Critical Matters

In today’s episode, we will discuss the management of severe alcohol withdrawal in the intensive care unit. Our guest is Dr. Nick Mark (@nickmmark), a critical care physician practicing in Seattle, Washington. Dr. Mark is the founder and creator of www.onepagerICU.com - a wonderful resource that provides regularly updated comprehensive and practical one-page summaries on various critical care topics. Additional Resources: Link to the onepager on Alcohol Withdrawal. -https://onepagericu.com/ A statement on research needs for inpatient management of severe alcohol withdrawal from the American Thoracic Society. - https://www.atsjournals.org/doi/10.1164/rccm.202108-1845ST Guidelines for clinical management of alcohol withdrawal from American Society of Addiction Medicine (ASAM). - https://bit.ly/3GIRkq6 Books mentioned in this episode: Surely You’re Joking, Mr. Feynman! By Richard Feynman. - https://amzn.to/34IZBgs Sapiens: A Brief History of Humankind. By Yuval Noah Harari. - https://amzn.to/3HGqsbE

Haney Mallemat, a critical care intensivist and ultrasound expert at Cooper University Health, dives deep into the nuances of fluid resuscitation. He discusses the balance between the benefits and potential harms of fluid therapy, emphasizing the importance of predicting fluid responsiveness. Haney highlights dynamic versus static assessment techniques, including the use of ultrasound to assess the IVC and the effectiveness of tests like passive leg raises. He also pushes for a thoughtful approach to fluid administration, treating it like a medication rather than a blanket solution.

As we start a new year, we look forward with the hope to grow and improve critical care medicine. In today’s episode of the podcast, we will discuss a path forward focused on healing, recovery, and transformation. Our guest is Dr. Wes Ely, professor of medicine at Vanderbilt University School of Medicine and co-director of the Center for Critical Illness, Brain dysfunction, and Survivorship (CIBS Center). Dr. Ely is the author of Every Deep-Drawn Breath – a wonderful book that will guide our discussion in this episode. Additional Resources: Link to the CIBS Center website, which contains a wealth of resources for intensivists on the topic of delirium: https://www.icudelirium.org Kaleidoscope by Wes Ely: https://pubmed.ncbi.nlm.nih.gov/25599355/ Don’t give COVID-19 long-haulers the Silent Treatment by Wes Ely: https://bit.ly/3GfgJbC ABCDEF Bundle and Supportive ICU Practices for Patients with Coronavirus Disease 2019 Infection - An International Point Prevalence Study. K Liu, et al. Critical Care Explorations 2021: https://bit.ly/3qepqgS Caring for Critically Ill Patients with the ABCDEF Bundle - Results of the ICU Liberation Collaborative in Over 15,000 Adults: https://bit.ly/3FeX0Hw Books Mentioned in this Episode: Every Deep-Drawn Breath by Wes Ely: https://www.icudelirium.org/every-deep-drawn-breath In Shock by Rana Awdish: https://amzn.to/3JY9p6n Arrowsmith by Sinclair Lewis: https://amzn.to/339MJ2m East of Eden by John Steinbeck: https://amzn.to/3JXpRDN

In today’s podcast episode, we will discuss Point of Care Ultrasonography (POCUS). We examine key trends in technology, the relationship of POCUS to consultative ultrasonography, growing clinical applications, and challenges with POCUS. Our guest is Dr. Jose Luis Diaz-Gomez. Dr. Diaz- Gomez is the Chief of Transplant, Cardiovascular, and Mechanical Support Critical Care, and Director of Critical Care Echocardiography at Baylor, St. Luke’s Medical Center in Houston, Texas. He is a Senior Faculty in Cardiovascular Anesthesia and Critical Care at Baylor College of Medicine. Additional Resources: Point of Care Ultrasonography. By J.L. Diaz-Gomez et al. New England Journal of Medicine 2021: https://bit.ly/3JftVPt Multi-organ point of care ultrasound for COVID-19 (PoCUS4COVID). Expert Consensus: https://bit.ly/3mrXvaF Society of Critical Care Medicine Resources for critical care ultrasound: https://bit.ly/3yZsW1m Point of care ultrasonography Certification – CHEST: https://bit.ly/32bZfyd Books Mentioned in this Episode: The Myth of Artificial Intelligence: Why Computers Can’t Think the Way We Do. By Erik Larson: https://amzn.to/3ySWDRm Essentialism: The Disciplined Pursuit of Less. By Greg McKeown: https://amzn.to/3EfVeFT

