Critical Matters

May is National Critical Care Awareness and Recognition Month, a time to celebrate our ICU teams and honor our patients. In this episode of the podcast, we will focus on the forgotten patient – the loved ones and families of critically ill patients. We will explore the topic through the lens of a cardiac arrest co-survivor. Our guest is Kristin Flanary, a cognitive neuroscientist and social psychologist. Kristin is a co-survivor of cancer(twice) and a co-survivor of sudden cardiac arrest. She is also known for her social media alter ego – Lady Glaucomflecken. In 2022 Kristin co-founded Glaucomflecken LLC, where she works to advocate for caregivers and co-survivors of medical trauma and critical illness, community CPR and AED use, and sudden cardiac arrest survivorship. She has written about her experience as a co-survivor in medical journals and has received an EMS Cardiac Arrest Save Challenge Coin, the Citizen CPR Foundation’s '40 Under 40' award, and the American Heart Association’s Resuscitation Champion award. Additional Resources: The Quiet Place. K. Flanary. Journal of Cardiac Failure, 2021: https://www.onlinejcf.com/article/S1071-9164(21)00403-6/fulltext Roger. K Flanary. CHEST. 2022: https://journal.chestnet.org/article/S0012-3692(22)04029-6/fulltext Life after Cardiac Arrest: The importance of engaging with the “forgotten patient.” K Haywood & K Dainty. Resuscitation, 2018: https://www.resuscitationjournal.com/article/S0300-9572(18)30195-3/pdf Link to the Glaucomflecken’s website: https://glaucomflecken.com/ Books Mentioned in this Episode: In Shock. By Rana Awdish: https://bit.ly/441b0Cx

Transitions of care during a patient’s hospitalization are points of vulnerability with a high potential for harm. In this episode, we will discuss transitions of care from the ICU to the wards. We will explore the ICU-PAUSE framework and how it can be implemented to improve this critical process of care delivery in the ICU. Our guest is Dr. Lekshmi Santhosh, a practicing pulmonary critical care physician at UCSF Health. She is an Associate Professor of Medicine in the Divisions of Pulmonary/Critical Care Medicine & Hospital Medicine at the University of California San Francisco. Dr. Santosh is one of the creators and leaders of the ICU-PAUSE initiative. Additional Resources American Thoracic Society (ATS) ICU-PAUSE initiative. https://www.thoracic.org/professionals/education/ats-icu-pause-initiative.php Creating the ICU-PAUSE Tool for Intensive Care Unit-Ward Transitions. L Santosh et al. ATS Scholar 2022. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9341494/ Characterizing ICU-ward handoffs at three academic medical centres: process and perceptions. L Santosh, et al. BMJQS 2018. https://pubmed.ncbi.nlm.nih.gov/30636201/ Implementation of the I-PASS handoff program in diverse clinical environments: A multicenter prospective effectiveness implementation study. A Starmer, et al. J Hosp Med 2023. https://pubmed.ncbi.nlm.nih.gov/36326255/ Books Mentioned in this Episode In Shock. By Rana Awdish: bit.ly/441b0Cx Every Deep Drawn Breath. By Wes Ely: bit.ly/3Aqt4IC Mom Milestones. By Grace Farris: bit.ly/3ArT06z Dare to Lead. By Brene Brown: bit.ly/3n3N54O Quiet. By Susan Cain: bit.ly/3HcuHxk The Credibility Code (Speech Skills). By Cara Hale Alter: bit.ly/40ErQE8

Despite all the advances developed in critical illness, survivors of the ICU have a long journey to healing and recovery. In this episode of the podcast, we will discuss outcomes after critical illness. Our guest is Dr. Margaret Herridge, Professor of Medicine, Senior Scientist in Critical Care and Respiratory Medicine at the University of Toronto. Dr. Herridge is also Director of Critical Care Research. Director of the RECOVER Program, and Clinical Director of the Grace RECOVER Program for Chronic Critical Illness, in the University Health Network, Toronto, Canada. Additional Resources: Outcomes after Critical Illness. M. Herridge and E. Azoulay: https://pubmed.ncbi.nlm.nih.gov/36884324/ Neuropsychological sequelae and impaired health status in survivors of severe acute respiratory distress syndrome. Hopkins RO, et al: https://pubmed.ncbi.nlm.nih.gov/10390379/ One-year outcomes in survivors of the acute respiratory distress syndrome. Herridge m, et al: https://pubmed.ncbi.nlm.nih.gov/12594312/ Long-term cognitive impairment after critical illness. Pandharipande PP, et al: https://pubmed.ncbi.nlm.nih.gov/24088092/ The RECOVER Program: disability risk groups and 1-year outcome after 7 or more days of mechanical ventilation. Herridge M, et al: https://pubmed.ncbi.nlm.nih.gov/26974173/ Determinants of long-term outcome in ICU survivors: results from the FROG-ICU study. Gayat E, et al: https://pubmed.ncbi.nlm.nih.gov/29347987/ Symptoms of anxiety and depression in family members of intensive care unit patients. Pochard F, et al: https://pubmed.ncbi.nlm.nih.gov/11588447/ Books Mentioned in this Episode: Bel Canto. By Ann Patchett: bit.ly/3nWs7Vp Commonwealth. By Ann Patchett: bit.ly/43pWSCt

