Critical Care Medicine Podcasts

SCCM Pod-440 Optimal Sedation in Patients Who Receive Neuromuscular Blocking Agent Infusions for Treatment of ARDS

Two previously published trials (ARDS et Curarisation Systematique [ACURASYS] and Reevaluation of Systemic Early Neuromuscular Blockade [ROSE]) presented equivocal evidence on the effect of neuromuscular blocking agent infusions in patients with acute respiratory distress syndrome. Host Kyle B. Enfield, MD, FCCM, is joined by Matthias Eikermann, MD, to discuss the different sedation regimens between these two trials as well as the different regimens within the ROSE trial between treatment and control groups. They will also discuss the hypothesis that the proportion of deeper sedation is a mediator of the effect of neuromuscular blocking agent infusions on mortality (Wongtangman K, et al. Crit Care Med. 2021;49:1137-1148; Jabaley C, Crit Care Med. 2021;49:1211-1213).

Dr. Eikermann is a professor of anesthesia at Harvard Medical School and an attending anesthesiologist and vice chair of faculty affairs in the Department of Anesthesia, Critical Care and Pain Medicine at Beth Israel Deaconess Medical Center. This podcast is sponsored by Sound Physicians.

Published: 8/31/2021

SCCM Pod-439 The Association Between Antibiotic Delay and Hospital Mortality

Rapid delivery of antibiotics is a cornerstone of sepsis therapy, although time targets for specific components of antibiotic delivery are unknown. Host Ludwig H. Lin, MD, is joined by Stephanie Parks Taylor, MD, to discuss the significance of time lead for suspected sepsis patients, how to use a generous time window wisely, and new and reconfigured technologies opportunities (Taylor SP, et al. Crit Care Med. 2021 May;49:741-747). 

Dr. Taylor is an associate professor in the Department of Internal Medicine at Atrium Health’s Carolinas Medical Center in Charlotte, North Carolina, USA. This podcast is sponsored by Biofire. 

Published: 7/11/2021

SCCM Pod-437 Enteral Feeding Intolerance in the Mechanically Ventilated Critically Ill

Enteral feed intolerance occurs frequently during enteral nutrition delivery in the critically ill and is associated with lower enteral nutrition delivery and worse clinical outcomes. Host Ludwig H. Lin, MD, is joined by Daren K. Heyland, MD, MSc, FRCPC, to discuss the incidence of enteral feed intolerance, identify factors associated with enteral feed intolerance, and assess the relationship between enteral feed intolerance and key nutritional and clinical outcomes in critically ill patients (Heyland D, et al. Crit Care Med. 2021 Jan;49:49-49). Dr. Heyland is director of the clinical evaluation research unity at Kingston General Hospital and professor in the department of critical care medicine at Queen’s University School of Medicine in Kingston, Ontario, Canada. This podcast is sponsored by Biofire.

Published: 5/11/2021

SCCM Pod-433 Choosing Wisely for Critical Care: The Next Five
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. Host Elizabeth H. Mack, MD, MS, FCCM, is joined by Jerry J. Zimmerman, MD, PhD, FCCM and Pamela L. Smithburger, PharmD, MS, BCPS, BCCCP, FCCP, FCCM, to formulate new “Choosing Wisely” for Critical Care recommendations that identify best practices to avoid waste and promote value while providing critical care (Zimmerman J, et al. Crit Care Med. 2021;49:472-481). Dr. Zimmerman is professor of pediatrics and anesthesiology and a faculty member and emeritus division chief of pediatric critical care medicine at Seattle Children's Hospital, Harborview Medical Center, and University of Washington School of Medicine in Seattle, WA. Dr. Smithburger is associate professor at University of Pittsburgh School of Pharmacy and pharmacist at University of Pittsburgh Medical Center, in Presbyterian in Pittsburgh, PA. This podcast is sponsored by Biofire. Published: 4/7/2021

SCCM Pod-430 Optimal Bundle of Management for Cardiac Arrest
Sudden cardiac arrest remains a leading cause of premature death worldwide. The reported likelihood of survival with favorable neurologic function is less than 10% in most communities, despite widespread CPR training and increased advanced care EMS systems. Host Margaret M. Parker, MD, MCCM, is joined by Paul E. Pepe, MD, MPH, MACP, FAEMS, MCCM, to review a practical, attainable roadmap for enhancing the likelihood of neurologically intact survival following sudden cardiac arrest  (Pepe P, et al. Crit Care Explor. 2020;2:e0214). Dr. Pepe is professor of management policy and community health at the University of Texas Health Science Center in Houston, Texas, USA, and global coordinator of the Metropolitan EMS Medical Directors Alliance and medical director of the Dallas County emergency medical services in Dallas, Texas, USA. This podcast is sponsored by ZOLL. Published: 12/10/2020

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. Published: 11/19/2020

SCCM Pod-423 Coagulopathy in COVID-19 Patients

COVID-19 is associated with a high prevalence of coagulopathy and venous thromboembolism. Host Kyle B. Enfield, MD, FCCM, talks with Jerrold H. Levy, MD, FAHA, FCCM, about what clinicians need to know about this serious problem and how it impacts care delivery (Iba et al. Crit Care Med. 2020;48:1358-1364). Dr. Levy is professor of anesthesiology, critical care professor of surgery (cardiothoracic), and codirector of the cardiothoracic ICU at Duke University Hospital in Durham, North Carolina, USA. This podcast is sponsored by BioFire.

Published: 9/30/2020

SCCM Pod-420 Nebulized Bacteriophages for Prophylaxis of Experimental MRSA VAP
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 (Prazak J, et al. Crit Care Med. 2020;48:1042-1046). Dr. Cameron is research group leader in the department of intensive care medicine at Inselspital, Bern University Hospital in Bern, Switzerland. Published: 9/10/2020

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. Published: 6/24/2020

SCCM Pod-416 COVID-19 Learning: Multiple Patients on a Single Ventilator
In a situation where ventilators are in short supply, multiple patients on a single ventilator could be a strategy of last resort. In this podcast, Arthur S. Slutsky, MD, discusses his article "Personalized Ventilation to Multiple Patients Using a Single Ventilator: Description and Proof of Concept" (Han J, et al. Crit Care Explor. 2020;2:e0118). A figure included in the article will provide a valuable visual aid to listeners.

Dr. Slutsky will discuss publishing information he hopes no one will ever have to use, but he encourages institutions to practice and test the proof of concept as an exercise in emergency preparedness.

The concept may also have benefit for resource-limited areas. Beyond the complexity of building the circuits, challenges related to alarms, infection control, and other complexities must also be considered.

"In a time of crisis where resources are limited, we introduce a system of multiple secondary breathing circuits driven by a ventilator in preference to that of simply splitting the breathing circuits, which has been shown to raise multiple risks for patients," he writes.

Dr. Slutsky is vice president or research at St. Michael's Hospital and professor of medicine, surgery, and biomedical engineering at University of Toronto in Ontario, Canada. Published: 5/28/2020