In this episode of Critical Matters, we will discuss the Surviving Sepsis Campaign Guidelines 2021 update. Our guest is Dr. Laura Evans. Dr. Evans is the medical director for critical care and professor in the division of pulmonary, critical care and sleep medicine at the University of Washington Medical Center. She is the current Surviving Sepsis Campaign guidelines co-chair and the lead author for the 2021 Surviving Sepsis Campaign Guidelines. Additional Resources: Surviving Sepsis Campaign Guidelines 2021: https://journals.lww.com/ccmjournal/Fulltext/2021/11000/Surviving_SepExecutive Summary: Surviving Sepsis Campaign Guidelines 2021: https://journals.lww.com/ccmjournal/Fulltext/2021/11000/Executive_Summary__Surviving_Sepsis_Campaign_.14.aspx Society of Critical Care Medicine Resources for SSC: https://www.sccm.org/SurvivingSepsisCampaign/Home Hanlon's Razor: https://thedecisionlab.com/reference-guide/philosophy/hanlons-razor/ Books Mentioned in this Episode: Good Night Stories for Rebel Girls: 100 Tales of Extraordinary Women by Elena Favilli and Francesca Vallo: https://www.amazon.com/Good-Night-Stories-Rebel-Girls/dp/0997895810/ref=sr_1_1?crid=13KK590LSPF64&keywords=good+night+stories+for+rebel+girls&qid=1638473265&sprefix=good+night+%2Caps%2C182&sr=8-1

In this episode of Critical Matters, we discuss the management of severe acute pancreatitis. Our guest is Dr. Marc G Besselink (@MarcBesselink). He is Professor of pancreatic and hepatobiliary(HPB) surgery, at Amsterdam University Medical Centers in the Netherlands. Dr. Besselink is a member of the Dutch Pancreatitis Study Group and is the senior investigator of the POINTER clinical trial (recently published in the New England Journal of Medicine). Additional Resources: Acute Pancreatitis: https://bit.ly/3D6kONK POINTER Clinical Trial - Immediate Versus Postponed Intervention for Infected Necrotizing Pancreatitis: https://bit.ly/3wxRLQN PYTHON Clinical Trial - Early Versus On-demand Nasoenteric Tube Feeding in Acute Pancreatitis: https://bit.ly/3km1STK APEC Clinical Trial - Urgent Versus Conservative ERCP for Acute Pancreatitis: https://bit.ly/3qlVK1I Books Mentioned in this Episode: The House of God by Samuel Shem: https://amzn.to/3wy8Lq2

In this episode of Critical Matters, we will discuss two important clinical questions regarding intravenous fluids. First: Does the composition of intravenous fluids impact patient outcomes? Second: Does the mode of administration (rapid bolus vs. slower infusion) matter? Our guest is Michael J. Connor, Jr., MD, a practicing intensivist and nephrologist. He is an Associate Professor & Senior Physician of Critical Care Medicine & Nephrology at the Division of Pulmonary, Allergy, Critical Care, & Sleep Medicine, Emory University School of Medicine. In addition, Dr. Connor is the Director for Critical Care Nephrology at the Emory Critical Care Center at Grady Memorial Hospital. Additional Resources: Does Crystalloid Composition or Rate of Fluid Administration Make a Difference When Resuscitating Patients in the ICU?: https://bit.ly/DDtMOT BaSICS Trial – Balanced Solutions vs. 0.9 % Saline: https://bit.ly/3pH7Q51 BaSICS Trial – Slower vs, Faster Intravenous Fluid Bolus Rates: https://bit.ly/2ZvYSgy The SPLIT Randomized Clinical Trial: https://bit.ly/3El5op1 The SMART Clinical Trial: https://bit.ly/DGMDQb Books Mentioned in this Episode: Quiet: The Power of Introverts in a World that Can’t Stop Talking by Susan Cain: https://amzn.to/AZza5g Talk Like TED: The 9 Public-Speaking Secrets of the World’s Top Minds by Carmine Gallo: https://amzn.to/3pG0e2V

