Critical Matters

Latest Episodes:

Management of C-difficile Infection (CDI) Apr 09, 2021

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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

ECMO In COVID - 19 Feb 11, 2021

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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

Professional Transcendence Jan 28, 2021

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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

Management Of Acute - On - Chronic Liver Failure: Part 2 Jan 14, 2021

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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

Management Of Acute - On - Chronic Liver Failure: Part 1 Dec 25, 2020

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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

Thrombosis In COVID - 19 Dec 10, 2020

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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

Above Average - How To Make Teams Better Nov 26, 2020

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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

Death By Neurologic Criteria Nov 12, 2020

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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/

Circle Up Oct 29, 2020

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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/

Liberation From Mechanical Ventilation Oct 08, 2020

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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

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