SCCMPod-561: Microcirculation and Shock in Critical Care

In this episode of the Society of Critical Care Medicine (SCCM) Podcast, host Marilyn N. Bulloch, PharmD, BCPS, FCCM, speaks with Olfa Hamzaoui, MD, PhD, professor of intensive care at Robert Debré Hospital in Reims, France, about her Peter Safar Honorary Lecture at the 2025 Critical Care Congress. The conversation centers on tissue perfusion, microcirculation, and shock, with a focus on bridging the gap between bench research and bedside practice. Dr. Hamzaoui shares insights on current scientific understanding of microcirculation and shock, including research on tools to monitor microcirculation, such as handheld video microscopy. The discussion highlights the utility of capillary refill time as a simple, noninvasive tool for guiding resuscitation. Dr. Hamzaoui advocates for early and repeated echocardiographic assessment in shock management, including during de-resuscitation. She also discusses her 2023 article in Clinical Medicine, which proposed titrating norepinephrine to individualized targets. This episode offers a compelling look at how emerging tools and research can refine shock management and promote precision care in critical illness. This podcast is sponsored by Fresenius Kabi. Resources referenced in this episode:  Effects of a Resuscitation Strategy Targeting Peripheral Perfusion Status versus Serum Lactate Levels Among Patients with Septic Shock. A Bayesian Reanalysis of the ANDROMEDA-SHOCK Trial (Zampieri FG, et al. Am J Respir Crit Care Med. 2020;201:423-429) The Eight Unanswered and Answered Questions about the Use of Vasopressors in Septic Shock (Hamzaoui O, et al. J Clin Med. 2023;12:4589) Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock 2021 (Evans L, et al. Crit Care Med. 2021;49:e1063-e1143)

In this episode of the Society of Critical Care Medicine (SCCM) Podcast, host Kyle B. Enfield, MD, FCCM, speaks with Sumeet Rai, PhD, FCICM, senior intensivist at Canberra Hospital, about his study, “Pawsitive Care: Canine-Assisted Intervention for Anxiety in ICU Patients and Family Members: A Single-Center, Single-Arm Study,” published in the May 2025 compendium of Critical Care Explorations. Dr. Rai explains how positive anecdotal experiences of animal therapy in the ICU inspired his team to conduct this study. Guided by infection control protocols, they implemented a program allowing accredited therapy dogs to visit patients and families for 15- to 20-minute sessions. More than 60% of patients and more than 90% of family members had a clinically meaningful reduction in anxiety scores, and patients reported decreased pain. No adverse events were observed, demonstrating the feasibility and safety of this approach. Dr. Rai addresses the study’s limitations, such as the impracticality of conducting a randomized trial, and highlights the need for research into staff well-being, which appeared to benefit from therapy dog visits. He also underscores the importance of a safety program, including infection control precautions. This episode offers practical insights for implementing animal therapy programs in the ICU and invites listeners to consider new approaches to improving mental health and well-being for patients, families, and staff. Resources referenced in this episode:  Pawsitive Care: Canine-Assisted Intervention for Anxiety in ICU Patients and Family Members: A Single-Center, Single-Arm Study (Cook K, et al. Crit Care Explor. 2025;7:e1258).

In this episode of the Society of Critical Care Medicine (SCCM) Podcast, host Elizabeth H. Mack, MD, MS, FCCM, speaks with Rebecca Mitting, MD, MRCPCH, consultant pediatric intensivist and clinical lead for the PICU at Imperial College Healthcare NHS Trust in London. They discuss Dr. Mitting’s article, “Sedation and Ventilator Weaning Bundle and Time to Extubation in Infants With Bronchiolitis: Secondary Analysis of the Sedation AND Weaning in Children (SANDWICH) Trial,” published in the April 2025 issue of Pediatric Critical Care Medicine. The SANDWICH trial, conducted in the United Kingdom, evaluated a nurse-led intervention of sedation scoring, goal-based sedation weaning, and protocolized extubation readiness testing. While the original trial demonstrated only a modest reduction in ventilation duration, Dr. Mitting’s subgroup analysis of infants with bronchiolitis found a reduction of median time to successful extubation by approximately 16 to 17 hours. Dr. Mitting highlights the importance of these findings during the winter season when bronchiolitis drives up PICU occupancy and strain. The critical trade-off between minimizing ventilator days and avoiding extubation failure is discussed, as well as implementation challenges after the COVID-19 pandemic, the importance of protocolized care under resource strain, and future directions for predictive models and personalized strategies to optimize extubation timing. Listeners will gain practical insights into evidence-based approaches for improving outcomes in infants with bronchiolitis and the broader implications for PICU workflow and patient safety. Resources referenced in this episode: Sedation and Ventilator Weaning Bundle and Time to Extubation in Infants With Bronchiolitis: Secondary Analysis of the Sedation AND Weaning in Children (SANDWICH) Trial (Mitting RB, et al. Pediatr Crit Care Med. 2025;26:e423-e431). Effect of a Sedation and Ventilator Liberation Protocol vs Usual Care on Duration of Invasive Mechanical Ventilation in Pediatric Intensive Care Units: A Randomized Clinical Trial (Blackwood B, et al. JAMA. 2021;326:401-410).

