PRISM Rounds: Pulmonary Critical Care & Sleep Podcast

@bronchoscope
  • 5.0 (2)
  • Medicine
  • Updated Biweekly

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. 2d ago

    S1E53 | SynAIRgy: The First Pill for Sleep Apnea? A Phase 3 Trial of AD109

    Could a bedtime pill become a meaningful treatment for obstructive sleep apnea?In PRISM Rounds Season 1, Episode 53, we examine “Aroxybutynin and atomoxetine (AD109) for obstructive sleep apnea: a randomized phase 3 trial (SynAIRgy).”This randomized, double-blind, placebo-controlled trial evaluated AD109, an investigational combination of aroxybutynin and atomoxetine, in adults with obstructive sleep apnea who could not or would not use positive airway pressure therapy.AD109 improved the apnea-hypopnea index and measures of oxygenation over 26 weeks. However, the average placebo-adjusted reduction was four respiratory events per hour, fatigue did not significantly improve compared with placebo, and approximately one in five participants discontinued treatment because of adverse effects.We discuss:• How AD109 is intended to improve upper-airway muscle function• The trial design and primary findings• Relative versus absolute reductions in the apnea-hypopnea index• Intention-to-treat versus on-treatment results• Hypoxic burden and changes in sleep architecture• Insomnia, dry mouth, tachycardia, and treatment discontinuation• Which patients might benefit if AD109 is approved• Why CPAP remains the most effective and best-established treatment for most patientsDoes SynAIRgy represent the beginning of oral precision therapy for sleep apnea, and can better phenotyping identify patients whose benefits outweigh the adverse effects?Primary article: https://doi.org/10.1093/ajrccm/aamag215Accompanying editorial: https://doi.org/10.1093/ajrccm/aamag243PRISM Rounds is intended for education and discussion and does not provide medical advice.Tags: PRISM Rounds, SynAIRgy, AD109, aroxybutynin, atomoxetine, obstructive sleep apnea, OSA, sleep apnea treatment, sleep medicine, CPAP, positive airway pressure, apnea-hypopnea index, AHI, hypoxic burden, randomized clinical trial, phase 3 trial, AJRCCM, pulmonary medicine, clinical research, medical education, FOAMed#PRISMRounds #SynAIRgy #AD109 #SleepApnea #OSA #SleepMedicine #CPAP #ClinicalTrials #PulmonaryMedicine #MedicalEducation #FOAMed

    S1E53 | SynAIRgy: The First Pill for Sleep Apnea? A Phase 3 Trial of AD109

  2. Aug 6

    S01E52: The LOGICAL Trial | Conservative Oxygen After Cardiac Arrest

    Should oxygen be aggressively limited after cardiac arrest to reduce reperfusion injury?The LOGICAL trial randomized 1,840 unresponsive, mechanically ventilated adults after cardiac arrest to conservative or liberal oxygen therapy. Favorable functional outcomes at 180 days occurred in 38.2% versus 39.7%, with no significant difference between strategies.In this episode, we examine the trial design, oxygen targets, treatment separation, protocol deviations, key results, limitations, and practical implications for post-cardiac arrest care.Read the article in the New England Journal of Medicine:https://doi.org/10.1056/NEJMoa2513814Educational use only. This is not medical advice.Tags:LOGICAL trial, cardiac arrest, post cardiac arrest care, oxygen therapy, conservative oxygen, hyperoxemia, hypoxemia, reperfusion injury, critical care, intensive care, ICU, mechanical ventilation, resuscitation, neurocritical care, NEJM, Mega-ROX, evidence based medicine, journal club, pulmonary critical care, PRISM Rounds

    S01E52: The LOGICAL Trial | Conservative Oxygen After Cardiac Arrest

  3. Jul 30

    S01E51: The NEXIS Trial, Cycling, Amino Acids, and ICU Recovery

    Can early in-bed cycling plus intravenous amino acids improve recovery after critical illness? The NEXIS trial randomized 115 adults with acute respiratory failure to protocolized cycling plus higher amino acid delivery or usual care. The intervention substantially increased rehabilitation time and protein intake, but did not improve six-minute walk distance at hospital discharge, strength, duration of ventilation, length of stay, mortality, or six-month recovery. This episode examines the trial design, intervention delivery, safety findings, limitations, and bedside implications. The discussion also addresses why a biologically plausible intervention may fail to produce better patient-centered outcomes, and why the results should not be interpreted as an argument against individualized ICU rehabilitation. Tags PRISM Rounds, NEXIS trial, critical care, intensive care, ICU rehabilitation, ICU acquired weakness, early mobility, in-bed cycling, cycle ergometry, amino acids, protein supplementation, acute respiratory failure, mechanical ventilation, six-minute walk distance, physical function, critical illness recovery, post-intensive care syndrome, nutrition in critical illness, AJRCCM, randomized clinical trial, pulmonary critical care, evidence-based medicine, journal club, medical education

    S01E51: The NEXIS Trial, Cycling, Amino Acids, and ICU Recovery

  4. Jul 23

    S01E50: The MARCH Trial, When ICU Mucoactives Cause Harm Without Benefit

    Should mechanically ventilated patients with difficult-to-clear secretions routinely receive carbocisteine or nebulized hypertonic saline? In this episode of PRISM Rounds, we examine the MARCH randomized trial, which enrolled 1,956 patients across 71 UK intensive care units. Neither intervention shortened mechanical ventilation or improved major clinical outcomes. However, carbocisteine increased clinically important gastrointestinal bleeding, while hypertonic saline increased bronchoconstriction and hypoxemia during nebulization. We discuss the trial’s factorial design, the absence of a number needed to treat, and the approximate numbers needed to harm: 88 for gastrointestinal bleeding with carbocisteine, 51 for bronchoconstriction with hypertonic saline, and 26 for hypoxemia during nebulization. We then translate these findings into practical de-implementation strategies for airway care in the ICU. Article:https://www.nejm.org/doi/10.1056/NEJMoa2603406 Educational use only. This podcast is not medical advice. TagsMARCH trial, carbocisteine, hypertonic saline, mucoactive agents, mechanical ventilation, acute respiratory failure, airway secretions, mucus clearance, hypoxemia, bronchoconstriction, gastrointestinal bleeding, critical care, intensive care, ICU, respiratory therapy, pulmonary medicine, evidence-based medicine, randomized clinical trial, de-implementation, NEJM, PRISM Rounds

    S01E50: The MARCH Trial, When ICU Mucoactives Cause Harm Without Benefit

  5. Jul 17

    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

  6. Jul 10

    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

  7. Jul 3

    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

  8. Jun 26

    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?
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About

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

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