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    Health & Fitness

    Critical Matters – Sound Physicians

    Podcast by Sound Physicians

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    Latest Episodes:
    Hyperglycemic Emergencies Oct 22, 2024

    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

    Music and Critical Illness Oct 10, 2024

    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/9781250132222 Musicophilia: A Tale of Music and the Brain. By Oliver Sacks: https://bit.ly/4dCTjwv St. Matthew Passion – Johann Sebastian Bach (Composer), Leonard Bernstein (Conductor): https://amzn.to/4eZmgE5 Lute Sonatas Nos. 30 & 39 & 96: 11 Silvius Leopold Weiss (Composer), Robert Barto (Performer): https://bit.ly/3YfXha2

    Albumin in Critical Care Sep 30, 2024

    In this episode of Critical Matters, Dr. Zanotti discusses the use of intravenous albumin in critical care. He is joined by Dr. 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/4dAimRa The Time Machine. By H.G. Wells: https://amzn.to/4eK4apG

    Neurological support post-cardiac arrest Sep 12, 2024

    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-injury Books 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/4d4xHZC C. Miller Fisher: Stroke in the 2oth Century. By LR Caplan: https://bit.ly/3XFw3Jw

    Vasoplegia after cardiac surgery Aug 29, 2024

    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/3XmWPGA Every Deep-Drawn Breath. By Wes Ely: https://bit.ly/4cODkeq In Shock: My Journey from Death to Recovery to Redemption. By Rana Awdish: https://bit.ly/3Z4mC7z

    Tracheostomy Emergencies Aug 08, 2024

    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-emergencies Bleeding 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/3pq0CkR Where the Red Fern Grows. By Wilson Rawls: amzn.to/3AawH6a

    The Forgotten Patient Jul 25, 2024

    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/fulltext Roger. K Flanary. CHEST. 2022: journal.chestnet.org/article/S0012-…029-6/fulltext Life after Cardiac Arrest: The importance of engaging with the “forgotten patient.” K Haywood & K Dainty. Resuscitation, 2018: www.resuscitationjournal.com/article/S0…0195-3/pdf Link to the Glaucomflecken’s website: glaucomflecken.com/ Books Mentioned in this Episode: In Shock. By Rana Awdish: bit.ly/441b0Cx

    Temporary Pacing in the ICU Jul 11, 2024

    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/3XWFo0d The Mutiny on the Bounty. By Peter FitzSimons: https://bit.ly/4cwGkNb

    The Neuro Exam Jun 27, 2024

    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=1677810255 Clinical Neuroanatomy Made Ridiculously Simple. Edition 6. Stephan Goldberg, MD: https://amzn.to/4cC34uZ Books mention in the episode: Meditations. By Marcus Aurelius. Translation by Gregory Hayes: https://amzn.to/4eBxK1d

    Mechanical Circulatory Support - Part 2 Jun 13, 2024

    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/

    Mechanical Circulatory Support - Part 1 May 23, 2024

    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

    Goal-Directed Mechanical Ventilation May 09, 2024

    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-tab Mechanical Ventilation Mode Taxonomy App: iPhone: https://apps.apple.com/us/app/ventilator-mode-map/id1508307955 Android: https://play.google.com/store/apps/details?id=org.ccf.vmm&hl=en_US Books mentioned in this episode: Solito: A Memoir. By Javier Zamora: https://bit.ly/4b6hPG8

    Life-Threatening Asthma Apr 25, 2024

    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.com Last Week Now! - A curated newsletter by ResusX: https://www.resusx.com/newsletter Keynotable – a course for beginners and seasoned speakers: https://www.keynotable.net Books mentioned in this episode: How to Win Friends and Influence People. By Dale Carnegie: https://bit.ly/49WlcOd

    Corticosteroids in Critical Illness Update Apr 11, 2024

    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=Fulltext Adjunctive 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/NEJMoa2215145 Books mentioned in this episode: Elon Musk. By Walter Isaacson: https://bit.ly/3PVXWsG The Autumn Ghost: How the Battle Against a Polio Epidemic Revolutionized Modern Medical Care. By Hannah Wunsch: https://bit.ly/4avevns

