Critical Matters

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

In this episode of Critical Matters, listen to the recording of Sound Critical Care’s webinar, Personalized Selection of Vasopressors in the Treatment of Shock. Our guest for this episode is Dr. Lakhmir Chawla, Chief Medical Officer of La Jolla Pharmaceutical in San Diego, California. During this webinar, we discuss lessons learned from the clinical use of the new vasopressor Angiotensin II, as well as personalization of vasopressor therapy in the treatment of vasodilatory shock. Watch the video recording: https://bit.ly/2jZ1z5h

Hyponatremia and hypernatremia are common in ICU patients and they are associated with increased morbidity and mortality. In this episode of Critical Matters, we discuss the diagnostic approach and treatment of sodium disorders in the ICU. Our guest is Dr. Lawrence Weisberg, Head of the Division of Nephrology and Deputy Chair of Medicine at Cooper University Health Care. Dr. Weisberg is also Professor of Medicine and Assistant Dean for Curriculum at the Cooper Medical School of Rowan University, in Camden, New Jersey. Additional Resources: Disorders of Plasma Sodium - Causes, Consequences, and Correction: https://bit.ly/2TT9SNB Rate of Correction of Hypernatremia and Health Outcomes in Critically Ill Patients: https://bit.ly/2P2wxrY Evidence for Managing Hypernatremia: Is It Just Hyponatremia in Reverse?: https://bit.ly/2HjZn0S Books Mentioned in this Episode: From Fish to Philosopher; the Story of our Internal Environment by Homer William Smith: https://amzn.to/30nrraU Operating Manual for Spaceship Earth by R. Buckminster Fuller: https://amzn.to/2Z6coWt Critical Path by R. Buckminster Fuller: https://amzn.to/2MA9vH9

In this episode of Critical Matters, we will discuss the role of early neuromuscular blockers in the treatment of severe ARDS. Our guest is Dr. Arthur Slutsky, Professor of Medicine, Surgery and Biomedical Engineering at the University of Toronto. Dr. Slutsky is a world-renowned clinician and investigator with a special interest in ARDS. We will review a recently published clinical trial and discuss its result within the context of available evidence. Additional Resources: Neuromuscular Blockers in Early Acute Respiratory Distress Syndrome: https://bit.ly/2YwXxnG Neuromuscular Blocking Agents in ARDS: https://bit.ly/2KmMZiA Early Neuromuscular Blockade in the Acute Respiratory Distress Syndrome: https://bit.ly/2ROMJea Early Paralytic Agents for ARDS? Yes, No, and Sometimes: https://bit.ly/2ZONDuB Books Mentioned in this Episode: Nudge: Improving Decisions About Health, Wealth and Happiness by Richard H. Thaler and Cass R. Sunstein: https://amzn.to/2Kv75pD Misbehaving: The Making of Behavioral Economics by Richard H. Thaler: https://amzn.to/2YRm5Dc Bad Blood: Secrets and Lies in a Silicon Valley Startup by John Carreyrou: https://amzn.to/2MPDjyN

One in five US residents receives ICU care at the end of life. In this episode of Critical Matters, we discuss different aspects of end of life care in the ICU. Our guest is Dr. BJ Miller, a palliative care physician at the University of California, San Francisco and former Executive Director of Zen Hospice Project. He is a powerful advocate for the role of our senses, community, and presence in delivering palliative care and for ushering in a new perspective on living with death. Additional Resources: What really matters at the end of life, BJ Miller presented at TED 2015: https://bit.ly/1PlAuNP Clinician-Family Communication About Patients' Values and Preferences in Intensive Care Units. Scheunemann LP et al, JAMA Internal Medicine, 2019: https://bit.ly/2LEH0Y5 A Beginner's Guide to the End: Practical Advice for Living Life and Facing Death. BJ Miller and Shoshana Berger: https://amzn.to/30VVWEV Vital Talk courses, a set of online and in person courses designed to equip clinicians with the tools to have difficult conversations with patients and families:https://bit.ly/30SPrm6 Books Mentioned in this Episode: Man’s Search for Meaning by Viktor Frankl: https://amzn.to/2JPJjFQ Mortally Wounded: Stories of Soul Pain, Death and Healing by Michael Kearney: https://amzn.to/2YkDPuF Bering Mortal: Medicine and What Matters in the End by Atul Gawande: https://amzn.to/2GsTXjH The Denial of Death by Ernest Becker: https://amzn.to/2SyY7LI

In this episode of Critical Matters, we discuss lessons learned from the clinical use of Angiotensin II (GIAPREZA™), which was approved for use in patients with vasodilatory shock a little over a year ago. Our guest is Dr. Lakhmir S. Chawla, Chief Medical Officer of La Jolla Pharmaceutical in San Diego, California. Dr. Chawla was the designer and lead investigator of the ATHOS (Angiotensin II for the Treatment of High Output Shock) trial which results led to the ATHOS 3 trial, (The Phase 3 clinical trial of angiotensin II, for the treatment of catecholamine-resistant hypotension). ADDITIONAL RESOURCES: ATHOS-3 Clinical Trial. Randomized controlled trial evaluating the efficacy of Angiotensin II in raising blood pressure in vasodilatory shock: https://bit.ly/2r5SpG0 Outcomes in Patients with Vasodilatory Shock and Renal Replacement Therapy Treated with Intravenous Angiotensin II: https://bit.ly/2JttWTj Sensitivity to angiotensin II dose in patients with vasodilatory shock: a prespecified analysis of the ATHOS-3 trial: https://bit.ly/2xDVVsr ALBUMS AND BOOKS MENTIONED IN THIS EPISODE: The Dark Side of the Moon, Pink Floyd: https://amzn.to/2XZr34x Wish You Were Here, Pink Floyd: https://amzn.to/2Lc2lbb Loonshots: How to Nurture the Crazy Ideas That Win Wars, Cure Diseases, and Transform Industries, Safi Bachall: https://amzn.to/2S4IrPU

Dr. M. Kamran Athar, a neurointensivist at the Farber Institute for Neuroscience, dives deep into acute neuromuscular disorders like Guillain-Barré syndrome and myasthenia gravis. He discusses differential diagnostics and explains when to admit patients to the ICU based on respiratory and autonomic concerns. Unique insights include predicting respiratory failure in GBS and the role of immunotherapies versus corticosteroids. Athar also highlights the importance of patient dignity and effective decision-making in critical care.