In this episode, we will discuss Mechanical Power and ventilator induced lung injury (VILI). Our guest is Dr. Jason Bartock, a practicing intensivist at Cooper Medical System in Camden, New Jersey. Dr. Bartock is faculty and Program Director of the Critical Care Medicine Fellowship at Cooper Medical School of Rowan University, Camden, New Jersey. Additional Resources: Mechanical power: meaning, uses and limitations. L Gattinoni, et al: https://pubmed.ncbi.nlm.nih.gov/36884050/ Mechanical Power: A New Concept in Mechanical Ventilation Poudel, et al: https://pubmed.ncbi.nlm.nih.gov/34597688/ Mechanical power at a glance: a simple surrogate for volume-controlled ventilation. L Giosa, et al: https://pubmed.ncbi.nlm.nih.gov/31773328/ The future of driving pressure: a primary goal for mechanical ventilation? H. Aoyama, et al. https://pubmed.ncbi.nlm.nih.gov/30305906/ Seminal clinical trial comparing low tidal volumes to traditional tidal volumes in ARDS. ARDS Network: https://www.nejm.org/doi/full/10.1056/nejm200005043421801 Educational website with mechanical ventilation content: https://www.criticalcareatcooper.com/masterin-mechanical-ventilation Books Mentioned in this Episode: Crucial Conversations: Tools for Talking When Stakes are High. By Joseph Grenny, et al: https://bit.ly/3FL4Xr9 Critical Maters Podcast – Interrupting the VILI Vortex. Guest J. Marini, MD: https://soundphysicians.com/podcast-episode/?podcast_id=342&track_id=819824731 Critical Matters Podcast- Initial Management of ARDS. Guest R.P. Dellinger, MD: https://soundphysicians.com/podcast-episode/?podcast_id=342&track_id=635607780

In this episode of the podcast, we will discuss the current management of Acute Pulmonary Embolism. Our guest is Dr. Belinda Rivera-Lebron, a pulmonary critical care physician who practices at the University of Pittsburgh Medical System. She is an Associate Professor of Medicine and is the Director of the UPMC Acute Pulmonary Embolus (PE) Program and the UPMC Chronic Thromboembolic Pulmonary Hypertension (CTEPH) Program. Dr. Rivera-Lebron’s areas of interest include pulmonary embolism and pulmonary hypertension. Additional Resources Diagnosis, Treatment and Follow Up of Acute Pulmonary Embolism: Consensus Practice from the PERT Consortium.: https://pubmed.ncbi.nlm.nih.gov/31185730/ AHA Scientific Statement. Surgical Management and Mechanical Circulatory Support in High-Risk Pulmonary Embolisms: https://pubmed.ncbi.nlm.nih.gov/36688837/ PERT Consortium website: https://pertconsortium.org/ Books Mentioned in this Episode: The Trusted Advisor. By David H. Meister, et al: bit.ly/3mq9Oap

In this episode of the podcast, we will discuss Fluid Management for Sepsis through the lens of the recently published CLOVERS clinical trial. Our guest is Dr. Nathan Shapiro, Professor of Emergency Medicine at Harvard Medical School, and an attending physician in the Department of Emergency Medicine at Beth Israel Deaconess Medical Center. Dr. Shapiro is the Vice Chairman of Research for the Emergency Department. Dr. Shapiro is a lead author and investigator for the recently published CLOVERS clinical trial. Additional Resources Early Restrictive or Liberal Fluid Management for Sepsis-Induced Hypotension. CLOVERS clinical trial: https://www.nejm.org/doi/full/10.1056/NEJMoa2212663 Restriction of Intravenous Fluids in ICU Patients with Septic Shock. CLASSIC clinical trial: https://www.nejm.org/doi/full/10.1056/NEJMoa2202707 Surviving Sepsis Campaign: Guidelines 2021: https://www.sccm.org/Surviving-Sepsis-Guidelines-2021 Early Goal-Directed Therapy in the Treatment of Severe Sepsis and Septic Shock: https://www.nejm.org/doi/full/10.1056/nejmoa010307 Early, Goal-Directed Therapy for Septic Shock: Metanalysis of the ARISE, ProCESS, and PriMISe clinical trials: https://www.nejm.org/doi/10.1056/nejmoa1701380 Books Mentioned in this Episode: Extreme Ownership: How Navy SEALs Lead and Win. By Jocko Willink and Leif Babin: https://bit.ly/3Ktadmk