    Conflict Resolution in Healthcare Mar 28, 2024

    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/R3wz29W3C4g Conflict Management in the ICU. Previous Critical Matters podcast episode with Dr. Joshua Kayser. https://soundphysicians.com/podcast-episode/?podcast_id=342&track_id=1378454077 Books Mentioned in this Episode: Nonviolent Communication. By Marshal B. Rosenberg: https://bit.ly/4a8h0fp Getting to YES: Negotiating Agreement Without Giving In. By Roger Fisher and William Ury: https://bit.ly/3TSD5J3 Possible: How We Survive (and Thrive) in an Age of Conflict. By William Ury: https://bit.ly/4aauFCK Crucial Conversations: Tools For Talking When Stakes are High. By Joseph Grenny, et al: https://bit.ly/43AU6La The Anatomy of Peace: Resolving the Heart of Conflict. By the Arbinger Institute: https://bit.ly/4a1v0HL

    ECMO for Respiratory Failure Mar 14, 2024

    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 Resources Efficacy 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 episode Endurance: Shackleton’s Incredible Voyage. By Alfred Lansing: https://bit.ly/43g71C1 South!: The Story of Shackleton’s Last Expedition 1914-1917. By Ernest Shackleton: https://bit.ly/49NyJbU

    Critical care of neuromuscular disorders Feb 22, 2024

    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/S0960896618304231 Books 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

    ARDS Respiratory Support Update Feb 08, 2024

    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.202311-2011ST Prone Positioning in Severe Acute Respiratory Distress Syndrome. PROSEVA Clinical Trial. N Engl J of Med 2013: https://www.nejm.org/doi/full/10.1056/nejmoa1214103 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 Books mentioned in this episode: A Portrait of the Artist as a Young Man. By James Joyce: https://bit.ly/49kzmtn

    Seizure Management in the ICU Jan 18, 2024

    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

    Evaluation of Fever in the ICU Patient Dec 14, 2023

    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 Kluger https://www.amazon.com/Splendid-Solution-Jonas-Conquest-Polio/dp/0425205703/ref=tmm_pap_swatch_0?_encoding=UTF8&qid=1702571365&sr=8-2

    Brain Death / Death by Neurologic Criteria Nov 30, 2023

    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-Boat Team of Rivals: The Political Genius of Abraham Lincoln. By Doris Kearns Goodwin: https://t.ly/7F1My Nine Stories. By JD Salinger: https://t.ly/qM5w_

    Central Line-Associated Bloodstream Infections (CLABSI) Nov 16, 2023

    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/4rjx6st8 The Checklist Manifesto. By Atul Gawande The Checklist Manifesto- Atul Gawande: https://tinyurl.com/5pccn98p

    Failing Well Oct 26, 2023

    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/AmyEdmondson Strategies for Learning from Failure. By A. Edmondson. Harvard Business Review 2011: https://hbr.org/2011/04/strategies-for-learning-from-failure Books Mentioned in this Episode: Adapt: Why Success Always Starts with Failure. By Tim Hartford: https://shorturl.at/mpQU1 Being Wrong: Adventures in the Margin of Error. By Kathryn Shulz: https://shorturl.at/qAHJ0 Principles: Life and Work. By Ray Dalio: https://shorturl.at/JRSZ1

    ICU Management of the Organ Donor Oct 12, 2023

    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-ICU Website 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=1304762116 The 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.15100 Books Mentioned in this Episode: The Holy Bible, KJV: https://shorturl.at/wyLM4

    Hospital Sepsis Program Sep 28, 2023

    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.html SCCM Surviving Sepsis Guidelines: https://journals.lww.com/ccmjournal/pages/articleviewer.aspx?year=2021&issue=11000&article=00021&type=Fulltext Characterising 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/s13012-015-0300-7 Effect 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.pdf Books 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

    Cardiogenic Shock Update Sep 14, 2023

    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 Resources Concise 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/31104355 SCAI 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+risk Advances 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.2022.100120 Machine 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.2022.100126 Extracorporeal 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/44S0tZD The Lord of the Rings Trilogy by JRR Tolkien: https://bit.ly/45Q9NP0 The House of God. By Samuel Shem: https://bit.ly/48gnusc

    Management of Acute-on-Chronic Liver Failure in the ICU Aug 24, 2023

    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 Resources Executive 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=Fulltext 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=00011&type=Fulltext Guideline 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.aspx Previous Episodes of Critical Matters on the Topic of Acute-on-Chronic Liver Failure: https://soundphysicians.com/podcast-episode/?podcast_id=342&track_id=953807698 https://soundphysicians.com/podcast-episode/?podcast_id=342&track_id=965563996 Books Mentioned in this Episode: Noise: A Flaw in Human Judgement. By Daniel Kahneman, et al: https://bit.ly/3sqfRin Seven Brief Lessons on Physics. By Carlo Rovelli: https://bit.ly/45jv82N Anaximander: And the Birth of Science. By Carlo Rovelli: https://bit.ly/3sqgqbZ

