Host Diane C. McLaughlin, DNP, AGACNP-BC, CCRN, FCCM, welcomes Matthew Kirschen, MD, PhD, FAAN, FNCS, to discuss what critical care professionals need to know about determining brain death/death by neurologic criteria (BD/DNC).

In October 2023, a revised consensus practice guideline for the determination of brain death in both children and adults was published in Neurology (Greer DM, et al. Neurology. 2023;101;1112-1132). The guideline integrated guidance for adults and children to provide a comprehensive, practical way to evaluate patients with catastrophic brain injuries to determine whether they meet the criteria for brain death.

The Society of Critical Care Medicine (SCCM) offers several additional resources to support critical care clinicians’ understanding of the updated guidelines, including an article published in the March 2024 issue of Critical Care Medicine addressing what the critical care team needs to know about the guidelines (Kirschen MP, et al. Crit Care Med. 2024;52:376-386). Dr. Kirchen was the lead author of that article and shares key points in this podcast episode.

Other resources include:

• Pediatric and Adult Brain Death/Death by Neurologic Criteria Consensus Practice Guidelines 2024 Critical Care Congress presentation
• Free AAN evaluation tool that walks clinicians through the process of brain death evaluation.
• Special article in Neurology: Clinical Practice that provides a detailed narrative about what has changed in the 2023 guidelines compared to prior guidelines. The article also includes tables outlining comparisons, bolding new recommendations, and italicizing age-specific guidance to easily identify the differences between determining brain death in children versus adults.

Host Elizabeth H. Mack, MD, MS, FCCM, welcomes Elizabeth Y. Killien, MD, MPH, to discuss pediatric acute respiratory distress syndrome (PARDS). Dr. Killien explains the findings from her retrospective study on PARDS severity, emphasizing how factors such as severe hypoxemia can impact health-related quality of life (HRQL) after discharge. (Killien EY, et al. Pediatr Crit Care Med. 2024;25:816-827). Dr. Killien is an attending physician in the pediatric ICU and an assistant professor at Seattle Children’s Hospital, University of Washington School of Medicine, in Seattle, Washington.

Host Elizabeth H. Mack, MD, MS, FCCM, is joined by Samuel Snider, MD, and Michael Fong, MD, to discuss a retrospective cohort study that examined factors such as cardiac arrest, brain neoplasms, and EEG patterns to determine their association with status epilepticus and isolated seizures in critically ill patients, aiming to improve monitoring and treatment strategies for high-risk patients (Snider SB, et al. Crit Care Med. 2023 Aug;51:1001-1011). Samuel Snider, MD, is a board-certified neurologist at Brigham and Women's Hospital and an instructor of neurology at Harvard Medical School in Boston, Massachusetts. Michael Fong, MD, is an assistant professor adjunct at the Yale School of Medicine in New Haven, Connecticut.

Extubation is a high-risk endeavor in some COVID-19 patients. Host Pamela M. Peeke, MD, MPH, FACP, FACSM, is joined by Joshua H. Atkins, MD, PhD; Christopher Rassekh, MD; and Ara Chalian, MD, to discuss recognizing risks surrounding extubation in ventilated COVID-19 patients.

Targets for treatment of raised intracranial pressure or decreased cerebral perfusion pressure in pediatric neurocritical care are not well defined.

COVID-19 complicated critical care clinicians' decision-making with regard to tracheostomy.

Five new recommendations to reduce waste and enhance value in the practice of critical care address invasive devices, proactive liberation from mechanical ventilation, antibiotic stewardship, early mobilization, and providing goal-concordant care.

With widespread utilization of continuous renal replacement therapy, its critical to know about how citrate may have a role.

Mannitol is a commonly used osmotherapy agent in raised intracranial pressure (ICP) but the side effects are significant.

Sudden cardiac arrest remains a leading cause of premature death worldwide.

Continuous renal replacement therapy (CRRT) is complex, and dosing varies among institutions.

Each year, approximately 790,000 patients in the United States develop acute respiratory failure that requires intubation and mechanical ventilation.

Severe COVID-19 infection can be a form of viral sepsis with occasionally concomitant bacterial infection.

Host Elizabeth H. Mack, MD, MS, FCCM, is joined by Luregn J. Schlapbach, MD, PhD, FCICM, to discuss the Pediatric Critical Care Medicine article, "Resuscitation With Early Adrenaline Infusion for Children With Septic Shock: A Randomized Pilot Trial" (Harley A, et al. Pediatr Crit Care Med. 2024 Feb;25:106-117). The study found that a fluid-sparing algorithm for children presenting with septic shock using early adrenaline is feasible. Dr. Schlapbach is a professor and chief of intensive care and neonatology at the University Children's Hospital in Zurich, Switzerland.

