In this episode of, Dr. Sergio Zanotti explores the vital role of enteral nutrition in the ICU—a foundational element in the prevention and treatment of disease-related malnutrition among critically ill patients. He is joined by Dr. Leah Gramlich, a distinguished gastroenterologist and physician nutrition specialist from the Royal Alexandra Hospital in Alberta, Canada. Dr. Gramlich is a Professor of Medicine at the University of Alberta and the founding president of the Canadian Nutrition Society. She has also served on the Board of Directors for the American Society for Parenteral and Enteral Nutrition and chaired the Canadian Malnutrition Task Force, bringing deep expertise to this essential topic. Additional resources: Enteral Nutrition in Hospitalized Adults. Lead Gramlich, Peggi Guenter. New Engl J Med 2025: https://pubmed.ncbi.nlm.nih.gov/40239069/ Individualized nutritional support in medical inpatients at nutritional risk: a randomized clinical trial. The EFFORT Clinical Trial. Lancet 2019: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(18)32776-4/abstract Low versus standard calorie and protein feeding in ventilated adults with shock: a randomised, controlled, multicentre, open-label, parallel-group trial (NUTRIREA-3). Lancet Respir Med 2023: https://pubmed.ncbi.nlm.nih.gov/36958363/ The effect of higher protein dosing in critically ill patients with high nutritional risk (EFFORT Protein): an international, multicentre, pragmatic, registry-based randomised trial. Lancet 2023: https://pubmed.ncbi.nlm.nih.gov/36708732/ Books mentioned in this episode: The Overstory: A Novel. By Richard Powers: https://bit.ly/43Drra1

In this episode, Dr. Zanotti discusses the science of hope. He's joined by Dr. Stephen Trzeciak, a physician-scientist, the Edward D. Viner Endowed Chief of Medicine at Cooper University Health Care, and Professor and Chair of Medicine at Cooper Medical School of Rowan University in Camden, New Jersey. Dr. Trzeciak is a practicing intensivist and a clinical researcher with more than 100 publications in the scientific literature. In addition, he is co-author of two excellent books: Wonder Drug: 7 Scientifically Proven Ways That Serving Others Is the Best Medicine for Yourself (2022) and Compassionomics: The Revolutionary Scientific Evidence that Caring Makes a Difference (2019). Additional resources: Recovery Expectations and Long-term Prognosis of Patients with Coronary Heart Disease Barefoot JC, et al. JAMA Internal Medicine 2011: https://pubmed.ncbi.nlm.nih.gov/21357800/ Optimism and Rehospitalization After Coronary Artery Bypass Graft Surgery. Scheler MF, et al. JAMA Int Med 1999: https://pubmed.ncbi.nlm.nih.gov/10219928/ The median is not the message. By Jay Gould: https://journalofethics.ama-assn.org/sites/joedb/files/2018-05/mnar1-1301.pdf Books mentioned in this episode: Man’s Search for Meaning. By Viktor E. Frankl: https://bit.ly/3SqsNyt Wonder Drug: 7 Scientifically Proven Ways That Serving Others Is the Best Medicine for Yourself. By Stephen Trzeciak and Anthony Mazzarelli: https://bit.ly/4kiyA5q Compassionomics: The Revolutionary Scientific Evidence that Caring Makes a Difference. By Stephen Trzeciak and Anthony Mazzarelli: https://bit.ly/43ul5IE

In this episode, Dr. Sergio Zanotti discusses rational fluid therapy. He is joined by Dr. Adrian Wong, a practicing intensive care medicine and anesthesia physician. Dr. Wong is a consultant and clinical lead at King’s College Hospital, London. He also serves as a committee member for the Intensive Care Society FUSIC, examiner for the European Diploma of Intensive Care Medicine, on the executive committee of the International Fluid Academy. Additional resources: Intravenous fluid therapy in the perioperative and critical care setting” Executive summary of the International Fluid Academy (IFA). Malbrain ML, et al. Ann. Intensive Care 2020: https://pubmed.ncbi.nlm.nih.gov/32449147/ Multidisciplinary expert panel report on fluid stewardship: perspectives and practice. Malbrain ML, et al. Annals of Intensive Care 2023: https://pubmed.ncbi.nlm.nih.gov/37747558/ The emerging concept of fluid tolerance: A position paper. Kattan E, et al. Journal of Critical Care 2022: https://pubmed.ncbi.nlm.nih.gov/35660844/ Everything you need to know about derescuscitation. Malbrain ML, et al. Intensive Care Med 2022: https://pubmed.ncbi.nlm.nih.gov/35932335/ Start with Why. TED Talk presented by Simon Sinek: https://simonsinek.com/videos/ted-talks/ Books mentioned in this episode: Thinking Fast and Slow. By Daniel Kahneman: https://amzn.to/4hicUoj Start with Why: How Great Leaders Inspire Everybody to Take Action. By Simon Sinek: https://bit.ly/42hzt8n

In this episode of Critical Matters, we discuss pregnancy, critical care, and COVID-19. Our guest is Dr. Cesar Padilla. Dr. Padilla is an attending physician in the Department of Intensive Care and Resuscitation in the Cleveland Clinic in OHIO. He is a practicing anesthesia critical care physician with additional expertise and training in obstetric anesthesia. He is extremely interested in promoting better care of obstetrical patients requiring critical care and has worked in this area extensively from the clinical, educational, and research perspective. Additional Resources: Articles on Critical Care and Pregnancy by Dr. Padilla: - https://bit.ly/2BTHFkZ - https://bit.ly/2YKBrwH Development of a Comorbidity Index for Use in Obstetric Patients: https://bit.ly/38gtvq1 CDC COVID-19 and Pregnancy Resource Page: https://bit.ly/31v9XwH Articles by Dr. Padillas on KevinMD.com: https://bit.ly/31zIl9M Previous episodes on pregnancy and critical care: - https://bit.ly/2YPjld4 - https://bit.ly/38g5f7k Books Mentioned in this Episode: Twelve Rules for Life: An Antidote to Chaos by Jordan B. Peterson: https://amzn.to/2Zo8nu2

In this episode of Critical Matters, we discuss challenges related to providing compassionate patient aligned care in the intensive care unit within the frame of COVID-19. We also explore “The Pause”, a simple yet innovative practice with the power to transform our practices. Our guest is Dr. Silvia Perez Protto, an anesthesia and critical care attending at the Cleveland Clinic. Dr. Perez Protto is a faculty member of the Department of Intensive Care and Resuscitation and is the Medical Director for the End of Life Center at the Cleveland Clinic. Additional Resources: Empathy: The Human Connection to Patient Care: https://bit.ly/3hiRWHk The Pause (for iPhone: https://apple.co/2zqzGei The Pause (for Android: https://bit.ly/3fislgd The Conversation Project: https://bit.ly/3cRjMaj New York Times - “An Incalculable Lost”: https://nyti.ms/2MOipyQ Books Mentioned in this Episode: When Breath Becomes Air by Paul Kalanithi: https://amzn.to/2YgjVPe Outliers by Malcolm Gladwell: https://amzn.to/3hdy3l3 The Tipping Point: How Little Things Can Make a Big Difference by Malcolm Gladwell: https://amzn.to/37hJJyC

In this episode of the Critical Matters, we will discuss acute kidney injury (AKI) in patients with COVID-19. Our guest is Dr. Claudio Ronco, a thought leader in the field of acute kidney injury and nephrology critical care. Dr. Ronco is professor of Nephrology at the University of Padua. Dr. Ronco is also Director of the Department of Nephrology Dialysis & Transplantation and of the International Renal Research Institute (IRRIV) at San Bortolo Hospital in Vicenza, Italy. Additional Resources: Acute Kidney Injury: https://bit.ly/3daKxaD Management of Acute Kidney Injury in Patients with COVID-19: https://bit.ly/3daKyLJ Extracorporeal Blood Purification and Organ Support in the Critically Ill Patient During COVID-19 Pandemic: Expert Review and Recommendation: https://bit.ly/3c6fxre Video - Cappuccino with Claudio Ronco: https://bit.ly/2B5X3dr Books Mentioned in this Episode: Carpediem by Claudio Ronco: https://amzn.to/3ekVMxm From Fish to Philosopher by Homer W. Smith: https://amzn.to/3c8j8F9

