PRISM Rounds: Pulmonary, Critical Care & Sleep Medicine

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PRISM Rounds is a Pulmonary, Critical Care & Sleep Medicine podcast that reviews one new article each week. We break down the study design, statistics, results, and bedside implications—so you can interpret the trial quickly and stay current with the latest research.

  1. 1D AGO

    S01E13 Hypopnea Scoring and OSA in Women

    In this episode of PRISM Rounds, we review a 2025 open-access scoping review and commentary in Sleep Science and Practice examining how hypopnea scoring criteria—4% desaturation-only versus 3% desaturation or EEG arousal—can change the apnea–hypopnea index (AHI) and materially shift obstructive sleep apnea (OSA) diagnosis in women. We walk through what the review found across eight studies, why women are disproportionately affected (phenotype, smaller desaturations, arousal-associated events, and symptom patterns), and what this means for real-world testing pathways (PSG vs HSAT) and access to therapy. Educational use only—this is not medical advice.TagsSleep medicine, Obstructive sleep apnea, OSA, Women’s health, Hypopnea, AHI, Polysomnography, PSG, Home sleep apnea testing, HSAT, AASM scoring, Health equity, Diagnosis, CPAP, Respiratory physiologySource (paper landing page): https://link.springer.com/article/10.1186/s41606-025-00150-x

    33 min

  2. 1D AGO

    S01E12 HYPERION: Sotatercept in Early PAH

    In this episode of PRISM Rounds, we review “Sotatercept for Pulmonary Arterial Hypertension within the First Year after Diagnosis,” published in the New England Journal of Medicine (published online September 30, 2025; issue October 23, 2025). We break down the phase 3 HYPERION trial in newly diagnosed PAH on background double/triple therapy, focusing on the primary composite endpoint of clinical worsening, the interpretation challenges created by early trial termination, and the safety signals clinicians should anticipate (notably epistaxis and telangiectasia). Educational use only — not medical advice.Article (PubMed): https://pubmed.ncbi.nlm.nih.gov/41025556/NEJM landing page: https://www.nejm.org/doi/full/10.1056/NEJMoa2508170Trial registration: https://clinicaltrials.gov/study/NCT04811092TagsPulmonary Arterial Hypertension, PAH, Pulmonary Hypertension, Critical Care, Pulmonary Medicine, Cardiology, Journal Club, NEJM, Clinical Trials, Randomized Trial, HYPERION, Sotatercept, Right Heart Failure, 6-Minute Walk, NT-proBNP, Risk Stratification, REVEAL Lite 2, COMPERA 2.0, Pharmacotherapy, Evidence-Based Medicine

    27 min

  3. 4D AGO

    S01E11 ANDROMEDA-SHOCK 2 and the Return of Capillary Refill

    In this episode of PRISM Rounds, we journal-club ANDROMEDA-SHOCK 2, a multinational randomized clinical trial testing whether a personalized hemodynamic resuscitation protocol targeting capillary refill time (CRT-PHR) improves outcomes in early septic shock compared with usual care. The primary outcome was a 28-day hierarchical composite of mortality, duration of vital support, and hospital length of stay, analyzed using a win ratio approach. We walk through the protocol logic, feasibility at the bedside, and what drove the primary result (including whether effects clustered in mortality vs vital-support duration), then close with practical takeaways for ICU/ED teams. Educational use only — not medical advice. Source (JAMA/DOI): https://doi.org/10.1001/jama.2025.20402. Trial registration: https://clinicaltrials.gov/study/NCT05057611.Tags: Septic shock; Sepsis; Critical care; ICU; Emergency medicine; Hemodynamic resuscitation; Capillary refill time; CRT; Vasopressors; Norepinephrine; Lactate; Fluid resuscitation; Bedside ultrasound; Echocardiography; Clinical trial; Randomized trial; JAMA; Journal club; Evidence-based medicine; PRISM Rounds

    33 min

  4. 4D AGO

    S01E10 Mask vs NIV: The 3-Minute Preoxygenation Playbook to Avoid the Crash

    In this episode of PRISM Rounds (S1E10), we break down a JoVE video-protocol on preoxygenation for tracheal intubation in critically ill adults. We compare oxygen-mask strategies (non-rebreather and bag-valve-mask with a PEEP valve) with noninvasive ventilation (NIV/BPAP or ventilator NIV modes).We keep it practical and bedside-focused:Why it works: physiology, denitrogenation, and “safe apnea time”How to do it: step-by-step setup, key settings, leak control, and troubleshootingHow to choose: a simple approach for picking mask/BVM vs NIV when the patient is already hypoxemic or deterioratingEducational use only — not medical advice. PRISM Rounds reviews one paper per week to support critical appraisal and real-world translation for ICU/ED clinicians, trainees, nurses, respiratory therapists, and pharmacists. Disclosure: one of the authors is from the PRISM research group.Primary article (PubMed): https://pubmed.ncbi.nlm.nih.gov/41428629/DOI: https://doi.org/10.3791/68479JoVE video page: https://www.jove.com/video/68479PRISM Rounds; Critical Care; ICU; Emergency Medicine; Airway Management; Tracheal Intubation; Rapid Sequence Intubation; Preoxygenation; Noninvasive Ventilation; BiPAP; Bag-Valve-Mask; PEEP; Hypoxemia; Respiratory Therapy; Peri-Intubation Complications; Journal Club

