Essential Critical Care Podcast

Thrombotic microangiopathies are uncommon disorders, and can result in significant patient morbidity.  With the introduction of effective new therapies, the outlook for those suffering from these diseases is increasingly optimistic. Elie Azoulay is a professor of medicine, intensivist and board member of the French National Reference Centre for Thrombotic Microangiopathies.  See omnystudio.com/listener for privacy information.

Surgical site infections are a dreaded complication of all surgery, no more so than in cardiothoracics.  Antibiotics at the time of surgery has an established role in the prevention of infections, but the duration of therapy remains contentious. The CALIPSO trial will explore different approaches to this question, and chief investigator Trisha Peel joins Todd on the podcast to discuss the issue.See omnystudio.com/listener for privacy information.

Does my patient need bolus IV crystalloid fluids?This is a conundrum faced on a daily basis for clinicians working in the ICU.  As time goes by, more evidence of the harm fluids do becomes available, so how can we be sure the fluids we give benefit our patients?Xavier Monnet is an intensivist and fluids researcher, and he joins Todd on the podcast to discuss fluid responsiveness.See omnystudio.com/listener for privacy information.

The development of antimicrobial agents is one of the most influential achievements of modern medicine. However, where once we thought the days of sepsis deaths could be numbered, antimicrobial resistance has given us pause for pessimism. Professor Jan De Waele is a surgery-trained intensivist and clinical researcher from Ghent, Belgium, working on several aspects of optimizing antimicrobial use in the ICU, including Antimicrobial Stewardship.See omnystudio.com/listener for privacy information.

The pathophysiology of ARDS is complex and remains incompletely understood.  However, it is clear that ARDS is not simply a disease of the alveoli. Understanding the pathological basis of ARDS will assist in the development of new therapies for this potentially fatal disease. One such avenue is the role of thrombolysis.  Professor Anders Aneman and Dr Lucy Coupland are leaders of a new program of research looking at this potential intervention. See omnystudio.com/listener for privacy information.

The impact of resuscitation strategies on the gut is often neglected, as attention to circulatory and respiratory support takes priority. Leading ICU dietitian Varsha Asrani joins Todd to chat about the implications of gut ischaemia for the longterm recovery of our patients. See omnystudio.com/listener for privacy information.

Healthcare is a difficult industry to advance in.  Many of us are time-poor and there is little structure to training and learning outside formal college training programs.  Many clinicians are therefore turning to coaching and mentoring for answers.  These concepts are familiar to many in business, but they are only now working their way into mainstream healthcare. In this podcast, Rita Holland joins Todd to discuss the potential benefits of coaching in healthcare See omnystudio.com/listener for privacy information.

Traumatic brain injury is a significant problem, affecting patients of all ages across the globe.  Despite this, relatively little hard evidence supports the interventions commonly used in practice. Research in this area remains challenging, with many barriers to the traditional large-scale randomised controlled trial.  Perhaps alternative sources of evidence are required. In this podcast from the 24th annual ANZICS-CTG meeting in Noosa, Toby Jeffcote joins Todd to discuss these limitations, and how "big data" may provide the solution. See omnystudio.com/listener for privacy information.

In 2002, the critical care world was rocked by a pair of studies released simultaneously in the New England Journal of Medicine, which found that therapeutic hypothermia improved neurological outcomes for unconscious survivors of cardiac arrest. In the almost 20 years that have followed, several trials have produced conflicting results, culminating in the TTM-2 trial released in 2021, which seems to have finally put the issue to rest – cooling to 33 degrees Celsius is no better for patients than 37.5. Niklas Nielsen is Prof Anaes / CC at Lund University in Sweden, and the principle investigator of the TTM-2 trial, and he joins me on the podcast to discuss what’s next for hypothermia research. See omnystudio.com/listener for privacy information.

Plasmapheresis can be a life saving intervention in a number of ICU conditions.  Two potential methods are available – centrifugal plasmapheresis and membrane therapeutic plasma exchange.  But what do we know about the applicability, utilisation and complications of the latter? On this episode, Todd is joined by Mitul Chavda and Alpesh Patel, who recently published 6 years worth of prospective data from their service, run from the Flinders Medical Centre in South Australia.   Baxter Healthcare has provided an educational grant to sponsor this podcast. The content was developed independently of Baxter Healthcare and opinions expressed are those of the presenting healthcare professionals.   See omnystudio.com/listener for privacy information.

In this episode of the Careers in Health podcast, Todd chats to Rheumatologist Graeme Jones See omnystudio.com/listener for privacy information.

Part 2 of this interview with CLIP-2 chief investigator Michael Reade explores the structure of CLIP-2, some of the challenges the project has had to overcome, and the workings of a non-inferiority trial. See omnystudio.com/listener for privacy information.

Platelets are a critical component of haemostatic resuscitation, but there are significant challenges involved in their use, most notably, their short shelf life. Could frozen platelets be the answer? Michael Reade is an anaesthetist, intensivist and clinical researcher from the University of Queensland and the Australian Defence Force, and he joins Todd to discuss his research program in this area, known as CLIP See omnystudio.com/listener for privacy information.

Ketamine is regarded as a bit of a wonder drug in emergency and critical care areas, but is it all that it’s cracked up to be. Andrew Casamento is an Intensivist  / Emergency Physician at the Northern, Austin, Warringal Private and Bendigo Hospitals in Victoria, and is the author of a recent review of the role of ketamine in mechanically ventilated ICU patients.  He joins Todd on the podcast to discuss some of the important points. See omnystudio.com/listener for privacy information.

Bronchiolitis is a considerable portion of the workload of paediatric ICUs.  As an inflammatory disease process, treatment with corticosteroids may have benefit, and the alpha effects of adrenaline may reduce secretions.  However, evidence remains sparse, while international guidelines are conflicting. Ben Gelbart is a paediatric intensivist from the Royal Children's Hospital in Melbourne, and he joins the podcast to chat about a recently released paper on which he was the lead author, which explore the role of these two agents.   This is the second interview from our podcast series from the 2022 Noosa meeting of the ANZICS CTG See omnystudio.com/listener for privacy information.

Our guest on this podcast is Dr Emma Ridley, Manager of the ICU Nutrition Program at the Monash University ANZICS Research Centre.  She joins me Todd to chat about her survey of nutritional practice in Australasian ICUs, known as Nutrients, presented at the 2022 ANZICS-CTG conference in Noosa. See omnystudio.com/listener for privacy information.

Delirium and sleep deprivation are known to go hand in hand in the ICU. Could melatonin, a readily available, safe and cheap hormonal therapy, improve sleep, and thereby delirium, in a general population of ICU patients? Lead investigator of the recently released ProMEDIC study Dr Brad Wibrow joins Todd to discuss the results of his study. See omnystudio.com/listener for privacy information.

In this Careers in Health podcast, Todd chats to Ear, Nose and Throat surgeon, Dr David McIntosh See omnystudio.com/listener for privacy information.

Interstitial Lung Disease is like a black box for many intensivists.  The complexity of the pathology seems to be only matched by the complexity of the diagnostic classification, and the drug names used to treat them.   James Lindstrom is a dual trained intensivist and respiratory physician in Geelong, Australia, and he joins me to explore some of the issues related to ILD in the ICU See omnystudio.com/listener for privacy information.

It has been said that more people suffer harm from our management of diabetic ketoacidosis than those that do from the disease itself. So how do we avoid these pitfalls in the emergency department? Adan Atriham is an emergency physician from Houston, Texas See omnystudio.com/listener for privacy information.