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 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 104: Sepsis with Pam Lipsett

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

Episode 79: Pediatric Cardiothoracic Anesthesia with Dheeraj Goswami

In this episode, episode 79, I welcome Dr. Dheeraj Goswami to the show to discuss pediatric cardiothoracic anesthesiology.  We discuss the training required to do these cases, the most common cases and concerns, and how it differs from other forms of anesthesia.

Episode 69: Intro to Trauma with Bob Sikorski

In this episode, Episode 69, I welcome Dr. Bob Sikorski, director of trauma anesthesiology at Johns Hopkins, to the show to discuss a general overview of trauma anesthesia.  We discuss prehospital, ER and OR management and key things to keep in mind when caring for trauma patients.

References: Trauma references list

TEG diagram: 

 

Episode 52: Diastolic Heart Failure with Todd Dorman

In this episode, episode 52, I welcome Dr. Todd Dorman to the show.  Dr. Dorman is a professor of anesthesiology here at Johns Hopkins, is the Vice Chair for Critical Care, and is the immediate past president of the Society of Critical Care Medicine (SCCM).  Dr. Dorman and I discuss diastolic heart failure or heart failure with preserved ejection fraction (HFPEF), how it differs from systolic heart failure or heart failure with reduced ejection fraction (HFREF), how it presents, and how to manage it perioperatively.

References for peripheral vasopressors:

  1. Medlej K et al. Complications from Administration of Vasopressors Through Peripheral Venous Catheters: An Observational Study. JEM 2018. PMID: 29110979
  2. http://rebelem.com/peripheral-vasopressors-safe-dangerous/

Episode 45: Postop Delirium with Charlie Brown

In this episode, episode 45, I welcome Dr. Charlie Brown to the show.  Dr. Brown is one of our cardiac anesthesiologists with a research interest in postop delirium.  We discuss risk factors, consequences, prevention and treatment of postop delirium.