Optimizing renal replacement therapy in the ICU

Acute kidney injury is a frequent complication of critical illness, and a subgroup of these patients will require renal replacement therapy. In this episode. Dr. Sergio Zanotti discusses optimizing renal replacement therapy in the ICU. He is joined by Dr. Michael J. Connor, Jr., a practicing intensivist and nephrologist. He is a professor and senior physician of critical care medicine and nephrology at the Divisions of Pulmonary, Allergy, Critical Care, & Sleep Medicine and Renal Medicine at Emory University School of Medicine. In addition, he is the director of critical care nephrology at the Emory Critical Care Center at Grady Memorial Hospital. Additional resources: Delivering optimal renal replacement therapy to critically ill patients with acute kidney injury. Wald R, et al. Intensive Care Med 2022: https://pubmed.ncbi.nlm.nih.gov/36066597/ Initiation Strategies for Renal-Replacement Therapy in the Intensive Care Unit. AKIKI Study Group. N Engl J Med 2016: https://pubmed.ncbi.nlm.nih.gov/27181456/ Effect of Early vs Delayed Initiation of Renal Replacement Therapy on Mortality in Critically Ill Patients with Acute Kidney Injury. ELAIN Trial. JAMA 2016: https://pubmed.ncbi.nlm.nih.gov/27209269/ Timing of Renal-Replacement Therapy in Patients with Acute Kidney Injury and Sepsis. IDEAL-ICU Investigators. N Eng J Med 2018: https://pubmed.ncbi.nlm.nih.gov/30304656/ Timing of Initiation of Renal-Replacement Therapy in Acute Kidney Injury. STARRT-AKI Investigators. N Engl J Med 2020: https://pubmed.ncbi.nlm.nih.gov/32668114/ Comparison of two delayed strategies for renal therapy initiation for severe acute kidney injury. AKIKI 2 Trial. Lancet 2021: https://pubmed.ncbi.nlm.nih.gov/33812488/ Books and Music mentioned in this episode: The Invisible Life of Addie LaRue. By V.E. Schwab: The Invisible-Life-Addie-LaRue Moon Music. By Coldplay: Moon-Music-Coldplay

In this episode, Dr. Sergio Zanotti discusses rational fluid therapy. He is joined by Dr. Adrian Wong, a practicing intensive care medicine and anesthesia physician. Dr. Wong is a consultant and clinical lead at King’s College Hospital, London. He also serves as a committee member for the Intensive Care Society FUSIC, examiner for the European Diploma of Intensive Care Medicine, on the executive committee of the International Fluid Academy. Additional resources: Intravenous fluid therapy in the perioperative and critical care setting” Executive summary of the International Fluid Academy (IFA). Malbrain ML, et al. Ann. Intensive Care 2020: https://pubmed.ncbi.nlm.nih.gov/32449147/ Multidisciplinary expert panel report on fluid stewardship: perspectives and practice. Malbrain ML, et al. Annals of Intensive Care 2023: https://pubmed.ncbi.nlm.nih.gov/37747558/ The emerging concept of fluid tolerance: A position paper. Kattan E, et al. Journal of Critical Care 2022: https://pubmed.ncbi.nlm.nih.gov/35660844/ Everything you need to know about derescuscitation. Malbrain ML, et al. Intensive Care Med 2022: https://pubmed.ncbi.nlm.nih.gov/35932335/ Start with Why. TED Talk presented by Simon Sinek: https://simonsinek.com/videos/ted-talks/ Books mentioned in this episode: Thinking Fast and Slow. By Daniel Kahneman: https://amzn.to/4hicUoj Start with Why: How Great Leaders Inspire Everybody to Take Action. By Simon Sinek: https://bit.ly/42hzt8n

