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Michael Weinstein, MD, FACS, FCCP, discusses ultrasound credentialing with Michael Blaivas, MD, FAIUM, FACEP, at the 44th Critical Care Congress in Phoenix, Arizona. Dr. Blaivas is a member of the Society of Critical Care Medicine’s Ultrasound Certification Task Force and was instrumental in authoring a position statement for Critical Care Medicine that offered guidance to both providers and hospitals in the process of credentialing in critical care ultrasound and advanced critical care echocardiography. The task force recommended incorporating focused cardiac ultrasound into the practice of critical care ultrasound. Dr. Blaivas is Professor of Medicine at the University of South Carolina in Columbia, South Carolina and a member of the Department of Emergency Medicine at St. Francis Hospital in Columbus, Georgia.
Michael Weinstein, MD, FACS, FCCP, speaks with Hayley Beth Gershengorn, MD, lead author on an article published in the August Critical Care Medicine, “Understanding Changes in Established Practice: Pulmonary Artery Catheter Use in Critically Ill Patients.” Study investigators found that use of pulmonary artery catheters in intensive care unit (ICU) patients has declined with significant variation across units, with most removal occurring in non-surgical ICUs and patients. Dr. Gershengorn is an Intensivist and Pulmonary Physician at Beth Israel Medical Center in New York, New York. She is also Assistant Professor of Pulmonary Medicine at the Albert Einstein College of Medicine of Yeshiva University.
Margaret Parker, MD, FCCM, speaks with Heidi J. Dalton, MD, FCCM, about extracorporeal membrane oxygenation (ECMO) in pediatric critical care. Dalton provides of brief history of ECMO and discusses outcomes and complications as well as common techniques being used in these patients. Dalton Chief of Pediatric Critical Care Medicine at the Phoenix Children’s Hospital in Phoenix, Arizona, USA.
Richard D. Branson, RRT, FCCM, discusses his two upcoming presentations for the 38th Critical Care Congress, The Modes of Mechanical Ventilation and Mechanical Ventilation Modes: How and When. Both sessions will highlight new developments in mechanical ventilation and increase understanding. Mr. Branson is an assistant professor, division of trauma and critical care at the University of Cincinnati Medical Center in Ohio.
Combes et al (N Engl J Med. 2018;378:1965-1975) set out to determine whether the use of ECMO reduced mortality in patients with ARDS when defined by one of three criteria: P/F ratio < 50 mm Hg for > 3 hours, P/F ratio < 80 mm Hg for > 6 hours, or pH < 7.25 coupled with Paco2 ≥ 60 mm Hg for > 6 hours (with respiratory rate < 35 beats/min and plateau pressure ≤ 32 cm H2O).
This Concise Critical Appraisal explores a Lancet Respiratory Medicine article by Ramanathan et al, which outlines how to plan for extracorporeal membrane oxygenation (ECMO) for patients with severe acute respiratory distress syndrome (ARDS) related to COVID-19. ECMO is a complex therapy usually restricted to specialized centers. World Health Organization guidelines suggest that carefully selected patients with ARDS may benefit. The authors explore how good planning can help during outbreaks of emerging infectious diseases.
Each year, approximately 790,000 patients in the United States develop acute respiratory failure that requires intubation and mechanical ventilation. Host Ludwig H. Lin, MD, is joined by Gintas P. Krisciunas, MPH, MA, to explore whether a modifiable risk factor, endotracheal tube size, is associated with the diagnosis of postextubation aspiration in survivors of acute respiratory failure (Krisciunas G et al. Crit Care Med. 2020;48:1604-1611). Gintas P. Krisciunas is a research assistant professor of otolaryngology at Boston University School of Medicine and Boston Medical Center in Boston, Massachusetts, USA.
In a situation where ventilators are in short supply, multiple patients on a single ventilator could be a strategy of last resort. In this podcast, Arthur S. Slutsky, MD, discusses his article "Personalized Ventilation to Multiple Patients Using a Single Ventilator: Description and Proof of Concept" (Han J, et al. Crit Care Explor. 2020;2:e0118). A figure included in the article will provide a valuable visual aid to listeners.
Dr. Slutsky will discuss publishing information he hopes no one will ever have to use, but he encourages institutions to practice and test the proof of concept as an exercise in emergency preparedness.
The concept may also have benefit for resource-limited areas. Beyond the complexity of building the circuits, challenges related to alarms, infection control, and other complexities must also be considered.
"In a time of crisis where resources are limited, we introduce a system of multiple secondary breathing circuits driven by a ventilator in preference to that of simply splitting the breathing circuits, which has been shown to raise multiple risks for patients," he writes.
Dr. Slutsky is vice president or research at St. Michael's Hospital and professor of medicine, surgery, and biomedical engineering at University of Toronto in Ontario, Canada.
Ludwig Lin, MD, speaks with Michael Blaivas, MD, FACEP, FAIUM, about the article, “Guidelines for the appropriate use of bedside general and cardiac ultrasonography by the intensivist in the evaluation of critically ill patients—Part I: general ultrasonography,” published in Critical Care Medicine. Dr. Blaivas serves as a Professor of Medicine at the University of South Carolina School of Medicine, and works clinically in the St. Francis Hospital Emergency Department in Columbus, Georgia. In this article, Dr. Blaivas and coauthors seek to establish evidence-based guidelines for the use of bedside ultrasound by intensivists and specialists in the intensive care unit (ICU) and equivalent care sites for diagnostic and therapeutic purposes for organs of the chest, abdomen, pelvis, neck and extremities.
