PRISM Rounds: Pulmonary Critical Care & Sleep Podcast

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  S01E50: The MARCH Trial, When ICU Mucoactives Cause Harm Without Benefit 23.07.2026 53min

  Should mechanically ventilated patients with difficult-to-clear secretions routinely receive carbocisteine or nebulized hypertonic saline?In this episode of PRISM Rounds, we examine the MARCH randomized trial, which enrolled 1,956 patients across 71 UK intensive care units. Neither intervention shortened mechanical ventilation or improved major clinical outcomes. However, carbocisteine increased clinically important gastrointestinal bleeding, while hypertonic saline increased bronchoconstriction and hypoxemia during nebulization.We discuss the trial’s factorial design, the absence of a number needed to treat, and the approximate numbers needed to harm: 88 for gastrointestinal bleeding with carbocisteine, 51 for bronchoconstriction with hypertonic saline, and 26 for hypoxemia during nebulization. We then translate these findings into practical de-implementation strategies for airway care in the ICU.Article:https://www.nejm.org/doi/10.1056/NEJMoa2603406 Educational use only. This podcast is not medical advice.TagsMARCH trial, carbocisteine, hypertonic saline, mucoactive agents, mechanical ventilation, acute respiratory failure, airway secretions, mucus clearance, hypoxemia, bronchoconstriction, gastrointestinal bleeding, critical care, intensive care, ICU, respiratory therapy, pulmonary medicine, evidence-based medicine, randomized clinical trial, de-implementation, NEJM, PRISM Rounds
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  S01E49: VICTORY Trial, High-Dose Vitamin C in Severe Burns 17.07.2026 41min

  In this episode of PRISM Rounds, we review the VICTORY randomized clinical trial, published in JAMA on June 10, 2026, testing high-dose intravenous vitamin C in patients with severe burn injury.The trial randomized adults with deep second- or third-degree burns involving at least 20% total body surface area to high-dose IV vitamin C or placebo. VICTORY was stopped early for futility and harm. Vitamin C did not improve death or persistent organ dysfunction and raised concerning mortality signals.We discuss how the trial was conducted, why vitamin C was biologically appealing, what the results showed, and what this means for medical ICU patients with shock, sepsis, ARDS, and inflammatory critical illness.Article: https://doi.org/10.1001/jama.2026.10616 Educational content only; not medical advice.Critical Care, ICU, Medical ICU, Burn ICU, Severe Burns, Vitamin C, High-Dose Vitamin C, Ascorbic Acid, VICTORY Trial, JAMA, Randomized Clinical Trial, Organ Dysfunction, Shock, Sepsis, ARDS, Mortality, Evidence Based Medicine, Pulmonary Critical Care, Emergency Medicine, Pharmacy, Nursing, Respiratory Therapy, PRISM RoundsTags
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  S01E48 | Bicarbonate During In-Hospital Cardiac Arrest : The BIHCA Trial 10.07.2026 45min

  In this episode of PRISM Rounds, we discuss the JAMA randomized clinical trial BIHCA, which tested whether routine sodium bicarbonate improves outcomes during adult in-hospital cardiac arrest.Granfeldt and colleagues randomized adults with in-hospital cardiac arrest who had received epinephrine to sodium bicarbonate or placebo. Sustained return of spontaneous circulation occurred in 39% with bicarbonate vs 37% with placebo, with no significant difference. Survival and favorable neurologic outcome were also not clearly improved, while alkalosis and hypernatremia were more common with bicarbonate. We also discuss the accompanying editorial by Clifton Callaway, which asks whether this high-quality trial will change practice, given how deeply bicarbonate remains embedded in code culture despite guideline recommendations against routine use. Bottom line: bicarbonate changed the blood gas, but it did not change the patient-centered trajectory. Routine sodium bicarbonate should not be reflexive during in-hospital cardiac arrest, but targeted use remains appropriate for specific indications such as hyperkalemia or toxicologic sodium-channel blockade.Source article: https://doi.org/10.1001/jama.2026.10628Editorial: https://doi.org/10.1001/jama.2026.10508Tagscritical care, ICU, cardiac arrest, in-hospital cardiac arrest, sodium bicarbonate, bicarbonate, BIHCA, resuscitation, ACLS, code blue, epinephrine, return of spontaneous circulation, ROSC, neurologic outcome, JAMA, clinical trials, randomized trial, evidence-based medicine, emergency medicine, hospital medicine, pulmonary critical care, PRISM Rounds, FOAMed, medical education, CriticalCare, ICU, CardiacArrest, Resuscitation,
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  S01E47 | SODa-BIC: Sodium Bicarbonate for Metabolic Acidosis and Shock 03.07.2026 50min

