eCritCare Podcast

Swapnil Pawar
  • 4.5 (4)
  • Education
  • Updated Weekly

The landscape of Intensive care is changing. In the era of evidence based medicine, we try to make best possible decision for our patients based on best available evidence. Every fortnight, Dr Swapnil Pawar & Dr Jose Chacko will bring you one hot topic in Critical care. If you want to stay up to date with recent evidence or learn how to critically evaluate the literature in critical care, this podcast is for you.

  1. Oct 15

    #Epi 135 - SODa-BIC Trial: Sodium Bicarbonate for Metabolic Acidosis and Shock, with Prof. Ary Serpa Neto.

    A patient in shock, on noradrenaline, with a pH of 7.22 and a base excess of minus 8. Do you give bicarbonate? Depending on which ICU you work in, the answer ranges from almost never to almost always. In this episode of the eCritCare Podcast, Dr Swapnil Pawar is joined by Professor Ary Serpa Neto of Monash University, lead investigator of the SODa-BIC trial, published in the New England Journal of Medicine in 2026. SODa-BIC randomised 500 critically ill adults with metabolic acidosis receiving vasopressors, across 55 ICUs in seven countries, to sodium bicarbonate or placebo in a double-blind design. In this conversation: Why SODa-BIC was needed after BICAR-ICU, and why it targeted earlier, less severe acidaemia Choosing pH below 7.30, base excess below minus 4 and vasopressor use as entry criteria Why MAKE30 was the primary outcome rather than mortality alone How you blind bicarbonate: 5% dextrose bags, unblinded and blinded investigators at every site Sample size, a blinded re-estimation, and what Ary would do differently with a win ratio The results: faster correction of acidosis but no difference in MAKE30, mortality or persistent renal dysfunction The 4% lower rate of renal replacement therapy, and why a little bicarbonate before a Vascath may be reasonable Cost, sustainability and low and middle income settings Waivers of consent, a five-hour intervention and data minimalism What comes next: MOSAIC, an individual patient data meta-analysis and SODa-BIC sub-studies Read this episode on Substack: https://critcareedu.substack.com/p/soda-bic-trial-sodium-bicarbonate-metabolic-acidosis Paper: Serpa Neto A, McNamara M, White K, et al. Sodium Bicarbonate for Critically Ill Adults with Metabolic Acidosis and Shock. N Engl J Med. 2026. doi:10.1056/NEJMoa2600526

  2. Oct 11

    #Epi 134 - GASTRIC-PICU Trial: Stopping Routine Gastric Residual Volume Checks in Ventilated Children with Prof Lyvonne Tume

    Draw back the stomach contents, measure, and hold the feed if the number looks big. It has been routine in paediatric intensive care for decades. But does gastric residual volume tell us anything useful? In this episode of the eCritCare Podcast, Dr Swapnil Pawar is joined by Professor Lyvonne Tume, Professor of Critical Care Nursing and Chief Investigator of the GASTRIC-PICU trial, published in JAMA in 2026. GASTRIC-PICU randomised 4,700 mechanically ventilated children across 23 UK paediatric ICUs and one in Switzerland to routine gastric residual volume (GRV) measurement, or no routine measurement with feed tolerance assessed on clinical signs. In this conversation: Why GRV is such an unreliable number: syringe size, tube lumen, tip position, patient position and breast milk that clumps Why clinicians asked for proof it was safe to stop, and how that forced a non-inferiority design Choosing survival and ventilator-free days over VAP as the primary outcome, and the role of PICANet Sample size, crossover and why per-protocol power matters in a non-inferiority trial Strict non-adherence rules, the bedside education package, and the process evaluation that was cut The results: non-inferior on clinical outcomes, better early nutrition, and far fewer feeds stopped for a "high" GRV Why better nutrition did not shift ventilator days, and the hidden cost in long-stay complex children Cardiac and ECMO patients, generalisability to Australia, and why low and middle income settings differ A message for adult intensivists: de-implementation, not another trial Three months on: attitude change, guideline change and an aggressive implementation plan What comes next: reducing unnecessary fasting in PICU Read this episode on Substack: https://critcareedu.substack.com/p/gastric-picu-trial-gastric-residual-volume Paper: Tume LN, Mouncey PR, Broomhall JM, et al. Gastric Residual Volume Assessment in Critically Ill Children: The GASTRIC-PICU Randomized Clinical Trial. JAMA. 2026. doi:10.1001/jama.2026.10639 Please send us your feedback @ icuprimaryprepcast@gmail.com