This episode of Critical Matters will close 2024 with a year in review. Dr. Sergio Zanotti is going solo and will discuss a couple of relevant clinical guidelines and review five clinical trials. To close, he'll share some of his favorite books for 2024. Additional Resources: Critical Care Management of Patients Post Cardiac Arrest (AHA/NCS): Hirsch KG, Abella BS, Amorim E, et al. Critical Care Management of Patients After Cardiac Arrest: A Scientific Statement from the American Heart Association and Neurocritical Care Society. Neurocrit Care. 2024;40(1):1-37: https://bit.ly/4087o1w 2024 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations: Summary From the Basic Life Support; Advanced Life Support; Pediatric Life Support: Neonatal Life Support; Education, Implementation, and Teams; and First Aid Task Forces. Circulation 2024: https://bit.ly/4fD4o1R PREOXI Trial. Gibbs KW, Semler MW, Driver BE, et al. Noninvasive Ventilation for Preoxygenation during Emergency Intubation. N Engl J Med. 2024;390(23):2165-2177. doi:10.1056/NEJMoa2313680: https://bit.ly/4fD4pCX AMIKINHAL Trial. Ehrmann S, Barbier F, Demiselle J, et al. Inhaled Amikacin to Prevent Ventilator-Associated Pneumonia. N Engl J Med. 2023;389(22):2052-2062. doi:10.1056/NEJMoa2310307: https://bit.ly/4iQQvzU REVISE Trial. Cook D, Deane A, Lauzier F, et al. Stress Ulcer Prophylaxis during Invasive Mechanical Ventilation. N Engl J Med. 2024;391(1):9-20. doi:10.1056/NEJMoa2404245: https://bit.ly/3Pc4nqH TIGHT K Trial. O'Brien B, Campbell NG, Allen E, et al. Potassium Supplementation and Prevention of Atrial Fibrillation After Cardiac Surgery: The TIGHT K Randomized Clinical Trial. JAMA. 2024;332(12):979-988. doi:10.1001/jama.2024.17888: https://jamanetwork.com/journals/jama/fullarticle/2823246 BALANCE Trial. Daneman N, Rishu A, et al. Antibiotic Treatment for 7 versus 14 Days in Patients with Bloodstream Infections. N Engl J Med. Published online November 20, 2024. doi:10.1056/NEJMoa2404991: https://www.nejm.org/doi/abs/10.1056/NEJMoa2404991 CMD Study. Bodien YG, Allanson J, Cardone P, et al. Cognitive Motor Dissociation in Disorders of Consciousness. N Engl J Med. 2024;391(7):598-608. doi:10.1056/NEJMoa2400645: https://www.nejm.org/doi/full/10.1056/NEJMoa2400645 Books Mentioned in this Episode: Slow Productivity: The Lost Art of Accomplishment Without Burnout. By Cal New Port: https://amzn.to/4gTbkJ2 Meditations for Mortals: Four Weeks to Embrace Your Limitations and Make Time for What Counts. By Oliver Burkeman: https://bit.ly/4gURU6N Knife: Meditations After an Attempted Murder. By Salman Rushdie: https://bit.ly/3ZPsAIt

