PRISM Rounds: Pulmonary Critical Care & Sleep Podcast

PRISM Rounds
  • 5.0 (3)
  • Medicine
  • Bimonthly

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. 3d ago

    S01E64 | VASSPR Trial: Does Earlier Vasopressin Save Lives in Septic Shock?

    When should we add vasopressin in septic shock? At a norepinephrine dose of 0.1 mcg/kg/min, or should we wait until 0.4? In this episode of PRISM Rounds, we examine the VASSPR trial, published in JAMA in October 2026. This pragmatic, cluster-randomized crossover trial enrolled 3,959 patients across 13 hospitals and compared earlier versus later vasopressin initiation strategies. Earlier initiation increased vasopressin use and reduced the norepinephrine dose at which it was started. However, 28-day mortality was similar between groups (31.8% vs 33.0%), with no significant improvement in kidney replacement therapy-free days. We explore the trial's strengths, imperfect adherence, implications for current sepsis guidelines, and why a fixed norepinephrine threshold may not capture the complexity of septic shock. The central question: Should vasopressor management be guided by a number, or by the patient's evolving physiology? A practical, evidence-based discussion for intensivists, emergency physicians, hospitalists, fellows, nurses, and ICU pharmacists. Primary article: Peltan ID, et al. Effect of Vasopressin Initiation Threshold on Septic Shock Mortality: The VASSPR Cluster Crossover Randomized Strategy Trial. JAMA. October 14, 2026. https://doi.org/10.1001/jama.2026.21333 Tags: Septic Shock, VASSPR Trial, Vasopressin, Norepinephrine, Critical Care, Intensive Care, Sepsis, Vasopressors, Hemodynamics, JAMA, Clinical Trials, Evidence-Based Medicine, PRISM Rounds At PRISM Rounds, we use AI-generated voices to bring you thoughtfully curated medical research in an engaging, conversational format. While we do our best to keep things accurate, occasional errors or mispronunciations may slip through. We hope these episodes spark curiosity and encourage you to explore the original research.

    S01E64 | VASSPR Trial: Does Earlier Vasopressin Save Lives in Septic Shock?

  2. Oct 23

    S01E63 | Oveporexton for Narcolepsy Type 1: A New Approach to Wakefulness and Cataplexy

    Can stimulating the orexin receptor improve both sleepiness and cataplexy in narcolepsy type 1? In this episode of PRISM Rounds, we examine the First Light and Radiant Light phase 3 trials of oveporexton. Across two 12-week trials, oveporexton produced substantial improvements in objective wakefulness, patient-reported sleepiness, and cataplexy compared with placebo. We discuss what those changes could mean for patients, why urinary frequency and insomnia matter, and what remains uncertain about long-term safety and comparisons with existing treatments. Read the trial: https://www.nejm.org/doi/full/10.1056/NEJMoa2601598 Find more episodes at https://www.prismrounds.com and follow PRISM Rounds on Spotify or Apple Podcasts. Tags narcolepsy type 1, oveporexton, orexin, hypocretin, cataplexy, excessive daytime sleepiness, sleep medicine, clinical trials, First Light trial, Radiant Light trial, NEJM, PRISM Rounds

    S01E63 | Oveporexton for Narcolepsy Type 1: A New Approach to Wakefulness and Cataplexy

