Central venous access remains foundational to the delivery of critical care, yet the techniques used for central line insertion have evolved minimally since the introduction of the Seldinger method more than 70 years ago. This relative stagnation persists despite increasing patient complexity and heightened expectations for procedural safety, efficiency, and reliability.

This episode of the Society of Critical Care Medicine (SCCM) Podcast examines how procedural variability and fragmented workflows continue to contribute to risk during central venous catheter insertion in critically ill patients. It also considers the growing need to reassess long-standing approaches that may no longer align with the demands of contemporary ICU practice. Host Kyle B. Enfield, MD, speaks with Adnan Javed, MD, about emerging insertion techniques and integrated technologies designed to simplify procedural steps, reduce variability, and support more consistent performance at the bedside.

Through a focused exploration of innovation in procedural design, this discussion highlights how streamlined, integrated approaches may enhance clinician performance, improve safety, and advance the standard of care in high-acuity environments. This episode provides a critical perspective on the future of central venous access and the role of innovation in transforming a commonly performed, yet high-stakes, procedure.

This episode is sponsored by BD.

Learning Objectives

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Effective transitions of care are vital, particularly for children who have spent months in the neonatal intensive care unit (NICU). In this episode of the Society of Critical Care Medicine (SCCM) Podcast, host Maureen A. Madden, DNP, RN, CPNP-AC, CCRN, FCCM, speaks with Philip D. Cohen, MD, MSc, about his article, “Non-Emergent Neonatal ICU-to-PICU Transfers in the United States: Cross-Sectional Survey of Neonatologists and Pediatric Intensivists,” published in the May 2026 issue of Pediatric Critical Care Medicine.

Drawing on responses from neonatologists and pediatric intensivists across the United States, Dr. Cohen examines the challenges associated with transferring patients from the NICU to the pediatric intensive care unit (PICU) for ongoing care. Although these transfers occur infrequently, with a median of only five to six non-emergent transfers annually per institution, they often involve children with prolonged hospitalizations, significant medical complexity, and deeply established relationships with NICU care teams.

Survey findings suggest broad agreement among neonatologists and pediatric intensivists that standardized protocols are needed and that structured approaches improve the effectiveness of transfers. Key themes include multidisciplinary handoffs, earlier identification of transfer candidates, family-centered communication, and greater collaboration between NICU and PICU teams before and after transfer.

Dr. Cohen also explores opportunities for implementation science to advance this work, emphasizing the importance of incorporating perspectives from parents and caregivers, nurses, and advanced practice providers. This discussion will educate and inspire pediatric critical care teams seeking to improve continuity of care through adaptable, evidence-informed frameworks.

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Sepsis management has traditionally focused on timely antibiotic treatment, hemodynamic support, and source control, but emerging evidence suggests that outcomes may be shaped long before patients reach the ICU. In this episode of the Society of Critical Care Medicine (SCCM) Podcast, host Diane C. McLaughlin, DNP, AGACNP-BC, CCRN, FCCM, speaks with Sayed Abdulmotaleb Almoosawy, MBChB (Hons), about his article “The Association Between Socioeconomic Position and Mortality in Patients With Sepsis and Septic Shock—A Systematic Review and Meta-Analysis,” published in the April 2026 issue of Critical Care Medicine.

Drawing on 13 observational studies that encompassed nearly 4 million patients, the analysis evaluates how factors such as insurance status, income, education, and neighborhood deprivation relate to short-term mortality outcomes. The findings reveal a consistent association between lower socioeconomic position and increased mortality, with lack of private insurance demonstrating the strongest signal—likely reflecting barriers to timely access to care and delayed presentation.

This episode challenges clinicians and researchers alike to recognize the link between socioeconomic disadvantages and worse sepsis outcomes, highlighting the need to collect equity-relevant data and reduce gaps in care to improve survival for critically ill patients.

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Long after acute infection has resolved, many survivors of severe COVID-19 experience persistent symptoms. Understanding the causes of long COVID and developing effective treatments pose a challenge for clinicians and researchers alike. In this episode of the Society of Critical Care Medicine (SCCM) Podcast, host Kyle B. Enfield, MD, speaks with Matthew Baldwin, MD, MS, about his article published in the March 2026 issue of Critical Care Explorations that examines post-acute sequelae of COVID-19 in acute lung injury (ALI) and acute respiratory distress syndrome (ARDS) survivors over a three-year period.

One of the study’s most notable findings is that approximately one in four study patients, many of whom were middle-aged and previously healthy, continued to meet criteria for long COVID three years after infection. This finding emphasizes the burden of chronic illness caused by COVID-19 infection and the need to focus research and treatment efforts on this population of ALI/ARDS survivors.

