Critical Matters

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  Nutrition Therapy in the ICU 30.07.2026 1Std. 7Min.

  When it comes to critical illness, nutrition isn't just supportive care—it can be a key part of the treatment plan. In this episode, Dr. Sergio Zanotti sits down with Dr. Jayshil Patel to discuss nutrition therapy for critically ill adults and the growing evidence behind enteral nutrition's role in improving outcomes. Dr. Patel is a pulmonary and critical care physician in the Division of Pulmonary at the Medical College of Wisconsin whose research focuses on how enteral nutrition influences outcomes in critical care settings. Additional resources: * Nutrition Therapy in Critically Ill Adults. J. Patel, S McCLave. NEJM 2026. [https://www.nejm.org/doi/full/10.1056/NEJMra2506111] * Trial of the Route of Early Nutritional Support in Critically Ill Adults. CALORIES Trial. NEJM 2015. [https://www.nejm.org/doi/full/10.1056/NEJMoa1409860] * Enteral versus parenteral early nutrition in ventilated adults with shock: a randomised, controlled, multicentre, open-label, parallel-group study (NUTRIREA-2). LANCET 2018. [https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(17)32146-3/abstract] Books mentioned in this episode: * The Road to Character. By David Brooks. [https://www.amazon.com/Road-Character-David-Brooks/dp/0812983416/ref=tmm_pap_swatch_0?_encoding=UTF8&dib_tag=se&dib=eyJ2IjoiMSJ9.x3qP1bgxsh5RuSmmZooHQosrBncOJNi3Th3z3bC8fSUag_5sIV8FIyuBVvddoWmmu7gtuC_KckVDGmHMxQuUx7DemnI9fvw8DE8Vma1JCv5SFVrNyQF6yvfby2f6MfPKgruI700_V54H8SfzdjQT-MbEIlaMzoMYRg3C-iG6vU9-d4SFKdJWt1bCxU_KKUBaBXuA0A2Qj4IuYbEOyXJCUeypt4p7AvTkPilPqkcEog8.Uz71TdXKXddCTMHS3MaU_YCENZGsmSV_gIAcyj0tY0g&qid=1785246704&sr=8-1]
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  Sepsis - Beyond the guidelines 09.07.2026 53Min.

  In a recent episode, Dr. Sergio Zanotti discussed the 2026 iteration of the Surviving Sepsis Guidelines. In this episode, the discussion continues, focusing on important aspects beyond clinical guidelines. He is joined by Dr. Andre Kalil, a physician specializing in critical care and infectious diseases. Dr. Kalil is a Professor in the Division of Infectious Diseases and Director of Transplant Infectious Diseases at the University of Nebraska Medical Center (UNMC). Dr. Kalil is a prolific author and has participated in several IDSA/SCCM Clinical Guidelines and has written extensively on critical care and infectious disease topics. Additional resources: Surviving sepsis campaign 2026 guidelines | Critical Matters [https://www.soundphysicians.com/podcast/critical-matters/surviving-sepsis-campaign-2026-guidelines/] Sepsis. M Singer, et al. The Lancet 2026. [https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(25)02422-5/abstract] Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock 2026. Crit Care Medicine 2026. [https://journals.lww.com/ccmjournal/pages/articleviewer.aspx?year=2026&issue=04000&article=00005&type=Fulltext] Subphenotypes and phenotypes to resolve sepsis heterogeneity: hype or hope? Andre Kalil, et al. Intensive Care Med 2025. [https://pubmed.ncbi.nlm.nih.gov/40047867/] Early Goal-Directed Therapy for Sepsis: A Novel Solution for Discordant Survival Outcomes in Clinical Trials. Andre Kalil, et al. Crit Care Med 2017. [https://pubmed.ncbi.nlm.nih.gov/28067711/] Books mentioned in this episode: Curious: The Desire to Know and Why Your Life Depends on It. By Ian Leslie. [https://soundphysicians.sharepoint.com/sites/MarcomTeam/Shared%20Documents/General/Media/Audio/Critical%20Matters%20Podcast/2026/9%20Sepsis/Curious-Desire-Know-Future-Depends]
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  The Fearless ICU, revisited 25.06.2026 50Min.

  This episode was originally posted Feb. 24, 2022. The last 24 months have pushed ICU teams around the world to their limits. As we move forward, we need to heal and rebuild our critical care teams. Healthcare more than ever will require ICU teams to perform at the highest levels and to continuously innovate to deliver high-value care to the sickest of the sick. In this episode, Dr. Sergio Zanotti discusses the elements of The Fearless ICU. He is joined by Amy Edmondson (@AmyCEdmondson), the Novartis Professor of Leadership and Management at the Harvard Business School. For the last two decades, she has studied the elements of high-performing teams in complex environments. Additional Resources: Faculty page for Amy Edmondson. A great jumping point to her vast body of work. [https://www.hbs.edu/faculty/AmyEdmondson] How to turn a group of strangers into a team. TED Talk by Amy Edmondson [https://bit.ly/3vaKwzA/] The Fearless Organization. By Amy Edmondson. [https://amzn.to/3v7JzrJ] What Google Learned in its Quest to Build the Perfect Team. New York Times. [https://nyti.ms/3p84qHk] Implementing New Practices: An Empirical Study of Organizational Learning in Hospital Intensive Care Units. A. Edmondson et al. Management Science 2007. [https://bit.ly/3JJXisP] Books Mentioned in this Episode: Get Rid of the Performance Review! By Samuel Culbert. [https://amzn.to/354mYl3] Mindset. By Carol Dweck. [https://amzn.to/3LRR2B8]
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  Caring for older adults in the ICU 11.06.2026 53Min.

