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Category: Pulmonary

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Concise Critical Appraisal: Effect of Low Versus Intermediate Tidal Volume Strategy

Simonis et al (JAMA. 2018;320;1872-1880) set out to evaluate the effect of an LTVV strategy versus an intermediate tidal volume ventilation strategy in intensive care unit patients without ARDS.

SCCM Pod-408 Vaping-Associated Respiratory Distress Syndrome

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 (Lilly C, et al. Crit Care Explor. 2020;2(2): e0081).

They explore screening and risk stratification, vaping exposure criteria, patient evaluation and monitoring, and more. Dr. Lilly is professor of medicine, anesthesiology, and surgery at UMass Memorial Medical Center in Worcester, Massachusetts, USA.

SCCM Pod-204 CCM: Surveillance Definitions for VAP

Michael Weinstein, MD, FACS, FCCP, speaks with Michael Klompas, MD, MPH, about his article, “Objective Surveillance Definitions for Ventilator-Associated Pneumonia,” published in the December issue of Critical Care Medicine. Investigators concluded that objective surveillance definitions are more logical and are subject to less interpretation and are used to provide [clinicians] the quality care that we want to at the beside, and to evaluate opportunities for performance improvement so that we ultimately can further care in the ICU and improve patient care for the future. Klompas is an infectious disease physician and associate hospital epidemiologist at Brigham and Women’s Hospital in Boston, Massachusetts. He is also an assistant professor in the Department of Population Medicine at Harvard Medical School and Harvard Pilgrim HealthCare Institute.

SCCM Pod-195 CCM: Tracheostomy Practice in Critically Ill Patients

Jeffrey Guy, MD, MSc, MMHC, speaks with Bradley D. Freeman, MD, FACS, to discuss his article published in the October Critical Care Medicine, “Tracheostomy Practice in Adults with Acute Respiratory Failure.” The article provides a comprehensive review of the benefits of tracheostomy as well as the latest techniques and offers insight on future studies. Freeman is a professor of surgery in the Section of Acute Care Surgery at Washington University School of Medicine in St. Louis, Missouri.

SCCM Pod-182 CCM: A Closer Look at Johns Hopkins' Percutaneous Tracheostomy Program

Jeffrey Guy, MD, MSc, MMHC, speaks with Marek A. Mirski, MD, PhD, about his article published in the June 2012 Critical Care Medicine, “Safety, Efficiency, and Cost-Effectiveness of a Multidisciplinary Percutaneous Tracheostomy Program.” Mirski is a professor of anesthesiology and critical care medicine and is director of the Neuroscience Critical Care Units at Johns Hopkins Hospital in Baltimore, Maryland.

SCCM Pod-159 Continuous Capnography and the Difficult Airway

The Fourth National Audit Project of the Royal College of Anaesthetists and Difficult Airway Society was designed to identify and study serious airway complications occurring during anaesthesia in the intensive care unit and emergency department. The group recently published its results in the British Journal of Anesthesia and lead author Tim M. Cook, FRCA, discusses the findings. He addresses specifically the use of continuous capnography to improve outcomes in patients that require intubations and gaps in care that may lead to adverse events. Cook is a consultant in anaesthesia and critical care medicine at Royal United Hospital in Bath, United Kingdom.

SCCM Pod-158 Mouth Care and VAP Prevention

Cindy L. Munro, RN, PhD, ANP-C, authored an article in the 2009 American Journal of Critical Care, titled “Chlorhexidine, Toothbrushing, and Preventing Ventilator-Associated Pneumonia (VAP) in Critically Ill Adults.” The study examined the effects of mechanical, pharmacological and combination oral care on the development of VAP among critically ill patients. Munro is a professor of nursing at Virginia Commonwealth University School of Nursing in Richmond, Virginia, and co-editor of the American Journal of Critical Care.

SCCM Pod-120 CCM: Tracheostomy Practice in the Surgical ICU

Bradley D. Freeman, MD, discusses his article published in the December 2009 issue of Critical Care Medicine, titled “Examination of Non-Clinical Factors Affecting Tracheostomy Practice in an Academic Surgical Intensive Care Unit.” Freeman is an associate professor of surgery at Washington University School of Medicine in St. Louis, Missouri. Freeman discusses his study which centers on the topic of who should undergo a tracheostomy and when it should happen in the surgical ICU.

SCCM Pod-87 Managing Pulmonary Hypertension

Roham T. Zamanian, MD, discusses an article published in the September 2007 issue of Critical Care Medicine, titled "Management Strategies for Patients with Pulmonary Hypertension in the ICU." Dr. Zamanian is acting assistant professor of medicine at Stanford University Medical Center.

SCCM Pod-55 Enteral Therapy to Treat Respiratory Distress Syndrome

Eric Pacht, MD, discuss an editorial published in the September issue of Critical Care Medicine, "Enteral therapy to decrease morbidity and improve survival in acute respiratory distress syndrome: Its time has come." Dr. Pacht is a pulmonary and critical care specialist and the director of the intensive care unit at Licking Memorial Hospital in Ohio.

SCCM Pod-44 CCM: The Role of Weaning

Maged A. Tanios, MD, discusses his article, "A randomized, controlled trial of the role of weaning: Predictors in clinical decision making," from the October issue of Critical Care Medicine. Dr. Tanios is the director of the ICU at St. Mary Medical Center and assistant professor of medicine at the University of California, Los Angeles School of Medicine.

