of procalcitonin-guided treatment on mortality in acute respiratory infections: https://bit.ly/2Un6Lgz FDA Executive Summary on Procalcitonin assay: https://bit.ly/2EiBN4r
BOOKS MENTIONED IN THIS EPISODE:
7 Habits of Highly Effective People by Stephen R. Covey: https://amzn.to/2Ss0mPq Partners of the Heart by Vivien Thomas: https://amzn.to/2QC6vLP
Lung protective ventilation for ARDS includes the use of low tidal volumes, positive-end expiratory pressure (PEEP), and limiting of airway plateau pressure to minimize ventilator-induced lung injury. However, in the sickest subset of patients with ARDS hypoxemia may persist despite optimal lung protective strategies. In this episode of Critical Matters, we discuss salvage therapies for patients with refractory hypoxemia. Our guest is Dr. Robert Hyzy, Medical Director of the Critical Care Medicine Unit and Co-Chair of the Critical Care Committee at the University of Michigan Hospital.
Acute respiratory distress syndrome (ARDS) is a severe form of respiratory failure that affects approximately 200,000 patients each year in the United States, resulting in nearly 75,000 deaths annually. In this episode of Critical Matters, our guest Dr. R. Phillip Dellinger discusses the current management of patients with ARDS. Dr. Dellinger is a recognized thought leader in the field, a prolific author, an accomplished researcher, and the recipient of multiple awards for his contributions to critical care.
ADDITIONAL RESOURCES:
The PROSEVA clinical trial showed that in patients with severe ARDS prone position ventilation improved mortality: https://bit.ly/2Dp3LdS The ACURASYS clinical study showed that in patients with severe ARDS 48 hours of neuromuscular blockade was associated with improved mortality: https://bit.ly/2FqI7Zn The EOLIA study was stooped early for futility. However, many think that it still has important findings regarding the use of ECMO in severe ARDS: https://bit.ly/2QI1Cxu
BOOKS MENTIONED IN THIS EPISODE:
Evidence-Based Critical Care: A Case Study Approach: https://amzn.to/2PYeD8V
Caring for critically ill pregnant patients poses a series of unique challenges for the intensivist. In part two of this two-episode series, we discuss critical care in pregnancy with Dr. Stephen Lapinsky. Dr. Lapinsky is a practicing intensivist and professor of medicine at the University of Toronto. He is a member of the editorial board of the journal, Obstetric Medicine, and sits on the steering committee of the North American Society of Obstetric Medicine. Dr. Lapinsky is also the executive of the Women’s Health Network of the ACCP. Today (Part 2) we will cover general conditions that may lead to critical illness in pregnant women.
Additional Resources:
Practice bulletin on Critical Care in Pregnancy from the American College of Obstetrics and Gynecology (ACOG): https://bit.ly/2OtJARU A comprehensive review on acute respiratory failure in pregnancy: https://bit.ly/2DKzwjl AHA scientific statement on cardiac arrest in pregnancy: https://bit.ly/2QpGWtK
Caring for critically ill pregnant patients poses a series of unique challenges for the intensivist. In this two-episode series, we discuss critical care in pregnancy with Dr. Stephen Lapinsky. Dr. Lapinsky is a practicing intensivist and professor of medicine at the University of Toronto. He is a member of the editorial board of the journal, Obstetric Medicine, and sits on the steering committee of the North American Society of Obstetric Medicine. Dr. Lapinsky is also the executive of the Women’s Health Network of the ACCP. Today (Part 1) will cover unique conditions associated with pregnancy that may lead to critical illness.
Additional Resources:
Practice bulletin on Critical Care in Pregnancy from the American College of Obstetrics and Gynecology (ACOG): https://bit.ly/2OtJARU A comprehensive review on acute respiratory failure in pregnancy: https://bit.ly/2DKzwjl AHA scientific statement on cardiac arrest in pregnancy: https://bit.ly/2QpGWtK
In today’s episode, we will discuss the recently released 2018 Clinical Practice Guidelines for the Prevention and Management of Pain, Agitation/Sedation, Delirium, Immobility, and Sleep Disruption in Adult Patient s in the ICU. Our guest is John Devlin, PharmD, BCCCP, FCCM, FCCP. Dr. Devlin is the lead author of these guidelines and a recognized leader in the field.