  In this episode, Dr. Sergio Zanotti discusses the care of older adults in the ICU. He is joined by Dr. Lauren Ferrante, a pulmonary critical care physician in the medical intensive care unit at Yale New Haven Hospital. She is an Associate Professor of Medicine at the Yale School of Medicine and serves as Director, Operations Core, at the Yale Claude D. Pepper Older Americans Independence Center. Dr. Ferrante is the lead author of the recently published "Society of Critical Care Medicine Guidelines on Caring for Older Adults in the ICU." Additional resources: Society of Critical Care Medicine Guidelines on Care for Older Adults in the ICU. Crit Care Medicine 2026 [https://journals.lww.com/ccmjournal/pages/articleviewer.aspx?year=2026&issue=05000&article=00003&type=Fulltext] Society of Critical Care Medicine Guidelines on Care for Older Adults in the ICU. Implementation Toolkit [https://sccm.org/SCCM/media/SCCM/PDFs/Older-Adults-Guidelines-Toolkit.pdf?_gl=1*rv4da8*_gcl_au*MzczOTk1NDAxLjE3NzgyNjIxMjM] American Geriatric Society Beers Criteria (Pocket Guide) [https://thecarepartnerproject.org/wp-content/uploads/The-Beers-List.pdf] Books mentioned in this episode: The Correspondent. By Virginia Evans [https://www.amazon.com/Correspondent-Deluxe-Novel-Virginia-Evans/dp/B0GJJMQDQ7/ref=sr_1_2?crid=25ME8EPSOYN7D&dib=eyJ2IjoiMSJ9.D76nq4yGpTti41c7DtcoCqe0m3dKRCBuU-4hbvBMVU1GssH5_NW3BzGt-flD25Ztw7DXNNlrtXJMBz5ppeRjbV3iZXYdE6MspTKg2l1c5Lw1guNSjgC40VKXrMP-32Hwuj47A9mKUJMV3moCDI2MdXQTGT8UHPSMfutcDh6lI7Qx6fd6pcBUxKKb6yS_6-Dinrg4WNbY4HzeqenSCQ3acHZnshv4OdsWqA7OhG4cy-4.qRMb0Y_zhSSdUjnCc2veC1LXI1TqA3lMwtJ2SB1ozPo&dib_tag=se&keywords=The+Correspondent&qid=1779487491&sprefix=the+correspondent%2Caps%2C231&sr=8-2]
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  Rethinking arterial lines 28.05.2026 40Min.

  In this episode, Dr. Sergio Zanotti discusses arterial catheters in shock through the lens of the recently published EVERDAC trial. He is joined by Dr. Gregoire Muller, a critical care physician in the Department of Intensive Care Medicine and Resuscitation at the University Hospital Center of Orléans, Orléans, France. Dr. Muller is an accomplished clinician and researcher. He is the principal investigator/lead author of the EVERDAC clinical trial published in the New England Journal of Medicine. Additional resources: Deferring Arterial Catheterization in Critically Ill Patients with Shock. EVERDAC Trial. New Engl J Med 2025. [https://www.nejm.org/doi/full/10.1056/NEJMoa2502136] Arterial lines in the ICU: A call for rigorous controlled trials. CHEST 2014. [https://pubmed.ncbi.nlm.nih.gov/25367469/] Hemodynamic monitoring in shock and implications for management. International Consensus Conference, Paris, France 2006. Intensive Care Med 2007. [https://pubmed.ncbi.nlm.nih.gov/17285286/] Noninvasive BP monitoring in the critically ill: time to abandon the arterial catheter? CHEST 2018.  [https://pubmed.ncbi.nlm.nih.gov/29108815/] Books mentioned in this episode: Getting Things Done: The Art of Stress-Free Productivity. By David Allen. [https://www.amazon.com/Getting-Things-Done-Stress-Free-Productivity/dp/B0DSK27GHG/ref=sr_1_1?crid=1QKAX43VHCDFV&dib=eyJ2IjoiMSJ9.JPu08UYkU4zwl38D65fqtHs5WdjMvGXKvCCqQyacQBM44z_sLrGzTFHqEZ3fzEJuAL9aXpfJWUGTuCZnRQ_TriznRd3Q5dGi9_XLfcpoU97SZPrygidyCFH0Ba51Rw2haSP-Oau7LSfKjk3_bZa1c4Crh7L1IR9Na_cLSPFsyyPXp-oE4MYu_i1IWZxT6A35EPwV4shAX-92XL9nCtKXwtlp4W2bbtB3JsCR_QrkNxg.bG1GTvFi830elLm8P0akcNT2Ab3A4MMczqm6Jy8UT5c&dib_tag=se&keywords=getting+things+done&qid=1775490069&sprefix=getting+things+done%2Caps%2C162&sr=8-1]
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  Invasive Candidiasis 14.05.2026 57Min.

