Icritical Care: All Audio

The increasing use of electronic health records (EHRs) has inspired the need for a more dynamic checklist. Geva et al conducted a before-after quality improvement study by replacing a static checklist with an updated dynamic checklist.

When should clinicians intubate preterm infants? The answer is not always straightforward, according to podcast guest Deepak Jain, MD, FAAP. He and host Pamela M. Peeke, MD, MPH, FACP, FACSM, discuss strategies that optimize noninvasive ventilation and when such strategies are appropriate.

Healthcare workload has emerged as an important metric associated with poor outcomes. To measure workload, studies have used bed occupancy as a surrogate. However, few studies have examined frontline clinician workload and outcomes.

In the ICU, medical staff do all they can to assist patients and get them back to health as quickly as possible. In the process of saving lives, bedside manner and communication may suffer. Host Elizabeth H. Mack, MD, MS, FCCM, is joined by Lauren Rissman, MD, to discuss the eye-opening experience Dr. Rissman had when she was admitted to the ICU from the labor and delivery unit and the importance of having a patient advocate.

Since the publication of the Surviving Sepsis Campaign guidelines, the focus has been on sepsis management, early identification, and treatment. (Evans L, et al. Crit Care Med. 2021;49:e1063-e1143). As more patients are surviving sepsis, they may be left with short- and long-term problems that need to be addressed. Host Ludwig H. Lin, MD, is joined by Christa A. Schorr, DNP, MSN, RN, FCCM, to discuss the implementation of initiatives for preventing impairments due to sepsis. They will also discuss the challenges faced by survivors of sepsis and the difficulties of matching care to the patient's and family's goals of care.

In this podcast, host Kyle B. Enfield, MD, FSHEA, FCCM, is joined by Samuel K. McGowan, MD, to discuss a systematic review that found significant differences in care and outcomes, including mortality rates, among intensive care unit (ICU) patients of different races (McGowan S, et al. Crit Care Med. 2022 Jan;50:1-20). Dr. McGowan is a first-year fellow in pulmonary and critical care at University of California in San Francisco, California, USA. This podcast is sponsored by Sound Physicians.

The PANDEM guidelines evaluate current practices and provide recommendations for management of pain, agitation, iatrogenic withdrawal, neuromuscular blockade, delirium, ICU environment, and early mobility in critically ill infants and children. Host Margaret M. Parker, MD, MCCM, is joined by Heidi A. B. Smith, MD, MSCI, FAAP, to discuss the guidelines.

This podcast will describe the principle of albumin dialysis of the molecular adsorbent recirculating system (MARS). Host Pamela M. Peeke, MD, MPH, FACP, FACSM, is joined by Ram M. Subramanian, MD, MBA, FCCM, to discuss the logistics of starting a MARS program to outline indications for MARS. Dr. Subramanian is a hepatologist at Emory University in Atlanta, Georgia. This podcast is sponsored by Baxter.

Clinicians aim to communicate with surrogates of ICU patients in ways that both inform them of the patient’s medical condition and support their emotional needs. Written communication, as a supplement to traditional verbal communication, may overcome some of the challenges that clinicians face when engaging with families in the ICU. Diane C. McLaughlin, DNP, AGACNP-BC, CCRN, FCCM, is joined by Jared Greenberg, MD, MSc, to discuss the article "Daily Written Care Summaries for Families of Critically Ill Patients: A Randomized Controlled Trial," published in the September 2022 issue of Critical Care Medicine. Dr. Greenberg is assistant professor of internal medicine in the Division of Pulmonary, Critical Care and Sleep Medicine at Rush University Medical Center in Chicago, Illinois. This podcast is sponsored by Sound Physicians.

Clazakizumab is a monoclonal antibody against human interleukin-6 that may benefit patients hospitalized with severe or critical COVID-19 accompanied by hyperinflammation. Although not yet FDA approved, clinical trials of clazakizumab for treatment of COVID-19 are under way worldwide. Samantha Gambles Farr, MSN, NP-C, CCRN, RNFA, is joined by Bonnie E. Lonze, MD, PhD, to discuss the article, A Randomized Double-Blinded Placebo Controlled Trial of Clazakizumab for the Treatment of COVID-19 Pneumonia With Hyperinflammation, published in the September 2022 issue of Critical Care Medicine. Dr. Lonze is a faculty transplant surgeon at NYU Langone in New York, New York, USA, focusing primarily on kidney transplants. As vice chair for research of the NYU Langone Transplant Institute, she leads the research group on clinical trials and regulatory oversight.

