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Category: Pulmonary

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SCCM Pod-342 Clinician Pro/Con: Paralysis and Proning in ARDS

Margaret Parker, MD, MCCM, speaks with John J. Marini, MD, about the Congress session "Clinician Pro/Con: Paralysis and Proning in ARDS," which was presented at the 45th Critical Care Congress in Orlando, Florida. Dr. Marini served as moderator for this session and is Professor of Medicine at the University of Minnesota and Director of Research at Regions Hospital in Saint Paul, Minnesota. In this interview, Dr. Marini reflects on the use of neuromuscular blockers and prone position in ARDS. 


SCCM Pod-332 Dexmedetomidine Use in Critically-Ill Children with Acute Respiratory Failure

Margaret Parker, MD, MCCM, speaks with Mary Jo C. Grant, APRN, PhD, about the article, “Dexmedetomidine Use in Critically-Ill Children with Acute Respiratory Failure,” published in the December 2016 issue of Pediatric Critical Care Medicine. Dr. Grant is a Pediatric Critical Care Nurse Practitioner in the Department of Pediatric Critical Care at Primary Children’s Hospital in Salt Lake City, Utah. In this article, Dr. Grant and coauthors complete a secondary analysis of data from the RESTORE clinical trial to describe dexmedetomidine (DEX) use in children supported on mechanical ventilation for acute respiratory failure. Pediatr Crit Care Med. 2016; 17(12):1131-1141.


SCCM Pod-329 A Bedside Model for Mortality Risk in Pediatric Patients with ARDS

Margaret Parker, MD, MCCM, speaks with Aaron C. Spicer, MD, MAS, about the article, “A Simple and Robust Bedside Model for Mortality Risk in Pediatric Patients With Acute Respiratory Distress Syndrome,” published in the October 2016 issue of Pediatric Critical Care Medicine. Dr. Spicer completed a pediatric residency and critical care fellowship and now is a resident in the Department of Anesthesia, Critical Care, and Pain Medicine at the Massachusetts General Hospital in Boston, Massachusetts. In this article, Dr. Spicer and coauthors examine ways to identify patients that are at highest risk of mortality from ARDS. Pediatr Crit Care Med. 2016; 17(10):907-916.


SCCM Pod-273 Basic Critical Care Echocardiography by Pulmonary Fellows

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.


SCCM Pod-259 NEJM Study Examines if Simvastatin Improves ARDS Outcomes

Todd Fraser, MD, speaks with Daniel F. McAuley, MD, about his article, “Simvastatin in the Acute Respiratory Distress Syndrome,” published in the October 2014 New England Journal of Medicine. McAuley and the Irish Critical Care Trials Group tested the hypothesis that treatment with simvastatin would improve clinical outcomes in patients with acute respiratory distress syndrome (ARDS). Studies in animals and in vitro and phase 2 studies in humans suggest that statins may be beneficial in the treatment of this condition.


SCCM Pod-216 PCCM: Critical Pertussis Illness in Children

Margaret Parker, MD, FCCM, speaks with John T. Berger, MD, FCCM, Medical Director for Cardiac Critical Care at Children’s National Medical Center in Washington, DC, USA. Dr. Berger is with us today to discuss his article “Critical Pertussis Illness in Children, A Multicenter Prospective Cohort Study” which was published in the May 2013 Pediatric Critical Care Medicine. Dr. Berger and his colleagues found that pulmonary hypertension may be associated with mortality in pertussis critical illness.


SCCM Pod-186 PCCM: Variability and Challenges in Pediatric Asthma

Margaret Parker, MD, FCCM, associate podcast editor, speaks with Susan L. Bratton, MD, MPH, about her paper published in the July Pediatric Critical Care Medicine, “Critical Care for Pediatric Asthma: Wide Care Variability and Challenges for Study." Bratton is a professor of pediatrics at the University of Utah in Salt Lake City, Utah. She is also in the Division of Critical Care Medicine at Primary Children’s Medical Center.


SCCM Pod-165 PCCM: PAI-1 May Lead to Early Diagnosis of VAP in Children

Ramya Srinivasan, MD, discusses her article published in the January Pediatric Critical Care Medicine titled, “Plasminogen Activation Inhibitor Concentrations in Bronchoalveolar Lavage Fluid Distinguishes Ventilator-Associated Pneumonia from Colonization in Mechanically Ventilated Pediatric Patients.” The article found that PAI-1 discriminated well between pediatric patients diagnosed clinically with VAP compared with those who were considered colonized. This resulted in PAI-1 being useful in directing appropriate antibiotic therapy in intubated patients suspected of having a new pulmonary infection. Srinivasan is a pediatric intensivist at Sutter Memorial Hospital in Sacramento and a translational researcher at the University of California in San Francisco.


SCCM Pod-141 PCCM: Emergent Endotracheal Intubations in Children

Christopher L. Carroll, MD, FCCM, lead author of an article published in the May 2010 issue of Pediatric Critical Care Medicine, “Emergent Endotracheal Intubations in Children: Be Careful if it's Late When You Intubate,” which discusses the risks of emergent tracheal intubations in children. Carroll is an assistant professor at Connecticut Children’s Medical Center in Hartford, Connecticut.


SCCM Pod-70 PCCM: Childhood Obesity and Severe Asthma

Christopher Carroll, MD, discusses an article published in Pediatric Critical Care Medicine titled, "Childhood Obesity Increases Duration Of Therapy During Severe Asthma Exacerbations." Dr. Carroll is a pediatric intensivist at Connecticut Children's Medical Center.