  In this, Dr. Sergio Zanotti discusses the management of invasive candidiasis in critically ill patients. Invasive candidiasis is frequent in critically ill patients and is associated with high mortality and morbidity. He is joined by Dr. Max Adelman, a practicing critical care and infectious disease physician at Houston Methodist Hospital. Dr. Adelman is an Assistant Professor of Medicine at Weill Cornell Medical College. Dr. Adelman's clinical interests include bacteremia, hospital-acquired infections, immunocompromised hosts, multidrug-resistant organisms, and septic shock. Additional Resources: Invasive candidiasis in critically ill patients: Fundamental concepts and future directions. Perez MA, Hoffman WJ, Perez JC, and Adelman MH. CHEST 2026. [https://pmc.ncbi.nlm.nih.gov/articles/PMC12833977/] Empirical Micafungin Treatment and Survival Without Invasive Fungal Infection in Adults With ICU-Acquired Sepsis, Candida Colonization, and Multiple Organ Failure: The EMPIRICUS Randomized Clinical Trial. JAMA 2016. [https://pubmed.ncbi.nlm.nih.gov/27706483/] Global guideline for the diagnosis and management of candidiasis: an initiative of the ECMM in cooperation with ISHAM and ASM. THE LANCET- Infectious Diseases 2025. [https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(24)00749-7/fulltext] Books and Music mentioned in this episode: Four Thousand Weeks: Time Management for Mortals. By Oliver Bukerman. [https://www.amazon.com/Four-Thousand-Weeks-Management-Mortals-ebook/dp/B08FGV64B1/ref=sr_1_1?crid=2FJQE691JB5H3&dib=eyJ2IjoiMSJ9.2e1RiAVyclMJkGOzA0_LWuOFXqzlWVq4HXhGGCLYJkq42yY3fyrFid2V2RWVYAdCocEfe-dC53eZrwRdWHCE_1MaqwrB709y5e0yLKMHz9LnfGRf5QJ-wLCRiAzdH7kVR46dRiaR2gVhC_jzwds3n5_xX_d_AW_S13TIIyLrLOqSOuv-oYr6mbT2Njsj_js3DTTqQ_mCWc9_B21M1aSFewYT6KKUt--nOvMZpRgxMDc.-la6JVEfHMmdSUeP7zTTiPceOEFurUE-heTTBp1GNYA&dib_tag=se&keywords=4000+weeks&qid=1773886412&sprefix=4000%2Caps%2C179&sr=8-1] Lonesome Drifter. By Charlie Crockett. [https://www.amazon.com/Lonesome-Drifter-Charley-Crockett/dp/B0DVCD1G2P/ref=sr_1_1?crid=22893TOCDJZWD&dib=eyJ2IjoiMSJ9.b1CwNZUYAALfDS7k8KR2RS_mSBY4uX4w0LTD3OwPjOybHyYk_aueyvzPHpeMpDY1TYwXRkAT2TKX5zpJwi1NlHBtOarry61Tx4o1MJGHmU7djgWrUecopo7wDozEYp0_041tWC02nXRMiq4_UX6XHVuPK2JBTZxbST_Zg0QZfW2uTwBP_odXrBnaKzXUo4u4s1j9GpccN1M6jdil6DbZDSB5lrKZf8Vr54xikYKm21s.l7mqkLPc0vNa6ouQ4UfDw2x4Mzs9pxEA8fag6xyy6vc&dib_tag=se&keywords=charlie+crockett+cd&qid=1773886517&sprefix=Charlie+Crockett%2Caps%2C168&sr=8-1]
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  Surviving sepsis campaign 2026 guidelines 23.04.2026 1Std. 11Min.

  In this episode, Dr. Zanotti discusses the Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock 2026. He is joined by Dr. Hallie Prescot and Dr. Bram Rochwerg. Dr. Hallie Prescott is an Associate Professor in Pulmonary & Critical Care Medicine at the University of Michigan and a staff physician at the Ann Arbor Veterans Affairs Healthcare System. She serves as co-chair of the international Surviving Sepsis Campaign Guidelines. Dr. Bram Rochwerg is an associate professor and critical care physician at McMaster University in Hamilton, Ontario, Canada. He is co-vice-chair of the Surviving Sepsis Campaign Adult Guidelines. Additional Resources: Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock 2026. Crit Care Medicine 2026 [https://journals.lww.com/ccmjournal/pages/articleviewer.aspx?year=2026&issue=04000&article=00005&type=Fulltext] Executive Summary: Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock 2026. Crit Care Medicine 2026 [https://journals.lww.com/ccmjournal/fulltext/2026/04000/executive_summary__surviving_sepsis_campaign_.4.aspx] SCCM Point-of-Care (POC) APP: https://play.google.com/store/apps/details?id=org.sccm.mobl&hl=en https://apps.apple.com/us/app/sccm-poc/id1079591546 Books and music mentioned in this episode: William Osler: A Life in Medicine. By Michael Bliss [https://www.amazon.com/s?k=william+osler+a+life+in+medicine&crid=223XQKG5A3G59&sprefix=william+osler%2Caps%2C174&ref=nb_sb_ss_p13n-expert-pd-ops-ranker_1_13] Blood Poison: The Untold Story of Sepsis. By Parsa Shahinpoor [https://www.amazon.com/s?k=blood+poisoning+sepsis+book&crid=OZ8K6XSSSF21&sprefix=blood+poisoning+sepsis+book%2Caps%2C157&ref=nb_sb_noss_1] Album: Bloodline Artist: Mon Rovia [https://www.amazon.com/Bloodline-Mon-Rovia/dp/B0FTT3T73H/ref=sr_1_1?crid=22AJI8OQM1EFK&dib=eyJ2IjoiMSJ9.dhGf63BzRrcKmdMaCo4ZSNJeOERxpsAeipsmoWwGlco.GUaMo5NBKQiqaYla1XPDidy4PFFxThNo99Kf6g1M-2E&dib_tag=se&keywords=mon+rovia+bloodline+cd&qid=1776111640&sprefix=mon+Rovia%2Caps%2C176&sr=8-1]
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  Management of Impella Emergencies 09.04.2026 55Min.