    Medical Errors Aug 10, 2023

    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/25077248 Medical error – the third leading cause of death in the US: https://www.ncbi.nlm.nih.gov/pubmed/27143499 The Safety of Inpatient Health Care. New England Journal of Medicine 2023; https://www.nejm.org/doi/full/10.1056/NEJMsa2206117 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 patient’s harm: https://www.ahrq.gov/professionals/quality-patient-safety/patient-safety-resources/resources/candor/introduction.html A powerful video on to topic of disclosure of medical errors. Worth a view: https://www.youtube.com/watch?time_continue=4&v=xeMWizTodYw Books Mentioned in this Episode: The Fearless Organization: Creating Psychological Safety in the Workplace for Learning, Innovation, and Growth. By Amy Edmondson: https://bit.ly/3OQe1zV Pachinko. By Min Lee Jee: https://bit.ly/3DNJegK

    Oncologic Emergencies Jul 27, 2023

    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/3KddG7C The Structure of Scientific Revolutions: By William Kuhn: https://bit.ly/43HkS34 The Physicists: The History of a Scientific Community in Modern America. By Daniel Kevles: https://bit.ly/477Z8jO American Prometheus: The Triumph and Tragedy of j. Robert Oppenheimer. By Kai Bird and Martin Sherwin: https://bit.ly/479AEqn

    Acute Disorders of Consciousness Jul 13, 2023

    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 Resources State-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-scale Updated 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=1533382963 Books mentioned in this episode: Bed Number Ten. By Sue Baier and Mary Zimmeth Schomaker: amzn.to/3O8Fmgp The Diving Bell and the Butterfly. By Jean-Dominique Bauby: bit.ly/44Hxhon Clinical Neuroanatomy Made Ridiculously Simple. By Stephen Goldberg: https://amzn.to/3PUF7Xu

    Prone Position Jun 22, 2023

    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 Resources Factors 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/s00134-023-07050-7 ATS/ESICM/SCCM Clinical Practice Guideline: Mechanical Ventilation in Adult Patients with Acute Respiratory Distress Syndrome: https://www.atsjournals.org/doi/10.1164/rccm.201703-0548S Prone 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/nejmoa1214103 Books Mentioned in this Episodes The Omnivore’s Dilemma: A Natural History of Four Meals, By Michael Pollan: https://bit.ly/42FpndS

    CNS Infections Jun 08, 2023

    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 Resources Infectious 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 Episode The Acute Neurology Survival Guide. By Catherine Albin and Sahar Zafar :bit.ly/45Ttfuo Why We Sleep: Unlocking the Power of Sleep and Dreams. By Matt Walker: https://bit.ly/3MNoWs0

    Right Ventricular Failure May 25, 2023

    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 Resources Right 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

    The Forgotten Patient May 11, 2023

    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

    ICU-PAUSE Apr 27, 2023

    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 Resources American 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 Episode In Shock. By Rana Awdish: bit.ly/441b0Cx Every Deep Drawn Breath. By Wes Ely: bit.ly/3Aqt4IC Mom Milestones. By Grace Farris: bit.ly/3ArT06z Dare to Lead. By Brene Brown: bit.ly/3n3N54O Quiet. By Susan Cain: bit.ly/3HcuHxk The Credibility Code (Speech Skills). By Cara Hale Alter: bit.ly/40ErQE8

    Outcomes After Critical Illness Apr 14, 2023

    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/3nWs7Vp Commonwealth. By Ann Patchett: bit.ly/43pWSCt

    Mechanical Power Mar 23, 2023

    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-ventilation Books Mentioned in this Episode: Crucial Conversations: Tools for Talking When Stakes are High. By Joseph Grenny, et al: https://bit.ly/3FL4Xr9 Critical Maters Podcast – Interrupting the VILI Vortex. Guest J. Marini, MD: https://soundphysicians.com/podcast-episode/?podcast_id=342&track_id=819824731 Critical Matters Podcast- Initial Management of ARDS. Guest R.P. Dellinger, MD: https://soundphysicians.com/podcast-episode/?podcast_id=342&track_id=635607780

