There is enormous heterogeneity in clinical outcomes and severity of septic shock, with some patients needing only supportive care in the ICU and others progressing to multiorgan system failure and death. How can clinicians identify patients at higher risk of death?

In this episode of the Society of Critical Care Medicine (SCCM) Podcast, host Marilyn Bulloch, PharmD, BCPS, FCCM, is joined by John A. Kellum, MD, FCCM, to discuss high endotoxin activity as a possible endotype for septic shock. Dr. Kellum’s article, “Organ Failure, Endotoxin Activity, and Mortality in Septic Shock,” was published in the September 2025 compendium of Critical Care Explorations. Dr. Kellum is a professor and director of the Center for Critical Care Nephrology, as well as vice chair for the Department of Critical Care Medicine, at the University of Pittsburgh in Pittsburgh, Pennsylvania, USA.

The study used a novel biomarker called the endotoxin activity assay (EAA) to detect endotoxin in the blood. While the EAA is not good at identifying patients who are at risk for sepsis, Dr. Kellum said that, when combined with organ failure, it identifies patients at high risk for endotoxic septic shock. In the study, these patients had a mortality rate of 60%.

Neither the EAA nor the anti-endotoxin therapy is readily available. And, although endotoxic septic shock is rare, occurring in only a quarter of patients with septic shock, Dr. Kellum hopes that, through precision medicine, segmenting this population into treatable subgroups may allow better diagnostics and opportunities to develop or repurpose therapies in the future. This episode is sponsored by Prenosis.

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In this episode of the Society of Critical Care Medicine (SCCM) Podcast, host Maureen Madden, DNP, RN, CPNP-AC, CCRN, FCCM, speaks with Javier Varela, MD, MSc, about his study, “Acute Bronchiolitis in Infants on Invasive Mechanical Ventilation: Physiology Study of Airway Closure,” published in the September 2025 issue of Pediatric Critical Care Medicine. The study revealed new insights into airway pathophysiology in infants with severe bronchiolitis who require mechanical ventilation, a population that comprises a substantial portion of winter pediatric intensive care unit (PICU) admissions worldwide. Dr. Varela is an intensivist in the PICU in the Department of Pediatrics at Clínica Alemana de Santiago, in Santiago, Chile.

Differing ventilatory strategies and the heterogeneous phenotypes of bronchiolitis motivated Dr. Varela’s team to investigate airway closure, which was detected in seven of the 12 patients included in the study. Airway opening pressure frequently exceeded the set positive end-expiratory pressure (PEEP) levels—highlighting a potential gap in traditional ventilator management. Dr. Varela explains that respiratory mechanics, particularly driving pressure and respiratory system compliance, can be misinterpreted when airway opening pressure is not considered.

Study limitations included bacterial coinfection in nearly half the patients and the constraints of a single-center design, but Dr. Varela said that these factors did not appear to alter the physiologic observations.

Although more research is needed before making clinical recommendations, the study established a foundational understanding of airway closure in patients with bronchiolitis and underscores the need for future work on personalized ventilation strategies, PEEP titration, and the potential heterogeneity of airway behavior in this population.

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In this episode of the Society of Critical Care Medicine (SCCM) Podcast, host Elizabeth H. Mack, MD, MS, FCCM, speaks with Nadir Yehya, MD, MSCE, an attending physician in the Pediatric Sepsis Program and the Division of Critical Care Medicine at the Children's Hospital of Philadelphia in Philadelphia, Pennsylvania, USA. They discuss Dr. Yehya’s study, “Parent and Provider Perspectives on Short-Term Outcomes of Critically Ill Ventilated Children,” published in the September 2025 issue of Pediatric Critical Care Medicine. The study explores whether widely used composite clinical outcomes such as ventilator-free days truly reflect what families value most when their child is in the pediatric intensive care unit (PICU).

Dr. Yehya discusses how the project emerged from a long-standing question in pediatric critical care research: Are the outcomes we measure in clinical trials aligned with the priorities and lived experiences of families? Because mortality is low in pediatrics, composite short-term outcomes such as ventilator-free days, ICU-free days, and hospital-free days are commonly used. However, little is known about whether these metrics are truly patient- and family-centered.

Using survey data from parents and PICU clinicians, the study found strong agreement between parents and clinicians on the importance of minimizing duration of invasive mechanical ventilation. But parents and clinicians diverged on other short-term outcomes. Families ranked oxygen duration as more important than ICU or hospital length of stay, reflecting concerns about ongoing medical needs, missed work, and the possibility of going home on oxygen. Clinicians prioritized ICU and hospital days over oxygen use. Substantial variation was also found within both groups.

