Critical Care Perspectives in Emergency Medicine

Brain damage and death from ischemic encephalopathy is common after cardiac arrest. Animal studies and limited observational studies suggest that high oxygen exposure after ROSC may result in neuronal death. As such, it is hypothesized that limiting oxygen exposure (conservative oxygen) many attenuate reperfusion injury and improve outcomes. At present, analyses from 2 trials in patients with cardiac arrest in the ICU suggested a benefit with conservative oxygen therapy.  In contrast, a trial of cardiac arrest patients in Denmark showed no difference in outcomes between conservative and liberal oxygen strategies (the BOX trial). In this podcast, we review the LOGICAL Trial, the latest study to compare conservative and liberal oxygen therapy in post-cardiac arrest patients.

Acute hypoxemic respiratory failure is a leading cause of ICU admission worldwide.  Oxygen is first-line therapy for patients with acute hypoxemic respiratory failure and can be given via nasal cannula (NC), non-rebreather mask (NRB), high-flow nasal cannula (HFNC), or noninvasive ventilation (NIV). At present, the literature is inconsistent on which mode of oxygen therapy reduces mortality.  In this podcast, we discuss the recently published SOHO Trial, that assessed whether HFNC was superior to standard oxygen therapy in reducing mortality in patients with acute hypoxemic respiratory failure.

Nearly 200,000 patients are admitted to the hospital each year in the United States for acute asthma exacerbations.  Approximately 2% of patients are intubated and placed on mechanical ventilation. In-hospital mortality is nearly 100 times higher when a patient with acute asthma exacerbation is intubated.  Non-invasive positive pressure ventilation is well known to improve outcomes for patients with an acute COPD exacerbation or with acute cardiogenic pulmonary edema. In contrast, the data on NIPPV for acute asthma is limited and remains debated. In this podcast, we discuss the latest study on the use of NIPPV in acute exacerbations of asthma.

Accurate assessment of intravascular volume is critical in managing sick patients in the emergency department or intensive care unit.   In this podcast we discuss a recently published article that evaluates clinical exam, radiographic, point-of-care ultrasound, and laboratory findings in the assessment of intravascular volume overload.

Each year, hundreds of articles are published that pertain to the resuscitation and care of critically ill emergency department patients. In this podcast, we review the key articles from the 2025 emergency medicine, resuscitation, and critical care literature that pertain to the care of critically ill ED patients.

More than 600,000 patients in North America sustain sudden cardiac arrest each year.  When return of spontaneous circulation (ROSC) is achieved, there are a number of critical interventions to consider in order to provide the patient with the best chance of being discharged with meaningful neurologic survival.  In this podcast, we discuss an excellent recent review article on the management of patients with ROSC following cardiac arrest.

Emergency physicians intubate critically ill patients daily.  Unfortunately, up to 17% of ED intubations can be complicated by peri-intubation hypoxemia, hypotension, and cardiac arrest. Efforts to optimize patient's physiology prior to rapid sequence intubation are critical in mitigating the risk of potentially disastrous peri-intubation complications.  In this podcast, we discuss a recent Clinical Policy from the American College of Emergency Physicians that addresses critical issues in the management of adult ED patients undergoing endotracheal intubation.  

Critically ill patients receiving mechanical ventilation require analgesia and sedation.  At present, propofol remains the most widely used sedative for intubated/ventilated patients.  Recent trials have suggested that dexmedetomidine may reduce delirium and the duration of mechanical ventilation compared with other sedative medications.  In fact, recent SCCM guidelines suggest the use of dexmedetomidine over propofol in intubated patients.  In this podcast, we discuss a recent randomized trial that compared the effectiveness and safety of a dexmedetomidine-based sedation strategy with a propofol-based sedation strategy in mechanically ventilated critically ill patients.

Approximately 75% of patients older than 65 years of age are seen in an ED within 6 months of their death.  While palliative care teams are now present in many hospitals in the US, they are often not present 24/7 or in resource-limited settings.  As such, there may be an opportunity to improve palliative care in the ED by providing palliative care education to ED team members.  In this podcast, we review the recently published PRIM-ER trial, which evaluated the impact of a robust primary palliative care intervention on hospital admission rates in 29 EDs across the US.

Sepsis results in more than 250,000 deaths each year in the United States. Resuscitation of the septic patient centers on timely recognition, early antibiotic administration, appropriate fluid administration, source control, and vasopressor administration for those with inadequate mean arterial pressures. At present, norepinephrine is the recommended first-line vasopressor for sepsis.  Current guidelines then recommend vasopressin as the second-line vasopressor agent, but the optimal timing of its initiation remains unknown. In this podcast, we discuss a recent article on the use of a machine learning tool for vasopressin administration to optimize short- and long-term outcomes in patients with sepsis.