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Intensive Care Network Podcasts

Podcasts on topics relevant to intensive care medicine

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113. Parr on Post Cardiac Arrest ICU Care

Michael Parr, director of Liverpool ICU, speaks at BCC4 on ICU care for patients post cardiac arrest.

23mins

10 Jan 2014

Rank #1

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ECMO

Associate Professor Samuel Galvagno: ECMO. From CICM ASM PROGRAM 2019

28mins

1 Aug 2019

Rank #2

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In-Flight Medical Emergencies Part 1

40mins

16 Dec 2014

Rank #3

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Inotrope therapy: Which one and when?

Inotropic agents are commonly used in critically ill patients to support myocardia contractility either in the setting of cardiac surgery or ischemia or in the setting of sepsis associated myocardial dysfunction. The most commonly used agents are beta-agonist drugs (dobutamine), mixed beta and alpha agents (adrenaline and dopamine), phosphodiesterase inhibitors (inodilators) such as milrinone or enoximone or calcium sensitizers (levosimendan). Such agents are currently used according to clinician and/or unit preference based on tradition, mentorship, belief, inductive physiological reasoning, familiarity, understanding of pharmacokinetic and pharmacodynamics properties, side effects, and cost. No randomized controlled trials exist to support the notion that treatment targeted to similar physiological outcomes (ie cardiac index or MVO2) with one drug versus another would yield a different clinical outcome. More recently, however, two double-blind RCTs have compared adjunctive inotropic therapy with levosimendan in patients with post-operative low-cardiac output syndrome or low pre-operative ejection fraction. Both found that the addition of levosimendan was not superior to the edition of placebo.  

22mins

6 Aug 2018

Rank #4

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Coronary flow for the critically ill

The intent of this presentation is to provide an update of coronary assessment and management for the adult intensivist. Discussion points will include:   1. An assessment of coronary severity, using established methods, in particular fractional flow reserve (FFR),   2. Which stent- highlight the evolution of the stent to the current generation and what is evolving,  3. How to keep the stent open with current concepts of antiplatelet therapy and how this impacts the critically ill patient   4. What to consider if the ECG is abnormal, but the coronaries are not flow limiting obstruction- an occasional dilemma in the critically ill patient and finally   5.  Discussion around a contemporary study regarding cardiogenic shock and coronary ischemia.  

18mins

9 Aug 2018

Rank #5

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Is there a life in MARS after hepatectomy? by Professor Lars Lundell

Hepatic resections are complex surgical procedures harboring a significant risk for complications. In line with the continued development of liver surgery, hepatic resections tend to be more complex and extensive, with to this associated enhanced risk for post-hepatectomy liver failure (PHLF). Despite these improvements in outcome after major liver resection, PHLF remains one of the most serious and fatal complication of major liver resection occurring in up to 8 % of the cases. Multiple factors increase the risk of PHLF but in clinical practice the risk of PHLF is closely associated with the assessment of the pre-operative Future Liver Remnant (FLR). Accordingly the prevention of PHLF is alleged to be affected by the induction of hypertrophy of the liver remnant via portal vein embolization or ligation if the expected functional left remnant in cases where the FLR is judged too small. An alternative therapeutic strategy is to perform a two-stage procedure allowing the FLR to grow after the first non-curative resection. Irrespective of these surgical-technical advancements, early recognition and initiation of supportive care is crucial to improve patient outcomes in PHLF. Despite its fatal consequences, the complexity behind the pathogenesis of PHLF remains poorly understood and treatment options (except for preventive measures) are limited. The advent of extra corporeal, albumin-based liver-dialysis system (Molecular Adsorbent Recirculating System, MARS) seemed to offer a treatment modality for patients with liver failure being either acute or acute on chronic (ACLF). The information on the use of MARS in PHLF is meager and basically no experiences have been reported with the use of well-defined criteria for liver failure. For instance Van de Kerkhove et al. reported on five patients treated with MARS due to unspecified PHLF, of whom 3 improved but only one survived. We have recently compiled our experience with MARS treatment for well-defined PHLF and found that four out of 13 patients survived (31%) three months postoperatively. However, this survival figure rose to 44% (4/9) if the analysis was confined to patients with primary PHLF fulfilling the Balzan criteria alone. These results formed the basis of a prospective clinical trial with the objective of evaluating early and consistent MARS treatment in patients with primary PHLF. Results from this study will be presented and discussed References Balzan S, Belghiti J, Farges O, Ogata S, Sauvanet A, Delefosse D, et al. The "50-50 criteria" on postoperative day 5: an accurate predictor of liver failure and death after hepatectomy. Annals of surgery. 2005;242(6):824-8 Stange J, Mitzner S, Ramlow W, Gliesche T, Hickstein H, Schmidt R. A new procedure for the removal of protein bound drugs and toxins. Asaio J. 1993;39(3):M621-5. Gilg S, Escorsell A, Fernandez J, Garcia-Valdecasas JC, Saraste L, Wahlin S Nowak G, Stromberg C, Lundell L, Isaksson B. Albumin dialysis with MARS in post-hepatectomy liver failure (PHLF): experiences from two HPB centers. Surgery Current Research, 2015, 6: 252.

