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. 6d ago

    #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

  2. 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).

  3. 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

  4. 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

  5. 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

  6. Aug 20

    #Epi 126 - The GUARDS Trial with Dr Ary Serpa Neto

    In this episode, Dr Swapnil Pawar is joined by Dr Ary Serpa Neto to discuss the GUARDS trial, which is testing whether dexamethasone reduces 60-day mortality in patients with moderate to severe ARDS. We cover the rationale for steroids in ARDS, the choice of drug and dose, the expanded eligibility criteria including non-intubated patients, how the sample size was calculated, and the funding and design realities behind running a trial of this scale.

  7. Aug 13

    #Epi 127 - The LOGICAL Trial: Conservative Oxygen Therapy After Cardiac Arrest

    Dr Swapnil Pawar is joined by Dr Jose Chacko to discuss the LOGICAL trial, published in the New England Journal of Medicine in June 2026. Does limiting oxygen after cardiac arrest protect the brain from reperfusion injury? LOGICAL (the largest randomised trial of oxygen therapy after cardiac arrest to date) randomised 1,840 patients across 53 ICUs in Australia, New Zealand and Ireland to conservative versus liberal oxygen therapy. In this episode: – The pathophysiological rationale: hypoxic-ischaemic encephalopathy, reperfusion injury and free radical damage – Where LOGICAL sits alongside EXACT, ICU-ROX, HOT-ICU and the Danish BOX trial – The Mega-ROX master protocol design, and why the sepsis and non-HIE brain injury arms are still to come – Trial design: SpO₂ upper limit of 95% and FiO₂ down to 0.21 in the conservative arm versus no upper limit and a floor of FiO₂ 0.3 in the liberal arm – The results: no difference in favourable neurological outcome at 180 days (38.2% vs 39.7%), survival, length of stay, quality of life or cognitive function – Strengths, limitations, and what it means at the bedside, including why the hosts have landed in different places on titrating down to room air Reference: The LOGICAL Investigators and the ANZICS Clinical Trials Group. Conservative Oxygen for Unresponsive Patients after Cardiac Arrest. N Engl J Med. 2026 Jun 10. Full summary, outcome tables and references at critcareedu.com.au

  8. Jul 16

    #Epi 125 - The SOHO Trial: High-Flow Nasal Oxygen in Acute Hypoxaemic Respiratory Failure

    In this episode, we discuss the SOHO trial, a large multicentre randomised controlled trial comparing high-flow nasal oxygen with conventional oxygen therapy in patients with acute hypoxaemic respiratory failure. We cover the trial methodology, the key findings on 28-day mortality and intubation rates, and what the results mean for practice in both ICU and ward settings.

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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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