Michael S. Weinstein, MD, FACS, FCCM, speaks with C. David Mazer, MD, FRCPC, and Gerard F. Curley, MB, MSc, PhD, FCARCSI, about the article, “Transfusion Triggers for Guiding RBC Transfusion for Cardiovascular Surgery: A Systematic Review and Meta-Analysis*,” published in Critical Care Medicine. In this article, the authors investigate whether perioperative restrictive transfusion thresholds are associated with inferior clinical outcomes in randomized trials of cardiovascular surgery patients.
Margaret Parker, MD, MCCM, speaks with Andrea Wolfler, MD, about the article, “Evolution of Non-Invasive Mechanical Ventilation Use: A Cohort Study Among Italian Pediatric Intensive Care Units,” published in the June 2015 issue of Pediatric Critical Care Medicine. Dr. Wolfler is a Medical Doctor in the Department of Anesthesia and Intensive Care at the Children’s Hospital in Milan, Italy. In this article, Dr. Wolfler and coauthors assess how clinical practice of non-invasive ventilation has evolved in the PICU.
Todd Fraser, MD, speaks with Kay Choong See, MRCP, about the article, “Basic Critical Care Echocardiography by Pulmonary Fellows: Learning Trajectory and Prognostic Impact Using a Minimally Resourced Training Model*,” published in the October 2014 issue of Critical Care Medicine. Dr. See is an Intensive Care Consultant in the Division of Respiratory and Critical Care Medicine at the National University Hospital in Singapore. Dr. See and coauthors found that basic critical care echocardiography training using minimal resources is feasible, and new trainees can achieve reasonable competency in most basic critical care echocardiography domains after performing about 30 examinations within the first year.
Margaret Parker, MD, MCCM, speaks with James Thomas, MD, about the article, “Extubation During Pediatric Extracorporeal Membrane Oxygenation: A Single-Center Experience,” published in Pediatric Critical Care Medicine. Dr. Thomas is a Professor of Pediatric Critical Care Medicine in the Department of Pediatrics at the Baylor College of Medicine in Houston, Texas and the Medical Director of their ECMO program. In this article, Dr. Thomas and coauthors compare the prevalence, resource utilization, and mortality for pediatric severe sepsis identified using two established identification strategies.
Margaret Parker, MD, FCCM, speaks with Carl O. Eriksson, MD, MPH, lead author on an article published in the November Pediatric Critical Care Medicine. Researchers found that prevention and early use of antiviral medications may reduce the risk of influenza-related acute respiratory failure requiring mechanical ventilator support. Eriksson is an attending physician in the pediatric intensive care unit at Oregon Health & Science University in Portland, Oregon, USA.
Michael Weinstein, MD, FACS, FCCP, speaks with Christopher W. Seymour, MD, MSc, lead author on an article published in the October Critical Care Medicine, “Diurnal Sedative Changes During Intensive Care: Impact on Liberation from Mechanical Ventilation and Delirium.” Seymour is an assistant professor of critical care and emergency medicine at the University of Pittsburgh School of Medicine in Pittsburgh, Pennsylvania. He also is a core faculty member in the Clinical Research, Investigation, and Systems Modeling of Acute Illness (CRISMA) Center in the Department of Critical Care, where he contributes to the Program on Critical Care Health Policy. Additionally, he was the Society’s 2012 Vision Grant recipient.
Michael Weinstein speaks with Ewan Goligher, MD, FRCPC, lead author on an article published in the October Critical Care Medicine, “Core Competency In Mechanical Ventilation: Development of Educational Objectives Using the Delphi Technique.” The study aimed to identify learning objectives that would encompass competency-based education in residents’ mechanical ventilation training. Goligher is a clinical associate and an MSc/PhD student in the Department of Physiology at the University of Toronto.
Michael S. Weinstein, MD, FACS, FCCP, speaks with Ellen Cowen Meltzer, MD, MSc, about her article published in the May 2012 Critical Care Medicine. The article illustrates the benefits lip-reading interpretation can provide to improve communication with patients capable of mouthing words. Meltzer is an assistant professor of medicine and public health in the Division of Medical Ethics at Weill Cornell Medical College of Cornell University in New York, New York. She is also an assistant attending physician at New York-Presbyterian Hospital.
Matthew Paden, MD, discusses his Pediatric Critical Care Medicine article, “Recovery of Renal Function and Survival After Continuous Renal Replacement Therapy During Extracorporeal Membrane Oxygenation.” The study examines the role continuous renal replacement therapy has on long-term renal outcomes during extracorporeal membrane oxygenation. Paden is an assistant professor in the department of pediatrics at Emory University School of Medicine in Atlanta, Georgia.
Graeme MacLaren, MD, FCCM, is the lead author on an article published in the March Pediatric Critical Care Medicine titled, “Central Extracorporeal Membrane Oxygenation for Refractory Pediatric Septic Shock.” MacLaren is a pediatric intensivist at The Royal Children’s Hospital in Melbourne, Australia. He is an adult and pediatric intensivist and the director of cardiothorasic intensive care in the department of cardiac, thorasic and vascular surgery at the National University Heart Centre in Singapore. He also serves as an assistant professor of surgery and pediatrics at the National University of Singapore.
Ravi Thiagarajan, MD, MBBS, MPH, discusses his article published in the January Pediatric Critical Care Medicine titled, “Blood Transfusion is Associated with Prolonged Duration of Mechanical Ventilation in Infants Undergoing Reparative Cardiac Surgery.” Thiagarajan is an assistant professor of pediatrics at Children’s Hospital Boston.