21mins

4 Mar 2018

Rank #6

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learnECMO 1: ECMO Gas Exchange

ECMO Gas Exchange by Steve Morgan & Sophie Connolly This is the first in a series of ECMO podcast from the LearnECMO team - starting with the physiology of ECMO gas exchange.

33mins

17 Oct 2016

Rank #7

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Neuro-Trauma

Neurotrauma – How to Put Humpty together again Humpty is a 23 year old egg, who fancied himself as a bit of a Hipster. Little did poor old Humpty know that his day was about to end in tears and he was to join the 1000 other Australians who annually have a severe head injury.  The talk focuses on Traumatic Brain Injury. There is particular emphasis on Traumatic Subarachnoid Haemorrhage and Transfusion Thresholds in Traumatic Brain Injury. The discussion explores the incidence and patterns of vasospasm following tSAH and the role, if any, of nimodipine and other therapies usually reserved for the aneurysm SAH population  The optimal target haemoglobin concentration following TBI is unknown. The discussion looks at the literature and explores the pathophysiology of anaemia in this setting.  A blood conservation strategy for patients with TBI is outlined

16mins

29 Aug 2015

Rank #8

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Lung Recruitment in ARDS - To be or not to be

Lung Recruitment in ARDS - To be or not to be by Dr Swapnil Pawar 

1hr

25 Sep 2018

Rank #9

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Clive Woolfe on Chronic Liver Disease

Clive Woolfe, Irishman and RPA Intensivist, speaks at Bedside Critical Care Conference. In this podcast, he gives an overview of the prognostication and management of chronic liver disease. See www.intensivecarenetwork.com for the slides and post.

21mins

7 Apr 2014

Rank #10

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Finfer: The Light and Dark Side of Research

Simon Finfer is a leading critical care clinical researcher. Hear his candid talk on the reality of research and publication and why it's relevant to you! Go to Intensive Care Network for the slides, videos and more.

1hr

28 Aug 2014

Rank #11

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Tranexamic Acid

Professor Stephen Bernard: Tranexamic Acid. From CICM ASM PROGRAM 2019.

18mins

11 Aug 2019

Rank #12

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Lil Mo PEEP

See the Post on Intensivecarenetwork.com Ash Banerjee talks about the history of ventilation and where we are today. He discusses in particular current concepts about lung protective ventilation strategies and how we can ventilate with the least amount of harm. For more details on how to select the ideal PEEP for a patient, or how one would set up the ventilator for an ARDS patient, have a look at Alex Yartsev’s site Deranged Physiology, where there’s a great post on the Optimal PEEP for Open Lung Ventilation in ARDS which specifically mentions Gattinoni’s recent review paper.

54mins

12 May 2017

Rank #13

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Acute liver failure - what tomorrow might bring?

Acute liver failure - what tomorrow might bring? by Professor Julia Wendon

33mins

21 Jan 2018

Rank #14

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Raw Science 1: Why Oxygen?