  In this episode, Dr. Sergio Zanotti discusses emergency management and resuscitation of patients with left-sided Impella support. We will base our discussion on a recently published United Kingdom multisociety consensus statement. Our guests for this episode are two of the authors of this consensus statement. Dr. Zanotti is joined by Dr. Waqas Akhtar, a consultant at Guy's & St Thomas' NHS Foundation Trust in the United Kingdom. Dr. Akhtar completed full postgraduate certification in Cardiology, Intensive Care & General Internal Medicine with a particular interest in cardiogenic shock, heart transplantation, and mechanical circulatory support. He is also joined by Dr. Vasileios Panoulas, a consultant cardiologist at Royal Brompton & Harefield NHS Trust and honorary senior clinical lecturer at Imperial College London. He has clinical expertise that encompasses both general and interventional cardiology. Additional resources: UK multisociety consensus statement on the emergency management and resuscitation of patients with left-sided Impella support: https://heart.bmj.com/content/early/2025/12/17/heartjnl-2025-326896 Microaxial Flow Pump or Standard Care in Infarct-Related Cardiogenic Shock. DanGer Shock Investigators: https://www.nejm.org/doi/full/10.1056/NEJMoa2312572 Effect of Microaxial Flow Pump on Hemodynamics in STEMI-Related Cardiogenic Shock. DanGer Shock Investigators: https://www.jacc.org/doi/abs/10.1016/j.jacc.2025.04.062 Long-Term Outcomes of the DanGer Shock Trial. DanGer Shock Investigators: https://pubmed.ncbi.nlm.nih.gov/40888722/ Music mentioned in this episode: Unlearning. By Teddy Swims. [https://www.amazon.com/Unlearning-Teddy-Swims/dp/B096TRTRVR/ref=sr_1_2?crid=YVQGYQ768N5Y&dib=eyJ2IjoiMSJ9._NA1GMm_CKB7H0oBRpQFuEVn9mh4rVGfgEBPM5ZOBI2UH7TLuCnvk1UXEz1l8yZtZ2P3473FeVoPO_cIfFgMfx7W1B3VuCDgOtCbU27n_KRskWWOmK1kM5IsZsFWqNfFmxAaQovt8BKAsXOkkCGPBrzpJ0dBZhwNUgEbcRnW8532UhBknHkUPp_RvPmA_4Jm23WTIBymO6yQmUY2S6RWAR8LzzApr_aiShzHfdOi8V8.rrzjPsSZaTkfmFxUXXuQBHxugpdG98k_NC8HoJc54yk&dib_tag=se&keywords=Teddy+unlearning&qid=1773763757&sprefix=teddy+unlearning%2Caps%2C184&sr=8-2] Minute a Moment. By Myles Smith. [https://www.amazon.com/Minute-Moment-Myles-Smith/dp/B0F6VXGB26/ref=sr_1_2?crid=1HF04N0B8TJYJ&dib=eyJ2IjoiMSJ9.skxNq4rN2r7zMLTfEFlr3a7RJE4YLPX5J1-7b4ZK1Xr__dTZh_nKywu3I7zFQ5UccEO-B2dK06lGDSgPy2fJ9ERFtpeug3RTYLB35OlJPMSvsajkVDlWNXhXQBZ7Sa3hOOkE3MikLMRgHNL0z14oUA.qLD2-2Hej1KERoL3pp-J2ZFQPJ5LtP_yRAQBzvTbPXY&dib_tag=se&keywords=myles+smith+a+minute+a+moment&qid=1773764196&sprefix=myles+smith+a+minute+a+moment%2Caps%2C127&sr=8-2] Sable, Fable. By Bon Iver. [https://www.amazon.com/Sable-Fable-Bon-Iver/dp/B0DWT6MPVB/ref=pd_sbs_d_sccl_1_1/139-4346088-5189726?pd_rd_w=EA3jv&content-id=amzn1.sym.aa738fbd-ad05-4d11-aae2-04b598db6305&pf_rd_p=aa738fbd-ad05-4d11-aae2-04b598db6305&pf_rd_r=HSX3NG0QT7RX42C7Z7CJ&pd_rd_wg=WwdLe&pd_rd_r=067b1e38-a2b9-40fe-996c-fb4181015b9e&pd_rd_i=B0DWT6MPVB&psc=1]
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  Acute Pulmonary Embolism: Clinical Guideline Update 19.03.2026 1Std. 9Min.