SCCM Pod-66 2007 Congress Special: Furosemide and Albumin in ARDS

Gregory Martin, MD, discusses some of the topics from his presentation during the 36th Critical Care Congress, "Furosemide and Albumin in ARDS." Dr. Martin is assistant professor of medicine at Emory University in Atlanta, Georgia, and the section head of pulmonary and critical care division at Grady Memorial Hospital where he is also the director of the medical and coronary ICUs. 


Effects of Positive End-Expiratory Pressure in “High Compliance” Severe Acute Respiratory Syndrome Coronavirus 2 Acute Respiratory Distress Syndrome

From Critical Care Medicine. In this study, the authors state their data suggest that a ""higher” positive end-expiratory pressure approach in patients with severe acute respiratory syndrome coronavirus 2 acute respiratory distress syndrome and high compliance improves oxygenation and lung aeration but may result in alveolar hyperinflation and hemodynamic alterations.
 


Letter to the Editor: Impact of Asynchronies in Acute Respiratory Distress Syndrome Due to Coronavirus Disease 2019

From Critical Care Explorations. In this Letter to the Editor, the authors state that close monitoring of patients with COVID-19 and mechanical ventilation is required; staying at the patient’s bedside is necessary to identify life-threatening asynchronies and must be resolved promptly, as well as finding strategies for prevention of asynchronies. 
 


Which patients should be proned and for how long?

Questions from social media, blogs and the various discussion forums, including the new SCCM COVID-19 Discussion Group, were answered. This microlearning content was taken from the COVID-19 Critical Care for Non-ICU Clinicians: Expert Panel Series held on February 24, 2021


SCCM Pod-457 CCM: Increased Incidence of Ventilator-Acquired Pneumonia in COVID-19 Patients

Little is known about the epidemiology of ventilator-acquired pneumonia among COVID-19 patients. Ashish K. Khanna, MD, FCCP, FCCM, is joined by Charles-Hervé Vacheron, MD, to discuss a cohort exposed/nonexposed study that found a higher incidence of ventilator-associated pneumonia among COVID-19 patients compared with the general population (Vacheron CH, et al. Crit Care Med. 2022;50:449-459). Dr. Vacheron is a physician in the Department of Anaesthesia and Intensive Care at Centre Hospitalier Lyon Sud in Pierre-Bénite, France.


SCCM Pod-438 Patient-Ventilator Dyssynchronies and Their Mechanisms

The prevalence and consequences of dyssynchronies are largely underestimated due to frequent lack of monitoring. Dedicated software solutions are needed to continuously and automatically detect dyssynchronies, which will allow for both clinical research and application aimed at determining the effects of dyssynchronies and their incidence among critically ill patients. Host Pamela M. Peeke, MD, MPH, FACP, FACSM, is joined by Laurent Brochard, MD, to explore the different mechanisms of the various patient-ventilator dyssynchronies and how to detect these dyssynchronies and evaluate their possible impact on patient-centered outcomes. Dr. Brochard is inter-department division director of critical care at the University of Toronto in Toronto, Ontario, Canada. This podcast is supported by an unrestricted education grant from Medtronic.


SCCM Pod-436 Interventions to Reduce Patient and Clinician COVID-19 Risk

Extubation is a high-risk endeavor in some COVID-19 patients. Host Pamela M. Peeke, MD, MPH, FACP, FACSM, is joined by Joshua H. Atkins, MD, PhD; Christopher Rassekh, MD; and Ara Chalian, MD, to discuss recognizing risks surrounding extubation in ventilated COVID-19 patients, provide framework for rapid assessment and iterative change in complex care settings, and identify essential elements of integration of data and teams for implementation of new care pathways. This episode’s guests are from the University of Pennsylvania Medical Center in Philadelphia, Pennsylvania, USA. Dr. Atkins is an anesthesiologist and Drs. Rassekh and Chalian are ENT surgeons. This podcast is supported by an unrestricted education grant from Medtronic.


SCCM Pod-434 Tracheostomy Adaptation for COVID-19 Patients

COVID-19 complicated critical care clinicians’ decision-making with regard to tracheostomy. ICU resource constraints and risk of staff exposure during an aerosol-generating procedure necessitated rapid adaption of clinical practice in the setting of many unknowns. Host Pamela M. Peeke, MD, MPH, FACP, FACSM, is joined by Joshua H. Atkins, MD, PhD; Christopher Rassekh, MD; and Ara Chalian, MD, to discuss essential considerations for tracheostomy in the COVID-19 setting and identify challenges to coordinated development of tracheostomy best practices. This episode’s guests are from the University of Pennsylvania Medical Center in Philadelphia, Pennsylvania, USA. Dr. Atkins is an anesthesiologist and Drs. Rassekh and Chalian are ENT surgeons. This podcast is supported by an unrestricted education grant from Medtronic.


RSV Vaccination in Adults May Curtail Morbidity and Mortality

This Concise Critical Appraisal delves into the impact of respiratory syncytial virus (RSV) and explores a recent trial that led to U.S. Food and Drug Administration approval of the first RSV vaccine. The Adult Respiratory Syncytial Virus (AReSVi-006) clinical trial is an ongoing, international, randomized, placebo-controlled trial that assesses the safety and effectiveness of a single dose of an RSV vaccine in nearly 25,000 patients.


SCCM Pod-448 Noninvasive Respiratory Support: Opinion- or Evidence-Based Medicine?

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, referring to a 2015 JAMA article (Stoll BJ et al. JAMA. 2015;314:1039-1051). Dr. Jain is interim chief in the Division of Neonatology at Rutgers Robert Wood Johnson Medical School. This podcast is supported by an unrestricted education grant from Medtronic.