In this episode of Critical Matters, we will discuss Ivermectin as a potential treatment for COVID-19. During the COVID-19 Delta surge, we have seen a sharp increase in the noise surrounding the use of Ivermectin. A record number of prescriptions have been filled during the last months and numerous news stories report families suing hospitals refusing to provide Ivermectin to patients. We will discuss the available evidence and the role of misinformation in this phenomenon. Additional Resources: The FDA approved drug Ivermectin inhibits replications of SARS-CoV2 in vitro: https://bit.ly/3ayUhvE Ivermectin to prevent hospitalizations in patients with COVID-19 (IVER-COVID 19): https://bit.ly/3DCOwJZ Effect of Ivermectin on Time to Resolution of Symptoms among Adults with Mild COVID-19: https://bit.ly/3v8QaQw Ivermectin for Prevention and Treatment of COVID-19 Infection: A Systematic Review, Meta-analysis, and Trial Sequential Analysis to Inform Clinical Guidelines: https://bit.ly/3lB7rPh Ivermectin for the Treatment of Coronavirus Disease 2019: A Systematic Review and Meta-analysis: https://bit.ly/3mU9s8w Ivermectin for preventing and treating COVID-19: Review: https://bit.ly/30dDzQD Books Mentioned in this Episode: Think Again: The Power of Knowing What You Don’t Know by Adam Grant: https://amzn.to/3j1CrGy

In this episode of Critical Matters, we will discuss the results of the recently published TTM2 clinical trial and the current state of evidence for Targeted Temperature Management in the post cardiac arrest patient. Our guest is Dr. Niklas Nielsen. Dr. Nielsen is an associate professor at the Department of Clinical Sciences at Helsingborg, Lund University, and consultant in Anesthesiology and Intensive Care at Helsingborg Hospital. He was the principal investigator for the TTM1 and TTM 2 clinical trials. Additional Resources: The International Cardiac Arrest Registry (INTCAR): https://bit.ly/2Xbe0yt Hypothermia versus Normothermia after Out-of-Hospital Cardiac Arrest: https://bit.ly/3nad5Jo Targeted Temperature Management at 33C versus 36C after Cardiac Arrest: https://bit.ly/38THRO9 Targeted Temperature Management for Cardiac Arrest with Nonshockable Rhythm: https://bit.ly/2X19aUj 2020 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care: https://bit.ly/3z0k7T3 Books Mentioned in this Episode: Oxygen: The Molecule that Made the World by Nick Lane: https://amzn.to/2WYMmVz Anna Karenina by Leo Tolstoy: https://amzn.to/3yVao0v

In this episode of Critical Matters, we will explore the Choosing Wisely for Critical Care. These are evidenced-based best practices to avoid waste and promote value in the practice of critical care medicine. We are fortunate to have with us today three of the authors of the recently published guidelines for critical care medicine – Choosing Wisely for Critical Care: The Next Five. Our guests are Jerry Zimmerman, Pamela Smithburger, and Anita Reddy. Jerry Zimmerman is a physician from the Department of Pediatrics, Seattle Children’s Hospital, Harborview Medical Center, University of Washington School of Medicine, in Seattle. Pamela Smithburger is a doctor in clinical pharmacy from the University Of Pittsburgh School Of Pharmacy, in Pittsburgh. Anita Reddy is a physician from the Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Cleveland Clinic, in Cleveland. Additional Resources: Choosing Wisely For Critical Care: The NEXT Five. Critical Care Medicine 2021: https://bit.ly/3hQFkbx Medicine’s Ethical Responsibility for Health Care Reform- The Top Five List: https://bit.ly/36nDhGI The Choosing Wisely Website – ABIM: https://bit.ly/3hLdsWt Society of Critical Care Medicine – Choosing Wisely Website: https://bit.ly/3yG4TTN Society of Critical Care Medicine – Knowledge and Education Group (KEG): https://bit.ly/36tKvJb Books Mentioned in this Episode: Pediatric Critical Care Medicine 6th Edition by Jerry Zimmerman Alexandre T. Rotta: https://amzn.to/3ADJk82 One Hundred Years of Solitude by Gabriel Garcia Marquez: https://amzn.to/3ARKJYS Love in the Times of Cholera by Gabriel Garcia Marquez: https://amzn.to/3jXWsyL