    Pulmonary Embolism Update Mar 09, 2023

    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 Resources Diagnosis, 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

    Fluid Management for Sepsis Feb 23, 2023

    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 Resources Early Restrictive or Liberal Fluid Management for Sepsis-Induced Hypotension. CLOVERS clinical trial: https://www.nejm.org/doi/full/10.1056/NEJMoa2212663 Restriction of Intravenous Fluids in ICU Patients with Septic Shock. CLASSIC clinical trial: https://www.nejm.org/doi/full/10.1056/NEJMoa2202707 Surviving Sepsis Campaign: Guidelines 2021: https://www.sccm.org/Surviving-Sepsis-Guidelines-2021 Early Goal-Directed Therapy in the Treatment of Severe Sepsis and Septic Shock: https://www.nejm.org/doi/full/10.1056/nejmoa010307 Early, Goal-Directed Therapy for Septic Shock: Metanalysis of the ARISE, ProCESS, and PriMISe clinical trials: https://www.nejm.org/doi/10.1056/nejmoa1701380 Books Mentioned in this Episode: Extreme Ownership: How Navy SEALs Lead and Win. By Jocko Willink and Leif Babin: https://bit.ly/3Ktadmk

    Skills, Super Skills, and Ultra Skills Feb 09, 2023

    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/3I7rq3o The Infinite Game. By Simon Sinek: https://bit.ly/3XhMgBe Drive. By Daniel Pink: https://bit.ly/3XlhFCS Deep Work. By Cal Newport: https://bit.ly/3YyXD99 Switch. By Chip Heath & Dan Heath: https://amzn.to/3IaXQdc Mindset. By Carol Dweck: https://bit.ly/3XhXS7l Leonardo Da Vinci. By Walter Isaacson: https://bit.ly/40AmwmJ Range. By David Epstein: https://bit.ly/3jGZ1ro Essentialism. By Greg McKeown: https://bit.ly/3xruX6B Mastery. By Robert Greene: https://bit.ly/3RKjicc Linchpin. By Seth Godin: https://bit.ly/3jKBu8U

    Post ROSC Golden Hour Dec 15, 2022

    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/s00134-021-06368-4 Oxygen Targets in Comatose Survivors of Cardiac Arrest. BOX Trial: https://www.nejm.org/doi/full/10.1056/NEJMoa2208686 Blood-Pressure Targets in Comatose Survivors of Cardiac Arrest. BOX Trial: https://www.nejm.org/doi/full/10.1056/NEJMoa2208687 Books Mentioned in this Episode: SmartLess. One of Haney’s favorite podcasts: https://podcasts.apple.com/us/podcast/smartless/id1521578868 How to win Friends & Influence People. By Dale Carnegie: bit.ly/3VVlTRQ EMRAP. A leading educational platform recommended by Haney: https://www.emrap.org/

    Acute Metabolic Encephalopathies Nov 24, 2022

    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.13538 Neurocinema: When Film Meets Neurology. By Eelco Wijdicks: bit.ly/3tQfD1t Neurocinema- The Sequel. By Eelco Wijdicks: bit.ly/3GAQ9g4 Books Mentioned in this Episode: The Origin of Species. By Charles Darwin: bit.ly/3TY9Xgw Charles Darwin: A Biography Vol 1. By Janet Browne: bit.ly/3EoAi1e Charles Darwin: A Biography Vol 2. By Janet Browne: bit.ly/3XriSdm A New Biographical Dictionary of Film: Sixth Edition. By David Thomson: bit.ly/3U4XjMC

    Conflict Management in the ICU Nov 10, 2022

    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/s00134-022-06771-5 Center 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

    Acute Ischemic Stroke Sep 15, 2022

    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

    Tracheostomy Emergencies Aug 11, 2022

    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

    Dogma in Critical Care Jul 28, 2022

    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

    Death by Neurologic Criteria Jul 14, 2022

    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/

    Intubation & Hypotension Jun 30, 2022

    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

    Wonder Drug Jun 09, 2022

    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

    Toxicology in the ICU (Part 2) May 26, 2022

    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

    Toxicology in the ICU (Part 1) May 19, 2022

    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

    Neuroprognostication after Cardiac Arrest Apr 28, 2022

    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

    End of Life Care in the ICU (Encore) Apr 14, 2022

    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

    Practicing Respect in the ICU Mar 31, 2022

    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

    The Fearless ICU (Part 2) Mar 17, 2022

    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 Fearless ICU Feb 24, 2022

    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

    Severe Alcohol Withdrawal Feb 10, 2022

    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 Responsiveness Jan 27, 2022

