Critical Matters

In this episode, Dr. Sergio Zanotti discusses the different aspects of managing pneumonia in critically ill patients. He covers the initial management of severe pneumonia, management of ventilator-associated pneumonia, and highlights the clinical approach to non-resolving pneumonia in the intensive care unit (ICU). He is joined by Dr. Andre Kalil, a physician specializing in critical care and infectious diseases. Dr. Kalil is a Professor in the Division of Infectious Diseases and Director of Transplant Infectious Diseases at the University of Nebraska Medical Center (UNMC). Additional resources: How to approach a patient hospitalized for pneumonia who is not responding to treatment? Pedro Povoa, et al. Intensive Care Med 2025: https://link.springer.com/article/10.1007/s00134-025-07903-3 Management of Adults With Hospital-acquired and Ventilator-associated Pneumonia: 2016 Clinical Practice Guidelines by the Infectious Diseases Society of America and the American Thoracic Society. Andre Kalil, et al. Clin Infect Dis. 2016: https://pmc.ncbi.nlm.nih.gov/articles/PMC4981759/ Management of Ventilator-Associated Pneumonia: Guidelines. M Metersky and Andre c. Kalil. Infect Dis Clin North Am. 202: https://pubmed.ncbi.nlm.nih.gov/38280768/ Hydrocortisone in Severe Community-Acquired Pneumonia. CAPE-COD Clinical Trial. N Eng J of Med 202: https://www.nejm.org/doi/full/10.1056/NEJMoa2215145 Continuous vs. Intermittent β-Lactam Antibiotic Infusions in Critically Ill Patients with Sepsis. BLING III Clinical Trial. JAMA 2024: https://jamanetwork.com/journals/jama/fullarticle/2819971 Music mentioned in this episode: Pat Metheny Group – We Live Here: https://bit.ly/44gt8Jl Antonio Carlos Jobin – Terra Basilis: http://bit.ly/4k4Amq1 Mahler: Symphony No.9 – Chicago Symphony Orchestra: http://bit.ly/4k9sXWn

Leah Gramlich, a leading gastroenterologist and nutrition specialist from Alberta, shares her extensive expertise on enteral nutrition in the ICU. The conversation delves into the critical impact of nutrition on patient recovery, emphasizing personalized dietary strategies. Gramlich highlights the ongoing debate between bolus and continuous feeding methods. She also discusses the evolving perspectives on gastric residual measurements and the importance of managing complications like glycemic issues. Listeners gain insight into the future of nutritional practices in critical care.

Dr. Stephen Trzeciak, a physician-scientist and chief of medicine at Cooper University Health Care, dives into the transformative science of hope. He discusses how fostering hope can significantly improve patient outcomes, contrasting it with feelings of helplessness. The conversation explores Hope Theory, emphasizing personal agency and resilience in healthcare. Dr. Trzeciak also highlights how literature, like Viktor Frankl's writings, can inspire hope and gratitude, offering invaluable insights into the human experience during critical care.

Join Dr. Emily Damuth, an Assistant Professor of Medicine and Emergency Medicine, as she shares her insights on mechanical ventilation tailored for severe asthma patients. She highlights the urgency of monitoring and decision-making in emergency settings and the vital role of timely interventions. The conversation dives into managing ventilator settings, understanding arterial blood gases, and the complexities of airway dynamics. Later, Dr. Damuth reflects on the importance of empathy and teamwork in medicine, emphasizing the balance between professional passion and personal life.

Joanna L. Stollings, PharmD, is a critical care pharmacotherapy expert at Vanderbilt University Medical Center and co-chair of the updated PADIS guidelines. In this engaging discussion, she dives into the crucial updates on managing pain, anxiety, and sedation in ICU patients. Joanna emphasizes the need for improved assessment tools for anxiety and highlights the shift towards dexmedetomidine for sedation. She also explores the advancements in delirium treatment, innovations in alcohol withdrawal management, and the significance of post-ICU care to enhance patient recovery.

Dr. Sara Nikravan, a leading cardiothoracic anesthesia critical care physician, discusses the groundbreaking role of transesophageal echocardiography (TEE) in cardiac emergencies. She highlights TEE's superior imaging capabilities over traditional methods for assessing cardiac function during critical situations. The importance of high-fidelity simulation training and timely interventions is emphasized, aiming to improve outcomes in resuscitation efforts. Dr. Nikravan also addresses the gaps in research on TEE’s impact in ICU settings and the need for enhanced training protocols for clinicians.

Dr. Sharad Patel, a critical care physician known for his expertise in nephrology and echocardiography, dives into the transformative world of artificial intelligence in healthcare. He discusses how AI enhances decision-making in intensive care units by processing vast medical data. Dr. Patel debunks myths surrounding AI, emphasizing its role as a supportive tool rather than a replacement for clinicians. He also shares insights on the importance of coding skills and AI literacy for future healthcare professionals, along with the personal growth benefits of embracing stillness.

Dr. Mervyn Singer, a leading figure in critical care at University College London, joins Dr. Sergio Zanotti to challenge outdated practices in the ICU. They discuss the pitfalls of prolonged antibiotic use and advocate for personalized treatment durations. The conversation also critiques rigid diabetic management protocols, emphasizing the need for tailored patient care. They touch on the misconceptions surrounding bicarbonate therapy in metabolic acidosis and encourage a critical reassessment of established medical norms while reflecting on the evolution of healthcare and the role of music.

Dr. Cameron Dezfulian, a pediatric and adult critical care physician at Texas Children's Hospital, delves into the complexities of managing adults with congenital heart disease in intensive care. He discusses the unique challenges these patients face, including chronic conditions and the need for specialized care transitions. The conversation also highlights the intricacies of airway management in congenital anomalies and the critical role of multidisciplinary collaboration and effective communication for optimal patient outcomes.

February 7-14 marks the observance of Congenital Heart Disease Awareness Week. In this podcast episode, Dr. Sergio Zanotti provides a unique perspective on adult congenital heart disease, drawing from his journey as a lifelong patient. He offers reflections shaped by his own experiences with complex adult congenital heart disease, including insights gained from a recent medical procedure that granted him a firsthand view of patient care in the ICU. Additional resources: ACC/AHA 2008 Guidelines for the Management of Adults With Congenital Heart Disease. Circulation 2008: https://www.ahajournals.org/doi/pdf/10.1161/CIRCULATIONAHA.108.190690 The Bell Curve. By Atul Gawande. The New Yorker 2004: https://www.newyorker.com/magazine/2004/12/06/the-bell-curve Website for the Adult Congenital Heart Association: https://www.achaheart.org/ Books and music mentioned in this episode: Montaigne. By Stefan Zweig: https://bit.ly/4gEOVP2 The Heart. A Novel. By Maylis De Kerangal: https://bit.ly/41ehqin The Essays: A Selection (Penguin Classics). By. Michel de Montaigne: https://bit.ly/3EvFwvW