In this episode of Critical Matters, we continue our exploration and discussion on respiratory support and mechanical ventilation with COVID-19. Our guest is Dr. John J. Marini, a thought leader in the field of critical care. Dr. Marini is Director of Academic Programs in Research and Education for the Department of Medicine of the Regions Hospital in St. Paul, Minnesota. In most of his research, he has positioned himself at the interface between basic physiology and clinical medicine to develop insights into advancing clinical practice. In this episode, he discusses evolving concepts related to ventilator-induced lung injury and how they apply to respiratory support in patients with COVID-19. Additional Resources: Management of COVID-19 Respiratory Distress: https://bit.ly/2WuwFCw Time Course of Evolving Ventilator-Induced Lung Injury: https://bit.ly/2YVyEkO Static and Dynamic Contributors to Ventilator-induced Lung Injury in Clinical Practice. Pressure, Energy, and Power: https://bit.ly/360Fmr5 Books Mentioned in this Episode: Nunn's Applied Respiratory Physiology by Andrew B. Lumb: https://amzn.to/2UQLeiX The Discoverers by DJ Boorstin: https://amzn.to/2yTnL8u Why Not Say it Clearly: A Guide to Scientific Writing by LS King.: https://amzn.to/2WV6tzI

In this episode of Critical Matters, we discuss ethical issues related to the COVID-19 pandemic. Our guest is Arthur L. Caplan, Ph.D. Dr. Caplan is the director of the Division of Medical Ethics at New York University Langone Medical Center and School of Medicine. He is the author and editor of 35 books and 750 peer-reviewed articles. Dr. Caplan is a recognized thought leader and expert in the field of medical ethics. Additional Resources: WHO – Guidance to Managing Ethical Issues in Infectious Disease Outbreaks: https://bit.ly/3bwhqOe Ethics of Outbreaks Position Statement. Part 1: Therapies, Treatment Limitations, and Duty to Treat: https://bit.ly/2Vs8i7G Ethics of Outbreaks Position Statement. Part 2: Family-Centered Care: https://bit.ly/3cQngun Fair Allocation of Scarce Medical Resources in the Time of COVID-19: https://bit.ly/2VRX1fQ Books Mentioned in this Episode: Plato: Five Dialogues by Plato: https://amzn.to/3bum1Rf Benjamin Franklin: An American Life by W. Isaacson: https://amzn.to/2VOpGTg Poor Richard’s Almanac by B. Franklin: https://amzn.to/2XUQqnK

On this episode of Critical Matters, we will focus on respiratory support and mechanical ventilation with COVID-19. Our guest is Dr. Luciano Gattinoni, a thought leader in the field of critical care. Dr. Gattinoni introduced the concept of lung rest by extracorporeal CO2 removal in acute respiratory failure. He pioneered the use of thoracic CT in ARDS, which culminated in the "baby lung", lung recruitability, and Mechanical Power concepts. His research is focused on the pathophysiology and treatment of acute respiratory failure, including prone positioning, sepsis and acid-based disorders. Dr. Gattinoni has published more than 400 research articles and reviews in peer-reviewed journals. Additional Resources: COVID-19 Does Not Lead to a “Typical” Acute Respiratory Distress Syndrome: https://bit.ly/3e2cNNw COVID-19 Pneumonia: Different Respiratory Treatment for Different Phenotypes?: https://bit.ly/2URaCFd Books Mentioned in this Episode: Siddharta by Herman Hess: https://amzn.to/3bXi6vP The Prince by Nicolo Machiaveli: https://amzn.to/2RjyOho Nunn's Applied Respiratory Physiology: https://amzn.to/2UQLeiX The Pathway for Oxygen by M.D. Edwald R. Weibel: https://amzn.to/2yKpNrf Clinical Physiology of Acid-Base and Electrolyte Disorders by Burton Rose and Theodore Post: https://amzn.to/3e2dDdh

In this episode of Critical Matters, we continue to discuss issues related to the COVID- 19 pandemic. The numbers of cases continue to rapidly climb in the US and the world. There are serious concerns for adequate supplies of personal protective equipment for clinicians. In today’s episode we talk about the rational use of personal protective equipment. We try to focus on facts over fear. The discussion is an excerpt from a webinar Dr. Zanotti presented to Sound's national group of clinicians. Additional Resources: World Health Organization (WHO)- Updated Guidance on PPE for COVID-19: https://bit.ly/3aenLxf; https://bit.ly/3dr1pul Centers for Disease Control (CDC) - Guidance on PPE for COVID-19: https://bit.ly/2UBG1tN COVID-19 and the Risk to Health Care Works: A Case Report: https://bit.ly/3bkcdsm Aerosol and Surface Stability of SARS-CoV-2 as Compared with SARS-CoV-1: https://bit.ly/2WMfLzB Keep the Coronavirus from Infection Health-Care Workers: https://bit.ly/3buvHuj Books Mentioned in this Episode: Man's Search for Meaning by Victor Frankl: https://amzn.to/3dtoMn0

In this episode of Critical Matters, we provide an update on the COVID-19 epidemic. As the epidemic continues to spread at a rapid pace around the world new information and guidance from health care authorities is coming at a furious pace. Our guest is Dr. Raquel Nahra, a critical care and infectious disease specialist. Dr. Nahra is faculty at the Cooper Medical School of Rowan University. In addition to her clinical roles, Dr. Nahra is the Hospital Epidemiologist at Cooper University Hospital in Camden NJ. Additional Resources: World Health Organization (WHO) - Coronavirus Updates: http://bit.ly/2UJKj4b Centers for Disease Control (CDC) - 2019-nCoV Resources and Information: http://bit.ly/2OMGsPO Lancet - Articles and Clinical Information on 2019-nCoV: http://bit.ly/3bxyiEE Johns Hopkins University HUB - Novel Coronavirus Information http://bit.ly/39xETxn Books Mentioned in this Episode: The Obstacle is the Way: The Timeless Art of Turning Trials Into Triumph by Ryan Holliday: https://amzn.to/3aKSGkE

In this episode of Critical Matters we discuss the outbreak of a novel coronavirus (2019-nCoV), a rapidly evolving epidemic that originated in China and now declared a health care emergency by the World Health Organization (WHO). In this episode, we discuss current understanding regarding the virus and its clinical impact. Our guest is Dr. Raquel Nahra, a critical care and infectious disease specialist. Dr. Nahra is faculty at the Cooper Medical School of Rowan University. In addition to her clinical roles, Dr. Nahra is the Hospital Epidemiologist at Cooper University Hospital in Camden NJ. Additional Resources: World Health Organization (WHO) - Coronavirus Status Updates: http://bit.ly/2UJKj4b Centers for Disease Control (CDC)- Resources and Information on 2019-nCoV: http://bit.ly/2OMGsPO Lancet - Articles and Clinical Information on 2019-nCoV: http://bit.ly/3bxyiEE Johns Hopkins University - Novel Coronavirus Information: http://bit.ly/39xETxn Jama Network - Clinical Characteristics of 138 Hospitalized Patients With 2019 Novel Coronavirus–Infected Pneumonia in Wuhan, China: http://bit.ly/2SAKOL8 Books Mentioned in this Episode: Waiting for Godot: A Tragicomedy in Two Acts by Samuel Beckett: https://amzn.to/2HhnUD8