  In this episode Dr. Sergio Zanotti discusses the recently released Clinical Practice Guideline for the Evaluation and Management of Acute Pulmonary Embolism in Adults. This guideline is a report of the American College of Cardiology / American Heart Association Joint Committee on Clinical Practice Guidelines. He is joined by Dr. Mark Creager, the lead author and chair of the writing committee for these guidelines. Dr. Creager is Professor of Medicine and Professor of Surgery at the Geisel School of Medicine at Dartmouth. A past president of the American Heart Association, he is an internationally recognized leader in vascular and cardiovascular medicine with more than 400 scientific publications. Additional resources: 2026 AHA/ACC/ACEP/CHEST/SCAI/SHM/SIR/SVM/SVN Guideline for the Evaluation and Management of Acute Pulmonary Embolism in Adults: A Report of the American College of Cardiology / American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation 2026: https://www.ahajournals.org/doi/10.1161/CIR.0000000000001415 Surgical Management and Mechanical Circulatory Support in High-Risk Pulmonary Embolisms: Historical Context, Current Status, and Future Directions: A Scientific Statement From the American Heart Association. Circulation 2023: https://www.ahajournals.org/doi/10.1161/CIR.0000000000001117 Antithrombotic Therapy for VTE Disease: Second Update of the CHEST Guideline and Expert Panel Report. CHEST 20: https://journal.chestnet.org/article/S0012-3692(21)01506-3/fulltext Books mentioned in this episode: Team of Rivals: The Political Genius of Abraham Lincoln. By Doris Kearns Goodwin: https://bit.ly/4skCS0c Alexander Hamilton. By Ron Chernow: https://bit.ly/4rFuxTw Vascular Medicine: A Companion to Braunwald's Heart Disease. By Mark Creager et al.: https://bit.ly/4uHZ4Dc
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  ECMO Emergencies 12.02.2026 46Min.

  In this episode, Dr. Sergio Zanotti discusses a structured approach to ECMO emergencies, focusing on recognizing cardiac arrest, organizing the team response, and early ECMO troubleshooting to support key life-saving interventions. He is joined by Dr. Waqas Akhtar, a consultant at Guy's & St Thomas' NHS Foundation Trustin the United Kingdom. Dr. Akhtar completed full postgraduate certification in Cardiology, Intensive Care & General Internal Medicine, with a particular interest in cardiogenic shock, heart transplantation, and mechanical circulatory support Additional resources: British societies guideline on the management of emergencies in patients on extracorporeal membrane oxygenation. Waqas Akhtar, et al. Intensive Care Med 2025: https://pubmed.ncbi.nlm.nih.gov/41051555/ UK multisociety consensus statement on the emergency and resuscitation of patients with left-sided Impella support. Waqas Akhtar, et al. BMJ Journals 2026: https://heart.bmj.com/content/early/2025/12/17/heartjnl-2025-326896 Books mentioned in this episode: His Dark Materials Series: The Golden Compass; The Subtle Knife; The Amber Spyglass: https://bit.ly/4cmSXgB
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  Acute Type B Aortic Dissection 25.12.2025 1Std. 7Min.

  In this episode of Critical Matters, Dr. Sergio Zanotti discusses the management of acute type B aortic dissection. He is joined by Dr. Firas Mussa, a vascular surgeon and professor at McGovern Medical School at UTHealth Houston. Dr. Mussa also holds a joint appointment with Imperial College in London. Additional resources: Management of Acute Type B Aortic Dissection. FF Mussa and P Kougias. N Engl J of Med 2025: https://pubmed.ncbi.nlm.nih.gov/40902163/ 2022 ACC/AHA Guideline for the Diagnosis and Management of Aortic Disease: A Report of the American Heart Association/American College of Cardiology Joint Committee on Clinical Practice Guidelines. EM Isselbacher, et al. Circulation 2022: https://pubmed.ncbi.nlm.nih.gov/36322642/ Society for Vascular Surgery (SVS) and Society of Thoracic Surgeons (STS) Reporting Standards for Type B Aortic Dissections. JV Lombardi, et al. J Vasc Surg 2020: https://pubmed.ncbi.nlm.nih.gov/32001058/ Endovascular repair of type B aortic dissection: long-term results of the randomized investigation of stent grafts in aortic dissection trial. INSTEAD-XL Trial. CA Nienaber, et al. Circ Cardiovasc Inter 2013: https://pubmed.ncbi.nlm.nih.gov/23922146/ Books mentioned in this episode: A Dangerous Liaison: A Revelatory New Biography of Simon de Beauvoir and Jean-Paul Satre. By Carole Seymour-Jones: https://bit.ly/3L0pIov A Time For All Things: The Life of Michael E. DeBakey. By Craig Miller, et al.: https://bit.ly/44B2uMw
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  PCT Reassessed 11.12.2025 43Min.

