Anesthesia and Critical Care Reviews and Commentary
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:
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.
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 BJ, Korcarz CE, Pellikka PA, Rahko PS, Siegel 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
In this 123rd episode I welcome Andrew Merelman to the show. Andrew is a paramedic and medical student with an interest in emergent surgical airway management. We discuss the human factors involved in the procedure, when it is indicated, how to do it and how to practice.
References and Links:
Airway Ap information:
http://www.airwaycollaboration.org/
iOS – https://itunes.apple.com/ca/app/the-airway-app/id1112657910?mt=8
Android- https://play.google.com/store/apps/details?id=com.parse.airway&hl=en
3D printed models – https://link.springer.com/article/10.1007%2Fs12630-017-0926-9 Videos:
https://emcrit.org/emcrit/real-surgical-airway/
https://www.airmedicaljournal.com/article/S1067-991X(09)00037-6/fulltext
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3727957/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5749220/
https://www.ncbi.nlm.nih.gov/pubmed/20491685
https://www.ncbi.nlm.nih.gov/pubmed/30173584
https://journals.lww.com/jtrauma/Citation/2012/09000/Is_bougie_aided_cricothyrotomy_really__extremely.42.aspx
In this 121st episode I welcome Dr. Lynette Mark to the show. Dr. Mark is the founder of our Difficulty Airway Response Team (DART) here at Hopkins and a founding director for the Society of Airway Management. We discuss the origins of the DART program and how to approach a difficult airway.
References:
https://www.criticalcare.theclinics.com/article/S0749-0704(17)30102-1/abstract
Difficult Airway Algorithm and Rescue Cricothyrotomy (DAARC): http://sgschallenge.com/2018daarc/
https://wamm2019.com World Airway Management Meeting, Amsterdam, Netherlands, November, 2019. Drs. Mark and Feinleib will be presenting about the DART program.
Dr. Cooper’s article on surgical airway: https://anesthesiology.pubs.asahq.org/article.aspx?articleid=2724164
Dr. Mark’s article from A&A and the accompanying editorial:
In this 119th episode I welcome Dr. Robert Sawyer to the show. Dr. Sawyer was the PI on the STOP-IT trial comparing a short course of antibiotics versus a longer course for complicated intraabdominal infections. We discuss the trial, the outcomes, and what the future of antimicrobial management in the surgical ICU may look like.
Reference:
STOP-IT Trial: https://www.nejm.org/doi/full/10.1056/NEJMoa1411162
In this 115th episode I welcome Dr. Steven Freiberg back to the show to discuss management of the contaminated airway.
References:
Han, S; Fisher, J. Airway Management During Persistent Flooding Of the Oropharyngeal Airway. Anesthesiology News. 2016. March.
Joshi, R; Hypes, C; et al. Difficult Airway Characteristics Associated with First-Attempt Failure at Intubation Using Video Laryngoscopy in the Intensive Care Unit. Ann Am Thorac Soc. 2017 Mar;14(3):368-375
Stockton, E.; Lockey, D; et. al. Contamination of the airway in pre-hospital trauma patients. European Journal of Anaesthesiology. 2008. May; 25:188
Uday, J; McCunn, M; et al. Management of the Traumatized Airway. Anesthesiology. 2016, Vol.124, 199-206
In this 111th episode I welcome Dr. Zandy Hillel to the show. Dr. Hillel is an otolaryngologist here at Johns Hopkins and we discuss tracheostomies, Cricothyrotomies, laryngeal surgery and difficult airways.
References:
Crichothyrotomies:
https://www.ncbi.nlm.nih.gov/pubmed/30054081
https://www.ncbi.nlm.nih.gov/pubmed/30726035
Difficult Airway Response Teams:
In this 106th episode I welcome Dr. Marius Fassbinder to the show to discuss the use of hydroxyethyl starches.
References:
1. Woodcock, T. E. & Woodcock, T. M. Revised Starling equation and the glycocalyx model of transvascular fluid exchange: an
improved paradigm for prescribing intravenous fluid therapy. British Journal of Anaesthesia 108, 384–394 (2012).
2. Westphal, M. et al. Hydroxyethyl starches: different products–different effects. Anesthesiology 111, 187–202 (2009).
3. Brunkhorst, F. M. et al. Intensive insulin therapy and pentastarch resuscitation in severe sepsis. N. Engl. J. Med. 358, 125–139
(2008).
4. Perner, A. et al. Hydroxyethyl Starch 130/0.42 versus Ringer’s Acetate in Severe Sepsis. N. Engl. J. Med. 367, 124–134 (2012).
6. Myburgh, J. A. et al. Hydroxyethyl Starch or Saline for Fluid Resuscitation in Intensive Care. N. Engl. J. Med. 367, 1901–1911
(2012).
7. Annane, D. et al. Effects of fluid resuscitation with colloids vs crystalloids on mortality in critically ill patients presenting with
hypovolemic shock: the CRISTAL randomized trial. JAMA 310, 1809–1817 (2013).
8. Joosten, A. et al. Crystalloid versus Colloid for Intraoperative Goal-directed Fluid Therapy Using a Closed-loop System: A
Randomized, Double-blinded, Controlled Trial in Major Abdominal Surgery. Anesthesiology 128, 55–66 (2018).
9. Gillies, M. A. et al. Incidence of postoperative death and acute kidney injury associated with 6% hydroxyethyl starch use: systematic review and meta-analysis. British Journal of Anaesthesia 112, 25–34 (2014).
In this 104th episode I welcome Dr. Pam Lipsett to the show to discuss the diagnosis and treatment of sepsis.
References:
Sepsis-3 guidelines from JAMA: https://jamanetwork.com/journals/jama/fullarticle/2492881
Marik Sepsis cocktail: Marik PE et al. Hydrocortisone, Vitamin C, and Thiamine for the Treatment of Severe Sepsis and Septic Shock. 2017: 151(6);1229–1238.
ADRENAL trial: https://www.nejm.org/doi/full/10.1056/NEJMoa1705835
APROCCHSS Trial: https://www.nejm.org/doi/10.1056/NEJMoa1705716
SEPSISPAM Trial: https://www.nejm.org/doi/full/10.1056/NEJMoa1312173