In this episode Dr. Zanotti discusses the current role of pulmonary artery catheters in critical care medicine. He is joined by Dr. Steven Hollenberg a critical care and cardiology physician. Dr. Hollenberg is a professor of medicine at Emory University School of Medicine and director of cardiac intensive care at the Emory Heart & Vascular Center. Additional resources: Pulmonary Artery Catheter Use and Risk of In-hospital Death in Heart Failure Cardiogenic Shock. Kanwar MK, et al. J Card Fail. 2023 Sep;29(9):1234-1244: https://pubmed.ncbi.nlm.nih.gov/37187230/ Pulmonary Artery Catheter Use and Mortality in the Cardiac Intensive Care Unit. Bernard S Kadosh, et al. JACC Heart Failure 2023: https://pubmed.ncbi.nlm.nih.gov/37318422/ Complete Hemodynamic Profiling With Pulmonary Artery Catheters in Cardiogenic Shock Is Associated With Lower In-Hospital Mortality. A Reshad Garan, et al. JACC Heart Failure 2020: https://pubmed.ncbi.nlm.nih.gov/33121702/ Right Heart Catheterization in Cardiogenic Shock Is Associated With Improved Outcomes: Insights From the Nationwide Readmissions Database. Sagar Ranka, et al. J Am Heart Assoc 2021: https://pubmed.ncbi.nlm.nih.gov/34423652/ Books mentioned in this episode: I Contain Multitudes: The Microbes Within Us and a Grander View of Life. By Ed Yong: https://www.amazon.com/Contain-Multitudes-Microbes-Within-Grander/dp/0062368605/ref=sr_1_1?crid=1EVOY6OVQZ437&dib=eyJ2IjoiMSJ9.Na-UJShWq7ngsH9dxvSV2Q.Ob-k26_k01p5WzKzo4CWnsvD4Jjq9RU1krhQhmUi9u4&dib_tag=se&keywords=I+contain+platitudes&qid=1732299607&sprefix=i+contain+platitudes%2Caps%2C132&sr=8-1 Kind of Blue. Miles Davis: https://www.amazon.com/Kind-Blue-Vinyl-Miles-Davis/dp/B0041TM5OU/ref=sr_1_2?crid=E6F0PBPV33BG&dib=eyJ2IjoiMSJ9.4Kk2sCHn8DAOl9j_qadqsZPMVZPlOuKNXg9vv_NTPEYrl10vHYNIC5-wrGJeFpn9K8rSS8aspG9zhJHjAyDqiIUiC9VKvvHjzQsAGmr4wP9VWUPWumInjcS72CDmoaEYr3h2Uoiy8yt-YfYFHm7Y-6XoPecnwju8_zumwohrrhYWC0X6rR8Ui3Xhp6ILDU3sBNb50TJ6iq_fjataiHX7X6fBL1YnUo3X-uBcnQVfKtc.v-zGaYaLVvE7BGxS1c-2_Brbwsq1kAxVKEuxqsaBci8&dib_tag=se&keywords=Miles+Davis+Kind+of+Blue&qid=1732299762&sprefix=miles+davis+kind+of+blue%2Caps%2C139&sr=8-2 Brahms: Ein Deutsches Requiem. Sir Simon Rattle: https://www.amazon.com/Brahms-Ein-Deutsches-Requiem-German/dp/B000MTEDIE/ref=sr_1_5?crid=2UCHLINLHSETV&dib=eyJ2IjoiMSJ9.aDG2ZKyB5OnEgO3Z6_VOsNplIVSXmtXffLy2Jrylq4vgaRHEYDyBsz_4YG1fE_88IJxJ2ScnxhBvvDkVZjauoazwhTEMef0o_nJN25zUb_7oXFNkPMo_U4WBLhgK5njVOkm2ae67weI5roWsx-KbokunvjgAf-tXngA30o2xDQxh0-9y0kJbJRdKtVY63PcPv3yp9YdOrpgo2PO-gpspQsio7uJ-dgz5SY1vX1je3U4.aMm-IxbuxnZSIacaIBGZWc36GYliQP4r-9f9-SBq5tQ&dib_tag=se&keywords=Brahms+requiem&qid=1732299866&sprefix=brahms+requiem%2Caps%2C142&sr=8-5e

In this episode, Dr. Sergio Zanotti discusses the application of behavioral economics to clinical practice, specifically choice framing in ICU goals-of-care Meetings. He is joined by Dr. Joanna Hart, a pulmonary critical care physician and assistant professor of medicine at the Perelman School of Medicine at the University of Pennsylvania in Philadelphia. She is also a core faculty member of the Palliative and Advanced Illness Research Center and is affiliated with the Center for Health Incentives and Behavioral Economics. Additional Resources: Clinician’s Use of Choice Framing in ICU Family Meetings. Joanna L Hart et al. Crit Care Med 2024: https://pubmed.ncbi.nlm.nih.gov/38912880/ Using Default Options and Other Nudges to Improve Critical Care. Scott Halpern. Crit Care Med 2019: https://pmc.ncbi.nlm.nih.gov/articles/PMC5826616/ Books mentioned in this episode: Demon Copperhead. By Barbara Kingsolver: https://bit.ly/4hYCqQv Thinking Fast and Slow. By Daniel Kahneman: https://bit.ly/4i3eknK Nudge. By Richard H. Thaler, et al.: https://bit.ly/3YUqxlG

