Critical Matters

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

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

Dr. Sayona John, a neurointensivist at Rush Medical College, shares her expertise on managing intracerebral hemorrhage (ICH), the deadliest stroke type affecting millions. She highlights the critical importance of rapid diagnosis using CT scans and how blood pressure control can mitigate hematoma expansion. Discussions include distinguishing between hypertensive and amyloid-related bleeds, the role of anticoagulant reversal, and effective surgical interventions for cerebellar hemorrhages. Dr. John emphasizes a systems approach to timely care and the need for clear protocols.