In this episode of the Society of Critical Care Medicine (SCCM) Podcast, host Diane C. McLaughlin, DNP, AGACNP-BC, CCRN, FCCM, speaks with Muhammad Mansoor Mohiuddin, MD, MBBS, DSc (Hon), FAST, director of the Cardiac Xenotransplantation Program at the University of Maryland School of Medicine, about his Thought Leader presentation at the 2025 Critical Care Congress, The Remarkable Potential of Xenotransplantation, and his groundbreaking work on that subject. Dr. Mohiuddin discusses the need to address the global shortage of donated organs and the use of genetically modified pig organs as a viable solution. He explains the science behind xenotransplantation, including the use of CRISPR-Cas9 gene editing technology to delete immunogenic pig genes and insert human-compatible genes. The conversation explores the unique immunologic challenges of xenotransplantation, particularly antibody-mediated rejection and the need for tailored immunosuppression protocols. Ethical considerations include religious perspectives and public opinion. Dr. Mohiuddin emphasizes the importance of continued research funding and collaboration with industry partners to advance clinical trials and refine genetic modifications. Listeners will gain insight into how decades of research are transforming xenotransplantation and its potential to extend life and reshape the future of organ transplantation.

In this episode of the Society of Critical Care Medicine (SCCM) Podcast, host Marilyn Bulloch, PharmD, BCPS, FCCM, speaks with Terry Fulmer, PhD, RN, FAAN, President of the John A. Hartford Foundation, about her Norma J. Shoemaker Honorary Lecture at the 2025 Critical Care Congress and the transformative impact of the 4Ms framework—What Matters, Medication, Mentation, and Mobility—on age-friendly critical care. Dr. Fulmer shares her journey from bedside critical care nurse to national leader in geriatric health, emphasizing the need to adapt healthcare systems to meet the needs of an aging population. She discusses the development of the Age-Friendly Health Systems initiative, a collaboration among the John A. Hartford Foundation, Institute for Healthcare Improvement, American Hospital Association, and Catholic Health Association. Now implemented in nearly 5000 facilities, the initiative is supported by evidence from models such as the Acute Care of the Elderly (ACE) units, Hospital Outcomes Program for Elders (HOPE) initiative, and Nurses Improving Care for Healthsystem Elders (NICHE) program. The episode highlights the January 2025 adoption of a Centers for Medicare and Medicaid Services measure that incorporates the 4Ms into inpatient care standards. Dr. Fulmer explains how hospitals of all sizes can implement age-friendly practices using existing resources and how multiprofessional collaboration is key to success. She also discusses findings from a national survey from Age Wave and the John A. Hartford Foundation, which revealed that only 19% of older adults feel their clinicians consistently address all 4Ms. Listeners will gain insight into how the 4Ms framework improves outcomes and promotes functional recovery in older adults. Whether you're a clinician, educator, or healthcare leader, this episode offers practical strategies and a compelling call to action to join the age-friendly health systems movement.

In this episode of the Society of Critical Care Medicine (SCCM) Podcast, host Samantha Gambles Farr, MSN, AG-ACNP, FNP-C, RNFA, speaks with Brian Boling, DNP, AGACNP-BC, FCCM, an advanced practice provider (APP) in the Department of Anesthesiology, Division of Critical Care Medicine, at the University of Kentucky and host of the Critical Care Scenarios podcast. They explore the challenges and opportunities facing novice nurses and APPs as they transition into new roles in critical care. Drawing from his own nontraditional path into nursing and advanced practice, Dr. Boling shares how self-directed learning—through podcasts, blogs, and social media—can supplement formal education and foster professional growth. He emphasizes the importance of building a personalized curriculum that balances foundational knowledge with emerging trends and encourages learners to focus not only on hot topics but also on the essential, everyday skills that drive patient outcomes. The conversation highlights strategies for identifying credible educational resources and maintaining work-life balance while pursuing lifelong learning. Listeners will gain insights into how experienced clinicians can support novice colleagues through informal mentorship and bedside teaching and how honesty about knowledge gaps can lead to deeper learning. Whether you're a new graduate, a transitioning clinician, or a seasoned clinician looking to mentor others, this episode offers practical guidance for education, growth, and leadership in critical care.

Mentorship can be transformative, especially for immigrant critical care professionals navigating unique career challenges. In this episode of the Society of Critical Care Medicine (SCCM) Podcast, host Ludwig Lin, MD, speaks with Fajun Wang, MD, a neurocritical care specialist and assistant professor at St. Louis University School of Medicine, about his experience in SCCM’s Immigrant Critical Care Professional (ICCP) mentorship program. Dr. Wang shares his journey from medical school in China to building a neurocritical care service line in the United States, highlighting how mentorship shaped his path at every stage. He reflects on the challenges of entering a healthcare system in a new country and emphasizes the benefits of connecting mentors and mentees who share similar backgrounds and experiences. Dr. Wang’s ICCP mentor provided guidance during the launch of his ICU leadership role, offering insights into service line development and support during challenging situations. The ICCP program, developed from a proposal by José L. Díaz-Gómez, MD, MAS, FASE, FCCM, launched its first six-month pilot in January 2024. The program focuses on five key domains: psychological and emotional support, self-efficacy, career development, scholarly support, and role modeling. A second pilot, currently under way, extends the mentorship to a full year. This episode will inspire listeners to seek mentorship and community to advance their careers and grow their confidence. Mentorship is not just about guidance—it’s about building relationships that empower individuals to lead, innovate, and give back.