As we begin a new year with the podcast, I have decided to depart from our customary guest format and usual clinical topics to focus on personal growth and mastery. I am a firm believer that mastery (learning new skills) is the key to an engaged and joyful clinical career. In this episode of the podcast, we will discuss Skills, Super Skills, and Ultra Skills. We will discuss this new framework for understanding and developing skills relevant to our professional and personal growth. Please reach out with comment on Twitter (@sergio_zanotti) or LinkedIn. Books and Podcasts Mentioned in this Episode: The Fearless ICU – Critical Matters Podcast with Amy Edmondson: http://bit.ly/3I7rq3o The Infinite Game. By Simon Sinek: https://bit.ly/3XhMgBe Drive. By Daniel Pink: https://bit.ly/3XlhFCS Deep Work. By Cal Newport: https://bit.ly/3YyXD99 Switch. By Chip Heath & Dan Heath: https://amzn.to/3IaXQdc Mindset. By Carol Dweck: https://bit.ly/3XhXS7l Leonardo Da Vinci. By Walter Isaacson: https://bit.ly/40AmwmJ Range. By David Epstein: https://bit.ly/3jGZ1ro Essentialism. By Greg McKeown: https://bit.ly/3xruX6B Mastery. By Robert Greene: https://bit.ly/3RKjicc Linchpin. By Seth Godin: https://bit.ly/3jKBu8U

In this episode of the podcast, we will discuss the first hour of clinical care post return of spontaneous circulation in cardiac arrest survivors. Our guest is Dr. Haney Mallemat a critical care intensivist and emergency medicine clinician at Cooper University Health. He is also an associate professor of medicine and of emergency medicine at Cooper Medical School of Rowan University, in Camden, New Jersey. Additional Resources: Critical Care Now: A site for intensivists and resuscitationists.: https://criticalcarenow.com/ RESUS-X: The ultimate resuscitation educational experience: https://www.resusx.com/ https://pubmed.ncbi.nlm.nih.gov/25599355/ European Resuscitation Council and European Society of Intensive Care Medicine guidelines 2021: post-resuscitation care: https://link.springer.com/article/10.1007/s00134-021-06368-4 Oxygen Targets in Comatose Survivors of Cardiac Arrest. BOX Trial: https://www.nejm.org/doi/full/10.1056/NEJMoa2208686 Blood-Pressure Targets in Comatose Survivors of Cardiac Arrest. BOX Trial: https://www.nejm.org/doi/full/10.1056/NEJMoa2208687 Books Mentioned in this Episode: SmartLess. One of Haney’s favorite podcasts: https://podcasts.apple.com/us/podcast/smartless/id1521578868 How to win Friends & Influence People. By Dale Carnegie: bit.ly/3VVlTRQ EMRAP. A leading educational platform recommended by Haney: https://www.emrap.org/

In this episode of the podcast, we will discuss the management of Acute Metabolic Encephalopathies. Our guest is Dr. Eelco Wijdicks (@EWijdicks on Twitter) Professor of Neurology at Mayo Clinic College of Medicine and Science. He is an attending Neurointensivist in the Neurosciences Intensive Care Unit at the Saint Mary’s Hospital campus, Rochester, Minn. He currently serves as the chair in the Critical Care and Hospital Neurology Division in the Department of Neurology. Additional Resources: Identifying encephalopathies from acute metabolic derangements. EFM Wijdicks: https://onlinelibrary.wiley.com/doi/full/10.1111/joim.13538 Neurocinema: When Film Meets Neurology. By Eelco Wijdicks: bit.ly/3tQfD1t Neurocinema- The Sequel. By Eelco Wijdicks: bit.ly/3GAQ9g4 Books Mentioned in this Episode: The Origin of Species. By Charles Darwin: bit.ly/3TY9Xgw Charles Darwin: A Biography Vol 1. By Janet Browne: bit.ly/3EoAi1e Charles Darwin: A Biography Vol 2. By Janet Browne: bit.ly/3XriSdm A New Biographical Dictionary of Film: Sixth Edition. By David Thomson: bit.ly/3U4XjMC

In this episode of the podcast, we will discuss the management of conflict in the intensive care unit (ICU). Our guest is Dr. Joshua Kayser. Dr. Kayser is Section Chief for Medical Critical Care Medicine and Medical ICU Director at the VA Medical Center in Philadelphia. He is also Professor of Clinical Medicine and Professor of Medical Ethics and Healthy Policy at the University of Pennsylvania. Additional Resources: Conflict Management in the ICU. JB Kayser and LJ Kaplan: https://pubmed.ncbi.nlm.nih.gov/32618689/ How doctors manage conflicts with families of critically ill patients during conversations about end-of-life decisions in neonatal, pediatric, and adult intensive care. AS Spijkers et al.: https://link.springer.com/article/10.1007/s00134-022-06771-5 Center to Advance Palliative Care Website – with great resources: https://www.capc.org/ Vital Talk website. A great resource for developing communication skills in healthcare: https://www.vitaltalk.org/ Books Mentioned in this Episode: In Shock. By Rana Awdish: https://amzn.to/3UzJtTg