  In this episode of PRISM Rounds, we discuss the NEJM SODa-BIC trial, a pragmatic, double-blind randomized trial of sodium bicarbonate versus placebo in critically ill adults with metabolic acidosis receiving vasopressors.The trial asked a common ICU question: when a patient in shock has a low pH, does bicarbonate improve outcomes or mainly improve the blood gas?SODa-BIC found that sodium bicarbonate improved acid-base parameters and reduced recurrent acidosis, but did not reduce major adverse kidney events at 30 days, mortality, renal replacement therapy dependence, or organ-support–free days.For bedside clinicians, the message is practical: bicarbonate may still have a role in selected scenarios, but routine use for moderate metabolic acidosis in vasopressor-dependent shock should not be expected to improve patient-centered outcomes.Article: https://doi.org/10.1056/NEJMoa2600526This episode is for educational purposes only and is not medical advice.TagsCritical Care, ICU, Shock, Metabolic Acidosis, Sodium Bicarbonate, SODa-BIC, NEJM, Renal Replacement Therapy, Acute Kidney Injury, Vasopressors, Sepsis, Acid Base, Nephrology, Emergency Medicine, Hospital Medicine, Pulmonary Critical Care, PRISM Rounds, FOAMed, Medical Podcast
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  S01E46 | ARISE FLUIDS: Early Vasopressors or More Fluids in Septic Shock? 26.06.2026 48min

  This week on PRISM Rounds, we discuss ARISE FLUIDS, a pragmatic NEJM trial asking a question every ICU and emergency department team faces: after initial fluid resuscitation in septic shock, should we give more crystalloid or move earlier to vasopressors?In adults with early septic shock, restricted fluids with early vasopressors changed the process of care and was associated with less pulmonary edema, but did not improve days alive and out of the hospital at 90 days compared with a more fluid-forward strategy.We place the trial in context with prior sepsis resuscitation evidence and discuss what it means at the bedside: not reflexive liters, not reflexive pressors, but thoughtful reassessment of perfusion, fluid responsiveness, pulmonary edema risk, and shock physiology.Listeners may also want to revisit PRISM Rounds Episode 35 on choosing fluids in sepsis and Episode 40 on the PRoMPT BOLUS study for related discussions.Article: Vasopressors or Fluids in Early Septic Shock. New England Journal of Medicine. Published June 11, 2026. https://doi.org/10.1056/NEJMoa2516225Tags:Critical Care, ICU, Sepsis, Septic Shock, ARISE FLUIDS, Vasopressors, Norepinephrine, IV Fluids, Fluid Resuscitation, Emergency Medicine, Pulmonary Critical Care, NEJM, Evidence Based Medicine, PRISM Rounds, Medical Podcast, FOAMed, Clinical Trials, Shock, Pulmonary Edema
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  S01E45: PROMINE Trial: Ketamine vs Propofol for ICU Intubation 21.06.2026 36min

  In this episode of PRISM Rounds, we discuss the PROMINE trial, a randomized trial comparing ketamine versus propofol for rapid sequence intubation in critically ill adults.Ketamine produced a modestly higher early mean arterial pressure in the first 10 minutes after induction, but the effect was transient and did not translate into a sustained hemodynamic advantage or clear improvement in patient-centered outcomes. We unpack what this means at the bedside, why sedative “reputation” can oversimplify ICU physiology, and why airway safety depends on the whole peri-intubation bundle—not just the induction agent.Article discussed: “Propofol versus ketamine in rapid sequence intubation in critically ill patients: a prospective, randomized, controlled trial.” Intensive Care Medicine, 2026.https://doi.org/10.1007/s00134-026-08351-3Educational only; not medical advice.TagsCritical Care, ICU, Pulmonary Critical Care, Emergency Intubation, Rapid Sequence Intubation, RSI, Airway Management, Ketamine, Propofol, PROMINE Trial, Intensive Care Medicine, Hemodynamics, Hypotension, Vasopressors, Mechanical Ventilation, Emergency Medicine, Anesthesia, FOAMed, MedEd, Journal Club
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  S01E44: Remote Rehab After the ICU — The iRehab Trial 12.06.2026 21min

