Critical Matters

Latest Episodes:

Toxicology in the ICU – Part 1 Jun 12, 2019

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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

Cognitive Impairment After Critical Illness Jun 12, 2019

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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

Neurologic Criteria for Death in Adults Jun 12, 2019

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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

SCCM Critical Care Congress Recap Jun 12, 2019

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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

Post-Intensive Care Syndrome (PICS) Jun 12, 2019

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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

Deep Dive in Delirium Jun 12, 2019

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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

Burnout in Healthcare Jun 12, 2019

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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

Critical Care of Patients with Cirrhosis Jun 12, 2019

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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

Procalcitonin as a Biomarker in Lower Respiratory Tract Infection and Sepsis Jun 12, 2019

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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

Refractory Hypoxemia Jun 12, 2019

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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.

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