Additional Resources:
Clinical Practice Guidelines for the Prevention and Management of Pain, Agitation/Sedation, Delirium, Immobility, and Sleep Disruption in Adult Patients in the ICU: https://bit.ly/2wzFNHv Executive Summary: Clinical Practice Guidelines for the Prevention and Management of Pain, Agitation/Sedation, Delirium, Immobility, and Sleep Disruption in Adult Patients in the ICU: https://bit.ly/2vOyVGP Interpreting and Implementing the 2018 of Pain, Agitation/Sedation, Delirium, Immobility, and Sleep Disruption Guidelines: https://bit.ly/2waInU7 Nocturnal low-dose Dexmedetomidine to prevent delirium in ICU patients: https://bit.ly/2MJ2TSi
Books Mentioned in This Episode:
Overtreated: Why Too Much Medicine Is Making Us Sicker and Poorer: https://amzn.to/2OAfZmD
In this episode of Critical Matters, we explore the role of the intensivist in the management of patients with ventricular assist devices. Our guest is Dr. John Greenwood, a practicing intensivist who splits his clinical time between the Cardiac & Vascular ICU and the ED-ICU at the Hospital of the University of Pennsylvania.
Additional Resources:
Summary of information presented during the episode kindly provided by Dr. John Greenwood: https://bit.ly/2MJdfSa HeartWare Waveforms App for iPad: https://apple.co/2NpyQEr
Articles Mentioned In This Episode:
Pratt AK, Shah NS, Boyce SW. Left ventricular assist device management in the ICU. Crit Care Med. 2014;42(1):158-68: https://bit.ly/2MKr3M6 Sen A, Larson JS, Kashani KB, et al. Mechanical circulatory assist devices: a primer for critical care and emergency physicians. Crit Care. 2016;20(1):153: https://bit.ly/2NoreC4
In this episode of Critical Matters, we continue the discussion of medical errors in healthcare with a specific focus on how to disclose medical errors to patients. Our guest is Dr. Nitin Puri, a practicing intensivist and medical educator at the Cooper Medical School of Rowan University and the Cooper Health System in Camden, New Jersey.
Additional Resources:
This is a CNN story on cardiothoracic fellow wrongly accused and sued for lying about a medical error: https://cnn.it/2vFEnLf The Communication and Optimal Resolution (CANDOR) toolkit from the Agency for Healthcare Research and Quality (AHRQ). CANDOR is a process that health care institutions and providers can use to respond in a timely, thorough and fair way when medical errors occur and cause patients harm: https://bit.ly/2m9fch7 A powerful video on the topic of the disclosure of medical errors: https://bit.ly/2DaD6TD
Article Mentioned in This Episode:
Mistakes Were Made (but Not by Me): Why We Justify Foolish Beliefs, Bad Decisions, and Hurtful Acts: https://amzn.to/2NorssU
In this episode of Critical Matters, we discuss “Compassionomics” with Dr. Stephen Trzceciak. Dr. Trzeciak is a practicing intensivist and prolific researcher. His research interests have focused recently on the hypothesis that compassion matters for patients, for healthcare outcomes, and for providers. Compassionomics is the revolutionary field of science focusing on caring, and the impact compassion has on healthcare.
Additional Resources:
How 40 Seconds of Compassion Could Save a Life: https://youtu.be/elW69hyPUuI Compassionomics: Hypothesis and experimental approach: http://compassionomics.net
Article Mentioned in This Episode:
A Patient’s Story: http://www.theschwartzcenter.org/media/patient_story.pdf
In this episode, we discuss the ABCDEF bundle, a tool used to promote evidence-based care that promotes healing and liberation from critical illness for patients in the ICU. Our guest is Dr. Julia Barr who is currently the Associate Professor of Anesthesia in the Medical Center Line at Stanford Medical School and a staff anesthesiologist and intensivist at the VA Palo Alto Medical Center. Dr. Barr has served as a national faculty member for the SCCM ICU Liberation Campaign ABCDEF Bundle Collaborative and is a member of the SCCM’s ICU Liberation Committee.