Transfusion of blood product is common in the intensive care unit. Blood product transfusions can be associated with complications and are often given in situations without a clear cut indication. In this episode of Critical Matters, we will discuss current evidence and proper use of blood products in the ICU. Our guest is Dr. Janice Zimmerman an adjunct Professor of Medicine at Baylor College of Medicine and president of the World Federation of Societies of Intensive and Critical Care Medicine. Additional Resources: A multicenter, randomized, controlled clinical trial of transfusion requirements in critical care. Transfusion Requirements in Critical Care Investigators, Canadian Critical Care Trials Group: http://bit.ly/37myULa Restrictive or Liberal Red-Cell Transfusion for Cardiac Surgery: http://bit.ly/2Go4NHn Liberal versus restrictive transfusion thresholds for patients with symptomatic coronary artery disease: http://bit.ly/2umO6sK Lower versus higher hemoglobin threshold for transfusion in septic shock: http://bit.ly/38xcoPx Transfusion strategies for acute upper gastrointestinal bleeding: http://bit.ly/37mzbOc Clinical Practice Guidelines From the AABB: Red Blood Cell Transfusion Thresholds and Storage: http://bit.ly/38zoQyB Books Mentioned in this Episode: Exodus: A Novel of Israel by Leon Uris: https://amzn.to/2Rgeiyh Texas: A Novel by James Michener: https://amzn.to/38qJfWn Oh, the Places You'll Go! by Dr. Seuss: https://amzn.to/30FMPZY

This episode of Critical Matters will close 2024 with a year in review. Dr. Sergio Zanotti is going solo and will discuss a couple of relevant clinical guidelines and review five clinical trials. To close, he'll share some of his favorite books for 2024. Additional Resources: Critical Care Management of Patients Post Cardiac Arrest (AHA/NCS): Hirsch KG, Abella BS, Amorim E, et al. Critical Care Management of Patients After Cardiac Arrest: A Scientific Statement from the American Heart Association and Neurocritical Care Society. Neurocrit Care. 2024;40(1):1-37: https://bit.ly/4087o1w 2024 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations: Summary From the Basic Life Support; Advanced Life Support; Pediatric Life Support: Neonatal Life Support; Education, Implementation, and Teams; and First Aid Task Forces. Circulation 2024: https://bit.ly/4fD4o1R PREOXI Trial. Gibbs KW, Semler MW, Driver BE, et al. Noninvasive Ventilation for Preoxygenation during Emergency Intubation. N Engl J Med. 2024;390(23):2165-2177. doi:10.1056/NEJMoa2313680: https://bit.ly/4fD4pCX AMIKINHAL Trial. Ehrmann S, Barbier F, Demiselle J, et al. Inhaled Amikacin to Prevent Ventilator-Associated Pneumonia. N Engl J Med. 2023;389(22):2052-2062. doi:10.1056/NEJMoa2310307: https://bit.ly/4iQQvzU REVISE Trial. Cook D, Deane A, Lauzier F, et al. Stress Ulcer Prophylaxis during Invasive Mechanical Ventilation. N Engl J Med. 2024;391(1):9-20. doi:10.1056/NEJMoa2404245: https://bit.ly/3Pc4nqH TIGHT K Trial. O'Brien B, Campbell NG, Allen E, et al. Potassium Supplementation and Prevention of Atrial Fibrillation After Cardiac Surgery: The TIGHT K Randomized Clinical Trial. JAMA. 2024;332(12):979-988. doi:10.1001/jama.2024.17888: https://jamanetwork.com/journals/jama/fullarticle/2823246 BALANCE Trial. Daneman N, Rishu A, et al. Antibiotic Treatment for 7 versus 14 Days in Patients with Bloodstream Infections. N Engl J Med. Published online November 20, 2024. doi:10.1056/NEJMoa2404991: https://www.nejm.org/doi/abs/10.1056/NEJMoa2404991 CMD Study. Bodien YG, Allanson J, Cardone P, et al. Cognitive Motor Dissociation in Disorders of Consciousness. N Engl J Med. 2024;391(7):598-608. doi:10.1056/NEJMoa2400645: https://www.nejm.org/doi/full/10.1056/NEJMoa2400645 Books Mentioned in this Episode: Slow Productivity: The Lost Art of Accomplishment Without Burnout. By Cal New Port: https://amzn.to/4gTbkJ2 Meditations for Mortals: Four Weeks to Embrace Your Limitations and Make Time for What Counts. By Oliver Burkeman: https://bit.ly/4gURU6N Knife: Meditations After an Attempted Murder. By Salman Rushdie: https://bit.ly/3ZPsAIt

In this episode of Critical Matters, we will discuss the latest evidence, the proper management and potential pitfalls of acute severe hypertension. Our guest is Dr. Aldo Peixoto. Dr. Peixoto is Professor of Medicine in the Section of Nephrology at the Yale University School of Medicine. He is also Vice Chair for Quality & Safety (Department of Internal Medicine) and Clinical Chief of the Section of Nephrology. Additional Links: Most recent US guidelines for the diagnosis and treatment of hypertension: http://bit.ly/39XlOFJ European position paper on management of hypertensive emergency: http://bit.ly/35G8eTT Severe Hypertension: http://bit.ly/2shwldW Books Mentioned in this Episode: Blindness by Jose Saramago: https://amzn.to/30863ak Portuguese Irregular Verbs by Alexander McCall Smith: https://amzn.to/35ARai4

In this episode of Critical Matters, listen to the recording of the Sound Critical Care’s latest webinar, Outliers and Super Users: Targeting Prolonged Use of MV in the ICU. Critically ill patients requiring prolonged mechanical ventilation have poor clinical outcomes and consume a disproportionate amount of resources. In this webinar, we will discuss outliers and super users in the ICU utilizing prolonged mechanical ventilation as a case study. We will also discuss outcomes for these patients and finally strategies to optimize the care of this difficult patient population. Watch the video recording: http://bit.ly/2MHL4Ga Additional Resources: The Hot Spotters by Atul Gawande: http://bit.ly/36lUdvT I-TRACH: Validating A Tool for Predicting Prolonged Mechanical Ventilation: http://bit.ly/2SEcOPy Expectations and outcomes of prolonged mechanical ventilation: http://bit.ly/2QbBDRp Long-term survival of critically ill patients treated with prolonged mechanical ventilation: a systematic review and meta-analysis: http://bit.ly/2tjQgJu Lean Six Sigma to Reduce Intensive Care Unit Length of Stay and Costs in Prolonged Mechanical Ventilation: http://bit.ly/359bYwV

Point-of-care ultrasound continues to grow in availability and is now embedded in many critical care practices. In this episode Critical Matters, we discuss the use of point-of-care ultrasound (POCUS) in the management of hypotension and shock. Our guest is Dr. Haney Mallemat a recognized educator with a strong interest in POCUS. Dr. Mallemat holds dual academic appointments in Critical Care Medicine and Emergency Medicine at Cooper Medical School of Rowan University. Additional Resources: Bedside ultrasound in resuscitation and the rapid ultrasound in shock protocol: http://bit.ly/359RkgX The Society of Point of Care Ultrasound: http://bit.ly/2senLMJ Guidelines for the Appropriate Use of Bedside General and Cardiac Ultrasonography in the Evaluation of Critically Ill Patients—Part II: Cardiac Ultrasonography: http://bit.ly/35b1D4r Does Point-of-Care Ultrasonography Improve Clinical Outcomes in Emergency Department Patients With Undifferentiated Hypotension? An International Randomized Controlled Trial From the SHoC-ED Investigators: http://bit.ly/2Ehzhd3 Rebel Cast Ep 58 - Would you be SHoC-ED if POCUS did not Improve Clinical Outcomes in Patients with Undifferentiated Shock?: http://bit.ly/345uq93 Clinical significance of portal hypertension diagnosed with bedside ultrasound after cardiac surgery: http://bit.ly/2LFJ7sY Education Conferences: UltraRounds: http://bit.ly/2RAgkdk ResusX: http://bit.ly/2t86q8J Music Mentioned in this Episode: The Joshua Tree by U2: https://amzn.to/2sYlOnM

