Critical Matters

This episode of Critical Matters will close 2024 with a year in review. Dr. Sergio Zanotti is going solo and will discuss a couple of relevant clinical guidelines and review five clinical trials. To close, he'll share some of his favorite books for 2024. Additional Resources: Critical Care Management of Patients Post Cardiac Arrest (AHA/NCS): Hirsch KG, Abella BS, Amorim E, et al. Critical Care Management of Patients After Cardiac Arrest: A Scientific Statement from the American Heart Association and Neurocritical Care Society. Neurocrit Care. 2024;40(1):1-37: https://bit.ly/4087o1w 2024 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations: Summary From the Basic Life Support; Advanced Life Support; Pediatric Life Support: Neonatal Life Support; Education, Implementation, and Teams; and First Aid Task Forces. Circulation 2024: https://bit.ly/4fD4o1R PREOXI Trial. Gibbs KW, Semler MW, Driver BE, et al. Noninvasive Ventilation for Preoxygenation during Emergency Intubation. N Engl J Med. 2024;390(23):2165-2177. doi:10.1056/NEJMoa2313680: https://bit.ly/4fD4pCX AMIKINHAL Trial. Ehrmann S, Barbier F, Demiselle J, et al. Inhaled Amikacin to Prevent Ventilator-Associated Pneumonia. N Engl J Med. 2023;389(22):2052-2062. doi:10.1056/NEJMoa2310307: https://bit.ly/4iQQvzU REVISE Trial. Cook D, Deane A, Lauzier F, et al. Stress Ulcer Prophylaxis during Invasive Mechanical Ventilation. N Engl J Med. 2024;391(1):9-20. doi:10.1056/NEJMoa2404245: https://bit.ly/3Pc4nqH TIGHT K Trial. O'Brien B, Campbell NG, Allen E, et al. Potassium Supplementation and Prevention of Atrial Fibrillation After Cardiac Surgery: The TIGHT K Randomized Clinical Trial. JAMA. 2024;332(12):979-988. doi:10.1001/jama.2024.17888: https://jamanetwork.com/journals/jama/fullarticle/2823246 BALANCE Trial. Daneman N, Rishu A, et al. Antibiotic Treatment for 7 versus 14 Days in Patients with Bloodstream Infections. N Engl J Med. Published online November 20, 2024. doi:10.1056/NEJMoa2404991: https://www.nejm.org/doi/abs/10.1056/NEJMoa2404991 CMD Study. Bodien YG, Allanson J, Cardone P, et al. Cognitive Motor Dissociation in Disorders of Consciousness. N Engl J Med. 2024;391(7):598-608. doi:10.1056/NEJMoa2400645: https://www.nejm.org/doi/full/10.1056/NEJMoa2400645 Books Mentioned in this Episode: Slow Productivity: The Lost Art of Accomplishment Without Burnout. By Cal New Port: https://amzn.to/4gTbkJ2 Meditations for Mortals: Four Weeks to Embrace Your Limitations and Make Time for What Counts. By Oliver Burkeman: https://bit.ly/4gURU6N Knife: Meditations After an Attempted Murder. By Salman Rushdie: https://bit.ly/3ZPsAIt

Dr. Steven Hollenberg, a critical care and cardiology physician at Emory University, discusses the evolving role of pulmonary artery catheters in modern medicine. He explores their historical significance and recent skepticism, particularly in cardiogenic shock cases. The conversation emphasizes the importance of proper patient selection and the benefits of accurate hemodynamic monitoring. It also touches on the need for clinician proficiency in catheter use, along with insights into the literature and personal growth through reading.

Dr. Joanna Hart, a pulmonary critical care physician and educator at the University of Pennsylvania, joins the discussion on how choice framing affects ICU goals of care meetings. They delve into decision architecture, emphasizing how the presentation of options shapes outcomes. The conversation reveals how loss aversion and cognitive biases impact high-stress decisions. Hart highlights the importance of empathy, effective communication, and aligning decisions with patients' true preferences during critical moments, particularly in emotionally charged situations.

In this discussion, Dr. Christopher Knoll, a critical care attending and associate program director at Cooper University Healthcare, dives into managing complications after cardiac surgery. He shares insights on the intricacies of handling hemorrhage and cardiac arrest, emphasizing the need for effective communication between surgical and intensive care teams. Dr. Knoll highlights the role of advanced technologies in improving outcomes and the importance of interdisciplinary collaboration. The conversation also takes a lighter turn, exploring music and travel interests, showcasing his engaging personality.