Additional Resources:
Society of Critical Care Medicine’s guidelines on management of pain, agitation and delirium: http://www.sccm.org/Research/Guidelines/Guidelines/Pain,-Agitation,-and-Delirium-in-Adult-Patients-in Society of Critical Care Medicine’s guidelines for Family-Centered Care in the ICU: http://www.sccm.org/Research/Guidelines/Guidelines/Family-Centered-Care-in-the-ICU
Books Mentioned in This Episode:
The Power of Habit: Why We Do What We Do in Life and Business: https://www.amazon.com/Power-Habit-What-Life-Business-ebook/dp/B0055PGUYU/ref=sr_1_2?ie=UTF8&qid=1530020419&sr=8-2&keywords=the+power+of+habit
In this episode, we discuss seizures in the ICU. We cover a broad range of topics related to the initial management of seizures, status epilepticus, and EEG monitoring in post-anoxic brain damage. Our guest is Dr. Thomas Bleck. Dr. Bleck is the professor of neurological sciences, neurosurgery, internal medicine and anesthesiology at Rush University Medical Center, where he is a neurointensivist and the director of clinical neurophysiology.
Additional Resources:
Evidence-Based Guideline: Treatment of Convulsive Status Epilepticus in Children and Adults: Report of the Guideline Committee of the American Epilepsy Society: http://www2.soundphysicians.com/l/403342/2018-06-27/cxz5ng/403342/102465/Evidence_Based_Guideline_Treatment_of_Convulsive_Status_Epilepticus_in_Children_an.pdf Guidelines for the Evaluation and Management of Status Epilepticus: http://www2.soundphysicians.com/l/403342/2018-06-27/cxz5nb/403342/102461/Guidelines_for_the_evaluation_and_management_of_status_epilepticus..pdf Clinical classification of post anoxic myoclonic status: http://www2.soundphysicians.com/l/403342/2018-06-27/cxz5nd/403342/102463/Clinical_classification_of_post_anoxic_myoclonic_status.pdf
Books Mentioned in This Episode:
Tinker, Tailor, Soldier, Spy: A George Smiley Novel: https://www.amazon.com/Tinker-Tailor-Soldier-Spy-George-ebook/dp/B004RKXNDU/ref=sr_1_1?ie=UTF8&qid=1530020470&sr=8-1&keywords=tinker+soldier+le+carre
In this episode of Critical Matters, we discuss the Hour-1 Bundle for sepsis. The Surviving Sepsis Campaign has been working on improving outcomes for patients with sepsis for well over a decade. Today we are fortunate to have one of its leaders as a guest to discuss the 2018 update: The Hour-1 Bundle. Our guest is Mitchell Levy, MD, MCCM. Dr. Levy is Professor of Medicine and Division Chief, Pulmonary and Critical Care Medicine at the Alpert Medical School of Brown University in Providence, Rhode Island.
Additional Resources:
The Surviving Sepsis Campaign website. A wealth of resources for clinicians interested in improving outcomes for patients with sepsis and septic shock. http://www.survivingsepsis.org/Pages/default.aspx The Surviving Sepsis Campaign Bundle: 2018 Update (The Hour-1-Bundle) http://www.survivingsepsis.org/SiteCollectionDocuments/Surviving-Sepsis-Campaign-Hour-1-Bundle-2018.pdf
Books Mentioned in This Episode:
Shambhala: The Sacred Path of the Warrior: https://www.amazon.com/Shambhala-Sacred-Warrior-Chogyam-Trungpa/dp/1611802326/ref=tmm_pap_swatch_0?_encoding=UTF8&qid=1528317558&sr=8-1
In this episode of Critical Matters, we discuss medical errors in healthcare. Our guest is Dr. Nitin Puri, a practicing intensivist and medical educator at the Cooper Medical School of Rowan University and the Cooper Health System in Camden, New Jersey. We discuss a range of topics related to medical errors in critical care medicine including the incidence of errors in our practice, causes, how to prevent them, and how we should deal with them when they occur.
Additional Resources:
To Err is Human: Building a Safer Health System. The landmark publication y the Institute of Medicine highlighting medical errors as a critical cause of deaths in the US healthcare system: https://www.ncbi.nlm.nih.gov/pubmed/25077248 Medical error – the third leading cause of death in the US: https://www.ncbi.nlm.nih.gov/pubmed/27143499
Books Mentioned in This Episode:
Haroun and the Sea of Stories: https://www.amazon.com/Haroun-Sea-Stories-Salman-Rushdie/dp/0140157379/ref=asap_bc?ie=UTF8 Invisible Man: https://www.amazon.com/Invisible-Vintage-International-Ralph-Ellison-ebook/dp/B003WUYR9K/ref=sr_1_2?ie=UTF8&qid=1525281632&sr=8-2&keywords=invisible+man+ralph+ellison
In this episode of Critical Matters, we discuss the role of noninvasive ventilation and high-flow oxygen nasal cannula in respiratory failure. Our guest, Dr. Pratik Doshi, is an academic intensivist and emergency medicine physician at the University of Texas Health Science Center in Houston, Texas. Dr. Doshi is the lead author and investigator of a recently published multicenter randomized clinical trial evaluating this topic.
