Critical Matters

In this episode of Critical Matters, we discuss the role of procalcitonin as a biomarker in lower respiratory tract infections and sepsis. Our guest is Dr. David Huang, the primary investigator in the recently published Procalcitonin-Guided Use of Antibiotics for Lower Respiratory Tract Infections (ProACT) clinical trial. He discusses lessons learned from this very important study and offers insight into the use of procalcitonin in clinical practice. ADDITIONAL RESOURCES: Procalcitonin-Guided Use of Antibiotics for Lower Respiratory Tract Infections (ProACT) clinical trial: https://bit.ly/2BTZNsf A meta-analysis evaluating the effect of procalcitonin-guided treatment on mortality in acute respiratory infections: https://bit.ly/2Un6Lgz FDA Executive Summary on Procalcitonin assay: https://bit.ly/2EiBN4r BOOKS MENTIONED IN THIS EPISODE: 7 Habits of Highly Effective People by Stephen R. Covey: https://amzn.to/2Ss0mPq Partners of the Heart by Vivien Thomas: https://amzn.to/2QC6vLP

Lung protective ventilation for ARDS includes the use of low tidal volumes, positive-end expiratory pressure (PEEP), and limiting of airway plateau pressure to minimize ventilator-induced lung injury. However, in the sickest subset of patients with ARDS hypoxemia may persist despite optimal lung protective strategies. In this episode of Critical Matters, we discuss salvage therapies for patients with refractory hypoxemia. Our guest is Dr. Robert Hyzy, Medical Director of the Critical Care Medicine Unit and Co-Chair of the Critical Care Committee at the University of Michigan Hospital.

Acute respiratory distress syndrome (ARDS) is a severe form of respiratory failure that affects approximately 200,000 patients each year in the United States, resulting in nearly 75,000 deaths annually. In this episode of Critical Matters, our guest Dr. R. Phillip Dellinger discusses the current management of patients with ARDS. Dr. Dellinger is a recognized thought leader in the field, a prolific author, an accomplished researcher, and the recipient of multiple awards for his contributions to critical care. ADDITIONAL RESOURCES: The PROSEVA clinical trial showed that in patients with severe ARDS prone position ventilation improved mortality: https://bit.ly/2Dp3LdS The ACURASYS clinical study showed that in patients with severe ARDS 48 hours of neuromuscular blockade was associated with improved mortality: https://bit.ly/2FqI7Zn The EOLIA study was stooped early for futility. However, many think that it still has important findings regarding the use of ECMO in severe ARDS: https://bit.ly/2QI1Cxu BOOKS MENTIONED IN THIS EPISODE: Evidence-Based Critical Care: A Case Study Approach: https://amzn.to/2PYeD8V

Caring for critically ill pregnant patients poses a series of unique challenges for the intensivist. In part two of this two-episode series, we discuss critical care in pregnancy with Dr. Stephen Lapinsky. Dr. Lapinsky is a practicing intensivist and professor of medicine at the University of Toronto. He is a member of the editorial board of the journal, Obstetric Medicine, and sits on the steering committee of the North American Society of Obstetric Medicine. Dr. Lapinsky is also the executive of the Women’s Health Network of the ACCP. Today (Part 2) we will cover general conditions that may lead to critical illness in pregnant women. Additional Resources: Practice bulletin on Critical Care in Pregnancy from the American College of Obstetrics and Gynecology (ACOG): https://bit.ly/2OtJARU A comprehensive review on acute respiratory failure in pregnancy: https://bit.ly/2DKzwjl AHA scientific statement on cardiac arrest in pregnancy: https://bit.ly/2QpGWtK

Caring for critically ill pregnant patients poses a series of unique challenges for the intensivist. In this two-episode series, we discuss critical care in pregnancy with Dr. Stephen Lapinsky. Dr. Lapinsky is a practicing intensivist and professor of medicine at the University of Toronto. He is a member of the editorial board of the journal, Obstetric Medicine, and sits on the steering committee of the North American Society of Obstetric Medicine. Dr. Lapinsky is also the executive of the Women’s Health Network of the ACCP. Today (Part 1) will cover unique conditions associated with pregnancy that may lead to critical illness. Additional Resources: Practice bulletin on Critical Care in Pregnancy from the American College of Obstetrics and Gynecology (ACOG): https://bit.ly/2OtJARU A comprehensive review on acute respiratory failure in pregnancy: https://bit.ly/2DKzwjl AHA scientific statement on cardiac arrest in pregnancy: https://bit.ly/2QpGWtK

John Devlin, a Professor at Northeastern University and lead author of the 2018 SCCM guidelines, dives into critical topics affecting ICU patients. He discusses the updated guidelines for pain, agitation, sedation, and sleep disruption, emphasizing individualized care. The conversation highlights innovative pain management strategies and the importance of early mobilization and sleep hygiene for recovery. Devlin also underscores the collaborative nature of care and how empowering patients can revolutionize ICU practices.