  3. Oct 6

    #Epi 133 - The Green ICU: Cutting the Environmental Footprint of Intensive Care with Dr Nicole Hunfeld

    More than one box of gloves per patient, per day. Glass bottles of IV paracetamol filling the waste room. Intensive care saves lives, but at what cost to the planet? In this episode of the eCritCare Podcast, Dr Swapnil Pawar is joined by Dr Nicole Hunfeld, ICU pharmacist and Chief Sustainability Officer at Erasmus University Medical Centre, Rotterdam, associate professor in sustainable healthcare, chair of the Dutch Green ICU Network and co-chair of the ESICM Environmental Sustainability Committee. Nicole shares how a COVID-era frustration became the Green ICU movement, now spread across all 70 ICUs in the Netherlands and beyond. In this conversation: How overflowing plastic waste during COVID sparked the Green ICU project The material flow hotspot analysis, published in Intensive Care Medicine, that gave the team data and a narrative 108 gloves per patient per day, and the journey of a single nitrile glove from Spain to Malaysia to Rotterdam Low hanging fruit: swapping blueys for towels, the "No risk, no glove" campaign, and IV to oral switches Why the paper recycling idea failed completely, and what it taught the team about going slow The paracetamol challenge: a giant tablet, 40 hospitals signing up in one day, and around 18,000 euros saved in a year on one drug Measuring what matters: carbon, cost and nurse workload Building a national network with a mixed nurse and intensivist committee Keeping momentum: green leaf icons in protocols and "oral first" prompts in the EHR Corporate anthropology and why you should embrace the no Where to start in your own ICU Read this episode on Substack: https://critcareedu.substack.com/p/green-icu-sustainable-intensive-care Please send us your feedback @ icuprimaryprepcast@gmail.com

  4. Sep 27

    #Epi 132 - TRICYCLE Trial: Early Triple Vasopressor Therapy in Septic Shock with Prof Giovanni Landoni & Dr Žiga Kalamar

    Norepinephrine first, titrate up, add vasopressin when the dose gets high, reach for a third agent when things get desperate. That stepwise approach is how most of us treat septic shock. What if all three went in together, early? In this episode of the eCritCare Podcast, Dr Swapnil Pawar is joined by Professor Giovanni Landoni (San Raffaele Hospital, Milan) and Dr Žiga Kalamar (Medical ICU, University Medical Centre Maribor, Slovenia) to discuss the TRICYCLE trial, published in Critical Care in 2026. TRICYCLE randomised 79 patients with septic shock to early simultaneous norepinephrine, vasopressin and angiotensin II at balanced starting doses, or to conventional stepwise vasopressor escalation. In this conversation: Why septic shock involves several broken vasoconstrictor pathways at once, and why one drug titrated to high doses may not be the answer Why a phase II mechanistic trial chose renin, not blood pressure or mortality, as its primary outcome The results: faster falls in renin and lactate, a 3-point SOFA improvement at 72 hours, and numerically lower mortality The striking drop in tachyarrhythmias, and the beta-adrenergic explanation behind it What went hard: strict inclusion criteria and running three infusion pumps to protocol A post hoc hint that high-renin patients may benefit most, and why phenotyping is still a long way off Angiotensin II cost and access, and what that means for resource-limited settings Next steps: a bigger trial powered on AKI or arrhythmias, and the idea of a meta-trial run across many small sites Read this episode on Substack: https://critcareedu.substack.com/p/tricycle-trial-multimodal-vasopressors-septic-shock Paper: Kalamar Ž, Landoni G, Gorenjak M, et al. Early multimodal vasopressor strategy in septic shock: results of the TRICYCLE randomized controlled trial. Crit Care. 2026. doi:10.1186/s13054-026-06323-z