    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/

    Every Deep-Drawn Breath: A Conversation with Wes Ely Jan 13, 2022

    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

    Point of Care Ultrasonography (POCUS) Dec 23, 2021

    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

    Surviving Sepsis Campaign Guidelines 2021 Dec 09, 2021

    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

    Severe Acute Pancreatitis Nov 11, 2021

    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

    Fluid BaSICS Oct 28, 2021

    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

    Ivermectin For COVID - 19 Oct 14, 2021

    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

    TTM Post-Cardiac Arrest Sep 09, 2021

    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

    Choosing Wisely for Critical Care Jul 08, 2021

    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

    Management Of The Difficult Airway Jun 24, 2021

    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

    Management Of Anaphylaxis Jun 10, 2021

    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

    Clinician Well-Being May 27, 2021

    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

    Judgment Under Uncertainty May 13, 2021

    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

    ICU Liberation COVID Mode Apr 22, 2021

    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

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

    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

    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

    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

    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

    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

    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

    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

    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

    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

    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

    Corticosteroids in COVID-19 ARDS Sep 10, 2020

    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

    Towards Personalized Vasopressor Support Aug 27, 2020

    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

    Racism In Healthcare Aug 13, 2020

    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

    COVID and ARDS - Back To Basics Jul 23, 2020

    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

    Pregnancy, Critical Care, And COVID - 19 Jul 02, 2020

    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

    The Pause Jun 11, 2020

    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

    AKI In COVID - 19 May 28, 2020

    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

    COVID - 19: Interrupting The VILI Vortex May 14, 2020

    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

    COVID - 19 Ethics During A Pandemic Apr 23, 2020

    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

    Mechanical Ventilation In COVID - 19 Apr 07, 2020

    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

    Rational Use Of PPE In COVID - 19 Mar 26, 2020

    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

    COVID - 19 Update Mar 12, 2020

    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

    Novel Coronavirus Feb 13, 2020

    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

    Use of Blood Products in the ICU Jan 23, 2020

    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

    Acute Severe Hypertension Jan 09, 2020

    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

    Outliers and Super Users: Targeting Prolonged Use of MV in the ICU Dec 26, 2019

    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

    POCUS For Shock Dec 12, 2019

    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

    Management of Intracerebral Hemorrhage Nov 28, 2019

    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

    Update On Cardiogenic Shock Nov 14, 2019

    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

    Vitamin C In Sepsis Oct 24, 2019

    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

    ICU Management of Acute Ischemic Stroke Oct 10, 2019

    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 In The ICU Sep 26, 2019

    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

    Personalization Of Vasopressor Therapy In The Treatment Of Vasodilatory Shock Sep 12, 2019

    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

    Disorders of Sodium and Water Balance in the ICU Aug 22, 2019

    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

    Neuromuscular Blockers In ARDS Aug 08, 2019

    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

    End of Life Care in the ICU Jul 25, 2019

    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

    Angiotensin II for Vasodilatory Shock: 2019 Update Jul 10, 2019

    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

    Critical Care of Neuromuscular Disorders Jun 17, 2019

    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

    Compassion in the ICU Jun 12, 2019

    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

    Toxicology in the ICU – Part 2 Jun 12, 2019

    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

    Toxicology in the ICU – Part 1 Jun 12, 2019

    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

    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

    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

    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

    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

    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

    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

    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

    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

    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.

    Initial Management Of ARDS Jun 12, 2019

    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

    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

    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

    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

    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

    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

    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

    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

    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

    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

    Medical Errors Jun 12, 2019

    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

    Noninvasive Ventilation (NIV) And High - Flow Oxygen Nasal Cannula Jun 12, 2019

    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

    Critical Care of the Cardiac Surgery Patient Jun 12, 2019

    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.

    Angiotensin II for Vasodilatory Shock Jun 12, 2019

    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

    From Everest To The ICU Jun 12, 2019

    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

    Practicing Respect in the ICU Jun 10, 2019

    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.

    Point-of-Care Ultrasound During Cardiac Arrest Jun 10, 2019

    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.

    Neuroprognostication after Cardiac Arrest Jun 10, 2019

    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.

    Critical Illness-Related Corticosteroid Insufficiency Jun 10, 2019

    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

    Vasopressor Update Jun 10, 2019

    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.

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