PRISM Rounds: Pulmonary Critical Care & Sleep Podcast

PRISM Rounds
  • 5.0 (3)
  • Medicine
  • Updated 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. 4d ago

    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

  2. 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

  3. Sep 4

    S01E56 SAVE-O2 AI: Can Oxygen Titrate Itself Better Than We Can?

    In this episode of PRISM Rounds, we discuss the SAVE-O2 AI randomized clinical trial, which tested autonomous closed-loop oxygen titration versus usual manual oxygen adjustment in 300 hospitalized adults receiving supplemental oxygen. The autonomous system kept patients in the target SpO2 range much more often, 85% vs 63%, while also reducing time spent in hypoxemia and, even more strikingly, hyperoxemia. We break down what the trial shows, what it does not show, the importance of pulse oximetry accuracy and skin pigmentation, and whether improved oxygen control is enough to justify broader implementation. We also discuss the accompanying editorial by Weingart and Matthay, which explores the potential impact on clinician workload, oxygen stewardship, resource-limited settings, and the next generation of implementation and outcomes studies. SAVE-O2 AI trial, JAMA Internal Medicinehttps://jamanetwork.com/journals/jamainternalmedicine/fullarticle/10.1001/jamainternmed.2026.4023DOI: https://doi.org/10.1001/jamainternmed.2026.4023 Invited Commentary: Potential Transformative Impact of Autonomous Oxygen Delivery in Hospitalized Patientshttps://jamanetwork.com/journals/jamainternalmedicine/fullarticle/10.1001/jamainternmed.2026.4038DOI: https://doi.org/10.1001/jamainternmed.2026.4038 Find more episodes at www.prismrounds.com and subscribe on Apple Podcasts or Spotify. Tags#PRISMRounds #SAVE02AI #CriticalCare #ICU #PulmonaryCriticalCare #OxygenTherapy #Hypoxemia #Hyperoxemia #PulseOximetry #ClosedLoopControl #ArtificialIntelligence #DigitalHealth #ClinicalTrials #RandomizedTrial #JAMAInternalMedicine #RespiratoryCare #FOAMcc #MedEd

    S01E56 SAVE-O2 AI: Can Oxygen Titrate Itself Better Than We Can?

  4. Aug 28

    S01E55 | Video Laryngoscopy in the OR: The COVALENT Trial

    Does video laryngoscopy improve first pass success for routine tracheal intubation, and does blade geometry matter? In this episode of PRISM Rounds, we discuss the COVALENT randomized clinical trial, which compared direct laryngoscopy, Macintosh style video laryngoscopy, and hyperangulated video laryngoscopy in more than 2,400 perioperative intubations. We review the higher first pass success with video laryngoscopy, why the hyperangulated strategy performed best, the important role of stylet use, and what the accompanying editorial adds to the interpretation. We also discuss how COVALENT builds on the DEVICE trial in critically ill adults and why the airway conversation may now be shifting from simply video versus direct toward which video strategy, blade, and adjunct work best in different clinical settings. Find PRISM Rounds on Apple Podcasts, Spotify, and https://prismrounds.com Tags:Critical Care, ICU, Airway Management, Video Laryngoscopy, Direct Laryngoscopy, COVALENT Trial, DEVICE Trial, Tracheal Intubation, First Pass Success, Emergency Airway, Anesthesiology, Pulmonary Critical Care, Evidence Based Medicine, Journal Club, PRISM Rounds, FOAMcc, FOAMed

    S01E55 | Video Laryngoscopy in the OR: The COVALENT Trial

  5. Aug 24

    S01E54: Rocuronium Dose and First-Pass Success: Are We Giving Enough?

    DescriptionWe obsess over the paralytic, but are we giving enough of it? In this episode of PRISM Rounds, we review a new AJRCCM secondary analysis of 1,822 critically ill adults from the DEVICE and PREOXI trials examining whether rocuronium dose is associated with first-attempt intubation success. Patients receiving more than 1.2 mg/kg had higher first-attempt success overall, with the strongest signal in ICU patients. But rocuronium dose was chosen by clinicians rather than randomized, so residual confounding matters. We break down the study, the accompanying editorial, the pharmacologic rationale for higher dosing, the ICU versus ED findings, and the key bedside question: Should this change how we dose rocuronium during emergency intubation? Original article:https://academic.oup.com/ajrccm/article/212/8/1740/8679093 Accompanying editorial:https://academic.oup.com/ajrccm/article/212/8/1680/8706698 Educational use only. This is not medical advice. TagsCritical Care, ICU, Airway Management, Tracheal Intubation, Emergency Intubation, Rocuronium, Neuromuscular Blockade, Rapid Sequence Intubation, RSI, First Pass Success, First Attempt Success, Video Laryngoscopy, DEVICE Trial, PREOXI Trial, AJRCCM, Pulmonary Critical Care, Emergency Medicine, Anesthesiology, Evidence Based Medicine, Journal Club, Medical Education, PRISM Rounds

    S01E54: Rocuronium Dose and First-Pass Success: Are We Giving Enough?

  6. Aug 16

    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

  7. 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

  8. 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
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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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