Intracerebral hemorrhage (ICH) affects more than one million people annually, worldwide, and is the deadliest and most disabling type of stroke. In this episode of Critical Matters we will discuss the critical care management of ICH. Our guest is Dr. Sayona John, Associate Professor in the Department of Neurological Sciences at Rush Medical College. She is a practicing neurointensivist and also serves as the Head of the Section of Critical Care Neurology and Medical Director of the Neuroscience Intensive Care Unit & Neuroemergency Transfer programs at Rush University Medical Center in Chicago. Additional Resources: AHA 2015 Guidelines for the Management of Spontaneous Intracerebral Hemorrhage: http://bit.ly/33ovvZo The ICH score: a simple, reliable grading scale for intracerebral hemorrhage: http://bit.ly/2rsRh0G ICH Score Calculator: http://bit.ly/2OotfNx Music Mentioned in this Episode: Brother in Arms by Dire Straits: https://amzn.to/34pMxYj Money for Nothing by Dire Straits: http://bit.ly/34pAWZ9

Cardiogenic shock (CS) is a common cause of mortality, and its management remains challenging despite significant advances in treatment options. In this episode of Critical Matters, we discuss basic concepts, a new proposed classification, and updates on the medical management of patients with cardiogenic shock. Our guest is Dr. Steve Hollenberg, a practicing cardiologist with dual training in cardiology and critical care medicine. Dr. Hollenberg is a Professor of Medicine at Hackensack Meridian School of Medicine at Seton Hall University and Associate Director of the CTICU at Hackensack Meridian University Hospital. Additional Resources: The paramedian lumbar puncture: http://bit.ly/2pk8JUw Contemporary Management of Cardiogenic Shock: A Scientific Statement From the American Heart Association: http://bit.ly/2Qdjoey SCAI clinical expert consensus statement on the classification of cardiogenic shock: http://bit.ly/2XdjeWa SCAI stages of cardiogenic shock stratify mortality risk: http://bit.ly/2CCzbf9 Books Mentioned in this Episode: Ulysses by James Joyce: https://amzn.to/2QgIoBW Gravity’s Rainbow by Thomas Pynchon: https://amzn.to/36Vgjps The Elements of Style by E. B. White: https://amzn.to/2QdklUa The Little Prince by Antoine de Saint-Exupéry https://amzn.to/352frOi

In this episode of Critical Matters, we will discuss the recently published CITRIS-ALI clinical trial evaluating the role of high dose Vitamin C in severe sepsis and ARDS. Our guest is Dr. Emily Brant. Dr. Brant is a practicing intensivist and faculty at the University of Pittsburgh Medical Center. She was the lead author in the JAMA editorial entitled “Is High-Dose Vitamin C Beneficial for Patients with Sepsis?” which was published alongside the CITRIS-ALI Clinical Trial. Additional Resources: Is High-Dose Vitamin C Beneficial for Patients with Sepsis?: http://bit.ly/2nWKoDp Effect of Vitamin C Infusion on Organ Failure and Biomarkers of Inflammation and Vascular Injury in Patients With Sepsis and Severe Acute Respiratory Failure: The CITRIS-ALI Randomized Clinical Trial: http://bit.ly/31s0QcD Hydrocortisone, Vitamin C, and Thiamine for the Treatment of Severe Sepsis and Septic Shock: A Retrospective Before-After Study: http://bit.ly/2pBs433 Phase I safety trial of intravenous ascorbic acid in patients with severe sepsis: http://bit.ly/2Bl523c Books Mentioned in this Episode: Becoming by Michelle Obama: https://amzn.to/2MvHRd3

Acute ischemic stroke is a leading cause of morbidity and mortality worldwide. Intensive care management of strokes is focused on reducing complications related to reperfusion treatment and decreasing secondary neurological injury. In this episode of Critical Matters, we will discuss the critical care management of acute ischemic strokes. Our guest is Dr. Sayona John, Associate Professor in the Department of Neurological Sciences at Rush Medical College. She is a practicing neurointensivist and also serves as the Head of the Section of Critical Care Neurology and Medical Director of the Neuroscience Intensive Care Unit & Neuroemergency Transfer programs at Rush University Medical Center in Chicago. Additional Resources: AHA 2018 Guidelines for the Early Management of Patients With Acute Ischemic Stroke: http://bit.ly/30TJkxL Educational video on performing the NIH Stroke Scale: http://bit.ly/2opldcZ Link to a pdf document with the NIH Stroke Scale: http://bit.ly/2LVtWMV How to do a four-minute neurological examination: http://bit.ly/328IXRr Books Mentioned in this Episode: Lincoln's Hundred Days: The Emancipation Proclamation and the War for the Union by Louis P. Masur: https://amzn.to/2VlTTse

Acute abdominal complications developing in critically ill patients in the ICU can be associated with significant morbidity and mortality. In this episode of Critical Matters, we discuss a variety of acute abdominal complications such as abdominal compartment syndrome, acalculous cholecystitis, toxic megacolon and ischemic bowel. Our guest is Dr. Samuel Tisherman. Dr. Tisherman is a surgical critical care physician at the R Adams Cowley Shock Trauma Center, University of Maryland Medical Center and a Professor of Surgery at the University of Maryland School of Medicine. Additional Resources: World Society of Abdominal Compartment Syndrome (WSACS) consensus definitions and recommendations: https://bit.ly/2l9m6EQ Acute Acalculous Cholecystitis: A Review. Huffman J, Schenker S. Clinical Gastroenterology and Hepatology: https://bit.ly/2nfssTL Ogilvie’s Syndrome: Management and Outcomes. Haj, M et al. Medicine: https://bit.ly/2mKLVM5 Books Mentioned in this Episode: Complications: A Surgeon’s Note on an Imperfect Science. By Atul Gawande: https://amzn.to/2laETzB

In this episode of Critical Matters, listen to the recording of Sound Critical Care’s webinar, Personalized Selection of Vasopressors in the Treatment of Shock. Our guest for this episode is Dr. Lakhmir Chawla, Chief Medical Officer of La Jolla Pharmaceutical in San Diego, California. During this webinar, we discuss lessons learned from the clinical use of the new vasopressor Angiotensin II, as well as personalization of vasopressor therapy in the treatment of vasodilatory shock. Watch the video recording: https://bit.ly/2jZ1z5h

Hyponatremia and hypernatremia are common in ICU patients and they are associated with increased morbidity and mortality. In this episode of Critical Matters, we discuss the diagnostic approach and treatment of sodium disorders in the ICU. Our guest is Dr. Lawrence Weisberg, Head of the Division of Nephrology and Deputy Chair of Medicine at Cooper University Health Care. Dr. Weisberg is also Professor of Medicine and Assistant Dean for Curriculum at the Cooper Medical School of Rowan University, in Camden, New Jersey. Additional Resources: Disorders of Plasma Sodium - Causes, Consequences, and Correction: https://bit.ly/2TT9SNB Rate of Correction of Hypernatremia and Health Outcomes in Critically Ill Patients: https://bit.ly/2P2wxrY Evidence for Managing Hypernatremia: Is It Just Hyponatremia in Reverse?: https://bit.ly/2HjZn0S Books Mentioned in this Episode: From Fish to Philosopher; the Story of our Internal Environment by Homer William Smith: https://amzn.to/30nrraU Operating Manual for Spaceship Earth by R. Buckminster Fuller: https://amzn.to/2Z6coWt Critical Path by R. Buckminster Fuller: https://amzn.to/2MA9vH9

