Critical Matters

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.

In this discussion, Fred Rincon, a board-certified neurologist and neurointensivist at Thomas Jefferson University, explores neuroprognostication after cardiac arrest. He emphasizes the importance of waiting 72 hours post-rewarming before making prognosis decisions, given advancements like targeted temperature management. Rincon explains how physical exams and biomarkers can aid in predicting recovery while highlighting their limitations. He also discusses aggressive treatment of myoclonic patterns and the role of imaging in the prognostication process.

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.