Critical Matters

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

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