  3. Oct 16

    S01E62 | High-Flow Oxygen vs NIV: What the New 2026 ATS Guidelines Recommend

    Choosing between high-flow nasal cannula, noninvasive ventilation (NIV), CPAP, and conventional oxygen is one of the most common decisions in critical care. The new 2026 American Thoracic Society (ATS) Clinical Practice Guideline provides updated, evidence-based recommendations across the spectrum of acute respiratory failure. In Season 1, Episode 62 of PRISM Rounds, we examine the guideline published in the American Journal of Respiratory and Critical Care Medicine and explore what its recommendations mean for bedside practice. We discuss four critical clinical questions: Acute hypoxemic respiratory failure: Why is high-flow nasal cannula strongly recommended over conventional oxygen, and when should clinicians consider NIV or CPAP? Acute hypercapnic respiratory failure: Why does NIV remain first-line therapy, and when might high-flow oxygen be a reasonable alternative? Preoxygenation before intubation: How can HFNC and NIV reduce peri-intubation hypoxemia? Postextubation respiratory support: Which patients benefit from preventive NIV or HFNC, and how can we reduce reintubation? We also examine the strength and certainty of the evidence, important limitations of network meta-analyses, and the distinction between reducing intubation and improving survival. The central clinical question: Are we choosing the right respiratory support strategy for the right patient, and recognizing early enough when that strategy is failing? This episode is designed for intensivists, pulmonologists, emergency physicians, respiratory therapists, critical care fellows, and other clinicians managing acute respiratory failure. Primary Reference:Goel NN, Ferreyro BL, et al. Noninvasive respiratory support for adult patients with acute respiratory failure: An official American Thoracic Society Clinical Practice Guideline. American Journal of Respiratory and Critical Care Medicine. 2026;212(9):2135–2158. https://doi.org/10.1093/ajrccm/aamag302 Listen and subscribe to PRISM Rounds on Apple Podcasts, Spotify, Youtube or visit https://www.prismrounds.com. Evidence reviewed. Clinical decisions informed. Tags ritical Care Pulmonary Medicine ATS Guidelines Noninvasive Ventilation NIV High-Flow Nasal Cannula HFNC CPAP Acute Respiratory Failure Hypoxemic Respiratory Failure Hypercapnic Respiratory Failure COPD Exacerbation Mechanical Ventilation Preoxygenation Extubation Intensive Care Medicine Evidence-Based Medicine Clinical Practice Guidelines Respiratory Therapy PRISM Rounds

    S01E62 | High-Flow Oxygen vs NIV: What the New 2026 ATS Guidelines Recommend

  4. Oct 11

    S01E61 | Plasma Exchange in Acute-on-Chronic Liver Failure: Buying Time or Saving Lives?

    Can therapeutic plasma exchange save lives in acute-on-chronic liver failure, or does it simply delay the inevitable? In Season 1, Episode 61 of PRISM Rounds, we examine a 2026 randomized controlled trial published in Hepatology evaluating therapeutic plasma exchange in 194 patients with acute-on-chronic liver failure (ACLF). The findings are striking. Plasma exchange reduced 28-day mortality from 63.9% to 44.3%, an absolute difference of nearly 20 percentage points. However, by 90 days, mortality was similar between groups, and more than 40% of patients could not complete the planned treatment. We examine the trial's methodology, treatment complications, and clinical implications alongside the 2023 EASL guidelines and a 2025 meta-analysis of plasma exchange in ACLF. The central question: Does plasma exchange meaningfully alter the course of liver failure, or does it provide a temporary bridge to hepatic recovery or transplantation? Join us as we explore what this trial should, and should not, change in ICU practice. Read the primary study:https://doi.org/10.1097/HEP.0000000000001755 Subscribe to PRISM Rounds on Apple Podcasts, Spotify, or YouTube. Visit https://www.prismrounds.com for more episodes. Tags Critical Care, Intensive Care, Hepatology, Acute-on-Chronic Liver Failure, ACLF, Therapeutic Plasma Exchange, Plasmapheresis, Liver Failure, Liver Transplantation, Randomized Controlled Trial, Evidence-Based Medicine, ICU Research, PRISM Rounds

    S01E61 | Plasma Exchange in Acute-on-Chronic Liver Failure: Buying Time or Saving Lives?

