Episode 146: Critical Care Ultrasound with Lee Goeddel

In this 146th episode I welcome back Dr. Lee Goeddel to the show to discuss critical care ultrasound including how it differs from POCUS and how people can prepare for the new certification exam.

References:

Pears and Pitfalls in Critical Care Ultrasonography: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5693549/

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.

Topmedtalk: https://www.topmedtalk.com

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 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

Episode 130: Adults with Congenital Heart Disease with Jochen Steppan

In this 130th episode I welcome back Dr. Jochen Steppan to discuss the perioperative care of adults with congenital heart disease. We discuss the incidence, evaluation and management including the different types of physiology that a provider might see and how to manage each one.

References:

http://www.pted.org/ For pictures of the lesions

Stoelting’s Anesthesia and Co-Existing Disease, 7th EditionChapter 7 “Congenital Heart Disease” by Jochen Steppan and Bryan Maxwell 

Int Anesthesiol Clin. 2018 Fall;56(4):3-20. “When Your 35-Year-Old Patient has a Sternotomy Scar: Anesthesia for Adult Patients with Congenital Heart Disease Presenting for Noncardiac Surgery” By Cheema A, Ibekwe S, Nyhan D, Steppan J.

Episode 129: Vascular Access with Dave Berman

In this 129th episode I welcome Dr. Dave Berman back to the show to discuss vascular access devices. We talk about what kinds of lines exist, how to choose, what the pros and cons are, and how to know what kind of flow you will get with a given catheter.

References are here:

Episode 128: Opioid Induced Respiratory Depression (The PRODIGY Trial) with Dr. Ashish Khanna

In this 128th episode I welcome Dr. Ashish Khanna to the show to discuss his trial, the PRODIGY trial, looking at opioid induced respiratory depression. We discuss the background of the trial, what it took to run a 16 site, 3 continent trial, what the risk factors were that went into the risk prediction model they developed, and where we go from here.

References:

Sun Z, Sessler DI, Dalton JE, et al. Postoperative Hypoxemia Is Common and Persistent: A Prospective Blinded Observational Study. Anesth Analg. 2015;121(3):709–715. doi:10.1213/ANE.0000000000000836

Lee LA, Caplan RA, Stephens LS, Posner KL, Terman GW, Voepel-Lewis T, Domino KB. Postoperative opioid-induced respiratory depression: a closed claims analysis. Anesthesiology. 2015 Mar;122(3):659-65. doi: 10.1097/ALN.0000000000000564.

Episode 124: POCUS with Lee Goeddel

In this 124th episode I welcome Dr. Lee Goeddel to the show to discuss Point Of Care Ultrasound (POCUS). We discuss what it is, what it covers in the cardiac, pulmonary, abdominal and vascular system, and what next steps are for those interested in taking their skills further.

References:

Anesth Analg. 2017 Mar;124(3):753-760. doi: 10.1213/ANE.0000000000001861.The Nuts and Bolts of Performing Focused Cardiovascular Ultrasound (FoCUS).PMID:28207445 

J Am Soc Echocardiogr. 2013 Jun;26(6):567-81. doi: 10.1016/j.echo.2013.04.001.Focused cardiac ultrasound: recommendations from the American Society of Echocardiography.Spencer KT1, Kimura BJKorcarz CEPellikka PARahko PSSiegel RJ.PMID 23711341

Chest. 2015 Jun;147(6):1659-1670. doi: 10.1378/chest.14-1313.BLUE-protocol and FALLS-protocol: two applications of lung ultrasound in the critically ill.Lichtenstein DA1.PMID: 26033127

Surg Clin North Am. 2011 Feb;91(1):195-207. doi: 10.1016/j.suc.2010.10.008.Focused assessment with sonography for trauma: methods, accuracy, and indications.Patel NY1, Riherd JM. PMID: 21184909