Nearly 4 million patients sustain out-of-hospital cardiac arrest (OHCA) worldwide each year.  International guidelines for the resuscitation of patients with OHCA recommend early administration of epinephrine in those with an initial nonshockable rhythm.  Both intravenous (IV) and intraosseous (IO) access are routinely attempted to gain vascular access to administer medications.  While IV access is recommended, this is based on very low certainty evidence.  In this podcast, we discuss three recently published randomized trials that investigated IO and IV access in patients with OHCA.

Both NIV and HFNC are used to treat patients with acute respiratory failure.  Current guidelines recommend NIV for acute respiratory failure caused by COPD and acute cardiogenic pulmonary edema.  However, NIV may be hard for some patients to tolerate. When compared to low-flow oxygen therapy, HFNC has been shown to improve oxygenation, improve alveolar recruitment, and enhance clearance of secretions. HFNC may be easier to use and tolerate than NIV, but there remains uncertainty regarding the effectiveness of HFNC compared to NIV for acute hypoxemic respiratory failure. In this podcast, we discuss the RENOVATE trial that sought to compare HFNC with NIV on rates of intubation in patients with acute respiratory failure.

NIPPV is frequently used in the management of critically ill patients presenting with an acute COPD exacerbation, as NIPPV decreases the rates of intubation and is associated with lower in-hospital mortality.  Typically, "low" intensity NIPPV, whereby inspiratory positive airway pressures less than 18 cm H2O are used. More recently, the use of "high" intensity NIPPV, with IPAPs between 20-30 cm H2O, has been shown to improve gas exchange, ventilatory function, and improve arterial PCO2 values.  In this podcast, we review the HAPPEN Trial, which compared low intensity to high intensity NIPPV on the need for intubation in patients with an acute COPD exacerbation and hypercapnia.

The incidence of opioid-associated out-of-hospital cardiac arrests continues to rise.  Current guidelines for the resuscitation of patients with OHCA advise the clinician to consider the administration of naloxone of patients with suspected opioid-associated OHCA.  In this podcast, we review a recenlty published study in JAMA that evaluated the association of naloxone with patient outcomes in opioid-associated OHCAs.

Timely administration of broad-spectrum antibiotics is a critical pillar in the resuscitation of patients with sepsis.  B-lactam antibiotics are an important class of antibiotics commonly administered to patients with sepsis.  Typically, B-lactam antibiotics are administered over 30 minutes, but optimal bactericidal activity requires the concentration of free drug to be above the MIC of the organism for 40-70% of the dosing interval.  In this podcast we discuss two recent publications that compare continuous infusions of B-lactam antibiotics with intermittent effusions in patients with sepsis.

Patients with COVID-19 can require supplemental oxygen for acute hypoxemic respiratory failure.  While international guidelines recommend a target SpO2 between 90-96%, a safe oxygenation strategy has not been identified.  In this podcast, we discuss the recently published HOT-COVID Trial, which compared a lower oxygenation strategy with a higher oxygenation strategy in adult ICU patients with COVID-19.

Over 1 million critically ill patients are intubated each year in the US.  Hypoxemia occurs in up to 20% of patients and can lead to peri-intubation cardiovascular collapse and cardiac arrest.  As such, adequate and appropriate preoxygenation is critical in increasing the safe apnea time and decreasing the risk of hypoxemia.  At present, the majority of patients receive preoxygenation through a non-rebreather mask.  In this podcast, we discuss a recent study that evaluated the use of noninvasive ventilation for preoxygenation in critically ill patients.

Timely and appropriate administration of empiric broad-spectrum antibiotics for adult patients with sepsis is critical.  Current guidelines recommend an antipseudomonal antibiotic for those at risk of a resistant gram-negative organism.  The two most common antipseudomonal antibiotics prescribed in this setting are cefepime and piperacillin-tazobactam.  In recent years, observational studies have reported an association with cefepime and neurotoxicity, whereas piperacillin-tazobactam has been associated with AKI especially when given with vancomycin.  In this podcast, we discuss the recently published ACORN Trial, a randomized trial that evaluated cefepime and piperacillin-tazobactam for adult patients with suspected infection.

In recent years, there has been intense focus on delivering high-quality compressions during the resuscitation of patients with OHCA.  In contrast, ventilation metrics in OHCA resuscitation have not been well studied.  In this podcast, we discuss a recent publication from Circulation that evaluated ventilation waveforms during OHCA resuscitation and the association of these metrics on patient outcomes.  Can we do better?

Critically ill patients commonly develop a dysregulated inflammatory response. Corticosteroids are hypothesized to be beneficial due to their anti-inflammatory properties.  In recent years, several studies have been published on the use of corticosteroids in select critical illnesses.  In this podcast, we review a recently published clinical update on the use of corticosteroids in sepsis, ARDS, and community acquired pneumonia.