In this episode, Dr. Sergio Zanotti discuss the management of critically ill patients undergoing hyperglycemic emergencies. He is joined by Dr. George Willis, a practicing emergency medicine physician. Dr. Willis is an Associate Professor and Associate Program Director for Emergency Medicine at the University of Texas Health Science Center in San Antonio, where he also serves as Vice Chair of Faculty Affairs. A recognized clinical educator, he holds a particular interest in endocrine emergencies, vascular emergencies, procedural education, and medical education. Additional resources: Hyperglycemic Crises in Adults with Diabetes: A Consensus Report. GE Umpierez, et al. Diabetes Care 2024: https://diabetesjournals.org/care/article/47/8/1257/156808/Hyperglycemic-Crises-in-Adults-With-Diabetes-A Clinical Effects of Balanced Crystalloids vs Saline in Adults With Diabetic Ketoacidosis. WH Self, et al. JAMA 2020: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7670314/ Evaluation and Management of the Critically Ill Adult with Diabetic Ketoacidosis. B Long, GC Willis, S Lentz, et al. J Emerg Med 2020: https://pubmed.ncbi.nlm.nih.gov/32763063/ The SQuID protocol (subcutaneous insulin in diabetic ketoacidosis) Impacts on ED operational Metrics. Acad Emerg Med 2023: https://pubmed.ncbi.nlm.nih.gov/36775281/ Books mentioned in this episode: Kintsugi: Finding Strength in Imperfection. By Celine Santini: https://bit.ly/3NCdAYB

This episode, Dr. Sergio Zanotti discusses music and critical illness and explores the topic through the lens of his guest – Andrew Schulman. Andrew is the first musician to be accepted as a professional Society of Critical Care Medicine (SCCM) member. He is a member of the SCCM ICU Liberation Committee, where he met and had the opportunity to work with Dr. Zanotti. Andrew and his wife Wendy, are the subjects of Josh Aronson's documentary film Andrew & Wendy (2015), which has aired multiple times on PBS-TV. He is the author of Waking The Spirit: A Musician’s Journey Healing Body, Mind, and Soul. Since its release in the U.S. in August 2016, Waking the Spirit has been chosen as an Oliver Sacks Foundation Best Book of the Year Selection, Finalist for the Books for a Better Life Award, and a People Magazine Pick in Nonfiction. Additional Resources: Andrew Schulman’s Website https://andrewschulmanmusic.com/about Books and Albums mentioned in this episode: Waking The Spirit: A Musicians’s Journey Healing Body, Mind and Soul. By Andrew Schulman: https://us.macmillan.com/books/9781250132222 Musicophilia: A Tale of Music and the Brain. By Oliver Sacks: https://bit.ly/4dCTjwv St. Matthew Passion – Johann Sebastian Bach (Composer), Leonard Bernstein (Conductor): https://amzn.to/4eZmgE5 Lute Sonatas Nos. 30 & 39 & 96: 11 Silvius Leopold Weiss (Composer), Robert Barto (Performer): https://bit.ly/3YfXha2

D. Jeannie Callum, Director of Transfusion Medicine and Professor at Queens University, dives deep into the complexities of intravenous albumin use in critical care. She discusses emerging evidence that questions its safety and efficacy, alongside challenges of inconsistent practices worldwide. Callum also addresses the financial implications and potential risks associated with albumin, especially in vulnerable patient groups. The conversation underlines the necessity of solid evidence and patient inclusion in treatment guidelines for better healthcare outcomes.

Join Dr. Edilberto Amorin, a neurologist with expertise in critical care and epilepsy, as he delves into essential neurological support for cardiac arrest survivors. They discuss various topics, including targeted temperature management and innovative monitoring techniques like optic nerve ultrasound. Dr. Amorin highlights the significance of individualized treatment strategies and the complexities of managing brain edema and seizures. The conversation emphasizes the critical balance of optimism and caution while navigating recovery in these vulnerable patients.

Dr. Iqbal Ratnani, an intensivist at the DeBakey Heart & Vascular Center, dives into the complexities of vasoplegia, a critical post-cardiac surgery condition. He discusses its refractory nature and the significant mortal risks associated. The conversation shifts to the importance of tailoring mean arterial pressure (MAP) targets, exploring new treatment strategies like hydroxycobalamin. Dr. Ratnani emphasizes the need for individual patient assessment and the future of vasoplegia research, highlighting ongoing trials aiming for better management outcomes.

Laura Bontempo, an associate professor at the University of Maryland, and Sara Manning, an Indiana University assistant professor, dive into the intricate world of tracheostomy emergencies. They discuss the prevalence of complications like obstruction and hemorrhage, stressing the urgency for effective management. Key techniques, including the use of inflatable balloons for bleeding, are shared, along with the overarching themes of empathy and collaboration in emergency care. The conversation also touches on the emotional impact of literature in shaping healthcare perspectives.