Critical Matters

In this episode of Critical Matters, we explore the role of the intensivist in the postoperative care of the cardiac surgical patient. Our guest is Dr. John Greenwood, a practicing intensivist who splits his clinical time between the Cardiac and Vascular ICU and the ED-ICU at the Hospital of the University of Pennsylvania. Additional Resources: Postoperative Critical Care of the Adult Cardiac Surgical Patient. Part I: Routine Postoperative Care: https://www.ncbi.nlm.nih.gov/pubmed/25962078 Postoperative Critical Care of the Adult Cardiac Surgical Patient: Part II: Procedure-Specific Considerations, Management of Complications, and Quality Improvement: https://www.ncbi.nlm.nih.gov/pubmed/26136101 Critical Care Perspectives in Emergency Medicine – a monthly CME podcast on resuscitation and critical care-related issues that can present to the ED https://www.criticalcareinem.com/ Critical Care Project – a multi-institutional website designed to be a multidisciplinary educational resource on topics in critical care. http://ccproject.com/ Books Mentioned in This Episode: How to Win Friends & Influence People: https://www.amazon.com/How-Win-Friends-Influence-People/dp/0671027034/ref=sr_1_3?ie=UTF8&qid=1521825606&sr=8-3&keywords=dale+carnegie The Last Lecture: https://www.amazon.com/Last-Lecture-Pausch-Randy-Hardcover/dp/B011MCWCDW/ref=sr_1_2?ie=UTF8&qid=1521826496&sr=8-2&keywords=the+last+lecture In the first of two episodes, we discuss general postoperative care, common complications, and the intensivist-cardiac surgeon relationship.

In our first episode of the Critical Matters podcast, we discussed the potential role of Angiotensin II in the treatment of distributive shock based on the results of the ATHOS 3 clinical trial. Now Angiotensin II is FDA approved and commercially available as a product named GIAPREZA™. In this episode we will discuss this topic further. Our guest is Dr. Lakhmir S. Chawla, Chief Medical Officer of La Jolla Pharmaceutical in San Diego, California. Previously, Dr. Chawla was a Professor of Medicine at the George Washington University. During his tenure at George Washington, 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. http://www.nejm.org/doi/full/10.1056/NEJMoa1704154 Outcomes in Patients with Vasodilatory Shock and Renal Replacement Therapy Treated with Intravenous Angiotensin II. https://www.ncbi.nlm.nih.gov/pubmed/?term=Outcomes+in+Patients+with+Vasodilatory+Shock+and+Renal+Replacement+Therapy+Treated+with+Intravenous+Angiotensin+II Prescribing information for Angiotensin II (GIAPREZA ™ ). http://giapreza.com/giapreza-prescribing-information.pdf Books Mentioned in This Episode: Atlas Shrugged: https://www.amazon.com/Atlas-Shrugged-Ayn-Rand/dp/0451191145/ref=sr_1_1?ie=UTF8&qid=1522104389&sr=8-1&keywords=atlas+shrugged+book

In this episode of Critical Matters, we explore the intersection of high-altitude medicine and physiology with critical care. Our guest is Robert B. Shoene, MD, FACP. Dr. Shoene is Associate Director, ICU and Critical Care, at St. Mary’s Medical Center in San Francisco. Dr. Shoene is a prolific author and researcher with more than 100 publications. His research has focused on pulmonary physiology and altitude medicine, and he has been part of numerous research expeditions to locations such as Mt. Everest and Denali. Additional Resources: Arterial Blood Gases and Oxygen Content in Climbers on Mount Everest: https://www.nejm.org/doi/full/10.1056/NEJMoa0801581 A comprehensive review on illnesses at high altitude: https://journal.chestnet.org/article/S0012-3692(08)60216-0/fulltext Everest: The West Ridge by Thomas Hornbein: https://www.amazon.com/Everest-West-Ridge-Thomas-Hornbein/dp/1594857075/ref=sr_1_1?ie=UTF8&qid=1520812701&sr=8-1&keywords=everest+the+west+ridge Endurance: Shackleton’s Incredible Journey by Alfred Lansing: https://www.amazon.com/Endurance-Shackletons-Incredible-Alfred-Lansing/dp/0465062881/ref=sr_1_1?s=books&ie=UTF8&qid=1520812797&sr=1-1&keywords=endurance Being Mortal: Medicine and What Matters in the End by Atul Gawande: https://www.amazon.com/Being-Mortal-Medicine-What-Matters/dp/1250076226/ref=sr_1_1?s=books&ie=UTF8&qid=1520812921&sr=1-1&keywords=Being+mortal Intensive Care, a poem by Dr. Robert Schoene: https://www.jstor.org/stable/1348231?seq=1#page_scan_tab_contents

In this episode, we discuss the practice of respect in the intensive care unit. Our guest is Samuel M. Brown, MD, MS, a practicing intensivist and Director of the Center for Humanizing Critical Care at Intermountain Medical Center in Murray, Utah. Dr. Brown holds an academic appointment as Associate Professor of Medicine at the University Of Utah School Of Medicine, Murray UT. He is a prolific investigator and author with a wide range of interests, including complexity in critical illness, echocardiography, and ethics. Our conversation covers topics such as dignity, respect, compassion and burnout. Join us in a fascinating discussion with a thought leader in bringing humanism to critical care. Additional Resources: - Recent article co-authored by Dr. Brown and colleagues reviewing important aspects of the practice of respect in critical care medicine. Click here to read. - The Center for Humanizing Critical Care works with researchers and clinicians with the goal of helping patients and family members make it through critical illness with their humanity intact. Learn more here. - Speak, Memory: An Autobiography Revisited by Vladimir Nabokov. Additional Resources: Recent article co-authored by Dr. Brown and colleagues reviewing important aspects of the practice of respect in critical care medicine. Click here to read. The Center for Humanizing Critical Care works with researchers and clinicians with the goal of helping patients and family members make it through critical illness with their humanity intact. Learn more here. Speak, Memory: An Autobiography Revisited by Vladimir Nabokov. Click here to learn more.