Additional Resources:
Official ERS / ATS Guidelines for non-invasive ventilation (NIV): https://www.ncbi.nlm.nih.gov/pubmed/28860265 High-velocity nasal insufflation in the treatment of respiratory failure: A randomized clinical trial by Doshi P et al: http://www.annemergmed.com/article/S0196-0644(17)31968-6/fulltext
Books Mentioned in This Episode:
The Alchemist: https://www.amazon.com/Alchemist-Paulo-Coelho-ebook/dp/B00U6SFUSS/ref=sr_1_1?ie=UTF8&qid=1523055572&sr=8-1&keywords=the+alchemist
In this episode of Critical Matters, we explore the role of the intensivist in the postoperative care of the cardiac surgical patient. Our guest is Dr. John Greenwood, a practicing intensivist who splits his clinical time between the Cardiac and Vascular ICU and the ED-ICU at the Hospital of the University of Pennsylvania.
Additional Resources:
Postoperative Critical Care of the Adult Cardiac Surgical Patient. Part I: Routine Postoperative Care: https://www.ncbi.nlm.nih.gov/pubmed/25962078 Postoperative Critical Care of the Adult Cardiac Surgical Patient: Part II: Procedure-Specific Considerations, Management of Complications, and Quality Improvement: https://www.ncbi.nlm.nih.gov/pubmed/26136101 Critical Care Perspectives in Emergency Medicine – a monthly CME podcast on resuscitation and critical care-related issues that can present to the ED https://www.criticalcareinem.com/ Critical Care Project – a multi-institutional website designed to be a multidisciplinary educational resource on topics in critical care. http://ccproject.com/
Books Mentioned in This Episode:
How to Win Friends & Influence People: https://www.amazon.com/How-Win-Friends-Influence-People/dp/0671027034/ref=sr_1_3?ie=UTF8&qid=1521825606&sr=8-3&keywords=dale+carnegie The Last Lecture: https://www.amazon.com/Last-Lecture-Pausch-Randy-Hardcover/dp/B011MCWCDW/ref=sr_1_2?ie=UTF8&qid=1521826496&sr=8-2&keywords=the+last+lecture
In the first of two episodes, we discuss general postoperative care, common complications, and the intensivist-cardiac surgeon relationship.
In our first episode of the Critical Matters podcast, we discussed the potential role of Angiotensin II in the treatment of distributive shock based on the results of the ATHOS 3 clinical trial. Now Angiotensin II is FDA approved and commercially available as a product named GIAPREZA™. In this episode we will discuss this topic further.
Our guest is Dr. Lakhmir S. Chawla, Chief Medical Officer of La Jolla Pharmaceutical in San Diego, California. Previously, Dr. Chawla was a Professor of Medicine at the George Washington University. During his tenure at George Washington, Dr. Chawla was the designer and lead investigator of the ATHOS (Angiotensin II for the Treatment of High Output Shock) trial which results led to the ATHOS 3 trial, (The Phase 3 clinical trial of angiotensin II, for the treatment of catecholamine-resistant hypotension).
Additional Resources:
ATHOS-3 Clinical Trial. Randomized controlled trial evaluating the efficacy of Angiotensin II in raising blood pressure in vasodilatory shock. http://www.nejm.org/doi/full/10.1056/NEJMoa1704154 Outcomes in Patients with Vasodilatory Shock and Renal Replacement Therapy Treated with Intravenous Angiotensin II. https://www.ncbi.nlm.nih.gov/pubmed/?term=Outcomes+in+Patients+with+Vasodilatory+Shock+and+Renal+Replacement+Therapy+Treated+with+Intravenous+Angiotensin+II Prescribing information for Angiotensin II (GIAPREZA ™ ). http://giapreza.com/giapreza-prescribing-information.pdf
Books Mentioned in This Episode:
Atlas Shrugged: https://www.amazon.com/Atlas-Shrugged-Ayn-Rand/dp/0451191145/ref=sr_1_1?ie=UTF8&qid=1522104389&sr=8-1&keywords=atlas+shrugged+book
In this episode of Critical Matters, we explore the intersection of high-altitude medicine and physiology with critical care. Our guest is Robert B. Shoene, MD, FACP.
