Critical Matters

Latest Episodes:

Initial Management Of ARDS Jun 12, 2019

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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

Critical Care In Pregnancy (Part 2) V1 Jun 12, 2019

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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

Critical Care in Pregnancy (Part 1) Jun 12, 2019

Show notes

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

2018 PADIS Guidelines Jun 12, 2019

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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

Ventricular Assist Device Management In The ICU Jun 12, 2019

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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

Disclosing Medical Errors Jun 12, 2019

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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

Compassionomics Jun 12, 2019

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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

The ABCDEF Bundle Jun 12, 2019

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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

Seizures In The ICU Jun 12, 2019

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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

The Hour-1 Bundle Jun 12, 2019

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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

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