Critical Matters

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

In this episode of Critical Matters, listen to the recording of the Sound Critical Care’s latest webinar, Outliers and Super Users: Targeting Prolonged Use of MV in the ICU. Critically ill patients requiring prolonged mechanical ventilation have poor clinical outcomes and consume a disproportionate amount of resources. In this webinar, we will discuss outliers and super users in the ICU utilizing prolonged mechanical ventilation as a case study. We will also discuss outcomes for these patients and finally strategies to optimize the care of this difficult patient population. Watch the video recording: http://bit.ly/2MHL4Ga Additional Resources: The Hot Spotters by Atul Gawande: http://bit.ly/36lUdvT I-TRACH: Validating A Tool for Predicting Prolonged Mechanical Ventilation: http://bit.ly/2SEcOPy Expectations and outcomes of prolonged mechanical ventilation: http://bit.ly/2QbBDRp Long-term survival of critically ill patients treated with prolonged mechanical ventilation: a systematic review and meta-analysis: http://bit.ly/2tjQgJu Lean Six Sigma to Reduce Intensive Care Unit Length of Stay and Costs in Prolonged Mechanical Ventilation: http://bit.ly/359bYwV

Point-of-care ultrasound continues to grow in availability and is now embedded in many critical care practices. In this episode Critical Matters, we discuss the use of point-of-care ultrasound (POCUS) in the management of hypotension and shock. Our guest is Dr. Haney Mallemat a recognized educator with a strong interest in POCUS. Dr. Mallemat holds dual academic appointments in Critical Care Medicine and Emergency Medicine at Cooper Medical School of Rowan University. Additional Resources: Bedside ultrasound in resuscitation and the rapid ultrasound in shock protocol: http://bit.ly/359RkgX The Society of Point of Care Ultrasound: http://bit.ly/2senLMJ Guidelines for the Appropriate Use of Bedside General and Cardiac Ultrasonography in the Evaluation of Critically Ill Patients—Part II: Cardiac Ultrasonography: http://bit.ly/35b1D4r Does Point-of-Care Ultrasonography Improve Clinical Outcomes in Emergency Department Patients With Undifferentiated Hypotension? An International Randomized Controlled Trial From the SHoC-ED Investigators: http://bit.ly/2Ehzhd3 Rebel Cast Ep 58 - Would you be SHoC-ED if POCUS did not Improve Clinical Outcomes in Patients with Undifferentiated Shock?: http://bit.ly/345uq93 Clinical significance of portal hypertension diagnosed with bedside ultrasound after cardiac surgery: http://bit.ly/2LFJ7sY Education Conferences: UltraRounds: http://bit.ly/2RAgkdk ResusX: http://bit.ly/2t86q8J Music Mentioned in this Episode: The Joshua Tree by U2: https://amzn.to/2sYlOnM

Intracerebral hemorrhage (ICH) affects more than one million people annually, worldwide, and is the deadliest and most disabling type of stroke. In this episode of Critical Matters we will discuss the critical care management of ICH. Our guest is Dr. Sayona John, Associate Professor in the Department of Neurological Sciences at Rush Medical College. She is a practicing neurointensivist and also serves as the Head of the Section of Critical Care Neurology and Medical Director of the Neuroscience Intensive Care Unit & Neuroemergency Transfer programs at Rush University Medical Center in Chicago. Additional Resources: AHA 2015 Guidelines for the Management of Spontaneous Intracerebral Hemorrhage: http://bit.ly/33ovvZo The ICH score: a simple, reliable grading scale for intracerebral hemorrhage: http://bit.ly/2rsRh0G ICH Score Calculator: http://bit.ly/2OotfNx Music Mentioned in this Episode: Brother in Arms by Dire Straits: https://amzn.to/34pMxYj Money for Nothing by Dire Straits: http://bit.ly/34pAWZ9