Dr. Shoene is Associate Director, ICU and Critical Care, at St. Mary’s Medical Center in San Francisco. Dr. Shoene is a prolific author and researcher with more than 100 publications. His research has focused on pulmonary physiology and altitude medicine, and he has been part of numerous research expeditions to locations such as Mt. Everest and Denali.
Additional Resources:
Arterial Blood Gases and Oxygen Content in Climbers on Mount Everest: https://www.nejm.org/doi/full/10.1056/NEJMoa0801581 A comprehensive review on illnesses at high altitude: https://journal.chestnet.org/article/S0012-3692(08)60216-0/fulltext Everest: The West Ridge by Thomas Hornbein: https://www.amazon.com/Everest-West-Ridge-Thomas-Hornbein/dp/1594857075/ref=sr_1_1?ie=UTF8&qid=1520812701&sr=8-1&keywords=everest+the+west+ridge Endurance: Shackleton’s Incredible Journey by Alfred Lansing: https://www.amazon.com/Endurance-Shackletons-Incredible-Alfred-Lansing/dp/0465062881/ref=sr_1_1?s=books&ie=UTF8&qid=1520812797&sr=1-1&keywords=endurance Being Mortal: Medicine and What Matters in the End by Atul Gawande: https://www.amazon.com/Being-Mortal-Medicine-What-Matters/dp/1250076226/ref=sr_1_1?s=books&ie=UTF8&qid=1520812921&sr=1-1&keywords=Being+mortal Intensive Care, a poem by Dr. Robert Schoene: https://www.jstor.org/stable/1348231?seq=1#page_scan_tab_contents
In this episode, we discuss the practice of respect in the intensive care unit. Our guest is Samuel M. Brown, MD, MS, a practicing intensivist and Director of the Center for Humanizing Critical Care at Intermountain Medical Center in Murray, Utah. Dr. Brown holds an academic appointment as Associate Professor of Medicine at the University Of Utah School Of Medicine, Murray UT. He is a prolific investigator and author with a wide range of interests, including complexity in critical illness, echocardiography, and ethics.
Our conversation covers topics such as dignity, respect, compassion and burnout. Join us in a fascinating discussion with a thought leader in bringing humanism to critical care.
Additional Resources:
- Recent article co-authored by Dr. Brown and colleagues reviewing important aspects of the practice of respect in critical care medicine. Click here to read.
- The Center for Humanizing Critical Care works with researchers and clinicians with the goal of helping patients and family members make it through critical illness with their humanity intact. Learn more here.
- Speak, Memory: An Autobiography Revisited by Vladimir Nabokov.
Additional Resources:
Recent article co-authored by Dr. Brown and colleagues reviewing important aspects of the practice of respect in critical care medicine. Click here to read. The Center for Humanizing Critical Care works with researchers and clinicians with the goal of helping patients and family members make it through critical illness with their humanity intact. Learn more here. Speak, Memory: An Autobiography Revisited by Vladimir Nabokov. Click here to learn more.
The use of point-of-care ultrasound (POCUS) has penetrated our clinical practice. In the hands of trained intensivists POCUS can quickly provide valuable diagnostic information and lead to specific therapeutic interventions. Today’s episode explores the use of POCUS during cardiac arrest.
Our guest is Haney Mallemat, MD. Dr. Mallemat is board certified in emergency medicine, internal medicine, and critical care medicine and works in the emergency department and intensive care unit at Cooper University Hospital in Camden, NJ. He has lectured both nationally and internationally and has contributed to several emergency medicine and critical care podcasts. He is a firm believer in the benefits of bedside ultrasound for better patient care. Additional Resources
- The REASON Trial evaluated the role of POCUS in out of hospital cardiac arrest arriving to the emergency department. Click here to read.
- Point of care ultrasound can be associated with frequent interruptions during CPR. As Dr. Mallemat discusses in the podcast, providers must pay very close attention to this issue.
