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Welcome to the ResusX:Podcast. Each episode features an amazing talk from the ResusX conference. This is a podcast dedicated to your sickest patients, and it'll all FOAMed. For more great content including our monthly grand rounds, newsletters and more go to www.ResusX.com now.
163 Episodes
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Sepsis and Coagulation: Is It Time to Put the Heparin Away?
Is "thinning the blood" the missing piece in the sepsis puzzle, or just a recipe for disaster? Sepsis triggers a deadly cascade of inflammation and clotting, yet the debate over therapeutic anticoagulation has left ICU clinicians caught between the potential for organ salvage and the perilous risk of hemorrhage. In this episode, we break down a 2026 systematic review and meta-analysis from the *Journal of International Medical Research*. The investigators pooled data from 10 major studies—including 8 randomized controlled trials—covering nearly 7,500 adult patients to determine if agents like heparin, antithrombin III, or recombinant thrombomodulin actually save lives. The verdict? We discuss why the data shows that routine anticoagulation in unselected sepsis patients offers **no significant mortality benefit** and trends toward a higher risk of major bleeding. We also unpack a critical discrepancy: while observational studies suggested a survival advantage, the rigorous RCTs flatly contradicted this, exposing the dangers of selection bias. Join us as we explore why the "one-size-fits-all" approach to sepsis anticoagulation is officially dead and why future hopes now rest entirely on high-risk subgroups like those with disseminated intravascular coagulation (DIC). Tune in to get the evidence you need to make safer decisions at the bedside.
Some random musings post shift
Is it time to retire the Bag-Valve-Mask for preoxygenation?
Emergency intubation carries a notorious risk of life-threatening hypoxemia, yet the debate on the safest way to build an oxygen reserve continues . In this episode, we unpack a 2026 systematic review and meta-analysis that challenges the status quo, pitting Noninvasive Ventilation (NIV) directly against standard Bag-Valve-Mask (BVM) ventilation .
We dive into data from three randomized controlled trials involving over 1,500 critically ill adults . The verdict? NIV emerged as the clear winner for efficacy, significantly slashing the risk of hypoxemia during intubation compared to BVM . Perhaps even more importantly for the safety-conscious provider, the study busts a persistent myth: NIV demonstrated no significant difference in regurgitation rates compared to BVM, alleviating long-held fears about aspiration risk .
So, what does this mean for your next airway crash? This evidence suggests NIV offers a superior safety buffer for oxygenation without the feared trade-offs . Tune in as we explore why this procedural switch could be a game-changer for patient safety in the ED and ICU.
A new podcast of just me in my car
Is the reign of "Normal" Saline over, or is the classic bag of salt water actually the hero of the trauma bay? For years, the critical care community has debated whether we should abandon 0.9% sodium chloride in favor of balanced crystalloids like Lactated Ringer’s or Plasma-Lyte to protect the kidneys and prevent acidosis. But a new study suggests we might be writing off saline too soon—especially when the brain is involved.
In this episode, we break down a 2026 systematic review and meta-analysis from the American Journal of Emergency Medicine . The researchers pooled data from six randomized controlled trials involving nearly 2,000 trauma patients to compare efficacy and safety . The results might surprise proponents of balanced fluids. While there was no significant difference in acute kidney injury or general mortality for non-head trauma, the data revealed a vital signal for Traumatic Brain Injury (TBI). In TBI patients, Normal Saline was actually associated with lower mortality and more ventilator-free days compared to balanced solutions .
So, what does this mean for your next trauma alert? It suggests that the slight hypertonicity of saline might be protective against cerebral edema, making it a potentially superior choice for head-injured patients . Tune in as we dissect the pathophysiology, the "chloride load" myth, and why Normal Saline remains a safe, standard option for undifferentiated trauma resuscitation.
Is Ketamine really the "hemodynamically stable" hero of airway management, or have we been unfairly vilifying Etomidate for decades? The debate over the perfect induction agent for critically ill patients just got a major influx of data that flips conventional wisdom on its head .
In this episode, we break down the landmark "RSI" trial, a massive multicenter randomized controlled study involving over 2,300 critically ill adults in EDs and ICUs across the US . The headline results are a shocker: Ketamine did not reduce 28-day mortality compared to Etomidate . Even more surprising? The "hemodynamically neutral" reputation of Ketamine took a hit. Patients randomized to Ketamine actually experienced significantly higher rates of cardiovascular collapse—including hypotension and increased vasopressor needs—during intubation compared to those receiving Etomidate .
We unpack what this means for your next shift: why the theoretical fears of Etomidate-induced adrenal suppression didn't translate to patient harm, and why Ketamine might be less forgiving in shock states than we previously thought . Tune in as we dissect the data and discuss whether it’s time to stop hesitating and reach for the Etomidate.
