Critical Matters

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

Dr. Belinda Rivera-Lebron, a pulmonary critical care physician and director of the UPMC Acute Pulmonary Embolus Program, shares her expertise on pulmonary embolism. She highlights PE as a major preventable killer and explains the importance of PE response teams in coordinating care. The conversation covers innovative AI tools for diagnosing PE, the role of anticoagulation therapies, and the nuances of catheter-directed therapies versus systemic thrombolysis. Belinda also discusses the significance of multidisciplinary follow-up and shares personal insights on leadership.

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/

Dr. Eelco Wijdicks, a neurology professor at the Mayo Clinic, dives deep into acute metabolic encephalopathies. He discusses the pitfalls of overusing the term 'metabolic encephalopathy' and urges a careful diagnostic approach. The conversation covers how severe electrolyte imbalances impact consciousness, alongside the complexities of EEG interpretations. Eelco also highlights the importance of recognizing structural injuries and shares insights on managing prolonged neurologic recovery, emphasizing compassion in critical care after pandemic challenges.

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

In this episode of the podcast, we discuss the management of Acute Ischemic Stroke (AIS). Our guest is Dr. Fred Rincon, a neurologist and critical care specialist with expertise in the resuscitation and management of acute brain injured patients. He is a Professor of Neurology at Cooper Medical School of Rowan University and Director of the Neuro-ICU at Cooper University Health Care in Camden, New Jersey. Additional Resources Management of Acute Ischemic Stroke. F. Herpich and F. Rincon: https://pubmed.ncbi.nlm.nih.gov/32947473/ AHA Guidelines for the Management of Acute Ischemic Stroke (2019): https://pubmed.ncbi.nlm.nih.gov/31662037/ Link to NIHSS Certification Course: https://www.nihstrokescale.org/ The intensive care management of acute ischemic stroke. D. Sharma and M. Smith: https://pubmed.ncbi.nlm.nih.gov/35034076/ Association of Neurocritical Care Services with Mortality and Functional Outcomes for Adults With Brain Injury. Meta-analysis. JAMA Neurology 2022: https://pubmed.ncbi.nlm.nih.gov/36036899/ Book Recommendations: The Servant: A Simple Story of About the True Essence of Leadership. By James C. Hunter: https://amzn.to/3U6u6SI How to Be a Leader: An Ancient Guide to Wise Leadership. By Plutarch: https://amzn.to/3eMBxhU

In this episode of the podcast, we will discuss tracheostomy emergencies. Tracheostomies are common in ICU patients. Every intensivist should be capable of recognizing and providing initial management to potentially serious complications associated with tracheostomies. Our guests are Drs. Laura Bontempo and Sara Manning, emergency physicians and educators with a special interest in the topic. Dr. Laura Bontempo is an associate professor of emergency medicine, and serves as Assistant Director for Faculty Development & Resident Education, in the Department of Emergency Medicine at the University of Maryland Medical School. Dr. Sara Manning is an Assistant Professor of Clinical Emergency Medicine, in the Department of Emergency Medicine at the Indiana University School of Medicine. Additional Resources: Tracheostomy Emergencies. LJ Bontempo and SL Manning. Emerg Med Clin N Am 2019: https://pubmed.ncbi.nlm.nih.gov/30454773/ Link to Onepager on Tracheostomy Emergencies: https://onepagericu.com/trach-emergencies Bleeding Tracheostomy. Kenji Inaba MD. Presented at Essentials of EM: https://www.facebook.com/EssentialsofEM/videos/1163679590380038/ Book Recommendations: Who Moved my Cheese?: An A-Mazing Way to Deal with Change in Your Work and in Your Life. By Spencer Johnson, et al: https://amzn.to/3pq0CkR Where the Red Fern Grows. By Wilson Rawls: https://amzn.to/3AawH6a

In this episode of the podcast, we will discuss dogma in critical care medicine. How do we fight dogma when the evidence is weak? Our guest is Dr. Mervyn Singer, an internationally recognized critical care clinician, investigator, and educator. Dr. Singer is professor of intensive care medicine at University College London. Additional Resources: Challenging management dogma where evidence is non-existent, weak, or outdated. By D. A Hofmaenner and M. Singer https://link.springer.com/article/10.1007/s00134-022-06659-4 Link to Gapminder, an independent educational non-profit fighting global misconceptions https://www.gapminder.org/ Think Again: The Power of Knowing What You Don’t Know. By Adam Grant https://amzn.to/3bceyLu Books Mentioned in this Episode: Factfulness: Ten Reasons We're Wrong About the World--and Why Things Are Better Than You Think. By Hans Rosling https://amzn.to/3S4kWFj