In this episode Dr. Zanotti discusses the current role of pulmonary artery catheters in critical care medicine. He is joined by Dr. Steven Hollenberg a critical care and cardiology physician. Dr. Hollenberg is a professor of medicine at Emory University School of Medicine and director of cardiac intensive care at the Emory Heart & Vascular Center. Additional resources: Pulmonary Artery Catheter Use and Risk of In-hospital Death in Heart Failure Cardiogenic Shock. Kanwar MK, et al. J Card Fail. 2023 Sep;29(9):1234-1244: https://pubmed.ncbi.nlm.nih.gov/37187230/ Pulmonary Artery Catheter Use and Mortality in the Cardiac Intensive Care Unit. Bernard S Kadosh, et al. JACC Heart Failure 2023: https://pubmed.ncbi.nlm.nih.gov/37318422/ Complete Hemodynamic Profiling With Pulmonary Artery Catheters in Cardiogenic Shock Is Associated With Lower In-Hospital Mortality. A Reshad Garan, et al. JACC Heart Failure 2020: https://pubmed.ncbi.nlm.nih.gov/33121702/ Right Heart Catheterization in Cardiogenic Shock Is Associated With Improved Outcomes: Insights From the Nationwide Readmissions Database. Sagar Ranka, et al. J Am Heart Assoc 2021: https://pubmed.ncbi.nlm.nih.gov/34423652/ Books mentioned in this episode: I Contain Multitudes: The Microbes Within Us and a Grander View of Life. By Ed Yong: https://www.amazon.com/Contain-Multitudes-Microbes-Within-Grander/dp/0062368605/ref=sr_1_1?crid=1EVOY6OVQZ437&dib=eyJ2IjoiMSJ9.Na-UJShWq7ngsH9dxvSV2Q.Ob-k26_k01p5WzKzo4CWnsvD4Jjq9RU1krhQhmUi9u4&dib_tag=se&keywords=I+contain+platitudes&qid=1732299607&sprefix=i+contain+platitudes%2Caps%2C132&sr=8-1 Kind of Blue. Miles Davis: https://www.amazon.com/Kind-Blue-Vinyl-Miles-Davis/dp/B0041TM5OU/ref=sr_1_2?crid=E6F0PBPV33BG&dib=eyJ2IjoiMSJ9.4Kk2sCHn8DAOl9j_qadqsZPMVZPlOuKNXg9vv_NTPEYrl10vHYNIC5-wrGJeFpn9K8rSS8aspG9zhJHjAyDqiIUiC9VKvvHjzQsAGmr4wP9VWUPWumInjcS72CDmoaEYr3h2Uoiy8yt-YfYFHm7Y-6XoPecnwju8_zumwohrrhYWC0X6rR8Ui3Xhp6ILDU3sBNb50TJ6iq_fjataiHX7X6fBL1YnUo3X-uBcnQVfKtc.v-zGaYaLVvE7BGxS1c-2_Brbwsq1kAxVKEuxqsaBci8&dib_tag=se&keywords=Miles+Davis+Kind+of+Blue&qid=1732299762&sprefix=miles+davis+kind+of+blue%2Caps%2C139&sr=8-2 Brahms: Ein Deutsches Requiem. Sir Simon Rattle: https://www.amazon.com/Brahms-Ein-Deutsches-Requiem-German/dp/B000MTEDIE/ref=sr_1_5?crid=2UCHLINLHSETV&dib=eyJ2IjoiMSJ9.aDG2ZKyB5OnEgO3Z6_VOsNplIVSXmtXffLy2Jrylq4vgaRHEYDyBsz_4YG1fE_88IJxJ2ScnxhBvvDkVZjauoazwhTEMef0o_nJN25zUb_7oXFNkPMo_U4WBLhgK5njVOkm2ae67weI5roWsx-KbokunvjgAf-tXngA30o2xDQxh0-9y0kJbJRdKtVY63PcPv3yp9YdOrpgo2PO-gpspQsio7uJ-dgz5SY1vX1je3U4.aMm-IxbuxnZSIacaIBGZWc36GYliQP4r-9f9-SBq5tQ&dib_tag=se&keywords=Brahms+requiem&qid=1732299866&sprefix=brahms+requiem%2Caps%2C142&sr=8-5e

In this episode of Critical Matters, we will discuss the role of early neuromuscular blockers in the treatment of severe ARDS. Our guest is Dr. Arthur Slutsky, Professor of Medicine, Surgery and Biomedical Engineering at the University of Toronto. Dr. Slutsky is a world-renowned clinician and investigator with a special interest in ARDS. We will review a recently published clinical trial and discuss its result within the context of available evidence. Additional Resources: Neuromuscular Blockers in Early Acute Respiratory Distress Syndrome: https://bit.ly/2YwXxnG Neuromuscular Blocking Agents in ARDS: https://bit.ly/2KmMZiA Early Neuromuscular Blockade in the Acute Respiratory Distress Syndrome: https://bit.ly/2ROMJea Early Paralytic Agents for ARDS? Yes, No, and Sometimes: https://bit.ly/2ZONDuB Books Mentioned in this Episode: Nudge: Improving Decisions About Health, Wealth and Happiness by Richard H. Thaler and Cass R. Sunstein: https://amzn.to/2Kv75pD Misbehaving: The Making of Behavioral Economics by Richard H. Thaler: https://amzn.to/2YRm5Dc Bad Blood: Secrets and Lies in a Silicon Valley Startup by John Carreyrou: https://amzn.to/2MPDjyN

One in five US residents receives ICU care at the end of life. In this episode of Critical Matters, we discuss different aspects of end of life care in the ICU. Our guest is Dr. BJ Miller, a palliative care physician at the University of California, San Francisco and former Executive Director of Zen Hospice Project. He is a powerful advocate for the role of our senses, community, and presence in delivering palliative care and for ushering in a new perspective on living with death. Additional Resources: What really matters at the end of life, BJ Miller presented at TED 2015: https://bit.ly/1PlAuNP Clinician-Family Communication About Patients' Values and Preferences in Intensive Care Units. Scheunemann LP et al, JAMA Internal Medicine, 2019: https://bit.ly/2LEH0Y5 A Beginner's Guide to the End: Practical Advice for Living Life and Facing Death. BJ Miller and Shoshana Berger: https://amzn.to/30VVWEV Vital Talk courses, a set of online and in person courses designed to equip clinicians with the tools to have difficult conversations with patients and families:https://bit.ly/30SPrm6 Books Mentioned in this Episode: Man’s Search for Meaning by Viktor Frankl: https://amzn.to/2JPJjFQ Mortally Wounded: Stories of Soul Pain, Death and Healing by Michael Kearney: https://amzn.to/2YkDPuF Bering Mortal: Medicine and What Matters in the End by Atul Gawande: https://amzn.to/2GsTXjH The Denial of Death by Ernest Becker: https://amzn.to/2SyY7LI