Dr. Yehya highlights the value of feedback from patient and family advisory councils in designing this type of research, explaining that such feedback informed the study’s instrument design and family approach. He calls for deeper investigation into post-discharge recovery, functional outcomes, and long-term developmental trajectories—areas families consistently identify as their greatest concerns.

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In this episode of the Society of Critical Care Medicine (SCCM) Podcast, host Marilyn N. Bulloch, PharmD, BCPS, FCCM, speaks with Olfa Hamzaoui, MD, PhD, professor of intensive care at Robert Debré Hospital in Reims, France, about her Peter Safar Honorary Lecture at the 2025 Critical Care Congress. The conversation centers on tissue perfusion, microcirculation, and shock, with a focus on bridging the gap between bench research and bedside practice.

Dr. Hamzaoui shares insights on current scientific understanding of microcirculation and shock, including research on tools to monitor microcirculation, such as handheld video microscopy. The discussion highlights the utility of capillary refill time as a simple, noninvasive tool for guiding resuscitation. Dr. Hamzaoui advocates for early and repeated echocardiographic assessment in shock management, including during de-resuscitation. She also discusses her 2023 article in Clinical Medicine, which proposed titrating norepinephrine to individualized targets.

This episode offers a compelling look at how emerging tools and research can refine shock management and promote precision care in critical illness.

This podcast is sponsored by Fresenius Kabi.

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In this episode of the Society of Critical Care Medicine (SCCM) Podcast, host Kyle B. Enfield, MD, FCCM, speaks with Sumeet Rai, PhD, FCICM, senior intensivist at Canberra Hospital, about his study, “Pawsitive Care: Canine-Assisted Intervention for Anxiety in ICU Patients and Family Members: A Single-Center, Single-Arm Study,” published in the May 2025 compendium of Critical Care Explorations.

Dr. Rai explains how positive anecdotal experiences of animal therapy in the ICU inspired his team to conduct this study. Guided by infection control protocols, they implemented a program allowing accredited therapy dogs to visit patients and families for 15- to 20-minute sessions. More than 60% of patients and more than 90% of family members had a clinically meaningful reduction in anxiety scores, and patients reported decreased pain. No adverse events were observed, demonstrating the feasibility and safety of this approach.

Dr. Rai addresses the study’s limitations, such as the impracticality of conducting a randomized trial, and highlights the need for research into staff well-being, which appeared to benefit from therapy dog visits. He also underscores the importance of a safety program, including infection control precautions.

This episode offers practical insights for implementing animal therapy programs in the ICU and invites listeners to consider new approaches to improving mental health and well-being for patients, families, and staff.

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In this episode of the Society of Critical Care Medicine (SCCM) Podcast, host Elizabeth H. Mack, MD, MS, FCCM, speaks with Rebecca Mitting, MD, MRCPCH, consultant pediatric intensivist and clinical lead for the PICU at Imperial College Healthcare NHS Trust in London. They discuss Dr. Mitting’s article, “Sedation and Ventilator Weaning Bundle and Time to Extubation in Infants With Bronchiolitis: Secondary Analysis of the Sedation AND Weaning in Children (SANDWICH) Trial,” published in the April 2025 issue of Pediatric Critical Care Medicine.

The SANDWICH trial, conducted in the United Kingdom, evaluated a nurse-led intervention of sedation scoring, goal-based sedation weaning, and protocolized extubation readiness testing. While the original trial demonstrated only a modest reduction in ventilation duration, Dr. Mitting’s subgroup analysis of infants with bronchiolitis found a reduction of median time to successful extubation by approximately 16 to 17 hours.

Dr. Mitting highlights the importance of these findings during the winter season when bronchiolitis drives up PICU occupancy and strain. The critical trade-off between minimizing ventilator days and avoiding extubation failure is discussed, as well as implementation challenges after the COVID-19 pandemic, the importance of protocolized care under resource strain, and future directions for predictive models and personalized strategies to optimize extubation timing.

Listeners will gain practical insights into evidence-based approaches for improving outcomes in infants with bronchiolitis and the broader implications for PICU workflow and patient safety.

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In this episode of the Society of Critical Care Medicine (SCCM) Podcast, host Diane C. McLaughlin, DNP, AGACNP-BC, CCRN, FCCM, speaks with Muhammad Mansoor Mohiuddin, MD, MBBS, DSc (Hon), FAST, director of the Cardiac Xenotransplantation Program at the University of Maryland School of Medicine, about his Thought Leader presentation at the 2025 Critical Care Congress, The Remarkable Potential of Xenotransplantation, and his groundbreaking work on that subject.

Dr. Mohiuddin discusses the need to address the global shortage of donated organs and the use of genetically modified pig organs as a viable solution. He explains the science behind xenotransplantation, including the use of CRISPR-Cas9 gene editing technology to delete immunogenic pig genes and insert human-compatible genes. The conversation explores the unique immunologic challenges of xenotransplantation, particularly antibody-mediated rejection and the need for tailored immunosuppression protocols.