  5. Sep 22

    #Epi 131 - T4P Trial: Platelet Transfusion Thresholds Before ICU Procedures with Prof Peter Watkinson & Prof Simon Stanworth

    A platelet count of 40 and a central line to put in. Transfuse first, or go ahead? Right now the answer depends on which ICU you work in, and nobody actually knows which is right. In this episode of the eCritCare Podcast, Dr Swapnil Pawar is joined by Professor Peter Watkinson (Professor of Intensive Care Medicine, University of Oxford, and Chief Investigator) and Professor Simon Stanworth (Professor of Haematology and Transfusion Medicine, University of Oxford) to discuss the T4P trial, Threshold for Platelets. T4P is a Bayesian adaptive randomised trial across five platelet transfusion thresholds, from below 10 to below 50, in critically ill patients undergoing low bleeding risk invasive procedures. It is recruiting 2,550 patients across the UK, Australia and Canada and has just passed the halfway mark. In this conversation: Why platelet transfusion practice in critical care was borrowed from blood cancer patients, and why the evidence never caught up The UK survey that showed thresholds anywhere from under 10 to under 50 for the same procedure The risks side of the ledger: a biological product, transfusion reactions, unknown effects, and around £290 per unit before lab and administration costs Why five thresholds instead of two: drawing the threshold-response curve so the optimum does not have to be one of the arms Which procedures are specified (central lines, pleural aspiration, paracentesis) and which are at clinician discretion The adherence question, and why even the below-10 arm is being followed The haematology confusion: why a patient's daily platelet threshold does not stop them being in T4P Rotating trainees, cross-specialty equipoise, and asking clinicians to step outside a comfort zone they have practised in for years Operator experience, ultrasound-guided lines, and what PACER did and did not show in critical care What success looks like: the biggest platelet transfusion study in critical care, and a practice-changing curve Read this episode on Substack: https://critcareedu.substack.com/p/t4p-trial-platelet-transfusion-thresholds Trial registration: ISRCTN79371664. Funded by the NIHR Health Technology Assessment Programme (NIHR131822).

  6. Sep 17

    Beyond the P Value Series #Ep 1 - Why RCTs Matter and Why They Mislead Us with Prof Paul Young

    Randomised controlled trials shape almost everything we do in the ICU. So why do so many of them seem to show nothing? And when a trial says "no benefit," what does that actually mean for the patient in front of you? This is the first episode of Beyond the P Value, a new eCritCare sub-series on interpreting RCTs in critical care with Professor Paul Young, intensivist and clinician researcher from New Zealand. Over the coming episodes, Dr Swapnil Pawar and Professor Young go past the abstract and the p-value to unpack how landmark ICU trials should be read, challenged and applied at the bedside. In this conversation: Why the RCT is still the gold standard for causal inference, and the three things to look at first: population, outcome, and plausibility of the treatment effect The two big weaknesses: surrogate outcomes that leave the patient out of the centre, and the gap between average effects and the individual patient Why "negative" trials never really fail, and how a neutral average can hide big benefit for some patients and big harm for others Individualised treatment effects, machine learning on trial datasets, and the coming oxygen target trial built on them Reinforcement learning in the ICU: how the Instagram feed model could one day balance treatments to maximise survival Availability bias at the bedside: why a rising blood pressure after a fluid bolus tells you almost nothing about outcome Heterogeneous populations, disease trajectories, and why you still have to start somewhere The collapsed right upper lobe that fixed itself, and what it says about how clinicians learn Where the practice-changing evidence actually lives: three journals, fewer than 20 papers a year, and the Critical Care Reviews meeting Next episode: how to interpret an RCT, and the anatomy of a trial. Read this episode on Substack: https://critcareedu.substack.com/p/beyond-the-p-value-why-rcts-matter