In this episode of Critical Matters, we discuss lessons learned from the clinical use of Angiotensin II (GIAPREZA™), which was approved for use in patients with vasodilatory shock a little over a year ago. Our guest is Dr. Lakhmir S. Chawla, Chief Medical Officer of La Jolla Pharmaceutical in San Diego, California. Dr. Chawla was the designer and lead investigator of the ATHOS (Angiotensin II for the Treatment of High Output Shock) trial which results led to the ATHOS 3 trial, (The Phase 3 clinical trial of angiotensin II, for the treatment of catecholamine-resistant hypotension). ADDITIONAL RESOURCES: ATHOS-3 Clinical Trial. Randomized controlled trial evaluating the efficacy of Angiotensin II in raising blood pressure in vasodilatory shock: https://bit.ly/2r5SpG0 Outcomes in Patients with Vasodilatory Shock and Renal Replacement Therapy Treated with Intravenous Angiotensin II: https://bit.ly/2JttWTj Sensitivity to angiotensin II dose in patients with vasodilatory shock: a prespecified analysis of the ATHOS-3 trial: https://bit.ly/2xDVVsr ALBUMS AND BOOKS MENTIONED IN THIS EPISODE: The Dark Side of the Moon, Pink Floyd: https://amzn.to/2XZr34x Wish You Were Here, Pink Floyd: https://amzn.to/2Lc2lbb Loonshots: How to Nurture the Crazy Ideas That Win Wars, Cure Diseases, and Transform Industries, Safi Bachall: https://amzn.to/2S4IrPU

In this episode of Critical Matters, we discuss acute neuromuscular disorders in the intensive care unit with Dr. M. Kamran Athar. The discussion focuses on the Guillain-Barre Syndrome and Myasthenia Gravis. Dr. M. Kamran Athar is a practicing neuro intensivist at the Farber Institute for Neuroscience in Philadelphia. Dr. Athar is an assistant professor of Medicine and of Neurology at the Jefferson School of Medicine in Philadelphia. Additional Resources: The clinical management of neuromuscular disorders in intensive care: https://bit.ly/2wWlYe1 Early predictors of mechanical ventilation in Guillain-Barré syndrome: https://bit.ly/2Icb1vi International consensus guidance for management of myasthenia gravis: https://bit.ly/2Ic2g4I Books Mentioned in this Episode: How Doctors Think by Jerome Groopman: https://amzn.to/2ZmHSmV

In this episode, we discuss compassion in the ICU with Dr. Stephen Trzeciak. Dr. Trzeciak is Chief of Medicine at Cooper University Health Care, and Professor and Chair of Medicine at Cooper Medical School of Rowan University in Camden, New Jersey. He is the co-author of a recently published book “Compassionomics: The Revolutionary Scientific Evidence that Caring Makes a Difference. In addition, Dr. Trzeciak and his research group have published several original research papers focusing on compassion in healthcare. Additional Resources: Healthcare provider compassion is associated with lower PTSD symptoms among patients with life-threatening medical emergencies: a prospective cohort study: http://bit.ly/2Wio1re Development and Validation of a Tool to Measure Patient Assessment of Clinical Compassion: http://bit.ly/2JR1ifr For patients, caregiver compassion is essential. The Washington Post: https://wapo.st/30yYtW1 Books and Albums Mentioned in This Episode: Compassionomics: The Revolutionary Scientific Evidence that Caring Makes a Difference by S. Trzeciak and A. Mazzarelli: https://amzn.to/2JQXv1y The Joshua Tree by U2: https://amzn.to/2JvU4hu The Koln Concert by Keith Jarrett: https://amzn.to/2VVBYMn

In this episode, we discuss Toxicology in the ICU. This is part two of a two-part series. Today’s episode will focus on specific toxic ingestions and their management. Our guest is Dr. Jerrold B. Leikin. Dr. Leikin is the Director of Medical Toxicology at North Shore University Health System-OMEGA, which includes several hospitals in Illinois. In addition, he is a Clinical Professor of Medicine at the Pritzker School of Medicine (University of Chicago) and Professor of Medicine and Pharmacology at Rush Medical College. Additional Links: American Association of Poison Control Centers Website: https://aapcc.org/ A three-part review series published in CHEST on Toxicology in the ICU. Part 1: https://bit.ly/2OhO2k5 Part 2: https://bit.ly/2UuLQY1 Part 3: https://bit.ly/2OiGM7A Albums Mentioned in this Episode: Live at the BBCby The Beatles: https://amzn.to/2vIrX5M

In this episode, we discuss toxicology in the ICU. This is part one of a two-part series. Today’s episode will focus on an overview of toxic ingestions and their general management. Our guest is Dr. Jerrold B. Leikin. Dr. Leikin is the Director of Medical Toxicology at North Shore University Health System-OMEGA, which includes several hospitals in Illinois. In addition, he is a Clinical Professor of Medicine at the Pritzker School of Medicine (University of Chicago) and Professor of Medicine and Pharmacology at Rush Medical College. Additional Links: American Association of Poison Control Centers Website: https://aapcc.org/ A three-part review series published in CHEST on Toxicology in the ICU. Part 1: https://bit.ly/2OhO2k5 Part 2: https://bit.ly/2UuLQY1 Part 3: https://bit.ly/2OiGM7A Books and Albums Mentioned in This Episode: Pops: A Life of Louis Armstrong by Terry Teachout: https://amzn.to/2IBYB1w Louis Armstrong: An Extravagant Life by Laurence Bergreen: https://amzn.to/2PnkvWC Complete Hot Five & Hot Seven Recordings 2 by Louis Armstrong: https://amzn.to/2Vjvbep

In this episode, we discuss the long term effects of critical illness on cognitive impairment. Our guest is Dr. James Jackson. Dr. Jackson is the Assistant Director of The ICU Recovery Center at Vanderbilt, a Research Associate Professor, and the lead psychologist for the Critical Illness, Brain Dysfunction and Survivorship (CIBS) Center at the Vanderbilt University School of Medicine. Additional Links: The BRAIN-ICU Study, a seminal prospective study that established the prevalence of long term cognitive dysfunction in critical illness survivors: https://bit.ly/2InupDw Cognitive outcomes after critical illness. A recent review article on the topic: https://bit.ly/2NLIuR1 Link to the CIBS Center website, which contains a wealth of resources for intensivists: https://bit.ly/2HfdQ0n Books Mentioned in This Episode: Fly Fishing Through the Midlife Crisis by Howell Raines: https://amzn.to/2OX9Bqp

For a long time death has been understood as the cessation of cardiopulmonary function. With the advent of mechanical ventilation and life support in the ICU, the concept of brain death emerged. In this episode of Critical Matters, we discuss the determination of death by neurologic criteria. Our guest is Dr. Fred Rincon, Associate Professor of Neurology and Neurological Surgery at Thomas Jefferson University in Philadelphia. Additional Resources: The most recent update to the evidence-based guidelines for determining brain death in adults: https://bit.ly/2TXjSZr Web-based toolkit and educational material for clinicians on brain death: https://bit.ly/2FA7KVj Previous episode of Critical Matters with Dr. Rincon where we discussed neuroprognostication after cardiac arrest: https://bit.ly/2JHFZ1q Books and Albums Mentioned in This Episode: Meditations by Marcus Aurelius: https://amzn.to/2FD1xIy Nevermind by Nirvana: https://amzn.to/2WmVVYd

n this episode of Critical Matters, we provide a quick recap on five things we learned after attending the annual Society of Critical Care Medicine Critical Care Congress. Four recent clinical studies released ahead of print during the congress are briefly discussed in addition to some thoughts on ECMO. Additional Resources: Bag-Mask Ventilation during Tracheal Intubation of Critically Ill Adults: https://bit.ly/2GRFbEH Effect of Titrating Positive End-Expiratory Pressure (PEEP) with Esophageal Pressure-Guided Strategy vs. an Empirical High PEEP-FiO2 Strategy on Death and Days Free From Mechanical Ventilation Among Patients with Acute Respiratory Distress Syndrome: https://bit.ly/2T38pqV Effect of a Resuscitation Strategy Targeting Peripheral Perfusion Status vs Serum Lactate Levels on 28-Day Mortality Among Patients With Septic Shock: https://bit.ly/2UcyoJ3 Adjunctive Intermittent Pneumatic Compression for Venous Thromboprophylaxis: https://bit.ly/2Xx4O35 Books Mentioned in This Episode: The Art of Living: The Classical Manual on Virtue, Happiness, and Effectiveness. Epictetus by Sharon Lebell: https://amzn.to/2ECiYIp