Pediatric advanced life support (PALS) guidelines include weight-based epinephrine dosing recommendations of 0.01 mg/kg with a maximum of 1 mg, which corresponds to a weight of 100 kg. But what are the actual practice patterns? Elizabeth H. Mack, MD, MS, FCCM, is joined by Martha Kienzle, MD, to discuss the article: Weight-Based Versus Flat Dosing of Epinephrine During Cardiac Arrest in the PICU: A Multicenter Survey, published in the October 2022 issue of Pediatric Critical Care Medicine. Dr. Kienzle is an attending physician in the Department of Anesthesiology and Critical Care Medicine at Children's Hospital of Philadelphia.

The American Heart Association's (AHA) cardiopulmonary resuscitation guidelines recommend against the routine administration of IV calcium during pediatric cardiopulmonary arrest because of its association with worse outcomes. However, IV calcium is routinely used in children with heart disease who have cardiopulmonary arrest. Maureen A. Madden, DNP, RN, CPNP-AC, CCRN, FCCM, is joined by Gurpreet S. Dhillon, MD, to discuss the article, Calcium Administration During Cardiopulmonary Resuscitation for In-Hospital Cardiac Arrest in Children With Heart Disease is Associated With Worse Survival - A Report From the American Heart Association's Get With the Guidelines-Resuscitation (GWTG-R) Registry, published in the November issue of Pediatric Critical Care Medicine (Dhillon G, et al. Pediatr Crit Care Med. 2022;23:860-871). Dr. Dhillon is a pediatric cardiac intensivist at Lucile Packard Children's Hospital at Stanford in Palo Alto, California.

Untreated hyperammonemia can cause irreversible neurologic damage, coma, or death. A high level of clinical suspicion is necessary to quickly recognize and implement emergency interventions for hyperammonemia in the acute presentation of urea cycle disorders (UCDs). Pamela M. Peeke, MD, MPH, FACP, FACSM, is joined by Anna-Kaisa Niemi, MD, PhD, and a patient who was hospitalized for hyperammonemia at age 8 years to discuss the importance of improved recognition of hyperammonemia and awareness of the underlying causes, such as UCDs. Dr. Niemi is a neonatologist and associate professor at Rady Children’s Hospital in San Diego, California, USA. This podcast is sponsored by Horizon Therapeutics.

Are there bullies in the world of advanced practice providers (APPs)? How is bullying defined in a clinical environment? In this podcast, hosted by Diane C. McLaughlin, DNP, AGACNP-BC, CCRN, three APPs from different hospitals debate incivility and workplace culture. They also address interpersonal relationships among APPs, physicians, and nurses.

Unrecognized clinical deterioration during illness requiring hospitalization is associated with high risk of mortality and long-term morbidity among children. In this podcast hosted by Maureen A. Madden, DNP, RN, CPNP-AC, CCRN, FCCM, Anoop Mayampurath, PhD, discusses a novel machine learning model that identifies ICU transfers in hospitalized children more accurately than current tools.

Nosocomial infections are a prevalent cause of death and complications in critically ill children. Conventional cultures are able to detect only up to 25% of bacteremias. Several studies have suggested that molecular tests could be a faster and effective tool for detection of bacterial infections.

This podcast will educate clinicians on the unfamiliar parameters of processed EEG (pEEG). Host Pamela M. Peeke, MD, MPH, FACP, FACSM, is joined by Meghan B. Lane-Fall, MD, MSHP, FCCM, to discuss the benefits of pEEG for monitoring sedated mechanically ventilated patients and patients undergoing neuromuscular blockade. Dr. Lane-Fall is an associate professor of anesthesiology, critical care, and epidemiology at the University of Pennsylvania. This podcast is sponsored by Medtronic.

Catecholamine is used in patients with septic shock to augment hemodynamics and achieve goal mean arterial pressure. Ludwig H. Lin, MD, is joined by Gretchen L. Sacha BCCCP, PharmD, to discuss this retrospective observational study to evaluate the associations of catecholamine dose, lactate concentration, and timing from shock onset at vasopressin initiation with in-hospital mortality. (Sacha G, et al. Crit Care Med. 2022;50:614-623). Dr. Sacha is a critical care clinical specialist at Cleveland Clinic in Cleveland, Ohio. This podcast is sponsored by Sound Physicians.

While little is known about the epidemiology of ventilator-acquired pneumonia among COVID-19 patients, some studies suggest a higher risk of ventilator-associated pneumonia in this specific population. Ashish K. Khanna, MD, FCCP, FCCM, is joined by Charles-Herve Vacheron, MD, to discuss the Cohort exposed/nonexposed study among the REA-REZO surveillance network.

This podcast will examine a retrospective, observational cohort study that found an association between excessive oxygen supplementation in the first day of mechanical ventilation with multiple organ dysfunction syndrome on day 7 of admission and in-hospital mortality in critically ill children. Host Elizabeth H. Mack, MD, MS, FCCM, is joined by L. Nelson Sanchez-Pinto, MD, MBI, to discuss the study's findings.