Is the "best of both worlds" actually saving lungs, or just complicating care? Theoretically, combining the powerful pressure support of Non-Invasive Ventilation (NIV) with the comfort and washout mechanisms of High-Flow Nasal Cannula (HFNC) sounds like the ultimate strategy to prevent intubation . But does this physiological synergy actually translate to patient survival?
In this episode, we break down a new meta-analysis from the American Journal of Emergency Medicine that pooled data from six RCTs and over 700 adults with Acute Respiratory Failure (ARF) . The researchers investigated whether alternating or combining these devices as an initial strategy is superior to using just one alone . The headline result might surprise you: the study found no significant reduction in intubation rates or mortality compared to monotherapy .
However, don't write off the combo just yet—the devil is in the details. We explore a fascinating data split where the efficacy of the combination hinged entirely on lung-protective strategies . We discuss why unchecked tidal volumes during NIV might be masking the benefits of the combination, leading to ventilator-induced lung injury (VILI) . Tune in for a critical look at why "more support" isn't always "smarter support," and how to identify the specific patients who might still benefit from this tag-team approach .
For decades, a single dogma has ruled neurotrauma resuscitation: Never use ketamine in TBI. The historical fear that ketamine spikes intracranial pressure (ICP) has kept one of the most versatile, hemodynamically friendly induction agents on the shelf—but is that fear based on fact or outdated physiology?
In this episode, we dissect a massive 2026 systematic review and meta-analysis from the Journal of Critical Care . By analyzing over 6,000 patients across 15 studies—including four RCTs and strictly post-2015 data—this paper puts the "old myth" to the ultimate test . We break down how the researchers compared ketamine against other agents like propofol and etomidate to evaluate hospital mortality, ICP crises, and adverse events in both adult and pediatric populations .
The findings are practice-changing. The data reveals zero association between ketamine use and ICP spikes or increased mortality, effectively debunking the classic contraindication . However, the review uncovers a controversial "plot twist": a potential link to hypotension that challenges our assumptions about ketamine's stability in catecholamine-depleted trauma patients .
Tune in as we analyze the "study dominance bias" that complicates these hemodynamic results and discuss exactly how this evidence should reshape your airway strategy for the severe TBI patient .
In this episode, we tackle one of the most persistent questions in perioperative care: how low is too low when it comes to hemoglobin in high-risk cardiac patients after major surgery? The long-standing restrictive threshold of 7 g/dL has been considered safe for years, but the TOP Trial challenges that comfort zone.
More than 1,400 high-risk veterans were randomized to either a liberal transfusion strategy (Hgb <10 g/dL) or a restrictive one (Hgb <7 g/dL). The primary outcome showed no significant difference in death or major ischemic events. That part was expected.
The surprise came in the secondary outcomes. Patients in the restrictive group had nearly double the rate of non-fatal cardiac complications, including new heart failure and dangerous arrhythmias. The liberal strategy cut those complications by almost 40 percent.
This episode breaks down what these findings mean for real-world practice, how they challenge current transfusion guidelines, and when you might reconsider your trigger for your most vulnerable post-op patients.
If you take care of surgical patients with cardiac risk, this is an episode you cannot skip.
Can a Single Word Change the Culture of an ICU?
Burnout is an epidemic in our Intensive Care Units, affecting staff well-being, patient care, and even hospital costs. But what if the solution to this widespread problem was simpler than we think?
This week, we’re diving into the Hello Trial, a massive 1:1 cluster-randomized controlled trial conducted across 370 ICUs in 60 countries. Researchers tested a simple, four-week, unit-based intervention designed to promote positive workplace culture and within-team support using tools like posters, email nudges, positive message boxes, and role modeling.
The results are practice-changing:
The intervention significantly reduced burnout prevalence from 63.3% in the control group to 52.2% in the intervention group (P < 0.001).
It improved perceptions of job satisfaction, workplace safety, ethical climate, and patient- and family-centered care.
Staff in the intervention arm were less likely to consider changing jobs.
They also had lower emotional exhaustion, lower depersonalization, and higher personal accomplishment scores.
Here’s the bedside “so what”: A pragmatic, system-level focus on positive communication and team cohesion can rapidly and meaningfully shift your unit’s culture—directly improving staff well-being.
Forget the individual-focused, time-draining wellness programs. The answer might be in a simple, collective shift in how we interact. Tune in as we break down the specific components of the Hello intervention and how you can bring this powerful, low-cost strategy to your ICU.
For decades, we’ve been told vasopressors belong only through central lines — but what if that’s not the whole story? In this episode, we unpack a groundbreaking multicenter study from Addis Ababa that dares to challenge convention.