In this episode, Dr. Sergio Zanotti discusses the management of critically ill patients after cardiac surgery, focusing on the clinical management of two important complications: hemorrhage and cardiac arrest. He is joined by Dr. Christopher Noel, a critical care attending at Cooper University Healthcare. Dr. Noel is also an assistant professor of medicine at Cooper Medical School of Rowan University and associate program director for the Critical Care Medicine Fellowship and the Clerkship Director for Critical Care Medicine Clerkships for Medical Students. Additional resources: American Association for Thoracic Surgery (AATS) TSRA Primer- Critical Care: https://www.aats.org/tsra-primer-post-operative-bleeding https://www.aats.org/tsra-primer-cardiac-arrest-post-cardiotomy The Society of Thoracic Surgeons Expert Consensus for the Resuscitation of Patients Who Arrest After Cardiac Surgery. Ann Thorac Surg 2017: https://pubmed.ncbi.nlm.nih.gov/28122680/ Society of Cardiovascular Anesthesiologists clinical practice improvement advisory for the management of perioperative bleeding and hemostasis in cardiac surgery patients. J of Cardiothoracic and Vascular Anesthesia 2019: https://pubmed.ncbi.nlm.nih.gov/31613811/ Music mentioned in this episode: The Outsiders. By Eric Church: https://bit.ly/4fHvxkp Collective Soul. By Collective Soul: https://bit.ly/3AzLcUd

In this episode, Dr. Sergio Zanotti discuss the management of critically ill patients undergoing hyperglycemic emergencies. He is joined by Dr. George Willis, a practicing emergency medicine physician. Dr. Willis is an Associate Professor and Associate Program Director for Emergency Medicine at the University of Texas Health Science Center in San Antonio, where he also serves as Vice Chair of Faculty Affairs. A recognized clinical educator, he holds a particular interest in endocrine emergencies, vascular emergencies, procedural education, and medical education. Additional resources: Hyperglycemic Crises in Adults with Diabetes: A Consensus Report. GE Umpierez, et al. Diabetes Care 2024: https://diabetesjournals.org/care/article/47/8/1257/156808/Hyperglycemic-Crises-in-Adults-With-Diabetes-A Clinical Effects of Balanced Crystalloids vs Saline in Adults With Diabetic Ketoacidosis. WH Self, et al. JAMA 2020: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7670314/ Evaluation and Management of the Critically Ill Adult with Diabetic Ketoacidosis. B Long, GC Willis, S Lentz, et al. J Emerg Med 2020: https://pubmed.ncbi.nlm.nih.gov/32763063/ The SQuID protocol (subcutaneous insulin in diabetic ketoacidosis) Impacts on ED operational Metrics. Acad Emerg Med 2023: https://pubmed.ncbi.nlm.nih.gov/36775281/ Books mentioned in this episode: Kintsugi: Finding Strength in Imperfection. By Celine Santini: https://bit.ly/3NCdAYB

This episode, Dr. Sergio Zanotti discusses music and critical illness and explores the topic through the lens of his guest – Andrew Schulman. Andrew is the first musician to be accepted as a professional Society of Critical Care Medicine (SCCM) member. He is a member of the SCCM ICU Liberation Committee, where he met and had the opportunity to work with Dr. Zanotti. Andrew and his wife Wendy, are the subjects of Josh Aronson's documentary film Andrew & Wendy (2015), which has aired multiple times on PBS-TV. He is the author of Waking The Spirit: A Musician’s Journey Healing Body, Mind, and Soul. Since its release in the U.S. in August 2016, Waking the Spirit has been chosen as an Oliver Sacks Foundation Best Book of the Year Selection, Finalist for the Books for a Better Life Award, and a People Magazine Pick in Nonfiction. Additional Resources: Andrew Schulman’s Website https://andrewschulmanmusic.com/about Books and Albums mentioned in this episode: Waking The Spirit: A Musicians’s Journey Healing Body, Mind and Soul. By Andrew Schulman: https://us.macmillan.com/books/9781250132222 Musicophilia: A Tale of Music and the Brain. By Oliver Sacks: https://bit.ly/4dCTjwv St. Matthew Passion – Johann Sebastian Bach (Composer), Leonard Bernstein (Conductor): https://amzn.to/4eZmgE5 Lute Sonatas Nos. 30 & 39 & 96: 11 Silvius Leopold Weiss (Composer), Robert Barto (Performer): https://bit.ly/3YfXha2