In this episode of Critical Matters, we explore the role of the intensivist in the management of patients with ventricular assist devices. Our guest is Dr. John Greenwood, a practicing intensivist who splits his clinical time between the Cardiac & Vascular ICU and the ED-ICU at the Hospital of the University of Pennsylvania. Additional Resources: Summary of information presented during the episode kindly provided by Dr. John Greenwood: https://bit.ly/2MJdfSa HeartWare Waveforms App for iPad: https://apple.co/2NpyQEr Articles Mentioned In This Episode: Pratt AK, Shah NS, Boyce SW. Left ventricular assist device management in the ICU. Crit Care Med. 2014;42(1):158-68: https://bit.ly/2MKr3M6 Sen A, Larson JS, Kashani KB, et al. Mechanical circulatory assist devices: a primer for critical care and emergency physicians. Crit Care. 2016;20(1):153: https://bit.ly/2NoreC4

In this episode of Critical Matters, we continue the discussion of medical errors in healthcare with a specific focus on how to disclose medical errors to patients. Our guest is Dr. Nitin Puri, a practicing intensivist and medical educator at the Cooper Medical School of Rowan University and the Cooper Health System in Camden, New Jersey. Additional Resources: This is a CNN story on cardiothoracic fellow wrongly accused and sued for lying about a medical error: https://cnn.it/2vFEnLf The Communication and Optimal Resolution (CANDOR) toolkit from the Agency for Healthcare Research and Quality (AHRQ). CANDOR is a process that health care institutions and providers can use to respond in a timely, thorough and fair way when medical errors occur and cause patients harm: https://bit.ly/2m9fch7 A powerful video on the topic of the disclosure of medical errors: https://bit.ly/2DaD6TD Article Mentioned in This Episode: Mistakes Were Made (but Not by Me): Why We Justify Foolish Beliefs, Bad Decisions, and Hurtful Acts: https://amzn.to/2NorssU

In this episode of Critical Matters, we discuss “Compassionomics” with Dr. Stephen Trzceciak. Dr. Trzeciak is a practicing intensivist and prolific researcher. His research interests have focused recently on the hypothesis that compassion matters for patients, for healthcare outcomes, and for providers. Compassionomics is the revolutionary field of science focusing on caring, and the impact compassion has on healthcare. Additional Resources: How 40 Seconds of Compassion Could Save a Life: https://youtu.be/elW69hyPUuI Compassionomics: Hypothesis and experimental approach: http://compassionomics.net Article Mentioned in This Episode: A Patient’s Story: http://www.theschwartzcenter.org/media/patient_story.pdf

In this episode, we discuss the ABCDEF bundle, a tool used to promote evidence-based care that promotes healing and liberation from critical illness for patients in the ICU. Our guest is Dr. Julia Barr who is currently the Associate Professor of Anesthesia in the Medical Center Line at Stanford Medical School and a staff anesthesiologist and intensivist at the VA Palo Alto Medical Center. Dr. Barr has served as a national faculty member for the SCCM ICU Liberation Campaign ABCDEF Bundle Collaborative and is a member of the SCCM’s ICU Liberation Committee. Additional Resources: Society of Critical Care Medicine’s guidelines on management of pain, agitation and delirium: http://www.sccm.org/Research/Guidelines/Guidelines/Pain,-Agitation,-and-Delirium-in-Adult-Patients-in Society of Critical Care Medicine’s guidelines for Family-Centered Care in the ICU: http://www.sccm.org/Research/Guidelines/Guidelines/Family-Centered-Care-in-the-ICU Books Mentioned in This Episode: The Power of Habit: Why We Do What We Do in Life and Business: https://www.amazon.com/Power-Habit-What-Life-Business-ebook/dp/B0055PGUYU/ref=sr_1_2?ie=UTF8&qid=1530020419&sr=8-2&keywords=the+power+of+habit