    34 min

  5. 4D AGO

    S01E09 Adjunctive Glucocorticoids in CAP: The SONIA Pragmatic RCT

    Welcome to PRISM Rounds, where we break down one study at a time.This week we review the SONIA trial (a pragmatic randomized clinical trial across Kenyan public hospitals) evaluating whether adjunctive low-dose glucocorticoids added to usual care reduce 30-day mortality in adults hospitalized with community-acquired pneumonia (CAP)—and we pair it with the accompanying NEJM editorial on why context and implementation matter.We discuss: trial design choices in low-resource settings, interpreting absolute vs relative effects, safety/feasibility (especially glucose monitoring), and what ICU/ward teams (physicians, trainees, nurses, pharmacists, and respiratory therapists) can reasonably take back to practice.Educational purpose only. This episode is for education and discussion and is not medical advice.Links:NEJM Trial (SONIA): https://www.nejm.org/doi/abs/10.1056/NEJMoa2507100NEJM Editorial: https://www.nejm.org/doi/abs/10.1056/NEJMe2514533PubMed (Editorial): https://pubmed.ncbi.nlm.nih.gov/41159881/TagsPRISM Rounds, Pulmonary, Critical Care, Hospital Medicine, Infectious Diseases, Community-Acquired Pneumonia, CAP, Sepsis, Global Health, Low-Resource Settings, Pragmatic Trial, Randomized Trial, NEJM, Glucocorticoids, Steroids, Mortality, Evidence-Based Medicine, Journal Club, Clinical Epidemiology, Medical Education

    32 min

  6. 5D AGO

    S01E08 Ketamine vs Etomidate for RSI in Critical Illness

    In this episode of PRISM Rounds, we break down the NEJM randomized trial comparing ketamine vs etomidate for induction during emergency tracheal intubation in critically ill adults. We focus on what matters at the bedside: 28-day in-hospital mortality, peri-intubation cardiovascular collapse, and practical workflow implications for ICU/ED physicians, nurses, pharmacists, and respiratory therapists. We also discuss the accompanying editorial (if included in your reading list) and how to translate the trial’s uncertainty into safer airway practice.Read the trial (NEJM): https://www.nejm.org/doi/full/10.1056/NEJMoa2511420PubMed: https://pubmed.ncbi.nlm.nih.gov/41369227/ClinicalTrials.gov: https://clinicaltrials.gov/study/NCT05277896TagsPRISM Rounds, Critical Care, ICU, Emergency Medicine, Airway Management, Rapid Sequence Intubation, Ketamine, Etomidate, NEJM, Randomized Controlled Trial, Hemodynamics, Patient Safety

    32 min

  7. 5D AGO

    S01E07 Automated Ventilation vs Human Experts in ACTiVE

    Confidence: High (study-specific details reflect only the uploaded JAMA RCT + editorial; no added claims.)Spotify Episode DescriptionA ventilator that adjusts support automatically sounds like the future—but does it improve outcomes patients actually feel? In this PRISM Rounds journal club, two hosts break down the ACTiVE randomized clinical trial comparing closed-loop INTELLiVENT-ASV vs protocolized conventional mechanical ventilation across 7 ICUs in the Netherlands and Switzerland. We walk through the study design (including deferred consent and a very strong “best-practice” control arm), the primary endpoint (ventilator-free days at day 28), key secondary outcomes (including mortality), and what the accompanying editorial argues about case mix, generalizability, and whether we’re ready for “autopilot ventilation.”For education only — not medical advice. Always follow your local protocols and clinical judgment.LinksACTiVE Trial (JAMA): https://doi.org/10.1001/jama.2025.24384Editorial (JAMA): https://doi.org/10.1001/jama.2025.24401ClinicalTrials.gov: https://clinicaltrials.gov/study/NCT04593810Tagscritical care, ICU, mechanical ventilation, ventilator management, closed-loop ventilation, INTELLiVENT-ASV, adaptive support ventilation, weaning, spontaneous breathing trial, ventilator-free days, randomized trial, JAMA, journal club, respiratory therapy, sedation, analgosedation, evidence-based medicine, clinical trials, pulmonary critical care, PRISM Rounds

    32 min

  8. 5D AGO

    S01E06 Managing Shock Without Arterial Lines: EVERDAC

    In this PRISM Rounds journal club, we unpack EVERDAC (NEJM)—a multicenter noninferiority randomized trial (n=1,010) asking a deceptively simple ICU question: Do most adults with acute circulatory failure really need an early arterial line, or can we start with cuff-only blood pressure monitoring and “rescue” to an A-line only when safety criteria demand it?We break down the noninferiority design, the prespecified crossover triggers (including the very high vasopressor dose threshold and unit conventions), and what the results mean for real-world ICU workflows—nursing, RT, pharmacy, and trainees included. Bottom line: mortality was similar, while arterial line–site bleeding/hematoma was much lower with a cuff-first strategy—so it’s time to re-think our default threshold for invasive monitoring.Study (NEJM): https://www.nejm.org/doi/10.1056/NEJMoa2502136Editorial (NEJM): https://www.nejm.org/doi/10.1056/NEJMe2512006Norepinephrine-equivalent dosing reference (PubMed): https://pubmed.ncbi.nlm.nih.gov/33220576/Tags: Critical Care; ICU; Shock; Hemodynamics; Arterial Line; Blood Pressure Monitoring; Vasopressors; Norepinephrine; Epinephrine; Noninferiority Trial; Randomized Trial; NEJM; Journal Club; Evidence-Based Medicine; Nursing; Respiratory Therapy; Pharmacy; Fellows; Residents; PRISM Rounds

    33 min
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PRISM Rounds is a Pulmonary, Critical Care & Sleep Medicine podcast that reviews one new article each week. We break down the study design, statistics, results, and bedside implications—so you can interpret the trial quickly and stay current with the latest research.

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