  5. Oct 4

    S01E60: Olanzapine vs Dexmedetomidine for ICU Delirium

    In this episode of PRISM Rounds, we examine a new randomized clinical trial comparing olanzapine with low-dose dexmedetomidine for established delirium in critically ill adults. The primary outcome was neutral: patients in both groups had a median of 3 days alive without delirium or coma. But the study also found more adverse events with dexmedetomidine and a provocative difference in 90-day mortality that demands careful interpretation. We place these findings in the context of MIND-USA, AID-ICU, SPICE III, nocturnal dexmedetomidine studies, and the 2025 PADIS guideline update. The key issue is not simply which drug performed better, but whether ICU clinicians are asking medications to do different jobs: prevent delirium, control agitation, or actually treat established delirium. We discuss what this trial adds, its major limitations, why the mortality signal should remain hypothesis-generating, and what the results should—and should not—change at the bedside. Primary article:https://doi.org/10.1093/ajrccm/aamag235 Listen and subscribe on Apple Podcasts, Spotify, YouTube, or at https://www.prismrounds.com PRISM Rounds, critical care, ICU, delirium, ICU delirium, dexmedetomidine, olanzapine, antipsychotics, sedation, agitation, PADIS, MIND-USA, AID-ICU, SPICE III, mechanical ventilation, intensive care medicine, pulmonary critical care, evidence based medicine, journal club, randomized controlled trial, FOAMcc, FOAMed Tags

    S01E60: Olanzapine vs Dexmedetomidine for ICU Delirium

  6. Sep 26

    S01E59 | ICECAP :Does Longer Cooling Improve Recovery After Cardiac Arrest?

    How long should comatose patients remain at 33°C after out-of-hospital cardiac arrest? In this episode of PRISM Rounds, we examine the icecap randomized clinical trial, which studied 1,158 comatose OHCA survivors who had already been rapidly cooled to 33°C. Patients were assigned to different cooling durations ranging from 6 to 72 hours. Longer cooling did not improve neurological recovery, mortality, or secondary neurological outcomes. We discuss the adaptive trial design, the separate shockable and nonshockable rhythm cohorts, the meaning of the approximately 50% probability that 6 hours was the shortest optimal duration, and why this does not establish a universal six-hour protocol. The episode places icecap in context with TTM, TTM2, and HYPERION while keeping clear that these trials addressed different temperature-management questions. Read the study:https://jamanetwork.com/journals/jama/fullarticle/2852508 Subscribe to PRISM Rounds on Apple Podcasts, Spotify, or YouTube, and visit:https://www.prismrounds.com Tags:icecap, cardiac arrest, out-of-hospital cardiac arrest, OHCA, targeted temperature management, therapeutic hypothermia, post-cardiac arrest care, neuroprotection, neurological recovery, TTM, TTM2, HYPERION, critical care, intensive care, emergency medicine, resuscitation, ICU, fever prevention, modified Rankin Scale, PRISM Rounds

    S01E59 | ICECAP :Does Longer Cooling Improve Recovery After Cardiac Arrest?

  7. Sep 17

    S01E58: SCCM Heat Stroke Guidelines - Cool Fast, Treat Smart

    In Season 1, Episode 58 of PRISM Rounds, we review the 2025 Society of Critical Care Medicine guideline for the treatment of heat stroke and translate its recommendations into practical bedside decisions for emergency and critical care clinicians. We discuss why active cooling should begin immediately, why cold- or ice-water immersion is preferred when feasible, and why the guideline emphasizes both the speed of cooling and the goal of reaching a core temperature below about 39°C within 30 minutes. We also review what to do when immersion is not practical and how the guideline approaches classic versus exertional heat stroke. The episode also covers therapies that should generally be avoided. Routine acetaminophen, NSAIDs, salicylates, and dantrolene are not recommended for temperature reduction, and prophylactic antibiotics or antiseizure medications should be limited to research settings. An important theme is the strength of the recommendations versus the strength of the evidence. Several recommendations are strong despite very low-certainty evidence, reflecting the practical and ethical difficulty of conducting randomized trials that delay effective cooling in patients with true heat stroke. The bedside message is simple: recognize heat stroke early, start the fastest feasible active cooling strategy, continue simultaneous resuscitation and organ support, and avoid medications that do not address the underlying problem. Read the guideline:https://doi.org/10.1097/CCM.0000000000006551 More PRISM Rounds:https://www.prismrounds.com Available on Apple Podcasts, Spotify, YouTube, and other major podcast platforms. Tags:PRISM Rounds, S01E58, critical care, ICU, heat stroke, heatstroke, hyperthermia, SCCM, Society of Critical Care Medicine, emergency medicine, cooling, cold water immersion, ice water immersion, exertional heat stroke, classic heat stroke, temperature management, dantrolene, antipyretics, heat illness, resuscitation, evidence based medicine, clinical guidelines, guideline review, medical education, FOAMed, pulmonary critical care

