PRISM Rounds: Pulmonary Critical Care & Sleep Podcast

@bronchoscope
  • 5,0 (1)
  • Medizin
  • Zweiwöchentlich

PRISM Rounds is a clinical review series by the PRISM research team. Every other week, we break down a high-impact Pulmonary, Critical Care, or Sleep article into three segments: The Blueprint: Study design and methodology. The Math: Demystifying the statistics. The "So What?": Real-world bedside implications. We bridge the gap between the journal and the clinic/ICU, helping you interpret trials quickly and skip the noise. Learn more about our research and clinical trials at: https://www.prismtrials.com/ For questions and suggestions contact: bronchoscope@gmail.com

  1. vor 4 Tagen

    S01E49: VICTORY Trial, High-Dose Vitamin C in Severe Burns

    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 Rounds Tags

    S01E49: VICTORY Trial, High-Dose Vitamin C in Severe Burns

  2. 10. Juli

    S01E48 | Bicarbonate During In-Hospital Cardiac Arrest : The BIHCA Trial

    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.2026.10508 Tags critical 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,

    S01E48 | Bicarbonate During In-Hospital Cardiac Arrest : The BIHCA Trial

  3. 3. Juli

    S01E47 | SODa-BIC: Sodium Bicarbonate for Metabolic Acidosis and Shock

    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/NEJMoa2600526 This episode is for educational purposes only and is not medical advice. Tags Critical 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

    S01E47 | SODa-BIC: Sodium Bicarbonate for Metabolic Acidosis and Shock

  4. 26. Juni

    S01E46 | ARISE FLUIDS: Early Vasopressors or More Fluids in Septic Shock?

    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/NEJMoa2516225 Tags: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

    S01E46 | ARISE FLUIDS: Early Vasopressors or More Fluids in Septic Shock?

  5. 21. Juni

    S01E45: PROMINE Trial: Ketamine vs Propofol for ICU Intubation

    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/s00134-026-08351-3 Educational 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

    S01E45: PROMINE Trial: Ketamine vs Propofol for ICU Intubation

  6. 12. Juni

    S01E44: Remote Rehab After the ICU — The iRehab Trial

    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.2026.5761 Educational 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

    S01E44: Remote Rehab After the ICU — The iRehab Trial

  7. 4. Juni

    S01E43 | EDTA for CVADs: Can a Line Lock Reduce ICU Catheter Complications?

    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.2026.6025 TagsCritical 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

    S01E43 | EDTA for CVADs: Can a Line Lock Reduce ICU Catheter Complications?

  8. 3. Juni ·  Bonus

    S01 Bonus Episode01: Prevent and Reverse Heart Disease — A Patient-Friendly Book Review

    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. Tags Cardiovascular 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

    S01 Bonus Episode01: Prevent and Reverse Heart Disease — A Patient-Friendly Book Review
Alle anzeigen (50)

Info

PRISM Rounds is a clinical review series by the PRISM research team. Every other week, we break down a high-impact Pulmonary, Critical Care, or Sleep article into three segments: The Blueprint: Study design and methodology. The Math: Demystifying the statistics. The "So What?": Real-world bedside implications. We bridge the gap between the journal and the clinic/ICU, helping you interpret trials quickly and skip the noise. Learn more about our research and clinical trials at: https://www.prismtrials.com/ For questions and suggestions contact: bronchoscope@gmail.com

Informationen

Das gefällt dir vielleicht auch