  In this episode, Dr. Zanotti discusses the role of Procalcitonin in the ICU. He is joined by Dr. Simran Gupta, an infectious disease specialist at Brigham & Women's Hospital in Boston. Dr. Gupta has additional training in Clinical Research, Transplant, and Infectious Disease. She recently published an article on reassessing the role of Procalcitonin in critically ill patients with sepsis. Additional resources: Reassessing Procalcitonin-Guided Antibiotic Therapy in Critically Ill Patients with Sepsis: Lessons from the ADAPT-Sepsis Trial. S. Gupta, et al. Clinical Infectious Disease 2025: https://pubmed.ncbi.nlm.nih.gov/40579227/ Biomarker-Guided Antibiotic Duration for Hospitalized Patients With Suspected Sepsis: The ADAPT-Sepsis Randomized Clinical Trial. JAMA 2025: https://pubmed.ncbi.nlm.nih.gov/39652885/ Procalcitonin-guided antibiotic therapy may shorten the length of treatment and may improve survival- a systematic review and meta-analysis. M Papp, et al. Crit Care 2023: https://pubmed.ncbi.nlm.nih.gov/37833778/ Books and entertainment mentioned in this episode: Shantaram: A Novel. By Gregory David Roberts: https://bit.ly/4ovVHKX SHANTARAM – Apple TV series: https://tv.apple.com/us/show/shantaram/umc.cmc.atxsrive40xli3zh3uxjimut
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  Capillary Refill Time (CRT) 19.11.2025 56Min.

  In this episode, Dr. Sergio Zanotti discusses the assessment of peripheral perfusion as a tool to guide treatment in septic shock. Specifically, he dives into Capillary Refill Time. He is joined by Dr. Eduardo Kattan, a critical care and anesthesia physician. Dr. Kattan is an Assistant Professor at the Pontificia Catholic University of Chile, where he also serves as Adult Critical Care Program Director and Director of Research and Academics in the Department of Critical Care Medicine. A prolific investigator, he focuses his research on septic shock and medical education. Dr. Rattan is the Co-Principal Investigator of the recently published ANDROMEDA-SHOCK 2 clinical trial. Additional resources: Personalized Hemodynamic Resuscitation Targeting Capillary Refill Time in Early Septic Shock. The ANDORMEDA-SHOCK-2 Randomized Clinical Trial. JAMA 2025: https://jamanetwork.com/journals/jama/fullarticle/2840823 Effect of Resuscitation Strategy Targeting Peripheral Perfusion Status vs Serum Lactate Levels on. 28-Day Mortality Among Patients With Septic Shock. The ANDROMEDA-SHOCK Randomized Clinical Trial. JAMA 2019: https://jamanetwork.com/journals/jama/fullarticle/2724361 Perspectives on peripheral perfusion assessment. Eduardo Kattan, et al. Curr Opin Crit Care 2023: https://pubmed.ncbi.nlm.nih.gov/37078639/ Books mentioned in this episode: The Little Prince. By Antoine de Saint-Exupery: https://bit.ly/49YcSRJ The Autumn Ghost: How the Battle Against a Polio Epidemic Revolutionized Modern Medical Care. By Hannah Wunsch: https://bit.ly/4i9PiUf
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  Peripheral vasopressors 23.10.2025 54Min.

  In this episode, Dr. Sergio Zanotti discusses the administration of vasopressor agents through peripheral intravenous lines (or what we refer to as "peripheral vasopressors"). He is joined by Dr. Elizabeth Munroe, a practicing pulmonary/critical care physician and an Assistant Professor of Pulmonary and Critical Care at Intermountain Health in Salt Lake City, Utah. Her research interests include evidence-based resuscitation practices in early sepsis and septic shock, vasopressor administration practices, peripheral vasopressor use, and clinical trials, particularly novel, pragmatic clinical trial designs. Additional resources: Peripheral Vasopressor Use in Early Sepsis-Induced Hypotension. ES Munroe, et al. JAMA Network 2025: https://pubmed.ncbi.nlm.nih.gov/40864467/ Early Restrictive or Liberal Fluid Management for Sepsis-Induced Hypotension. Shapiro NI, et al. CLOVERS Trial. New Engl J of Med 2025: https://pubmed.ncbi.nlm.nih.gov/36688507/ Overview of Peripheral Vasopressor Use in an Academic Health System. D Shyu, et al. Ann Am Thorac Soc 2025: https://pubmed.ncbi.nlm.nih.gov/40126143/ Safety of peripheral intravenous administration of vasoactive medication. J Cardenas-Garcia, et al. J Hosp Med 2015: https://pubmed.ncbi.nlm.nih.gov/26014852/ Books mentioned in this episode: Ending Medical Reversal- Improving Outcomes, Saving Lives. By Vinayak K. Parsad, et al: https://bit.ly/4nhCNam
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  Fluid Overload in the ICU 09.10.2025 1Std. 13Min.