Ethical considerations include religious perspectives and public opinion. Dr. Mohiuddin emphasizes the importance of continued research funding and collaboration with industry partners to advance clinical trials and refine genetic modifications.

Listeners will gain insight into how decades of research are transforming xenotransplantation and its potential to extend life and reshape the future of organ transplantation.

In this episode of the Society of Critical Care Medicine (SCCM) Podcast, host Marilyn Bulloch, PharmD, BCPS, FCCM, speaks with Terry Fulmer, PhD, RN, FAAN, President of the John A. Hartford Foundation, about her Norma J. Shoemaker Honorary Lecture at the 2025 Critical Care Congress and the transformative impact of the 4Ms framework—What Matters, Medication, Mentation, and Mobility—on age-friendly critical care.

Dr. Fulmer shares her journey from bedside critical care nurse to national leader in geriatric health, emphasizing the need to adapt healthcare systems to meet the needs of an aging population. She discusses the development of the Age-Friendly Health Systems initiative, a collaboration among the John A. Hartford Foundation, Institute for Healthcare Improvement, American Hospital Association, and Catholic Health Association. Now implemented in nearly 5000 facilities, the initiative is supported by evidence from models such as the Acute Care of the Elderly (ACE) units, Hospital Outcomes Program for Elders (HOPE) initiative, and Nurses Improving Care for Healthsystem Elders (NICHE) program.

The episode highlights the January 2025 adoption of a Centers for Medicare and Medicaid Services measure that incorporates the 4Ms into inpatient care standards. Dr. Fulmer explains how hospitals of all sizes can implement age-friendly practices using existing resources and how multiprofessional collaboration is key to success. She also discusses findings from a national survey from Age Wave and the John A. Hartford Foundation, which revealed that only 19% of older adults feel their clinicians consistently address all 4Ms.

Listeners will gain insight into how the 4Ms framework improves outcomes and promotes functional recovery in older adults. Whether you're a clinician, educator, or healthcare leader, this episode offers practical strategies and a compelling call to action to join the age-friendly health systems movement.

In this episode of the Society of Critical Care Medicine (SCCM) Podcast, host Samantha Gambles Farr, MSN, AG-ACNP, FNP-C, RNFA, speaks with Brian Boling, DNP, AGACNP-BC, FCCM, an advanced practice provider (APP) in the Department of Anesthesiology, Division of Critical Care Medicine, at the University of Kentucky and host of the Critical Care Scenarios podcast. They explore the challenges and opportunities facing novice nurses and APPs as they transition into new roles in critical care.

Drawing from his own nontraditional path into nursing and advanced practice, Dr. Boling shares how self-directed learning—through podcasts, blogs, and social media—can supplement formal education and foster professional growth. He emphasizes the importance of building a personalized curriculum that balances foundational knowledge with emerging trends and encourages learners to focus not only on hot topics but also on the essential, everyday skills that drive patient outcomes. The conversation highlights strategies for identifying credible educational resources and maintaining work-life balance while pursuing lifelong learning.

Listeners will gain insights into how experienced clinicians can support novice colleagues through informal mentorship and bedside teaching and how honesty about knowledge gaps can lead to deeper learning. Whether you're a new graduate, a transitioning clinician, or a seasoned clinician looking to mentor others, this episode offers practical guidance for education, growth, and leadership in critical care.

Mentorship can be transformative, especially for immigrant critical care professionals navigating unique career challenges. In this episode of the Society of Critical Care Medicine (SCCM) Podcast, host Ludwig Lin, MD, speaks with Fajun Wang, MD, a neurocritical care specialist and assistant professor at St. Louis University School of Medicine, about his experience in SCCM’s Immigrant Critical Care Professional (ICCP) mentorship program.

Dr. Wang shares his journey from medical school in China to building a neurocritical care service line in the United States, highlighting how mentorship shaped his path at every stage. He reflects on the challenges of entering a healthcare system in a new country and emphasizes the benefits of connecting mentors and mentees who share similar backgrounds and experiences. Dr. Wang’s ICCP mentor provided guidance during the launch of his ICU leadership role, offering insights into service line development and support during challenging situations.

The ICCP program, developed from a proposal by José L. Díaz-Gómez, MD, MAS, FASE, FCCM, launched its first six-month pilot in January 2024. The program focuses on five key domains: psychological and emotional support, self-efficacy, career development, scholarly support, and role modeling. A second pilot, currently under way, extends the mentorship to a full year.

This episode will inspire listeners to seek mentorship and community to advance their careers and grow their confidence. Mentorship is not just about guidance—it’s about building relationships that empower individuals to lead, innovate, and give back.