The use of point-of-care ultrasound (POCUS) has penetrated our clinical practice. In the hands of trained intensivists POCUS can quickly provide valuable diagnostic information and lead to specific therapeutic interventions. Today’s episode explores the use of POCUS during cardiac arrest. Our guest is Haney Mallemat, MD. Dr. Mallemat is board certified in emergency medicine, internal medicine, and critical care medicine and works in the emergency department and intensive care unit at Cooper University Hospital in Camden, NJ. He has lectured both nationally and internationally and has contributed to several emergency medicine and critical care podcasts. He is a firm believer in the benefits of bedside ultrasound for better patient care. Additional Resources - The REASON Trial evaluated the role of POCUS in out of hospital cardiac arrest arriving to the emergency department. Click here to read. - Point of care ultrasound can be associated with frequent interruptions during CPR. As Dr. Mallemat discusses in the podcast, providers must pay very close attention to this issue. Additional Resources: The REASON Trial evaluated the role of POCUS in out of hospital cardiac arrest arriving to the emergency department. Click here to read. Point of care ultrasound can be associated with frequent interruptions during CPR. As Dr. Mallemat discusses in the podcast, providers must pay very close attention to this issue. Click here to read more.

The advent of targeted temperature management has changed how we treat anoxic brain damage post cardiac arrest. In this episode of Critical Matters, we dive into the challenges and existing evidence regarding neuroprognostication in cardiac arrest survivors. Our guest is Fred Rincon, MD. Dr. Rincon is Associate Professor of Neurology and Neurological Surgery at Thomas Jefferson University in Philadelphia, PA. He is board certified in internal medicine and critical care (ABIM), neurology (ABPN), vascular neurology (ABPN), and neurocritical care (UCNS). Additional Resources - Practice Guidelines on reducing brain injury following cardiopulmonary resuscitation. These guidelines are published by the American Academy of Neurology and endorsed by the Neurocritical Care Society. Additional Resources: Practice Guidelines on reducing brain injury following cardiopulmonary resuscitation. These guidelines are published by the American Academy of Neurology and endorsed by the Neurocritical Care Society. Click here to read.

In this episode, we discuss critical illness-related corticosteroid insufficiency (CIRCI). Our guest is Stephen Pastores, MD, FACP, FCCP, FCCM. Dr. Pastores is Director of the Critical Care Medicine Fellowship Training and Research Programs at Memorial Sloan Kettering Cancer Center in New York, NY. Dr. Pastores co-chaired an international multispecialty task force addressing this important topic. During our podcast, he discusses the recent publications by this task force on corticosteroid insufficiency and the role on corticosteroid replacement in critical illness. Additional Resources: - Guidelines for the Diagnosis and Management of Critical Illness-Related Corticosteroid Insufficiency (CIRCI) in Critically Ill Patients (Part 1): Society of Critical Care Medicine (SCCM) and European Society of Intensive Care Medicine (ESICM) 2017. Click here to read. - Critical Illness-Related Corticosteroid Insufficiency (CIRCI): A Narrative Review from a Multispecialty Task Force of the Society of Critical Care Medicine (SCCM) and the European Society of Intensive Care Medicine (ESICM). Click here to read. - Adjunctive Glucocorticoid Therapy in Patients with Septic Shock​. ADRENAL Trial Investigators. Click here to read. Additional Resources: Guidelines for the Diagnosis and Management of Critical Illness-Related Corticosteroid Insufficiency (CIRCI) in Critically Ill Patients (Part 1): Society of Critical Care Medicine (SCCM) and European Society of Intensive Care Medicine (ESICM) 2017. https://www.ncbi.nlm.nih.gov/pubmed/28938253 Critical Illness-Related Corticosteroid Insufficiency (CIRCI): A Narrative Review from a Multispecialty Task Force of the Society of Critical Care Medicine (SCCM) and the European Society of Intensive Care Medicine (ESICM). https://www.ncbi.nlm.nih.gov/pubmed/28938251 Adjunctive Glucocorticoid Therapy in Patients with Septic Shock​. ADRENAL Trial Investigators. http://www.nejm.org/doi/full/10.1056/NEJMoa1705835?query=featured_home

In our first episode, we discuss the potential role of Angiotensin II for treating shock and review the results of the ATHOS-3 clinical trial. Our guest is Stephen W. Trzeciak, MD, MPH. Dr. Trzeciak is Interim Chair of Internal Medicine and Head of Critical Care Medicine at Cooper University Health Care. Dr. Trzeciak holds academic appointments as Professor of Medicine and Professor of Emergency Medicine at Cooper Medical School of Rowan University. He is also a prolific investigator and author, with recognized expertise in the treatment of shock, early interventions in critical illness, and the interface between the emergency department and the intensive care unit. Additional Resources: - Sound Critical Care webinar on vasopressors. Please review for a more comprehensive discussion on current evidence-based vasopressor use in clinical practice. - ATHOS-3 clinical trial. Randomized controlled trial evaluating the efficacy of Angiotensin II in raising blood pressure in vasodilatory shock. - FDA press release. After recording this podcast, the FDA announced the approval of Angiotensin II.