  Fluid overload is a common problem in critically ill patients. In this episode, Dr. Sergio Zanotti discuss recognizing and managing fluid overload in the ICU with guest Dr. Michael J. Connor, Jr., a practicing intensivist and nephrologist. Dr. Connor is a Professor and Senior Physician of Critical Care Medicine & Nephrology at the Divisions of Pulmonary, Allergy, Critical Care, and Sleep Medicine and Renal Medicine at Emory University School of Medicine. Additionally, he serves as the director of critical care nephrology at the Emory Critical Care Center at Grady Memorial Hospital. Additional resources European Society of Intensive Care Medicine Clinical Practice Guideline on fluid therapy in adult critically ill patients: Part 3- fluid removal at de-escalation phase. Intensive Care Med 2025: https://pubmed.ncbi.nlm.nih.gov/40828463/ Optimizing Fluid Therapy in the Critically Ill. International Fluid Academy website – 2025: https://www.fluidacademy.org/2025/01/17/optimising-fluid-therapy-in-the-critically-ill-introduction-to-7d/ Fluid overload in the ICU: evaluation and management. R. Claure-Del Granado and R. L. Mehta. BMC Nephrology 2016: https://pubmed.ncbi.nlm.nih.gov/27484681/ Books and music mentioned in this episode: Think Again: The Power of Knowing What You Don't Know. By Adam Grant: https://bit.ly/4gZvz9c RUSHMERE. By Mumford & Sons: https://bit.ly/473FzKc
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  Outcomes after critical illness 25.09.2025 1Std. 5Min.

  Originally posted in April of 2023, we are sharing this episode of Critical Matters again as Dr. Sergio Zanotti's discussion about the long journey to healing and recovery for those who've survived critical illness in the ICU remains pertinent and important. This conversation features Dr. Margaret Herridge, Professor of Medicine, Senior Scientist in Critical Care and Respiratory Medicine at the University of Toronto. Dr. Herridge is also Director of Critical Care Research. Director of the RECOVER Program, and Clinical Director of the Grace RECOVER Program for Chronic Critical Illness, in the University Health Network, Toronto, Canada. Additional Resources: Outcomes after Critical Illness. M. Herridge and E. Azoulay: https://pubmed.ncbi.nlm.nih.gov/36884324/ Neuropsychological sequelae and impaired health status in survivors of severe acute respiratory distress syndrome. Hopkins RO, et al: https://pubmed.ncbi.nlm.nih.gov/10390379/ One-year outcomes in survivors of the acute respiratory distress syndrome. Herridge m, et al: https://pubmed.ncbi.nlm.nih.gov/12594312/ Long-term cognitive impairment after critical illness. Pandharipande PP, et al: https://pubmed.ncbi.nlm.nih.gov/24088092/ The RECOVER Program: disability risk groups and 1-year outcome after 7 or more days of mechanical ventilation. Herridge M, et al: https://pubmed.ncbi.nlm.nih.gov/26974173/ Determinants of long-term outcome in ICU survivors: results from the FROG-ICU study. Gayat E, et al: https://pubmed.ncbi.nlm.nih.gov/29347987/ Symptoms of anxiety and depression in family members of intensive care unit patients. Pochard F, et al: https://pubmed.ncbi.nlm.nih.gov/11588447/ Books Mentioned in this Episode: Bel Canto. By Ann Patchett: bit.ly/3nWs7Vp Commonwealth. By Ann Patchett: bit.ly/43pWSCt
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  ECPR 14.08.2025 55Min.

  In this episode, Dr. Sergio Zanotti discusses ECPR–Extracorporeal Cardiopulmonary Resuscitation. ECPR is still be considered a niche therapy, but its relevance and availability are increasing. He is joined by Dr. Adam Green, a practicing intensivist at Cooper University Health Care and an Associate Professor of Medicine at Cooper Medical School of Rowan University (CMSRU). Dr. Green is the director of research for the division of Critical Care and has authored over 50 peer-reviewed publications. He has been part of the ECMO team at Cooper since its inception. Additional resources: Extracorporeal cardiopulmonary resuscitation for refractory cardiac arrest. The Lancet Respiratory Medicine 2025: https://www.sciencedirect.com/science/article/pii/S2213260025001225 Effect of Intra-arrest Transport, Extracorporeal Cardiopulmonary Resuscitation, and Immediate Invasive Assessment and Treatment on Functional Neurologic Outcome in Refractory Out-of-Hospital Cardiac Arrest. JAMA 2022: https://jamanetwork.com/journals/jama/fullarticle/2789313 Association between increasing institutional experience with ECPR and outcomes in patients with out-of-hospital cardiac arrest: A nationwide multicenter observational study in Japan (the JAAM–OHCA registry) RESUSCITATION 2025: https://www.resuscitationjournal.com/article/S0300-9572(24)00862-1/fulltext Early Extracorporeal CPR for Refractory Out-of-Hospital Cardiac Arrest. N Eng J of Med 2023: https://www.nejm.org/doi/full/10.1056/NEJMoa2204511 Books mentioned in this episode: The Perfect Predator: A Scientist's Race to Save Her Husband from a Deadly Superbug. By S. Strathdee and T Patterson: https://amzn.to/3Hxjmez
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  Transfusion of platelets and FFP in the ICU 09.07.2025 1Std. 2Min.