Basic Science Clinic by Steve Morgan Assume nothing, trust no one, give oxygen. – Anon Welcome to Basic Science Clinic Raw Science podcast series. In case you haven’t being paying attention, science is cool. Indulge your inner geek by joining us on our pursuit of developing an integrated scientific understanding from which you can develop a clinical practice informed by deeper insights and inoculation against magical thinking. We are going to take an unashamedly convoluted journey from atmospheric gas to the mitochondria and back again, to examine respiratory physiology and hopefully frame the information in a format that helps you on your inexorable march to examination success. Have you ever asked yourself what is all the fuss about oxygen? In the first two podcasts we are going to address why oxygen is the foundational slab of our hierarchy of needs and how it got here in the first place. It might just give you a renewed appreciation of nature’s most vital pharmaceutical. We would love to hear feedback and we will even take requests from the floor for future subjects. Apologies for any mistakes, we are always happy to learn so corrections are most welcome. Raw Science Factoids 2 x 1026 molecules of ATP formed daily, or ~160kg from 2500 calories. At any one time there is 50g of ATP in the body, cells contain ~1 billion ATP molecules, utilize 2 million ATP/s, regenerating ~600 ATP/s. On average we breath ~400 L O2/day and at rest consume ~350 L O2/day. Oxygen is the third most abundant element in the universe, and the most abundant by mass in the Earth’s biosphere. Increased solubility is evidenced by the increased density of life in the polar oceans. 

21mins

24 Dec 2015

Rank #15

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130. Pierre Janin on Targets in Neuro-ICU

Pierre Janin talks targets in neuro-icu, zoning in on blood pressure management in patients with ICH. This resource was recorded at Bedside Critical Care Conference 4.

19mins

8 Mar 2014

Rank #16

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Immune diseases - What about all those MABs

Monoclonal antibodies (MAbs), guided by molecular studies and personalised medicine are changing the face of clinical medicine.  They hold the promise of controlling diseases and improving survival whilst reducing the side effects of some ‘traditional’ therapies. MAbs are being used in conditions familiar to intensivists such as asthma, invasive candidiasis, RSV infection, reversal of novel anticoagulants and clostridium difficile infection as well as in those less commonly seen by intensivists such as multiple sclerosis, migraine, rheumatoid arthritis and numerous malignancies. Side effects of MAb treatment pose particular challenges for intensivists and range from cytokine release syndrome to autoimmune states (such as colitis, endocrinopathies, skin reactions), pneumonitis, thromboemboli, and infections. Pharmcokinetic interactions of MAbs with other drugs remain poorly studied and may be immune dependent, cytokine dependent or target dependent. Our traditional approach of triaging patients for ICU, based on organ failures and ‘prognosis  of underlying disease’ is going to be challenged by  MAbs with their disease modifying properties and unique side effects.

28mins

10 Oct 2018

Rank #17

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learnECMO 4: The Broken Heart

Pete McCanny gives a talk on the cutting edge management of cardiogenic shock and challenges the conventional approach to mechanical support. 

34mins

6 Jan 2017

Rank #18

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learnECMO 5: ECMO Haemodynamics

by Steve Morgan & Sophie Connolly Today we are going to cover the essentials of ECMO haemodynamics. Haemodynamics literally means blood movement and thus is the physical study of flowing blood and the structures through which it flows. In bedside vernacular we tend to use haemodynamics to refer to accessible surrogate measurements of cardiovascular performance, such as vascular and chamber pressures or quantifications of macrocirculatory blood flow. To understand the haemodynamic effects of ECMO we will consider the effects of the in-parallel VA circuit and the in-series VV circuit separately. The effect on cardiac performance can be best approached and compartmentalised by examining the impact of ECMO on each of the determinants of stroke volume: preload, afterload and contractility. This podcast covers: How can we best describe ventricular function and the effect of ECMO? What factors influence the net effect of VA ECMO on patient haemodynamics? What are the general primary haemodynamic effects of VA ECMO? How does cannulation site influence the haemodynamics of VA ECMO? What do you do about a non-ejecting heart on VA ECMO? What about the RV? How does the unique functional anatomy and physiology contribute to RV failure? What are the haemodynamic effects of VA ECMO on the RV? What are the haemodynamic effects of VV ECMO?

30mins

22 Mar 2017

Rank #19

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102. Mac Partlin on Emergency Airways Access

Matthew Mac Partlin talks about emergency airways access. Make sure you listen or watch this on www.intensivecarenetwork.com before Matthew's workshop on cricothyroidotomy at BCC Cairns!

31mins

5 Sep 2013

Rank #20