Episode 143: Fluid management and cardiac output monitors in ERAS with Michael Scott

In this 143rd episode I welcome Dr. Michael Scott to the show to discuss fluid management in ERAS cases and how cardiac output monitoring may help us do that well.

Episode 142: Driving Pressure and Transpulmonary Pressure with Marcos Vidal Melo

In this 142nd episode I welcome Dr. Marcos Vidal Melo to the show to discuss Driving Pressure and Transpulmonary pressure. We discuss what they are, how they differ from plateau pressure, and how they may help guide safe mechanical ventilation.

References:

  1. Driving Pressure and Transpulmonary Pressure: How Do We Guide Safe Mechanical Ventilation? Williams EC, Motta-Ribeiro GC, Vidal Melo MF. Anesthesiology. 2019 Jul;131(1):155-163. 
  2. Loring SH, Topulos GP, Hubmayr RD: Transpulmonary pressure: The importance of precise definitions and limiting assumptions. Am J Respir Crit Care Med 2016; 194:1452–7
  3. Mauri T, Yoshida T, Bellani G, Goligher EC, Carteaux G, Rittayamai N, Mojoli F, Chiumello D, Piquilloud L, Grasso S, Jubran A, Laghi F, Magder S, Pesenti A, Loring S, Gattinoni L, Talmor D, Blanch L, Amato M, Chen L, Brochard L, Mancebo J; PLeUral pressure working Group (PLUG—Acute Respiratory Failure section of the European Society of Intensive Care Medicine): Esophageal and transpulmonary pressure in the clinical setting: meaning, usefulness and perspectives. Intensive Care Med 2016; 42:1360–73
  4. Akoumianaki E, Maggiore SM, Valenza F, Bellani G, Jubran A, Loring SH, Pelosi P, Talmor D, Grasso S, Chiumello D, Guérin C, Patroniti N, Ranieri VM, Gattinoni L, Nava S, Terragni PP, Pesenti A, Tobin M, Mancebo J, Brochard L; PLUG Working Group (Acute Respiratory Failure Section of the European Society of Intensive Care Medicine): The application of esophageal pressure measurement in patients with respiratory failure. Am J Respir Crit Care Med 2014; 189:520–31

Episode 141: Nutrition in the ICU with Paul Wischmeyer

In this 141st episode I welcome Dr. Paul Wischmeyer to the show to discuss nutrition for critically ill patients with a focus on the question of whether to give enteral feeds to patients on pressors. You can follow Dr. Wischmeyer on twitter @Paul_Wischmeyer.

References:

Dr. Wischmeyer’s article on enteral nutrition for patients on vasopressors: https://journals.lww.com/ccmjournal/Citation/onlinefirst/Enteral_Nutrition_Can_Be_Given_to_Patients_on.95859.aspx

Episode 140: Transfusion Triggers and The TRICS 3 Trial with David Mazer

In this 140th episode I welcome Dr. David Mazer to the show. Dr. Mazer was the PI and first author on the TRICS 3 trial looking at liberal versus restrictive transfusion strategies in moderate to high risk cardiac surgery patients published in the NEJM in 2017.

Dr. Mazer would like to add the following random recommendation: For a great combination of live jazz and good food and drinks in Toronto, check out the Jazz Bistro just up the street from St. Michael’s Hospital.

Reference: https://www.nejm.org/doi/full/10.1056/NEJMoa1711818

Dr. Mazer can be reached at David.Mazer@UnityHealth.To

Episode 138: Lower Extremity Blocks Part 1: Ankle and Sciatic

In this 138th episode I welcome Drs. Segna and Rayaz back to the show to discuss lower extremity nerve blocks. We cover the ankle block and sciatic nerve block approaches today and will cover the anterior leg in a later episode.

The Medium Article: https://medium.com/@admiralcloudberg/the-near-crash-of-air-canada-flight-759-c61094867d45

Episode 137: Contracts and Negotiation with Steve Kaufman

In this 137th episode I welcome Steve Kaufman to the show to discuss contracts and negotiation for doctors. Steve is a lawyer with decades of experience helping doctors negotiate contracts.

If you have questions for Steve you can contact him directly at 410-659-1385, or email at SKaufman@wcslaw.com and he’s on twitter at @SKaufmanWCS

Episode 135: A Case For Low Dose Norepinephrine

In this 135th episode I discuss my argument for using low dose norepinephrine to treat or even prevent hypotension in the OR and ICU. I discuss the CENSER trial looking at early norepinephrine in sepsis as well as a paper looking at preemptive norepinephrine in open cystectomies and a review article of trials looking at pressor use in free flap surgery. Join in the conversation here with your comments and on the ACCRAC Facebook page and Twitter @accracpodcast and @jwolpaw.

References:

CENSER: https://www.atsjournals.org/doi/full/10.1164/rccm.201806-1034OC

Cystectomies: https://www.ncbi.nlm.nih.gov/pubmed/24012203

Free Flaps: https://www.ncbi.nlm.nih.gov/pubmed/26340760