In this episode of Critical Matters, Dr. Zanotti discusses the use of intravenous albumin in critical care. He is joined by Dr. Jeannie Callum, Director of Transfusion Medicine and Professor of Pathology and Molecular Medicine at Queens University in Ontario, Canada. Dr. Callum’s research focuses on blood utilization, hemostasis in the bleeding patient, and transfusion-related errors. She has received numerous awards and published extensively. Dr. Callum is the lead author of “Use of Intravenous Albumin: A Guidelines from the International Collaboration for Transfusion Medicine Guidelines,” published earlier this year in CHEST. Additional Resources: Use of Intravenous Albumin. A Guideline from the International Collaboration for Transfusion Medicine Guidelines. CHEST 2024: https://journal.chestnet.org/article/S0012-3692(24)00285-X/fulltext International Collaboration for Transfusion Medicine Guidelines Website: https://www.ictmg.org/ Ten myths about albumin. M Joannidis, et al. Intensive Care Med 2022: https://pubmed.ncbi.nlm.nih.gov/35247060/ A comparison of albumin and saline for fluid resuscitation in the intensive care unit. SAFE Study Investigators. N Engl J Med 2004: https://pubmed.ncbi.nlm.nih.gov/15163774/ Albumin Replacement in Patients with Severe Sepsis or Septic Shock. ALBIOS Study Investigators. N Engl J .Med 2014: https://www.nejm.org/doi/full/10.1056/NEJMoa1305727 Books mentioned in this episode: Ending Medical Reversal: Improving Outcomes, Saving Lives. By Vinayak K. Prasad: https://bit.ly/4dAimRa The Time Machine. By H.G. Wells: https://amzn.to/4eK4apG

Much attention has been paid to targeted temperature management (TTM) in post-cardiac arrest patients. The evidence for this practice continues to evolve, and previous episodes of Critical Matters have covered this topic. In this episode, Dr. Zanotti focuses on other aspects of Neurological Support in the ICU for post-cardiac arrest patients. He is joined by Dr. Edilberto Amorin, a neurologist with subspecialty training in critical care and epilepsy. He has expertise in neurological intensive care, telemedicine, and multimodal brain monitoring with EEG. Dr Amorin is an Assistant Professor of Neurology at UCSF Weill Institute for Neurosciences and directs the Epilepsy and Clinical Neurophysiology Service at the Zuckerberg San Francisco General Hospital. Additional resources: Critical Care Management of Patients After Cardiac Arrest: A Scientific Statement From the American Heart Association and Neurocritical Care Society. Circulation 2024: https://pubmed.ncbi.nlm.nih.gov/38040992/ Treating Rhythmic and Periodic EEG Patterns in Comatose Survivors of Cardiac Arrest.TELSTAR Investigators. N Engl J Med 2022: https://www.nejm.org/doi/full/10.1056/NEJMoa2115998 Improving Outcomes After Post-Cardiac Arrest Brain Injury: A Scientific Statement from the International Liaison Committee on Resuscitation. ILCOR 2024: https://www.ilcor.org/news/improving-outcomes-after-post-cardiac-arrest-brain-injury Books mentioned in this episode: As Real as it Gets: The Life of a Hospital at the Center of the AIDS Epidemic. By Carol Pogash: https://bit.ly/4d4xHZC C. Miller Fisher: Stroke in the 2oth Century. By LR Caplan: https://bit.ly/3XFw3Jw