  Surviving the ICU is not the same as recovering from critical illness. In this episode of PRISM Rounds, we discuss the JAMA iRehab randomized clinical trial, which tested whether a 6-week remote, multicomponent rehabilitation program could improve recovery for ICU survivors after hospital discharge.The primary 8-week quality-of-life endpoint was neutral, but the study showed important signals in secondary outcomes, including sit-to-stand performance, fatigue, anxiety, intervention acceptability, and 6-month quality of life. We also discuss the accompanying editorial and what this trial teaches us about post-ICU recovery, telerehabilitation, patient heterogeneity, and why ICU survivorship care cannot be one-size-fits-all.Article: https://doi.org/10.1001/jama.2026.7401Editorial: https://doi.org/10.1001/jama.2026.5761Educational content only; not medical advice.TagsCritical Care, ICU, ICU Survivorship, Post-Intensive Care Syndrome, PICS, Rehabilitation, Telerehabilitation, Remote Rehab, iRehab Trial, Mechanical Ventilation, JAMA, Pulmonary Critical Care, Physical Recovery, Quality of Life, Fatigue, Anxiety, Evidence-Based Medicine, PRISM Rounds
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  S01E43 | EDTA for CVADs: Can a Line Lock Reduce ICU Catheter Complications? 04.06.2026 23min

  In this episode of PRISM Rounds, we discuss the JAMA 2026 randomized clinical trial by Ornowska and colleagues testing whether 4% tetrasodium EDTA, or t-EDTA, used as a locking fluid for inactive central venous access device lumens, can reduce CVAD-associated complications in adult ICU patients.This pragmatic, triple-blind, multicenter, cluster-randomized crossover trial included 1468 ICU patients across 6 Canadian hospitals. The primary composite outcome—CVAD-associated bloodstream infection, catheter occlusion requiring alteplase, or catheter removal due to occlusion—occurred at 13.1 vs 19.9 events per 1000 catheter-days with t-EDTA versus control. The main signal was fewer catheter occlusions requiring alteplase; infection and thrombosis events were uncommon and should not be overinterpreted.Article link:https://jamanetwork.com/journals/jama/fullarticle/10.1001/jama.2026.6025TagsCritical Care, ICU, Central Line, CVAD, EDTA, t-EDTA, CLABSI, Catheter Occlusion, Alteplase, Venous Thrombosis, Infection Prevention, Vascular Access, JAMA, Randomized Trial, Pulmonary Critical Care, FOAMed, PRISMRounds
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  S01 Bonus Episode01: Prevent and Reverse Heart Disease — A Patient-Friendly Book Review 03.06.2026 1val 11min

  In this PRISM Rounds bonus episode, we step away from our usual journal-club format for a patient-facing book review of Prevent and Reverse Heart Disease by Caldwell B. Esselstyn Jr., M.D.This book was published in 2007, and cardiovascular prevention guidelines have evolved since then. But its central message remains practical and motivating: patients are not powerless, and daily food choices can be an important part of reducing cardiovascular risk.This episode is designed especially for physicians and clinicians who want a simple, shareable way to start a food-focused heart-health conversation with patients. We focus on practical steps individuals can take: improving breakfast, building plant-forward meals, stocking healthier foods at home, and making small sustainable changes.Educational only. Not medical advice. Patients should discuss major diet or medication changes with their healthcare team.TagsCardiovascular prevention, Heart disease, Plant-based diet, Lifestyle medicine, Patient education, Prevent and Reverse Heart Disease, Caldwell Esselstyn, Nutrition, Primary prevention, Secondary prevention, Cholesterol, Coronary artery disease, Food as medicine, PRISM Rounds, Bonus episode
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  S01E42: Auto-Adjusted NIV in OHS - The Pickwick Titration Trial 29.05.2026 24min