    S01E58: SCCM Heat Stroke Guidelines - Cool Fast, Treat Smart

  8. Sep 9

    S01E57 | PRAGUE-26: Early Catheter-Directed Thrombolysis for Intermediate-High-Risk Pulmonary Embolism

    Should we wait for a patient with intermediate-high-risk pulmonary embolism to deteriorate before pursuing reperfusion—or intervene before the right ventricle fails? In this episode of PRISM Rounds, we examine PRAGUE-26, a multicenter randomized trial published in the New England Journal of Medicine comparing conventional catheter-directed thrombolysis with low-dose alteplase plus anticoagulation against anticoagulation alone in patients with intermediate-high-risk acute pulmonary embolism. The headline result is striking: the 7-day composite of death, recurrent pulmonary embolism, or cardiorespiratory decompensation or collapse occurred in 0.7% with catheter-directed thrombolysis versus 6.8% with standard care. But the interpretation requires nuance. The benefit was driven primarily by fewer episodes of cardiorespiratory deterioration, not a demonstrated mortality reduction. Overall major bleeding was not clearly increased, yet two intracranial hemorrhages occurred in the thrombolysis group and none with anticoagulation alone. We break down patient selection, the low-dose alteplase strategy, the composite endpoint, rescue reperfusion, early RV recovery, bleeding risk, and the limitations of an open-label trial conducted in experienced tertiary cardiovascular centers. Most importantly, we ask what prague-26 should change at the bedside: Does this trial support routine early catheter-directed thrombolysis, or does it help us identify the selected patient who should undergo reperfusion before overt hemodynamic collapse? The article was published online in the New England Journal of Medicine on August 31, 2026, DOI 10.1056/NEJMoa2608012. PRISM Trials / PRISM Rounds: Visit PRISM Trials Journal article: Read “Catheter-Directed Thrombolysis in Intermediate-High-Risk Pulmonary Embolism” in NEJM Tags: #PRISMRounds #PRISMTrials #CriticalCare #CriticalCareMedicine #ICU #PulmonaryCriticalCare #PulmonaryMedicine #Pulmonology #PulmonaryEmbolism #PE #IntermediateHighRiskPE #SubmassivePE #CatheterDirectedThrombolysis #CDT #Thrombolysis #Alteplase #Anticoagulation #Reperfusion #PERT #PulmonaryEmbolismResponseTeam #RightVentricle #RVFailure #RightHeartStrain #HemodynamicCollapse #CardiorespiratoryDecompensation #Shock #VTE #VenousThromboembolism #EmergencyMedicine #Cardiology #InterventionalCardiology #IntensiveCare #ClinicalTrials #RandomizedTrial #RCT #EvidenceBasedMedicine #MedicalEducation #JournalClub #NEJM #FOAMed #FOAMcc #MedEd #EvidenceBasedCriticalCare

    S01E57 | PRAGUE-26: Early Catheter-Directed Thrombolysis for Intermediate-High-Risk Pulmonary Embolism
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5
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3 Ratings

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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