In this episode, Dr. Sergio Zanotti discusses the application of behavioral economics to clinical practice, specifically choice framing in ICU goals-of-care Meetings. He is joined by Dr. Joanna Hart, a pulmonary critical care physician and assistant professor of medicine at the Perelman School of Medicine at the University of Pennsylvania in Philadelphia. She is also a core faculty member of the Palliative and Advanced Illness Research Center and is affiliated with the Center for Health Incentives and Behavioral Economics. Additional Resources: Clinician’s Use of Choice Framing in ICU Family Meetings. Joanna L Hart et al. Crit Care Med 2024: https://pubmed.ncbi.nlm.nih.gov/38912880/ Using Default Options and Other Nudges to Improve Critical Care. Scott Halpern. Crit Care Med 2019: https://pmc.ncbi.nlm.nih.gov/articles/PMC5826616/ Books mentioned in this episode: Demon Copperhead. By Barbara Kingsolver: https://bit.ly/4hYCqQv Thinking Fast and Slow. By Daniel Kahneman: https://bit.ly/4i3eknK Nudge. By Richard H. Thaler, et al.: https://bit.ly/3YUqxlG

In this episode of Critical Matters, we discuss what happens to patients who survive the ICU. Our guest is Dr. Carla Sevin, Director for The ICU Recovery Center at the Vanderbilt School of Medicine. Dr. Sevin discusses current concepts regarding the post-intensive care syndrome (PICS) and shares her views on how we can prevent, identify, and treat it. Additional Resources: Link to Society of Critical Care Medicine webpage containing a host of resources related to the Post-Intensive Care Syndrome (PICS): https://bit.ly/2S34Xam Link to Understanding Your ICU Stay: Information for Patients and Families booklet: https://bit.ly/2SN6S7u Link to the CIBS Center website, which contains a wealth of resources for intensivists on the topic of ICU liberation and survivorship: https://bit.ly/2HfdQ0n Link to review article, Treatment of the Post-ICU Patient in an Outpatient Setting: https://bit.ly/2UUXkVg Books Mentioned in This Episode: In Shock: My Journey from Death to Recovery and Redemptive Power of Hope by Rana Awdish, MD: https://amzn.to/2SOLwX6 A View from the Edge — Creating a Culture of Caring by Rana Awdish, MD: https://bit.ly/2E6t1FF

In this episode of Critical Matters, we take a deep dive in delirium with Wesley Ely, MD. Dr. Ely is a professor of medicine at Vanderbilt University School of Medicine and the co-director of the Center for Critical Illness, Brain dysfunction, and Survivorship (CIBS Center), which has enrolled thousands of patients into clinical trials answering vital questions about ICU acquired brain disease and other components of ICU survivorship. His team developed the CAM-ICU, and he has published extensively on the topic. Additional Resources: Link to the CIBS Center website, which contains a wealth of resources for intensivists on the topic of delirium: https://bit.ly/2HfdQ0n The MIND-USA trial evaluated haloperidol and ziprasidone in ICU patients with delirium: https://bit.ly/2OQ5gIE Caring for Critically Ill Patients with the ABCDEF Bundle: Results of the ICU Liberation Collaborative in Over 15,000 Adults: https://bit.ly/2VWLUlm Books Mentioned in This Episode: The Boys in the Boat: Nine Americans and Their Epic Quest for Gold at the 1936 Berlin Olympics by Daniel James Brown: https://amzn.to/2RMmcRe Solzhenitsyn: A soul in exile by Joseph Pearce: https://amzn.to/2RPhpi0 Man’s Search for Meaning by Viktor E. Frankl: https://amzn.to/2VZ2ZLb Being Mortal: Medicine and What Matters in the End by Atul Gawande: https://amzn.to/2HfeQ4D Music Mentioned in This Episode: The Chronic by Dr. Dre: https://amzn.to/2HffeA7

In this episode of Critical Matters, we discuss burnout in healthcare. Burnout is an increasing problem in critical care that impacts growing numbers of providers, nurses and healthcare professionals working in the intensive care unit. This episode is based on a webinar I presented on the topic followed by a panel discussion with physician leaders. Additional Resources: An Official Critical Care Societies Collaborative Statement: Burnout Syndrome in Critical Care Health Care Professionals: A Call for Action: https://bit.ly/2M1PGFq Why Doctors Hate Their Computers by Atul Gawande, MD: https://bit.ly/2JCw1uz Institute for Healthcare Improvement White Paper – Framework for Improving Joy in Work: https://bit.ly/2zHs16F

In this episode of Critical Matters, we discuss the management of critically ill patients with cirrhosis. Our guest is Dr. Ram Subramanian, Medical Director of Liver Transplantation at the Emory School of Medicine in Atlanta. In his dual role as a transplant hepatologist and an intensivist, Dr. Subramanian is involved in the inpatient care of patients before and after liver transplantation and provides a unique perspective on caring for this complex patient population. ADDITIONAL RESOURCES: Management of critically ill cirrhotic patients: a multidisciplinary perspective: https://bit.ly/2Et9hN5 A detailed review on ACLF and the impact of scoring systems on prognosis: https://bit.ly/2AcTtev A recent study evaluating the incidence and outcomes for patients with cirrhosis admitted to the ICU with an associated editorial by our guest: https://bit.ly/2BnQaAJ hhttps://bit.ly/2QzuPPc BOOKS MENTIONED IN THIS EPISODE: The McKinsey Edge: Success Principles from the World’s Most Powerful Consulting Firm by Shu Hattori: https://amzn.to/2QVVvZW The McKinsey Mind: Understanding and Implementing the Problem-Solving Tools and Management Techniques of the World’s Top Strategic Consulting Firm by Ethan M. Rasiel and Paul N. Friga: https://amzn.to/2Glph6c

In this episode of Critical Matters, we discuss the role of procalcitonin as a biomarker in lower respiratory tract infections and sepsis. Our guest is Dr. David Huang, the primary investigator in the recently published Procalcitonin-Guided Use of Antibiotics for Lower Respiratory Tract Infections (ProACT) clinical trial. He discusses lessons learned from this very important study and offers insight into the use of procalcitonin in clinical practice. ADDITIONAL RESOURCES: Procalcitonin-Guided Use of Antibiotics for Lower Respiratory Tract Infections (ProACT) clinical trial: https://bit.ly/2BTZNsf A meta-analysis evaluating the effect of procalcitonin-guided treatment on mortality in acute respiratory infections: https://bit.ly/2Un6Lgz FDA Executive Summary on Procalcitonin assay: https://bit.ly/2EiBN4r BOOKS MENTIONED IN THIS EPISODE: 7 Habits of Highly Effective People by Stephen R. Covey: https://amzn.to/2Ss0mPq Partners of the Heart by Vivien Thomas: https://amzn.to/2QC6vLP

Lung protective ventilation for ARDS includes the use of low tidal volumes, positive-end expiratory pressure (PEEP), and limiting of airway plateau pressure to minimize ventilator-induced lung injury. However, in the sickest subset of patients with ARDS hypoxemia may persist despite optimal lung protective strategies. In this episode of Critical Matters, we discuss salvage therapies for patients with refractory hypoxemia. Our guest is Dr. Robert Hyzy, Medical Director of the Critical Care Medicine Unit and Co-Chair of the Critical Care Committee at the University of Michigan Hospital.