Continuous renal replacement therapy (CRRT) requires considerable involvement from the bedside nurse.

Cystic fibrosis patient care has advanced greatly in recent years and the mortality rate has improved.

Continuous monitoring on hospital wards can prevent adverse events and unnecessary ICU admissions.

COVID-19 is associated with a high prevalence of coagulopathy and venous thromboembolism.

Procalcitonin testing on admission seems to be a valuable piece of information for early risk assessment and ruling out bacterial co-infection in COVID-19 patients.

The increase in acute kidney injury in COVID-19 patients is resulting in more utilization of renal replacement therapy (RRT) and continuous renal replacement therapy (CRRT).

Alternative strategies are needed to combat and prevent antibiotic-resistant bacterial infections. Host Ashish K. Khanna, MD, FCCP, FCCM, talks with David R. Cameron, PhD, about the potential for bacteriophage prophylaxis in the context of experimental ventilator-associated pneumonia due to methicillin-resistant Staphylococcus aureus in rats.

Review how to best utilize parameters provided by minimally invasive advanced hemodynamic monitors. Host Michael Smith, MD, talks with Michael Scott, MBChB, about clinical thresholds that may warrant continuous advanced hemodynamic monitoring and the application of parameters such as stroke volume and stroke volume variation when administering fluid.

Montefiore Medical Center in the Bronx, New York, USA, quickly converted a children's hospital to an adult COVID-19 hospital.

Clinicians are working to understand and formulate an effective treatment for COVID-19-associated acute respiratory distress syndrome.

Host Kyle B. Enfield, MD, FCCM, is joined by Daisuke Kawakami, MD, to discuss the Critical Care Medicine article, “Evaluation of the Impact of ABCDEF Bundle Compliance Rates on Postintensive Care Syndrome: A Secondary Analysis Study.” (Kawakami D, et al. Crit Care Med. 2023 Dec;51:1685-1696). The study examines how compliance with the ICU Liberation Bundle (A-F) impacts post-intensive care syndrome and intensive care unit mortality rates Dr. Kawakami is a physician in the Department of Emergency and Critical Care Medicine at St. Marianna University School of Medicine in Kawasaki, Japan. Learn more about the ICU Liberation Bundle at sccm.org/iculiberation.

In a situation where ventilators are in short supply, multiple patients on a single ventilator could be a strategy of last resort.

The National Institutes of Health has released Coronavirus Disease 2019 (COVID-19) Treatment Guidelines.

Discovery, the Critical Care Research Network's Viral Infection and Respiratory Illness Universal Study creates a real-time COVID-19 registry of current ICU and hospital care patterns.

Explore the need for randomized COVID-19 clinical trials and the difficulties and potential consequences of misinformation with host Ashish K. Khanna, MD, FCCP, FCCM, and Nicholas E. Ingraham, MD.

Gain valuable insight on the clinical management of COVID-19 and its relevance to the pediatric critical care provider with host Elizabeth H. Mack, MD, MS, FCCM, and Jacqueline Ong, MB BChir, MMed (Paeds), MRCPCH

Margaret M. Parker, MD, MCCM, and Christopher S. Parshuram, MBChB, PhD, discuss clinician moral distress in Canadian pediatric and neonatal intensive care units.

Review neurologic manifestations of COVID-19 and other severe respiratory viral contagions with host Ludwig H. Lin, MD, and author Christopher P.

Explore the Surviving Sepsis Campaign Guidelines on the Management of Critically Ill Adults with Coronavirus Disease 2019 (COVID-19)

Kyle B. Enfield, MD, and Craig M. Lilly, MD, discuss the newly released guidance for vaping-associated respiratory distress syndrome, published in Critical Care Explorations.

Margaret M. Parker, MD, MCCM, and Jerry J. Zimmerman, MD, PhD, FCCM talk about the trajectory of long-term mortality and significant health-related quality of life disability among children encountering septic shock.

Delve into the realm of implementation science and its significance in bridging the gap between research-based evidence and critical care practice. Host Marilyn N. Bulloch, PharmD, BCPS, FCCM, is joined by Anne E. Sales, PhD, RN, to discuss the complexity of implementation science, which involves understanding human behavior change within organizational constraints. They explore examples such as hypertension treatment to illustrate the challenges and opportunities of implementing evidence-based practices. They discuss the importance of context, resources, and stakeholder engagement in successful implementation efforts in the critical care setting where complex interventions and rapid changes are common. Dr. Sales is a nurse and professor at the Sinclair School of Nursing and the Department of Family and Community Medicine in the School of Medicine at the University of Missouri, and associate dean for implementation research and health delivery effectiveness in the School of Medicine. She is a research scientist at the Center for Clinical Management Research at the VA Ann Arbor Health System in Ann Arbor, Michigan, USA.