  In this episode of PRISM Rounds, we discuss the AJRCCM 2026 Pickwick Titration Trial, which asked whether automatically adjusted noninvasive ventilation can match manually adjusted NIV titrated in the sleep lab for ambulatory patients with obesity hypoventilation syndrome.The trial found that auto-adjusted NIV produced similar 12-month improvement in daytime PaCO₂ compared with manually adjusted NIV, while reducing cost and potentially decreasing sleep-lab burden. The accompanying editorial highlights the real-world nuance: CPAP remains first-line for many stable OHS patients with severe OSA, but auto-adjusted NIV may be especially useful when NIV is indicated and access to in-lab titration is limited.Article: https://doi.org/10.1093/ajrccm/aamag018Editorial: https://doi.org/10.1093/ajrccm/aamag112This episode is for educational purposes only and is not medical advice. TagsCritical Care, Pulmonary Medicine, Sleep Medicine, Obesity Hypoventilation Syndrome, OHS, Noninvasive Ventilation, NIV, Auto NIV, Auto EPAP, AVAPS, CPAP, PaCO2, Hypercapnia, Sleep Lab, Polysomnography, AJRCCM, Pickwick Titration Trial, PRISM Rounds, Medical Education, Free Open Access Medical Education, FOAMed, AI Generated Medical Education, Research Summary, Journal Club, ICU, Respiratory Therapy, Pulmonary Critical Care
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  S01E41: EIT-Guided PEEP in ARDS — Precision Ventilation or Too Much Titration? 22.05.2026 22min

  In this episode of PRISM Rounds, we discuss the 2026 AJRCCM EITVent randomized clinical trial and its accompanying editorial. The study asked whether electrical impedance tomography, or EIT, could help clinicians individualize PEEP in adults with moderate to severe ARDS compared with the traditional lower PEEP/FIO2 table.The overall trial was neutral: EIT-guided PEEP did not reduce 28-day mortality, ventilator-free days, length of stay, or major safety outcomes. But an important subgroup signal emerged in patients with higher lung recruitability, raising a practical bedside question: should EIT be used selectively to guide precision ventilation rather than as routine daily exhaustive PEEP titration?We discuss the trial design, the “collapse-overdistension crossing point,” the editorial’s caution about repeated recruitment maneuvers and decremental PEEP trials, and how this should influence bedside ventilator thinking in ARDS.Educational only. Not medical advice. AI-generated voices are used and may occasionally mispronounce terms.Trial DOI: https://doi.org/10.1093/ajrccm/aamaf125Editorial DOI: https://doi.org/10.1093/ajrccm/aamag012#PRISMRounds#CriticalCare#PulmonaryCriticalCare#ICU#ARDS#MechanicalVentilation#PEEP#EIT#ElectricalImpedanceTomography#VentilatorManagement#LungProtectiveVentilation#PrecisionVentilation#Recruitability#DrivingPressure#MechanicalPower#PronePositioning#RespiratoryFailure#AJRCCM#EITVent#ClinicalTrials#JournalClub#EvidenceBasedMedicine#FOAMed#MedEd#ICUEducation#AIgeneratedPodcast#FreeOpenAccessMedEdTags
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  S01E40 | Balanced Fluids vs Saline in Pediatric Septic Shock: Why Adult ICUs Should Care 16.05.2026 47min

  This week on PRISM Rounds, we discuss the April 2026 New England Journal of Medicine PRoMPT BOLUS trial comparing balanced crystalloids with 0.9% saline in children treated for suspected septic shock.The trial enrolled more than 9,000 children across 47 emergency departments and found no significant difference in major adverse kidney events between balanced fluid and saline. Balanced fluids reduced hyperchloremia and hypernatremia, but those biochemical advantages did not translate into better kidney outcomes, mortality, or hospital-free days.Although this is a pediatric trial, it is relevant for adult ICU and ED clinicians because it speaks to a familiar bedside question: when we reach for crystalloid early in sepsis, does fluid type meaningfully change patient-centered outcomes?We connect this trial to adult sepsis resuscitation, prior fluid-choice studies, and the broader lesson that “more physiologic” does not always mean “better outcomes.”Article: Balanced Fluid or 0.9% Saline in Children Treated for Septic ShockDOI: https://doi.org/10.1056/NEJMoa2601969Educational only; not medical advice. This episode uses AI-generated voices. #PRISMRounds#CriticalCare#ICU#EmergencyMedicine#Sepsis#SepticShock#PediatricSepsis#BalancedCrystalloids#NormalSaline#FluidResuscitation#Resuscitation#KidneyOutcomes#MAKE30#NEJM#EvidenceBasedMedicine#MedicalEducation#FOAMed#FOAMcc#PulmonaryCriticalCare#AIgenerated#AIResearchSummary#FreeMedicalEducation#JournalClub#BedsideMedicineTags / Hashtags
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  S01E39 | The FAST Trial - Rapid AST for Gram-Negative Bacteremia 10.05.2026 19min