Researchers followed 250 patients in shock, tracking survival outcomes, complications, and safety when vasopressors were given peripherally instead of through central access. The result? A strikingly low extravasation rate of just 1.2%, with all complications occurring only after five days of infusion. For short-term management, the data suggests — peripheral might be not only feasible, but safe.
We’ll explore what this means for critical care teams everywhere — especially in resource-limited settings where central access isn’t always an option. Is it time to rewrite the playbook for shock management? What are the risks, the predictors of survival, and the real-world tradeoffs?
Tune in as we dig into the data, the debates, and the bedside lessons from this landmark study — and ask the question every critical care clinician should be thinking about: Are we overcomplicating vasopressor delivery?
Science meets practicality. Evidence meets the frontline. And the future of shock resuscitation might just look a little different.
Why are we still arguing about the best way to give fluids to patients with traumatic brain injury (TBI)? 🤔 This seems like a basic question, but the answer is complex and could mean the difference between life and death at the bedside.
A recent comprehensive review article from the Journal of Clinical Medicine dives deep into the clinical and physiological challenges of fluid resuscitation in TBI patients. The authors conducted a non-systematic literature review of studies over the last two decades, focusing on fluid management, types of fluids, and transfusion strategies. The research highlights a critical paradox: while hypotension (low blood pressure) is a known killer in TBI, giving too much fluid can be just as deadly by worsening cerebral edema.
The key takeaway? There is no one-size-fits-all approach. For fluid choice, the review argues against using balanced crystalloids like Ringer's lactate, suggesting they could worsen cerebral edema due to their relative hypotonicity. Instead, normal saline is often the preferred first-line fluid . As for blood transfusions, the data is contradictory. While some studies suggest a liberal transfusion strategy (aiming for a higher hemoglobin target) improves outcomes, others found no benefit and even a higher risk of adverse events . This means that transfusion decisions should be highly individualized, based on the patient's specific physiological parameters, not a fixed number .
This research is a wake-up call for frontline clinicians. It reminds us that blindly following protocols can be harmful. Every fluid bag, every pressor drip, and every unit of blood must be a thoughtful, personalized decision guided by robust
hemodynamic and neuromonitoring .
Want to know how to make smarter, more precise fluid decisions for your TBI patients? Tune in to this episode as we break down the latest evidence and translate it into actionable steps for your daily practice.
Are we giving our older patients with out-of-hospital cardiac arrest (OHCA) a fair shot? ⏱️ Current guidelines say an ECPR initiation time of up to 60 minutes is acceptable, but is that really the case for everyone? This is a question clinicians grapple with every day at the bedside.
A new nationwide observational study from South Korea tackles this head-on, analyzing data from 483 adult patients who received ECPR for non-traumatic OHCA. The study found that while both age and time to ECPR independently predict survival, the combination of the two is critical. The key takeaway? The "golden hour" for ECPR may not apply to our elderly patients.
The results are practice-changing and frankly, a wake-up call. The study found that in patients over 65, the probability of survival plummeted to less than 10% when ECPR was delayed beyond just 21 minutes. For their younger counterparts, a 10% survival rate was maintained for nearly twice as long, up to 38 minutes . This finding suggests that for older patients, the effective window for ECPR is much shorter than previously thought . The authors recommend a sense of urgency, urging clinicians to activate ECPR in carefully selected elderly patients almost immediately upon hospital arrival .
This isn't just about a new number; it's about re-evaluating our clinical protocols and embracing an age-specific approach to resuscitation. Tune in as we break down the data and discuss what this means for your next OHCA case.
When it comes to saving lives in the ICU, every breath counts. But what’s the best way to deliver that breath—pressure-controlled ventilation (PCV) or volume-controlled ventilation (VCV)?
In this episode, we dive into a new systematic review and meta-analysis that put these two ventilator modes head-to-head in over 1,100 patients with acute respiratory failure. The findings may surprise you: while both modes showed no major differences in barotrauma or overall mortality, PCV hinted at a slight edge in reducing deaths among patients with ARDS.
What does this mean for frontline clinicians? Could PCV be the more patient-friendly option when seconds matter? Join us as we unpack the data, discuss the implications for practice, and explore where future research needs to go.
Tune in for a deep dive into ventilator strategies that could shape critical care worldwide.
When a patient crashes with acute cardiogenic pulmonary edema, emergency teams need fast, effective solutions. For years, non-invasive ventilation (NIV) has been the gold standard — but could high-flow nasal cannula (HFNC) be just as good?
In this episode, we break down a prospective, randomized trial published in the American Journal of Emergency Medicine (Dec 2025) that compared HFNC head-to-head with NIV in the ED. The results? No difference in survival, respiratory rates, or dyspnea scores between the two therapies.