  In this episode, Dr. Sergio Zanotti discusses clinical guidelines for the transfusion of platelets and fresh frozen plasma (FFP) in critically ill patients. He is joined by Dr. Angel Coz Yataco, a practicing pulmonary critical care physician. Dr Coz Yataco is on the faculty of the Cleaveland Clinic Main Campus. He is also the lead author of the recently published American College of Chest Physicians Clinical Practice Guidelines on "Transfusion of Fresh Frozen Plasma and Platelets in Critically Ill Adults." Additional resources: American College of Chest Physicians Clinical Practice Guidelines on Transfusion of Fresh Frozen Plasma and Platelets in Critically Ill Adults. Coz Yataco a, et al. CHEST 2025: https://pubmed.ncbi.nlm.nih.gov/40074060/ Platelet Transfusion 2025 AAB and ICTMG International Clinical Practice Guidelines. JAMA 2025: https://pubmed.ncbi.nlm.nih.gov/40440268/ Platelet Transfusion before CVC Placement in Patients with Thrombocytopenia. Van Baarle LF, et al. New Eng J of Med 2023: https://www.nejm.org/doi/full/10.1056/NEJMoa2214322 Books mentioned in this episode: Think Again: The Power of Knowing What You Don't Know. By Adam Grant: https://bit.ly/404783f
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  Management of pneumonia in the ICU 26.06.2025 1Std. 24Min.

  In this episode, Dr. Sergio Zanotti discusses the different aspects of managing pneumonia in critically ill patients. He covers the initial management of severe pneumonia, management of ventilator-associated pneumonia, and highlights the clinical approach to non-resolving pneumonia in the intensive care unit (ICU). He is joined by Dr. Andre Kalil, a physician specializing in critical care and infectious diseases. Dr. Kalil is a Professor in the Division of Infectious Diseases and Director of Transplant Infectious Diseases at the University of Nebraska Medical Center (UNMC). Additional resources: How to approach a patient hospitalized for pneumonia who is not responding to treatment? Pedro Povoa, et al. Intensive Care Med 2025: https://link.springer.com/article/10.1007/s00134-025-07903-3 Management of Adults With Hospital-acquired and Ventilator-associated Pneumonia: 2016 Clinical Practice Guidelines by the Infectious Diseases Society of America and the American Thoracic Society. Andre Kalil, et al. Clin Infect Dis. 2016: https://pmc.ncbi.nlm.nih.gov/articles/PMC4981759/ Management of Ventilator-Associated Pneumonia: Guidelines. M Metersky and Andre c. Kalil. Infect Dis Clin North Am. 202: https://pubmed.ncbi.nlm.nih.gov/38280768/ Hydrocortisone in Severe Community-Acquired Pneumonia. CAPE-COD Clinical Trial. N Eng J of Med 202: https://www.nejm.org/doi/full/10.1056/NEJMoa2215145 Continuous vs. Intermittent β-Lactam Antibiotic Infusions in Critically Ill Patients with Sepsis. BLING III Clinical Trial. JAMA 2024: https://jamanetwork.com/journals/jama/fullarticle/2819971 Music mentioned in this episode: Pat Metheny Group – We Live Here: https://bit.ly/44gt8Jl Antonio Carlos Jobin – Terra Basilis: http://bit.ly/4k4Amq1 Mahler: Symphony No.9 – Chicago Symphony Orchestra: http://bit.ly/4k9sXWn
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  Enteral Nutrition in the ICU 12.06.2025 53Min.

  In this episode of, Dr. Sergio Zanotti explores the vital role of enteral nutrition in the ICU—a foundational element in the prevention and treatment of disease-related malnutrition among critically ill patients. He is joined by Dr. Leah Gramlich, a distinguished gastroenterologist and physician nutrition specialist from the Royal Alexandra Hospital in Alberta, Canada. Dr. Gramlich is a Professor of Medicine at the University of Alberta and the founding president of the Canadian Nutrition Society. She has also served on the Board of Directors for the American Society for Parenteral and Enteral Nutrition and chaired the Canadian Malnutrition Task Force, bringing deep expertise to this essential topic. Additional resources: Enteral Nutrition in Hospitalized Adults. Lead Gramlich, Peggi Guenter. New Engl J Med 2025: https://pubmed.ncbi.nlm.nih.gov/40239069/ Individualized nutritional support in medical inpatients at nutritional risk: a randomized clinical trial. The EFFORT Clinical Trial. Lancet 2019: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(18)32776-4/abstract Low versus standard calorie and protein feeding in ventilated adults with shock: a randomised, controlled, multicentre, open-label, parallel-group trial (NUTRIREA-3). Lancet Respir Med 2023: https://pubmed.ncbi.nlm.nih.gov/36958363/ The effect of higher protein dosing in critically ill patients with high nutritional risk (EFFORT Protein): an international, multicentre, pragmatic, registry-based randomised trial. Lancet 2023: https://pubmed.ncbi.nlm.nih.gov/36708732/ Books mentioned in this episode: The Overstory: A Novel. By Richard Powers: https://bit.ly/43Drra1