Acute respiratory distress syndrome (ARDS) is a severe form of respiratory failure that affects approximately 200,000 patients each year in the United States, resulting in nearly 75,000 deaths annually. In this episode of Critical Matters, our guest Dr. R. Phillip Dellinger discusses the current management of patients with ARDS. Dr. Dellinger is a recognized thought leader in the field, a prolific author, an accomplished researcher, and the recipient of multiple awards for his contributions to critical care. ADDITIONAL RESOURCES: The PROSEVA clinical trial showed that in patients with severe ARDS prone position ventilation improved mortality: https://bit.ly/2Dp3LdS The ACURASYS clinical study showed that in patients with severe ARDS 48 hours of neuromuscular blockade was associated with improved mortality: https://bit.ly/2FqI7Zn The EOLIA study was stooped early for futility. However, many think that it still has important findings regarding the use of ECMO in severe ARDS: https://bit.ly/2QI1Cxu BOOKS MENTIONED IN THIS EPISODE: Evidence-Based Critical Care: A Case Study Approach: https://amzn.to/2PYeD8V

Caring for critically ill pregnant patients poses a series of unique challenges for the intensivist. In part two of this two-episode series, we discuss critical care in pregnancy with Dr. Stephen Lapinsky. Dr. Lapinsky is a practicing intensivist and professor of medicine at the University of Toronto. He is a member of the editorial board of the journal, Obstetric Medicine, and sits on the steering committee of the North American Society of Obstetric Medicine. Dr. Lapinsky is also the executive of the Women’s Health Network of the ACCP. Today (Part 2) we will cover general conditions that may lead to critical illness in pregnant women. Additional Resources: Practice bulletin on Critical Care in Pregnancy from the American College of Obstetrics and Gynecology (ACOG): https://bit.ly/2OtJARU A comprehensive review on acute respiratory failure in pregnancy: https://bit.ly/2DKzwjl AHA scientific statement on cardiac arrest in pregnancy: https://bit.ly/2QpGWtK

Caring for critically ill pregnant patients poses a series of unique challenges for the intensivist. In this two-episode series, we discuss critical care in pregnancy with Dr. Stephen Lapinsky. Dr. Lapinsky is a practicing intensivist and professor of medicine at the University of Toronto. He is a member of the editorial board of the journal, Obstetric Medicine, and sits on the steering committee of the North American Society of Obstetric Medicine. Dr. Lapinsky is also the executive of the Women’s Health Network of the ACCP. Today (Part 1) will cover unique conditions associated with pregnancy that may lead to critical illness. Additional Resources: Practice bulletin on Critical Care in Pregnancy from the American College of Obstetrics and Gynecology (ACOG): https://bit.ly/2OtJARU A comprehensive review on acute respiratory failure in pregnancy: https://bit.ly/2DKzwjl AHA scientific statement on cardiac arrest in pregnancy: https://bit.ly/2QpGWtK

In today’s episode, we will discuss the recently released 2018 Clinical Practice Guidelines for the Prevention and Management of Pain, Agitation/Sedation, Delirium, Immobility, and Sleep Disruption in Adult Patient s in the ICU. Our guest is John Devlin, PharmD, BCCCP, FCCM, FCCP. Dr. Devlin is the lead author of these guidelines and a recognized leader in the field. Additional Resources: Clinical Practice Guidelines for the Prevention and Management of Pain, Agitation/Sedation, Delirium, Immobility, and Sleep Disruption in Adult Patients in the ICU: https://bit.ly/2wzFNHv Executive Summary: Clinical Practice Guidelines for the Prevention and Management of Pain, Agitation/Sedation, Delirium, Immobility, and Sleep Disruption in Adult Patients in the ICU: https://bit.ly/2vOyVGP Interpreting and Implementing the 2018 of Pain, Agitation/Sedation, Delirium, Immobility, and Sleep Disruption Guidelines: https://bit.ly/2waInU7 Nocturnal low-dose Dexmedetomidine to prevent delirium in ICU patients: https://bit.ly/2MJ2TSi Books Mentioned in This Episode: Overtreated: Why Too Much Medicine Is Making Us Sicker and Poorer: https://amzn.to/2OAfZmD

In this episode, Dr. Sergio Zanotti discusses the management of critically ill patients after cardiac surgery, focusing on the clinical management of two important complications: hemorrhage and cardiac arrest. He is joined by Dr. Christopher Noel, a critical care attending at Cooper University Healthcare. Dr. Noel is also an assistant professor of medicine at Cooper Medical School of Rowan University and associate program director for the Critical Care Medicine Fellowship and the Clerkship Director for Critical Care Medicine Clerkships for Medical Students. Additional resources: American Association for Thoracic Surgery (AATS) TSRA Primer- Critical Care: https://www.aats.org/tsra-primer-post-operative-bleeding https://www.aats.org/tsra-primer-cardiac-arrest-post-cardiotomy The Society of Thoracic Surgeons Expert Consensus for the Resuscitation of Patients Who Arrest After Cardiac Surgery. Ann Thorac Surg 2017: https://pubmed.ncbi.nlm.nih.gov/28122680/ Society of Cardiovascular Anesthesiologists clinical practice improvement advisory for the management of perioperative bleeding and hemostasis in cardiac surgery patients. J of Cardiothoracic and Vascular Anesthesia 2019: https://pubmed.ncbi.nlm.nih.gov/31613811/ Music mentioned in this episode: The Outsiders. By Eric Church: https://bit.ly/4fHvxkp Collective Soul. By Collective Soul: https://bit.ly/3AzLcUd

In this episode of Critical Matters, we explore the role of the intensivist in the management of patients with ventricular assist devices. Our guest is Dr. John Greenwood, a practicing intensivist who splits his clinical time between the Cardiac & Vascular ICU and the ED-ICU at the Hospital of the University of Pennsylvania. Additional Resources: Summary of information presented during the episode kindly provided by Dr. John Greenwood: https://bit.ly/2MJdfSa HeartWare Waveforms App for iPad: https://apple.co/2NpyQEr Articles Mentioned In This Episode: Pratt AK, Shah NS, Boyce SW. Left ventricular assist device management in the ICU. Crit Care Med. 2014;42(1):158-68: https://bit.ly/2MKr3M6 Sen A, Larson JS, Kashani KB, et al. Mechanical circulatory assist devices: a primer for critical care and emergency physicians. Crit Care. 2016;20(1):153: https://bit.ly/2NoreC4

In this episode of Critical Matters, we continue the discussion of medical errors in healthcare with a specific focus on how to disclose medical errors to patients. Our guest is Dr. Nitin Puri, a practicing intensivist and medical educator at the Cooper Medical School of Rowan University and the Cooper Health System in Camden, New Jersey. Additional Resources: This is a CNN story on cardiothoracic fellow wrongly accused and sued for lying about a medical error: https://cnn.it/2vFEnLf The Communication and Optimal Resolution (CANDOR) toolkit from the Agency for Healthcare Research and Quality (AHRQ). CANDOR is a process that health care institutions and providers can use to respond in a timely, thorough and fair way when medical errors occur and cause patients harm: https://bit.ly/2m9fch7 A powerful video on the topic of the disclosure of medical errors: https://bit.ly/2DaD6TD Article Mentioned in This Episode: Mistakes Were Made (but Not by Me): Why We Justify Foolish Beliefs, Bad Decisions, and Hurtful Acts: https://amzn.to/2NorssU

In this episode of Critical Matters, we discuss “Compassionomics” with Dr. Stephen Trzceciak. Dr. Trzeciak is a practicing intensivist and prolific researcher. His research interests have focused recently on the hypothesis that compassion matters for patients, for healthcare outcomes, and for providers. Compassionomics is the revolutionary field of science focusing on caring, and the impact compassion has on healthcare. Additional Resources: How 40 Seconds of Compassion Could Save a Life: https://youtu.be/elW69hyPUuI Compassionomics: Hypothesis and experimental approach: http://compassionomics.net Article Mentioned in This Episode: A Patient’s Story: http://www.theschwartzcenter.org/media/patient_story.pdf