We’ll explore:
Why HFNC may rival NIV for managing ACPE
The surprising equivalence in clinical outcomes at 30, 60, and 120 minutes
Patient comfort and tolerability — where HFNC may hold the edge
What this means for ED practice, protocols, and future airway management
If you’re an emergency physician, intensivist, or resuscitationist, this study has big implications: it suggests you may have more flexibility — and your patients, more comfort — than ever before.
When a patient is crashing and every second counts, airway decisions can mean life or death. For decades, clinicians have fiercely debated: should you reach for etomidate, the hemodynamic workhorse, or ketamine, the pressure-friendly multitasker?
In this episode, we dive deep into a new systematic review and meta-analysis that just might end the controversy once and for all. The surprising truth? Survival doesn’t change no matter which drug you choose.
We’ll unpack:
Why this finding is a game-changer for emergency physicians, intensivists, and resuscitationists.
What the evidence really says about mortality, intubation success, and cardiac arrest risk.
The nuances of post-induction hypotension and why it might not be the dealbreaker it once seemed.
How this study frees you to make airway decisions based on patient context and clinical judgment—not dogma.
Whether you’re on the front lines of the ED, running codes in the ICU, or training the next generation of airway masters, this episode will leave you with clarity, confidence, and a renewed perspective on one of emergency medicine’s longest-running debates.
When major abdominal surgery pushes patients to the brink, timing is everything, especially with norepinephrine. Could giving it earlier to high-risk patients prevent dangerous drops in blood pressure and reduce complications?
A new randomized controlled trial, published in Anesthesiology (2025), put this to the test, comparing early, low-dose norepinephrine infusion against standard care in high-risk surgical patients. The results may surprise you: early norepinephrine not only stabilized blood pressure faster but also significantly reduced postoperative complications without increasing adverse events.
In this episode, we break down what “early” really means, why the trial’s pragmatic design matters, and how this could reshape perioperative hemodynamic management in major surgery.
Key takeaways: • Early norepinephrine led to more stable intraoperative blood pressure • Reduced risk of postoperative complications in high-risk patients • No significant increase in adverse events compared to standard care
This isn’t just about drugs, it’s about redefining timing in critical surgical care.
Want to dig deeper? Check out the full study: Trocheris-Fumery O, Flet T, Scetbon C, et al. Early Use of Norepinephrine in High-Risk Patients Undergoing Major Abdominal Surgery: A Randomized Controlled Trial. Anesthesiology. 2025. doi:10.1097/ALN.0000000000005704
When it comes to getting patients off mechanical ventilation, clinical judgment isn’t always enough. What if you could use a real-time, bedside tool to boost your confidence—and your success rate?
In this episode, we dive into the power of diaphragmatic ultrasound in predicting successful weaning from mechanical ventilation. Based on the latest meta-analysis, we break down how measuring diaphragm function—like excursion and thickening fraction—can provide moderate-to-high diagnostic accuracy in identifying who’s ready to breathe on their own.
Find out:
Why traditional predictors aren’t cutting it
What makes diaphragmatic ultrasound a game-changer
And whether this tool should become your new go-to in the ICU
Based on the article of Tashiro, N., Nishiwaki, H., Ikeda, T. et al. titled "Clinical utility of diaphragmatic ultrasound for mechanical ventilator liberation in adults: a systematic review and meta-analysis" from j Intensive Care.
Can IV vitamin C really save lives in the PICU? It’s been a hot topic in critical care circles for years—but the VITACIPS trial just delivered a powerful dose of clarity. In this episode, we dive into the results of this rigorous study and what they mean for treating children in septic shock. Spoiler: it’s not the magic bullet many hoped for. We break down key findings, clinical implications, and why this trial is a turning point in how we think about adjunct therapies in pediatrics.
Whether you're treating pediatric patients or just curious about how cutting-edge research shapes real-world care, this one’s worth the listen.
Based on the article: “Vitamin C Versus Placebo in Pediatric Septic Shock (VITACIPS) – A Randomised Controlled Trial” by Jhuma Sankar et al., Journal of Intensive Care Medicine.
What happens when a patient in the ICU suddenly can't breathe—and the usual airway tools just won’t cut it? In this episode, we break down the high-stakes world of difficult airway management where seconds matter and lives hang in the balance. From using checklists like LEMON to deploying advanced gear like video laryngoscopes and rescue devices, this isn’t just medicine—it’s a strategic, lifesaving playbook in action. We explore the latest evidence, essential algorithms, and game-changing tools that are helping clinicians stay calm, stay sharp, and save lives when the pressure is highest.
Whether you're on the frontlines or just curious how modern medicine handles its toughest challenges, this is an episode you don’t want to miss.
Based on the article: “Difficult Airway Management in the Intensive Care Unit: A Narrative Review of Algorithms and Strategies” by Talha Liaqat et al., Journal of Clinical Medicine.
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