  In this episode of PRISM Rounds, we review the JAMA FAST randomized clinical trial of rapid antimicrobial susceptibility testing for gram-negative bloodstream infections and the accompanying editorial, “Is FASTer Better?” The trial did not improve the primary DOOR outcome at 30 days, but rapid AST shortened antibiotic modification times and may be most useful when resistant organisms, septic shock, or ineffective empiric therapy are in play. We discuss why faster lab data alone may not improve mortality unless stewardship, drug availability, and bedside action close the loop.Educational only. Not medical advice. https://pubmed.ncbi.nlm.nih.gov/41999287/ Tags:Critical Care, ICU, Sepsis, Gram Negative Bacteremia, Antimicrobial Stewardship, Antibiotic Resistance, Rapid Diagnostics, AST, Bloodstream Infection, Infectious Diseases, JAMA, FAST Trial, FOAMed, FOMEd, Free Open Access Medical Education, Research Summary, Pulmonary Critical Care, Hospital Medicine, Pharmacy, Microbiology
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  S01E38 | Portable TB Testing — MiniDock MTB and Diagnostic Equity 02.05.2026 18min

  In this episode of PRISM Rounds, we review the NEJM study of MiniDock MTB, a portable near-point-of-care molecular test for pulmonary tuberculosis using sputum and tongue swabs.The study found that MiniDock MTB outperformed smear microscopy, approached Xpert Ultra performance with sputum swabs, and met WHO near-point-of-care diagnostic accuracy targets. We discuss why this matters for resource-limited settings, where delayed TB diagnosis, repeat visits, and limited access to molecular testing remain major barriers to care.We also cover the key limitations: lower sensitivity in paucibacillary disease, smear-negative TB, and people living with HIV, plus the need for reflex drug-resistance testing.Educational use only. AI-generated voices may include occasional mispronunciations.Article: https://doi.org/10.1056/NEJMoa2509761Tuberculosis, TB, pulmonary tuberculosis, MiniDock MTB, point-of-care testing, near-point-of-care diagnostics, molecular diagnostics, tongue swab, sputum swab, Xpert Ultra, smear microscopy, global health, infectious diseases, pulmonary medicine, critical care, resource-limited settings, diagnostic equity, implementation science, public health, NEJM, medical podcast, journal club, evidence-based medicine, FOAMed, FOMEd, Free Open Access Medical Education, PRISM Rounds, AI-generated medical education, AI medical podcast, clinical research summaryTags
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  S01E37 | The HIT Trial: Is "Good Enough" Better for Hyponatremia Correction? 25.04.2026 23min

  Are we treating the monitor or the patient? This episode breaks down the HIT Trial (NEJM Evidence), where 2,173 patients with chronic hyponatremia were randomized to test if intensive sodium correction actually improves clinical outcomes. https://pubmed.ncbi.nlm.nih.gov/41733398/ The ResultsLab Normalization: The targeted algorithm was highly effective at "fixing the number," reaching normal sodium levels in 60.4% of patients compared to 46.2% in standard care. Clinical Outcomes: Despite better labs, there was no reduction in 30-day mortality or rehospitalization (20.5% vs. 21.8%, p=0.45). Safety: While correction was more aggressive in the intervention group, zero cases of osmotic demyelination syndrome occurred. Bedside TakeawayStandard care is likely "good enough" for moderate hyponatremia in the short term. We discuss the "Good Enough" trap and why pushing for perfect laboratory values doesn't always translate to better patient-centered survival.TagsHyponatremia Critical Care Pulmonary ICU Internal Medicine Medical Education Electrolytes HIT Trial NEJM Evidence Evidence Based Medicine Intensivist Physician Education
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  S01E36| The "Goldilocks Zone": A Masterclass in Lung- and Diaphragm-Protective Ventilation (LDPV) 19.04.2026 37min