Additional Resources:
The REASON Trial evaluated the role of POCUS in out of hospital cardiac arrest arriving to the emergency department. Click here to read. Point of care ultrasound can be associated with frequent interruptions during CPR. As Dr. Mallemat discusses in the podcast, providers must pay very close attention to this issue. Click here to read more.
The advent of targeted temperature management has changed how we treat anoxic brain damage post cardiac arrest. In this episode of Critical Matters, we dive into the challenges and existing evidence regarding neuroprognostication in cardiac arrest survivors.
Our guest is Fred Rincon, MD. Dr. Rincon is Associate Professor of Neurology and Neurological Surgery at Thomas Jefferson University in Philadelphia, PA. He is board certified in internal medicine and critical care (ABIM), neurology (ABPN), vascular neurology (ABPN), and neurocritical care (UCNS). Additional Resources
- Practice Guidelines on reducing brain injury following cardiopulmonary resuscitation. These guidelines are published by the American Academy of Neurology and endorsed by the Neurocritical Care Society.
Additional Resources:
Practice Guidelines on reducing brain injury following cardiopulmonary resuscitation. These guidelines are published by the American Academy of Neurology and endorsed by the Neurocritical Care Society. Click here to read.
In this episode, we discuss critical illness-related corticosteroid insufficiency (CIRCI). Our guest is Stephen Pastores, MD, FACP, FCCP, FCCM. Dr. Pastores is Director of the Critical Care Medicine Fellowship Training and Research Programs at Memorial Sloan Kettering Cancer Center in New York, NY.
Dr. Pastores co-chaired an international multispecialty task force addressing this important topic. During our podcast, he discusses the recent publications by this task force on corticosteroid insufficiency and the role on corticosteroid replacement in critical illness.
Additional Resources:
- Guidelines for the Diagnosis and Management of Critical Illness-Related Corticosteroid Insufficiency (CIRCI) in Critically Ill Patients (Part 1): Society of Critical Care Medicine (SCCM) and European Society of Intensive Care Medicine (ESICM) 2017. Click here to read.
- Critical Illness-Related Corticosteroid Insufficiency (CIRCI): A Narrative Review from a Multispecialty Task Force of the Society of Critical Care Medicine (SCCM) and the European Society of Intensive Care Medicine (ESICM). Click here to read.
- Adjunctive Glucocorticoid Therapy in Patients with Septic Shock. ADRENAL Trial Investigators. Click here to read.
Additional Resources:
Guidelines for the Diagnosis and Management of Critical Illness-Related Corticosteroid Insufficiency (CIRCI) in Critically Ill Patients (Part 1): Society of Critical Care Medicine (SCCM) and European Society of Intensive Care Medicine (ESICM) 2017. https://www.ncbi.nlm.nih.gov/pubmed/28938253
Critical Illness-Related Corticosteroid Insufficiency (CIRCI): A Narrative Review from a Multispecialty Task Force of the Society of Critical Care Medicine (SCCM) and the European Society of Intensive Care Medicine (ESICM). https://www.ncbi.nlm.nih.gov/pubmed/28938251
Adjunctive Glucocorticoid Therapy in Patients with Septic Shock. ADRENAL Trial Investigators. http://www.nejm.org/doi/full/10.1056/NEJMoa1705835?query=featured_home
In our first episode, we discuss the potential role of Angiotensin II for treating shock and review the results of the ATHOS-3 clinical trial.
Our guest is Stephen W. Trzeciak, MD, MPH. Dr. Trzeciak is Interim Chair of Internal Medicine and Head of Critical Care Medicine at Cooper University Health Care. Dr. Trzeciak holds academic appointments as Professor of Medicine and Professor of Emergency Medicine at Cooper Medical School of Rowan University. He is also a prolific investigator and author, with recognized expertise in the treatment of shock, early interventions in critical illness, and the interface between the emergency department and the intensive care unit.
Additional Resources:
- Sound Critical Care webinar on vasopressors. Please review for a more comprehensive discussion on current evidence-based vasopressor use in clinical practice.
- ATHOS-3 clinical trial. Randomized controlled trial evaluating the efficacy of Angiotensin II in raising blood pressure in vasodilatory shock.
- FDA press release. After recording this podcast, the FDA announced the approval of Angiotensin II.