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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.
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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.
When seconds count and precision matters—like during surgery—getting accurate, continuous blood pressure readings is critical. That’s where radial artery cannulation comes in. But while traditional methods rely on “feeling the pulse,” they’re not always reliable, especially in tough cases. Enter a game-changing technique: ultrasound-guided Dynamic Needle Tip Positioning (DNTP).
In this episode, we dive into a powerful new study that compares old-school palpation to DNTP and the results are stunning: an 88.5% first-pass success rate, fewer attempts, less time, and reduced equipment use with the ultrasound approach. We explore why this matters for patient safety, comfort, and clinical efficiency—and how this could redefine arterial cannulation in the OR.
Could this be the new gold standard for arterial access? Tune in and find out.
Read the full study: "Palpation versus Ultrasound-Guided Dynamic Needle Tip Positioning Technique for Radial Artery Cannulation" by Sujan Dhakal et al. in Annals of Cardiac Anaesthesia.
When someone is critically ill, whether battling sepsis, ARDS, or severe pneumonia, corticosteroids have long been a debated topic. A massive new meta-analysis pooling data from over 10,000 ICU patients finally brings clarity. The headline: early, low-dose, prolonged steroid therapy cuts short-term mortality by roughly 15%, slashes ICU stays by 2 days, reduces time on ventilators by over 4 days, and boosts ventilator-free days—all without increasing infection or bleeding risks. Sure, there’s a slight uptick in hyperglycemia, but that’s a small price for improved survival and recovery
What does this mean for frontline clinicians? Think “early, gentle, and sustained.” Start steroids within the first 72 hours, keep them on for at least a week, and tailor doses to lower than 400 mg of hydrocortisone per day. Most surprisingly, even septic shock patients benefit most when hydrocortisone is paired with fludrocortisone
Want to see the full picture? Check out the study: “Efficacy and safety of corticosteroids in critically ill patients” by Lei Cao et al. in BMC Anesthesiology (July 2025).
When seconds count in the ICU, the IV fluid you choose could literally make or break a patient’s recovery. In this episode, we’re unpacking one of the biggest debates in critical care: balanced crystalloids vs. normal saline. A massive new meta-analysis of over 35,000 patients drops a game-changing truth—your fluid choice must depend on whether the patient has a traumatic brain injury (TBI).
Balanced solutions may lower mortality in most critically ill patients, but for those with TBI, they could actually do harm. Tune in to hear how this data is flipping standard practice on its head and pushing the ICU world toward smarter, personalized resuscitation.
Want to dive deeper? Check out the full study “Effect of Treatment With Balanced Crystalloids Versus Normal Saline on the Mortality of Critically Ill Patients With and Without Traumatic Brain Injury” by José C. Diz et al. in Critical Care and Resuscitation.
In today’s episode, we’re diving into a game-changing question: Can swapping fentanyl for remifentanil help ventilated ICU patients breathe on their own sooner, and with fewer complications like delirium?
This fresh meta-analysis pulls data from multiple studies and suggests remifentanil could reduce ventilation time by up to 21 hours in some cases and may lower the risk of ICU-related delirium. While the evidence is still growing and more rigorous trials are needed, the findings raise big questions about how we manage pain and recovery in critical care.
Tune in for key takeaways, clinical implications, and what this could mean for the future of ICU sedation.
Want to go deeper? Read the full study: "Comparative efficacy of remifentanil and fentanyl in mechanically ventilated ICU patients: a systematic review and meta-analysis on ventilation duration and delirium incidence" by Hiromu Okano et al. in Journal of Anesthesia, Analgesia and Critical Care.
When it comes to oxygen therapy for critically ill, ventilated patients, more isn’t always better—but is less the answer? The UK-ROX trial set out to find out, tracking over 16,000 ICU patients across 97 hospitals to test if targeting lower oxygen saturation (SpO₂ ~90%) could improve survival rates.
Spoiler alert: it didn’t.
In this episode, we unpack why conservative oxygen therapy didn’t significantly impact 90-day mortality—and what that means for frontline ICU care today. With no meaningful differences in mortality, ICU stays, or days free from organ support, the results suggest that “usual care” oxygen strategies may already be doing the job.
Key takeaways: • Conservative O₂ therapy didn’t improve survival • 90-day mortality nearly identical across groups • Usual care remains a safe and effective standard
Breathe easy—this episode cuts through the noise and gives you the real clinical takeaways.
Want to dig deeper? Check out the full study: "Conservative Oxygen Therapy in Mechanically Ventilated Critically Ill Adult Patients" by Daniel S. Martin et al., published in JAMA.
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