  Is your patient "fighting the vent," or are they trying to tell you something?In this episode of PRISM Rounds, we move beyond the traditional "Lung-Protective" paradigm to explore the integrated frontier of Lung- and Diaphragm-Protective Ventilation (LDPV). We deep-dive into the physiological evidence showing that patient-ventilator asynchrony isn’t just a nuisance—it’s a mortality signal.Join us as we break down 30 years of research, from the foundational 1997 Foti study to the cutting-edge 2025 breakthroughs in non-invasive, real-time monitoring. We’ll teach you how to identify the "Goldilocks Zone" of respiratory effort—avoiding both the atrophy of over-assistance and the myotrauma of under-assistance.The Clinical Stakes: Why "clusters" of ineffective efforts and double-triggering are predictors of poor outcomes (Blanch 2015, Vaporidi 2017, Sousa 2021).The Toolset: How to perform and interpret bedside maneuvers like Delta Pocc, P0.1, and PMI without needing an esophageal balloon.The 2025 Horizon: A first look at N-Pmus—the future of non-invasive, real-time waveform monitoring (Lv 2025, Tonelli 2025).The Protocol: A step-by-step walk-through of the Dianti (2022) titration strategy for sedation, PEEP, and sweep gas flow.Target Audience: ICU Fellows, Residents, Intensivists, and Respiratory Therapists.Featured Research & LiteratureBelow are the pivotal studies discussed in this episode. Search these titles on PubMed or your institutional library for full-text access:Tonelli, R., et al. (2025) – Assessing inspiratory drive and effort in critically ill patients at the bedside. (Critical Care)Lv, Y., et al. (2025) – Respiratory effort monitoring: a novel, bedside, non-invasive, real-time method. (Critical Care)de Vries, H. J., et al. (2023) – Performance of Noninvasive Airway Occlusion Maneuvers to Assess Lung Stress and Diaphragm Effort. (Anesthesiology)Dianti, J., et al. (2022) – Strategies for lung- and diaphragm-protective ventilation in acute hypoxemic respiratory failure. (Critical Care)Sousa, M., et al. (2021) – Clusters of Double Triggering Impact Clinical Outcomes (EPISYNC Study). (Crit Care Med)Goligher, E. C., et al. (2020) – Lung- and Diaphragm-Protective Ventilation. (AJRCCM)Bertoni, M., et al. (2019) – A novel non-invasive method to detect excessively high respiratory effort ($\Delta P_{occ}$). (Critical Care)Vaporidi, K., et al. (2017) – Clusters of ineffective efforts during mechanical ventilation: impact on outcome. (Intensive Care Med)Blanch, L., et al. (2015) – Asynchronies during mechanical ventilation are associated with mortality. (Intensive Care Med)#CriticalCare #ICU #MechanicalVentilation #LDPV #Pulmonology #MedEd #PRISMRounds #FOAMed #InternalMedicine #FellowshipTraining #VentilatorManagement #DiaphragmProtection
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  S01E35 | Choosing Fluids in Sepsis: Does Strategy Change Everything? 11.04.2026 38min

  In this episode of PRISM Rounds, we break down a secondary analysis of the CLOVERS trial examining whether crystalloid choice interacts with resuscitation strategy in sepsis.The key finding: balanced crystalloids were associated with lower mortality in a liberal fluid strategy, while normal saline showed lower mortality estimates in a restrictive strategy. This challenges the idea that fluid choice is independent of how we resuscitate.We discuss the physiology, limitations, and what this means for bedside decision-making—especially during early sepsis management.📄 Article: https://doi.org/10.1016/j.chstcc.2025.100226Tags#CriticalCare #ICU #Sepsis #FluidResuscitation #CLOVERS #DAISY #BalancedCrystalloids #NormalSaline #Vasopressors #FOAMed #MedEd #FreeMedEd #MedicalEducation #AIinMedicine #AIResearchSummaries #ClinicalResearch #EvidenceBasedMedicine #PulmCrit #EmergencyMedicine #ICUEducation
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  S01E34 | CORAL Trial: Nalbuphine for IPF Cough — A Real Signal? 08.04.2026 45min