Cardiogenic shock (CS) is a common cause of mortality, and its management remains challenging despite significant advances in treatment options. In this episode of Critical Matters, we discuss basic concepts, a new proposed classification, and updates on the medical management of patients with cardiogenic shock. Our guest is Dr. Steve Hollenberg, a practicing cardiologist with dual training in cardiology and critical care medicine. Dr. Hollenberg is a Professor of Medicine at Hackensack Meridian School of Medicine at Seton Hall University and Associate Director of the CTICU at Hackensack Meridian University Hospital. Additional Resources: The paramedian lumbar puncture: http://bit.ly/2pk8JUw Contemporary Management of Cardiogenic Shock: A Scientific Statement From the American Heart Association: http://bit.ly/2Qdjoey SCAI clinical expert consensus statement on the classification of cardiogenic shock: http://bit.ly/2XdjeWa SCAI stages of cardiogenic shock stratify mortality risk: http://bit.ly/2CCzbf9 Books Mentioned in this Episode: Ulysses by James Joyce: https://amzn.to/2QgIoBW Gravity’s Rainbow by Thomas Pynchon: https://amzn.to/36Vgjps The Elements of Style by E. B. White: https://amzn.to/2QdklUa The Little Prince by Antoine de Saint-Exupéry https://amzn.to/352frOi

In this episode of Critical Matters, we will discuss the recently published CITRIS-ALI clinical trial evaluating the role of high dose Vitamin C in severe sepsis and ARDS. Our guest is Dr. Emily Brant. Dr. Brant is a practicing intensivist and faculty at the University of Pittsburgh Medical Center. She was the lead author in the JAMA editorial entitled “Is High-Dose Vitamin C Beneficial for Patients with Sepsis?” which was published alongside the CITRIS-ALI Clinical Trial. Additional Resources: Is High-Dose Vitamin C Beneficial for Patients with Sepsis?: http://bit.ly/2nWKoDp Effect of Vitamin C Infusion on Organ Failure and Biomarkers of Inflammation and Vascular Injury in Patients With Sepsis and Severe Acute Respiratory Failure: The CITRIS-ALI Randomized Clinical Trial: http://bit.ly/31s0QcD Hydrocortisone, Vitamin C, and Thiamine for the Treatment of Severe Sepsis and Septic Shock: A Retrospective Before-After Study: http://bit.ly/2pBs433 Phase I safety trial of intravenous ascorbic acid in patients with severe sepsis: http://bit.ly/2Bl523c Books Mentioned in this Episode: Becoming by Michelle Obama: https://amzn.to/2MvHRd3

Dr. Sayona John, a neurointensivist and Associate Professor at Rush Medical College, shares her expertise on managing acute ischemic stroke in intensive care. She discusses critical protocols for patient assessment using the NIH Stroke Scale, emphasizes the need for careful airway and blood pressure management, and navigates the complexities of thrombolytic therapy. Dr. John also highlights the challenges of individualized patient care and the importance of interdisciplinary collaboration, while sharing insights on leadership inspired by Abraham Lincoln's presidency.

Acute abdominal complications developing in critically ill patients in the ICU can be associated with significant morbidity and mortality. In this episode of Critical Matters, we discuss a variety of acute abdominal complications such as abdominal compartment syndrome, acalculous cholecystitis, toxic megacolon and ischemic bowel. Our guest is Dr. Samuel Tisherman. Dr. Tisherman is a surgical critical care physician at the R Adams Cowley Shock Trauma Center, University of Maryland Medical Center and a Professor of Surgery at the University of Maryland School of Medicine. Additional Resources: World Society of Abdominal Compartment Syndrome (WSACS) consensus definitions and recommendations: https://bit.ly/2l9m6EQ Acute Acalculous Cholecystitis: A Review. Huffman J, Schenker S. Clinical Gastroenterology and Hepatology: https://bit.ly/2nfssTL Ogilvie’s Syndrome: Management and Outcomes. Haj, M et al. Medicine: https://bit.ly/2mKLVM5 Books Mentioned in this Episode: Complications: A Surgeon’s Note on an Imperfect Science. By Atul Gawande: https://amzn.to/2laETzB