  7. Sep 17

    #Epi 129 - CLIP-II Trial: Cryopreserved vs Liquid-Stored Platelets with Prof Michael Reade

    Conventional platelets last five to seven days. Cryopreserved platelets last two years. So why aren't we using them everywhere? In this episode of the eCritCare Podcast, Dr Swapnil Pawar sits down with Professor Michael Reade, intensivist, researcher and chief investigator of the CLIP-II trial, published in JAMA in 2026. CLIP-II randomised 388 high-risk cardiac surgical patients across 11 Australian hospitals and compared cryopreserved platelets with standard liquid-stored platelets in the 202 who needed a transfusion. The headline result: cryopreserved platelets did not meet the pre-specified 20% non-inferiority margin for chest drain bleeding in the first 24 hours. But as Professor Reade explains, that is only part of the story. In this conversation: Why cardiac surgery was the right population, and the platelet transfusion risk calculator that came out of it How the team achieved double blinding with blood products (and what may have unblinded clinicians anyway) Why 20% was chosen as the non-inferiority margin What "could not conclude non-inferiority" actually means, and why 13% of not very much is not very much The mortality signal and what it does and does not tell us Would he give frozen platelets to a bleeding patient in a regional hospital? Yes. The unpublished New Zealand and US military trials still to come Behind the scenes: training blood bank staff, minus 80 freezers, and running a trial through COVID Paper: Reade MC, Marks DC, Howe BD, et al. Cryopreserved vs Liquid-Stored Platelets for the Treatment of Surgical Bleeding: The CLIP-II Randomized Noninferiority Clinical Trial. JAMA. 2026;335(7):600-608. doi:10.1001/jama.2025.23355

  8. Sep 3

    #Epi 128 - SuDDICU & The SDD Story with Prof Ian Seppelt

    In this episode, Dr Swapnil Pawar sits down with Professor Ian Seppelt, intensivist at Nepean Hospital, Sydney, and one of the lead investigators of the SuDDICU trial, to unpack the decades-long story of Selective Digestive Decontamination (SDD) in intensive care. Ian traces SDD from its haematology origins in the 1970s, through its adoption in the Netherlands, to the extraordinary behind-the-scenes journey of SuDDICU: failed international grants, the pivot from a parallel-group to a crossover cluster design, manufacturing a pharmaceutical-grade SDD preparation from scratch, and navigating ethics approval for a trial without individual patient consent. They discuss: What SDD actually is, and why "selective" matters Why infectious disease physicians resisted a therapy with one of the largest evidence bases in critical care The SuDDICU results: a non-significant mortality benefit, fewer positive blood cultures, fewer resistant organisms, and no signal of emerging resistance The Bayesian view, with a high posterior probability of survival benefit Where SDD goes next: enriched subgroups (neurological injury, pancreatitis), the PREVENT trial of prophylactic ceftriaxone in acute brain injury, and the unanswered question of high-resistance settings Why we adopt some interventions and ignore others: the psychology of evidence in ICU

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About

The landscape of Intensive care is changing. In the era of evidence based medicine, we try to make best possible decision for our patients based on best available evidence. Every fortnight, Dr Swapnil Pawar & Dr Jose Chacko will bring you one hot topic in Critical care. If you want to stay up to date with recent evidence or learn how to critically evaluate the literature in critical care, this podcast is for you.

Information

  • Creator
    Swapnil Pawar
  • Years Active
    2019 - 2026
  • Episodes
    100
  • Rating
    Clean
  • Copyright
    © @eCritCare Podcast
  • Show Website
    eCritCare Podcast

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