Concise Critical Appraisal: The Efficacy of ECMO for Severe ARDS

Combes et al (N Engl J Med. 2018;378:1965-1975) set out to determine whether the use of ECMO reduced mortality in patients with ARDS when defined by one of three criteria: P/F ratio < 50 mm Hg for > 3 hours, P/F ratio < 80 mm Hg for > 6 hours, or pH < 7.25 coupled with Paco2 ≥ 60 mm Hg for > 6 hours (with respiratory rate < 35 beats/min and plateau pressure ≤ 32 cm H2O). 

Discovery Grant Awarded to Researchers Seeking to Uncover Drivers of PARDS, Improve Therapy

Researchers seeking to evaluate the causes of PARDS and improve therapy options have been awarded the Discovery Research Grant, making it the first time the full grant has been awarded to a single project because of the strength of the grant.

Concise Critical Appraisal: Dexamethasone Use in the Treatment of ARDs

Villar et al (Lancet Respir Med. 2020;8:267-276) attempted to demonstrate the effect of steroids in patients with moderate to severe acute respiratory distress syndrome (ARDS) along with modern standard ICU practices, including lung-protective mechanical ventilation.

SCCM Pod-428 Endotracheal Tube Size and Aspiration

Each year, approximately 790,000 patients in the United States develop acute respiratory failure that requires intubation and mechanical ventilation. Host Ludwig H. Lin, MD, is joined by Gintas P. Krisciunas, MPH, MA, to explore whether a modifiable risk factor, endotracheal tube size, is associated with the diagnosis of postextubation aspiration in survivors of acute respiratory failure (Krisciunas G et al. Crit Care Med. 2020;48:1604-1611). Gintas P. Krisciunas is a research assistant professor of otolaryngology at Boston University School of Medicine and Boston Medical Center in Boston, Massachusetts, USA.

SCCM Pod-425 Outcomes in Cystic Fibrosis PICU Admissions

Cystic fibrosis patient care has advanced greatly in recent years and the mortality rate has improved. Host Margaret M. Parker, MD, MCCM, talks with Michael A. Smith, MD, about PICU mortality and the factors associated with death among critically ill children with cystic fibrosis (Smith M, et al. Pediatr Crit Care Med. 2020 Oct;21:e879-887). Dr. Smith is in a pediatric critical care medicine fellow in the department of pediatric critical care medicine at the University of California, San Francisco in San Francisco, California, USA.

SCCM Pod-424 Critical Care Implications of Respiratory Depression on Hospital Wards

Continuous monitoring on hospital wards can prevent adverse events and unnecessary ICU admissions. Michael Smith, MD, is joined by Ashish K. Khanna, MD, FCCP, FCCM, to review the demographics of respiratory depression, including opioid-induced respiratory depression on surgical and medical wards, and to correlate the results of the PRODIGY trial with the clinical practice of critical care medicine. Dr. Khanna is staff intensivist and anesthesiologist, associate professor of anesthesiology, and section head for research with the Department of Anesthesiology, Section on Critical Care Medicine at Wake Forest University School of Medicine in Winston-Salem, North Carolina, USA. This podcast is supported by an unrestricted education grant by Medtronic.

SCCM Pod-417 COVID-19-Associated Acute Respiratory Distress Syndrome

Clinicians are working to understand and formulate an effective treatment for COVID-19-associated acute respiratory distress syndrome (Marini J. Crit Care Med. 2020 May 13; Epub ahead of print). Host Kyle B. Enfield, MD, FCCM, discusses specifics with John J. Marini, MD.

They also discuss the need to continue sharing clinical data, experience, and ideas. Dr. Marini is director of physiological and translational research at Regions Hospital in Saint Paul, Minnesota, USA.

SCCM Pod-379 Opioid-Induced Respiratory Depression Risk Prediction Tool

Ludwig H. Lin, MD, and Ashish K. Khanna, MD, FCCP, FCCM, discuss Dr. Khanna’s top-rated abstract, Derivation and Validation of a Novel Opioid-Induced Respiratory Depression Risk Prediction Tool (Khanna A, et al. Crit Care Med. 2019;47:18), from the Society of Critical Care Medicine’s 48th Critical Care Congress.

Nearly half of all in-hospital cardiorespiratory arrests occur on general care floors; opioid-induced respiratory depression (OIRD) is one potential cause of these events.

Dr. Khanna investigated the incidence of OIRD as part of the PRODIGY trial. Dr. Khanna is an associate professor of anesthesiology and associate chief of research at Wake Forest University School of Medicine in Winston-Salem, North Carolina, USA.

Dr. Khanna discloses that he served on the executive advisory board for the respiratory monitoring division of Medtronic and received consulting fees from Medtronic for being part of the steering committee of the PRODIGY trial.

This podcast is supported by an unrestricted educational grant provided by Medtronic.

SCCM Pod-365 Medications and RRT: We Know How to Dose, Right?

Dr. Fraser, MD, speaks with Bruce A. Mueller, PharmD, FCCP, FASN, about his talk presented at the 47th Critical Care Congress in San Antonio, Texas, entitled "Artificial Kidney Meets Mechanical Lung: Comanaging the Patient with Renal and Respiratory Failure."

Dr. Mueller discusses the concepts of drug dosing during renal replacement therapy. Dr. Mueller is a Professor and Associate Dean at University of Michigan College of Pharmacy in Ann Arbor, Michigan.