  In this episode of PRISM Rounds, we break down the CORAL randomized clinical trial published in JAMA evaluating nalbuphine extended-release for chronic cough in idiopathic pulmonary fibrosis (IPF).In this episode, we discuss:The magnitude of cough reduction (~50–60% vs ~17% placebo)Why objective cough monitoring changes trial designDose-response and patient-reported outcomesSafety of a κ-opioid agonist / μ-antagonist strategyWhat this means for pulmonary and critical care practiceThis is one of the first trials to show a strong, clinically meaningful signal for treating IPF-associated cough—an area of major unmet need.📄 PubMed (CORAL Trial):https://pubmed.ncbi.nlm.nih.gov/38265368/📄 JAMA Article:https://jamanetwork.com/journals/jama/fullarticle/10.1001/jama.2025.26179PRISM Rounds is an audio journal club designed for clinicians who want high-yield, bedside-relevant discussions of new evidence.Tags#FOAMed #CriticalCare #Pulmonary #IPF #InterstitialLungDisease #ILD #ChronicCough #JAMA #RCT #EvidenceBasedMedicine #MedEd #MedicalPodcast #ICU #Respiratory #PulmCrit #JournalClub #Pharmacology #Opioid #Nalbuphine #ClinicalTrials #Healthcare #Medicine #Physicians #MedTwitter #PodcastMedicine #ATS #ERS
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  S01E33 | Surviving Sepsis Campaign 2026 — From Protocols to Precision 05.04.2026 29min

  In this episode of PRISM Rounds, we break down the 2026 Surviving Sepsis Campaign Guidelines and what they actually mean at the bedside.We focus on the major shifts shaping modern sepsis care: individualized fluid resuscitation, earlier vasopressor use, antimicrobial stewardship, and the move away from rigid protocol-driven management toward precision-informed decision-making.This episode highlights how experienced intensivists are likely to interpret these recommendations in real-world practice and what clinicians should do differently tomorrow.For ICU, ED, and pulmonary/critical care clinicians seeking a high-yield, practical update on sepsis management.Link: https://pubmed.ncbi.nlm.nih.gov/41869847/ Tags#CriticalCare #Sepsis #SepticShock #ICU #FOAMed #PulmCrit #EmergencyMedicine #IntensiveCare #MedEd #MedicalEducation #Guidelines #SurvivingSepsis #SSC #Resuscitation #Shock #Hemodynamics #Fluids #Vasopressors #Antibiotics #Stewardship #Norepinephrine #ICUrounds #JournalClub #PRISMRounds
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  S01E32: HI-PEITHO and the Management of Intermediate-Risk Pulmonary Embolism 02.04.2026 49min

  In this episode of PRISM Rounds, we review the HI-PEITHO trial and its accompanying editorial, both published in The New England Journal of Medicine, and examine their implications for the contemporary management of intermediate-risk pulmonary embolism.The discussion focuses on a clinically consequential subgroup of patients with acute pulmonary embolism who are hemodynamically stable yet demonstrate right ventricular dysfunction, myocardial injury, and signs of physiologic distress. We analyze the trial design, inclusion criteria, primary composite outcome, and safety results, with particular attention to the finding that ultrasound-facilitated catheter-directed thrombolysis was associated with a lower risk of early clinical deterioration, driven largely by a reduction in cardiorespiratory decompensation rather than a demonstrated mortality benefit.We also discuss how these data may influence multidisciplinary Pulmonary Embolism Response Team deliberations, especially when evaluating whether selected patients with intermediate-risk PE may benefit from earlier catheter-based intervention rather than continued observation with anticoagulation alone. The episode places HI-PEITHO in the broader context of prior thrombolysis literature, evolving reperfusion strategies, and the persistent tension between preventing hemodynamic collapse and avoiding bleeding complications.Key topics include patient selection, interpretation of the primary end point, safety considerations, the role of physiologic distress in escalation decisions, and the likely effect of this trial on real-world PERT practice.Primary Article: https://pubmed.ncbi.nlm.nih.gov/41910345/Editorial:https://pubmed.ncbi.nlm.nih.gov/41910345/This episode is intended for educational purposes only and should not be construed as medical advice. Audio is generated using AI voices.Tags#PulmonaryEmbolism #IntermediateRiskPE #VenousThromboembolism #Thrombosis #CriticalCare #IntensiveCare #PulmonaryCriticalCare #EmergencyMedicine #Cardiology #PERT #CatheterDirectedTherapy #Thrombolysis #UltrasoundFacilitatedThrombolysis #EvidenceBasedMedicine #JournalClub #NEJM #MedicalEducation #AcademicMedicine #ClinicalTrials #Resuscitation #AcuteCareMedicine #HospitalMedicine #FOAMed #FOAMcc #PRISMRounds #HI-PEITHO he