In this episode of the Society of Critical Care Medicine (SCCM) Podcast, host Diane McLaughlin, DNP, AGACNP-BC, CCRN, FCCM, is joined by John Appino, MBA, founder and CEO of Contract Diagnostics, and Ryan Hakimi, DO, MS, NVS, RPNI, CPB, FNCS, FCCM, neurointensivist at Prisma Health in Greenville, South Carolina, for a conversation on salary and contract negotiations for advanced practice providers (APPs). The guests explore the nuances of evaluating job offers and negotiating compensation, as well as prioritizing onboarding, mentorship, and job fit. Dr. Hakimi shares insights from his leadership roles in academic neuro-ICUs and his longstanding advocacy for APPs, while Mr. Appino offers a strategic perspective on contract structures, compensation models, and negotiation tactics. The discussion highlights the variability in contract practices across academic and private institutions, the importance of defining full-time employment expectations, and the role of offer letters versus formal contracts. Listeners will learn how to approach salary discussions with confidence, including when to negotiate, which data to reference (e.g., Medical Group Management Association and American Medical Group Association benchmarks), and how to assess a job offer beyond salary. This episode is valuable for APPs at any career stage seeking fair compensation and sustainable career growth. It emphasizes that successful negotiations are not just about salary—they are also about clarity, support, and long-term professional satisfaction.

In this episode of the Society of Critical Care Medicine (SCCM) Podcast, host Maureen Madden, DNP, RN, CPNP-AC, CCRN, FCCM, speaks with Jeremy Loberger, MD, assistant professor of pediatrics and medical director of the pediatric intensive care unit at the University of Alabama at Birmingham. Dr. Loberger shares insights from his work as lead author of “Implementing the Pediatric Ventilator Liberation Guidelines Using the Most Current Evidence,” and co-principal investigator of the multicenter collaborative Ventilation Liberation for Kids (VentLib4Kids), aimed at standardizing and improving extubation practices. Their conversation explores the evolving challenges of pediatric ventilator liberation, such as balancing extubation readiness with risks related to prolonged invasive mechanical ventilation and noninvasive respiratory support. Topics include the role of spontaneous breathing trials, pressure support strategies, sedation practices, and the impact of noninvasive modalities such as high-flow nasal cannula and bilevel positive airway pressure. They address the importance of individualized care, especially for high-risk patients such as children with neuromuscular disorders. Dr. Loberger explains the quality improvement efforts under way that focus on implementing current clinical practice guidelines, standardizing practice, and aligning goals. Listeners will gain a deep understanding of the nuanced decision-making involved in ventilator liberation and collaborative efforts to improve outcomes for critically ill children. Resources referenced in this episode: Implementing the Pediatric Ventilator Liberation Guidelines Using the Most Current Evidence (Loberger JM, et al. Respir Care. 2024;69:869-880) Executive Summary: International Clinical Practice Guidelines for Pediatric Ventilator Liberation, A Pediatric Acute Lung Injury and Sepsis Investigators (PALISI) Network Document (Abu-Sultaneh S, et al. Am J Respir Crit Care Med. 2023;207:17-28)

In this episode of the Society of Critical Care Medicine (SCCM) Podcast, host Diane C. McLaughlin, DNP, AGACNP-BC, CCRN, FCCM, welcomes guests Kaitlin M. Alexander, PharmD, BCCCP, and Ankit Sakhuja, MD, MS, FCCM, from SCCM’s Leadership, Empowerment, and Development (LEAD) Program, to discuss the use of AI in critical care education and clinical practice. Dr. Alexander is a clinical associate professor in the Department of Pharmacy Education and Practice at University of Florida. Dr. Sakhuja is the director of artificial intelligence and informatics at the Institute for Critical Care Medicine and director of clinical informatics research in the Division of Data-Driven and Digital Medicine. The discussion highlights how critical care educators and clinicians benefit from learning how to use AI and understanding its benefits and limitations. Incorporating AI into critical care education teaches students how to use AI responsibly in school and later in clinical practice. Clinicians should understand the utility of different AI models for patient care and be well versed in the ethical and legal treatment of patient data. Drs. Alexander and Sakhuja provide examples of practical uses for AI in critical care. AI can help students test their knowledge with interactive case simulations paired with discussion with instructors and peers. AI can analyze vast amounts of patient data, supporting clinical decision-making. The guests encourage clinicians and educators in critical care to engage with AI and contribute to its responsible use. Listeners will gain valuable insights into the uses of AI.