The Critical Care Commute Podcast

In this episode of the Critical Care Commute podcast, Dr. Smith discusses the multifaceted future of critical care medicine, touching on economic, political, and technological challenges. The conversation delves into the role of artificial intelligence in enhancing healthcare, the importance of clinician well-being, and the need for a human touch in medicine. The discussion also explores personal interests, travel experiences, and the ethical implications of AI in clinical practice, emphasizing the balance between technology and human interaction.Guests: Drs Marcus Peck and Jonny Wilkinson. Chapters00:00 The Future of Critical Care Medicine02:40 Artificial Intelligence in Healthcare05:38 Human Factors and Clinician Well-being08:22 Economic Challenges in Healthcare11:09 The Role of Politics in Healthcare14:13 The Turing Test and AI's Evolution16:41 Personal Interests and Travel Experiences19:57 AI's Impact on Clinical Practice22:38 Ethical Considerations of AI in Medicine25:19 The Future of AI and Human Interaction

Dr. Suzanne Crowe, a pediatric intensivist and president of the Medical College of Ireland, discusses the transformative power of kindness in healthcare. She suggests that kindness should be considered a 'prescribable intervention' to enhance patient outcomes. The conversation explores how simple acts, like attentive listening, can improve diagnostics and trust with families. Crowe emphasizes the role of leadership in fostering a culture of kindness and shares effective empathy training techniques, all while linking kindness to better healthcare experiences.

Join Peter Brindley and Leon Byker as they host David Bertoni, an ED physician and ECMO clinical lead, and Jorian 'Joe' Kippax, a trauma specialist and reservist, for an incredible story of a remote river rescue in Tasmania. The team responds to a distress call from a trapped rafting party in the Franklin River, one of Tasmania's most remote and formidable areas. The rescue involves complex logistical challenges, a field amputation, and the use of ECMO technology amidst perilous conditions. The patient, after 20 hours trapped in frigid water, undergoes a harrowing yet successful rescue and recovery. This episode offers a gripping recount of teamwork, medical ingenuity, and human resilience.00:00 Introduction and Guest Overview00:40 Setting the Scene: Remote River Rescue01:39 The Rescue Operation Begins03:13 Challenges and Techniques in the Rescue07:25 Field Amputation and Extraction18:35 Transport and ECMO Preparation23:20 Hospital Arrival and ECMO Procedure26:18 Patient Recovery and Reflections30:45 Conclusion and Final Thoughts

In this engaging discussion, Professor Mervyn Singer, author of Sepsis 3.0, shares his insights on the evolving treatment of sepsis. He addresses the crucial balance between antibiotics and steroids, emphasizing individualized care over rigid guidelines. The conversation highlights missed opportunities during the COVID-19 crisis and the complexities of managing the immune response in sepsis. Professor Singer also explores innovative strategies like metabolic interventions and the need for precision medicine, challenging traditional treatments for better patient outcomes.

Dr. Shannon Fernando is an intensivist at Lakeridge Health and a prolific researcher with over 150 publications. Known for his work in outcomes-based research across critical care, he joins us to discuss long-term outcomes after cardiogenic shock.About the Episode:This episode is part of our cardiovascular critical care series and explores what happens after the ICU for patients who survive cardiogenic shock. We unpack quality of life, functional outcomes, mental health, and the hidden burdens on both patients and caregivers. Dr. Fernando provides key data insights from his large cohort studies and shares reflections from ICU follow-up clinics. We also dive into the challenges of prognostication and how to communicate realistic expectations to families.Topics CoveredDefining Long-Term Outcomes:Beyond survival: functional independence, mental health, cognition, and system resource use.Key Findings from Ontario Cohort42% of cardiogenic shock survivors require increased levels of care15% die within a year post-dischargeModest impact of revascularization or mechanical support on long-term outcomesMorbidity and Quality of LifeLoss of independence and inability to return to workHigh incidence of PTSD, depression, and caregiver burdenDelayed functional recovery and unmet expectationsPrognostic Factors and Predictive MarkersFrailty as a key indicatorPre-existing mental health as a predictor of post-ICU mental health outcomesIn-hospital arrest characteristics: rhythm, downtime, comorbiditiesICU Follow-Up ClinicsValue in knowledge translation and emotional supportReal-world insights on functional recovery and patient satisfactionCommon patient sentiment: gratitude mixed with traumaCommunication with FamiliesAvoiding value impositionEmphasizing trajectory over fixed timelinesBalancing hope with realismRethinking Endpoints in ResearchLimitations of 28-day mortalityNeed for patient-centered, long-term functional outcomesTrajectory-based data over snapshot metricsKnowledge Translation as the InterventionEquipping clinicians and patients with realistic expectationsNormalizing psychological responsesShaping future research directions around lived experience

Dr. Emilie Belley-Côté, an Associate Professor at McMaster and expert in critical care cardiology, dives into the complexities of cardiogenic shock and the SCAI classification. She breaks down the five stages, illustrating their significance for patient care and interdisciplinary communication. The conversation highlights the critical need to recognize pre-shock conditions and the real-world applications of SCAI in guiding treatment decisions. Dr. Belley-Côté also touches on the challenges posed by mixed shock and the latest advancements in cardiac monitoring.

Dr. James Downar, a leading Canadian expert in palliative and critical care, dives into the fascinating world of psychedelics and their potential to alleviate psychological distress in patients facing critical illness. He discusses the transformative powers of substances like psilocybin and MDMA, exploring how they can help individuals confront fear and isolation. The conversation covers the structure of psychedelic-assisted therapy, the importance of 'set and setting,' and the need for compassion in integrating these therapies into traditional care.

Prof. Mervyn Singer, an ICU physician and critical care thought leader, shares insights on ischemia-reperfusion syndrome, a paradox where restoring blood flow can worsen injury. He breaks down the complex mechanisms at play, such as mitochondrial involvement and oxidative stress. The conversation delves into the variability in physiological responses to stress, advocating for a tailored approach to ICU interventions. Prof. Singer emphasizes the importance of clinical judgment and flexibility in treatment protocols, aiming for patient-centered care.

Dr. Mike Christian, a specialist in pre-hospital and critical care medicine with a military background, shares valuable insights on transforming emergency services in Canada. He discusses his unconventional journey from paramedic to physician, highlights the integration of AI in emergency dispatch, and contrasts Canada’s pre-hospital care with global models like the UK's. Mike emphasizes the critical role of physician-led teams, mentorship, and emerging technologies in improving patient outcomes and survival rates during emergencies.

Dr. Elizabeth Viglianti, an assistant professor and critical care specialist at the University of Michigan, shares her expertise on gender-based harassment in the medical field. She recounts her personal experiences that fueled her passion for this vital topic. The conversation delves into the prevalence of harassment and its impact on professional dignity, especially for women. Dr. Viglianti discusses systemic barriers in reporting and highlights recommendations for creating a more equitable and supportive environment in medicine.