Margaret M. Parker, MD, MCCM, and Scott L. Weiss, MD, FCCM, discuss the release of: Surviving Sepsis Campaign International Guidelines for the Management of Septic Shock and Sepsis-Associated Organ Dysfunction in Children

Ludwig H. Lin, MD, and Michael G.S. Shashaty, MD, MS, discuss acute kidney injury (AKI) biomarkers and whether they are ready for clinical use.

Margaret M. Parker, MD, MCCM, speaks with Rashid Alobaidi, MD, on his article titled Population-Based Epidemiology and Outcomes of Acute Kidney Injury in Critically Ill Children published in the January 2020 issue of Pediatric Critical Care Medicine.

Margaret M. Parker, MD, MCCM, and Mitchell M. Levy, MD, MCCM discuss the Hour-1 Bundle, the controversies of the Surviving Sepsis Campaign, and the future of sepsis.

Kyle B. Enfield, MD, and Marin H. Kollef, MD, discuss the findings and design of the cluster randomized crossover trial on early palliative care consultation in the medical intensive care unit (ICU) published in the December 2019 issue of Critical Care Medicine.

Michael Smith, MD, and Jayshil Patel, MD discuss the factors associated with managing malnutrition in the critical ill utilizing enteral nutrition.

Kyle B. Enfield, MD, FCCM, and Azra Bihorac, MD, MS, FCCM, discuss best practices and complexities of implementing biomarkers for kidney stress and acute kidney injury (AKI) and what the future holds for AKI biomarker literature.

Margaret M. Parker, MD, MCCM, speaks with Danny Hames, MD, on his article titled: Risk Factors for Mortality in Critically Ill Children Requiring Renal Replacement Therapy, published in the November 2019 issue of Pediatric Critical Care Medicine.

Michael Smith, MD, and Sarah Vest Cogle, PharmD, BCCCP, review current methodologies for managing nutrition concerns for critically ill morbidly obese patients.

Ludwig H. Lin, MD, and John A. Kellum, MD, MCCM, review factors associated with renal recovery, therapies and techniques used to enhance recovery, and long-term consequences of nonrecovery in critical illness.

Improving health literacy is vital for addressing disparities in healthcare access and quality. Join Host Kyle B. Enfield, MD, FSHEA, FCCM, and Jerome Adams, MD, MPH, FASA, as they discuss the urgent need for health equity initiatives and innovative solutions to systemic healthcare challenges. Learn why providing accessible information and empowering individuals to advocate for their health is key. Dr. Adams was the 20th U.S. Surgeon General when the COVID-19 pandemic began and had a front-row seat to the government’s response to COVID-19. Dr. Adams provided his perspective on that response in his book Crisis and Chaos: Lessons from the Front Lines of the War Against COVID-19, which was published in October 2023. The book examines the past three years since the pandemic began, but Dr. Adams said that it also applies to America’s future unless changes are made. He presented his perspectives during the 2024 Critical Care Congress in a thought leader session and shares additional insights during this podcast episode. While Dr. Adams was U.S. Surgeon General, from 2017 to 2021, he led the 6000-person U.S. Public Health Service through responses to three category 5 hurricanes and an opioid epidemic in addition to the COVID-19 pandemic. Previously he was Indiana’s state health commissioner, where he addressed Ebola, Zika, and HIV crises. Today he is the executive director of health equity initiatives at Purdue University in West Lafayette, Indiana, USA, where he is also a distinguished professor of practice in the public health and pharmacy practice departments.

Ranjit Deshpande, MD, and Pratik P. Pandharipande, MD, FCCM, discuss the impact of critical illness on neurocognitive and physical functions

Margaret M. Parker, MD, MCCM, speaks with Rakesh Lodha, MD, on his article titled Polyneuropathy in Critically Ill Mechanically Ventilated Children: Experience from Tertiary Care Hospital in North India, published the September issue of Pediatric Critical Care Medicine

Margaret M. Parker, MD, MCCM, and Lorry R. Frankel, MD, FCCM, discuss the updated pediatric critical care admission, discharge, and triage criteria and levels of care guidance published in the September issue of Pediatric Critical Care Medicine