Drs. Baldwin and Enfield discuss the relevance of inflammatory, thromboinflammatory, and endothelial biomarkers in understanding illness due to COVID-19. Surprisingly, the study found no association between long COVID symptoms and these biomarkers. Dr. Baldwin contextualizes this finding and encourages future studies to employ multiomics to better uncover the underlying mechanisms of these symptoms.

The discussion emphasizes the patient-centered approach of the study, which examines functional outcomes as well as biomarkers. Dr. Baldwin encourages clinicians to validate the experiences of severe COVID-19 survivors and guide them towards the next step in their recovery as researchers continue to look for better therapies.

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Propofol remains a cornerstone sedative for mechanically ventilated critically ill patients and is supported by PADIS guidelines and favored for its rapid onset, titratability, and limited side effects. However, its use in hemodynamically unstable patients remains a persistent clinical dilemma. In this episode of the Society of Critical Care Medicine (SCCM) Podcast, host Kyle Enfield, MD, is joined by Scott Benken, PharmD, MHPE, BCCCP, and Nathan Smischney, MD, MS, to explore the risks, benefits, and evolving evidence surrounding propofol use in this high-risk population.  

The discussion examines the physiologic basis of propofol-associated hypotension and how that can manifest in different patients, such as those with sepsis and septic shock. Patient selection and real-time assessment of hemodynamic trends are essential. Additional considerations include the recognition of and monitoring for propofol infusion syndrome, a rare but life-threatening complication.  

The episode also explores alternative drugs such as dexmedetomidine and ketamine, highlighting the benefits and risks of each. Emerging strategies are discussed, including a ketamine-propofol combination called ketafol and its utility in balancing sedation and hemodynamic stability. 

Listeners will gain expert insights into propofol use in the ICU and a deeper understanding of patient-centered approaches to sedation. 

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Sustaining critical care delivery in today’s healthcare environment requires more than resilience—it also calls for collective solutions to systemic challenges.

In this episode of the Society of Critical Care Medicine (SCCM) Podcast, Past President Jose L. Pascual, MD, PhD, FRCS(C), FACS, FCCM, elaborates on the session presented during the 2026 Critical Care Congress, Critical Care Under Pressure: Sustaining the Workforce and Infrastructure Amid Rising Demands.

Joined by host Marilyn Bulloch, PharmD, BCPS, FCCM, Dr. Pascual examines the complex forces reshaping critical care, from shrinking ICU capacity and hospital closures to persistent workforce shortages and shifting training pipelines. He highlights concerning trends such as reduced entry into certain critical care pathways, particularly anesthesiology. At the same time, he points to encouraging growth in other pathways, with increasing participation from clinicians in emergency medicine, neurology, and surgery.

The conversation underscores disparities in access to care, particularly for rural and community hospitals. Dr. Pascual explores the tension between the regionalization of specialized care and the need to maintain equitable access across health systems, emphasizing the importance of thoughtful resource distribution and collaboration across institutions. Beyond workforce numbers, the evolution of leadership in critical care is also impactful, including the migration of experienced clinicians into administrative roles and the potential need for cyclical leadership models that maintain clinical engagement.

Meeting these challenges requires innovation and cooperation. Dr. Pascual highlights advancements in education, particularly the expansion of simulation-based training, as critical tools for maintaining competency and improving team performance.

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Sepsis is a global health emergency, with nearly half of all septic patients being children.

In this episode of the Society of Critical Care Medicine (SCCM) Podcast, Samantha Gambles Farr, MSN, NP-C, CCRN, RNFA, speaks with Niranjan Kissoon, MD, MBBS, FRCP(C), FACPE, MCCM, about his Thought Leader presentation at the 2026 Critical Care Congress, Making Sepsis the Next Success Story in Global Health. The panel also discusses how access and equity play a part in how sepsis is treated.

From a global perspective, Dr. Kissoon emphasizes that the most important thing is advocacy and prevention from a governmental level by creating national action plans, making sure the healthcare system is resilient, and utilizing technology and innovation to create better ways of providing care; and from a societal level by educating patients and families about nutrition, hygiene, vaccinations, and seeking care early.

Niranjan Kissoon, MD, MBBS, FRCP(C), FACPE, MCCM, is a professor in the Department of Pediatrics (Pediatrics and Surgery, Emergency Medicine) at the University of British Columbia in Vancouver, British Columbia, Canada. He is the past president of the World Federation of Pediatric Critical and Intensive Care Societies and currently serves as president of the Global Sepsis Alliance. He is cochair of the pediatric Surviving Sepsis Campaign, vice president of the Canadian Sepsis Foundation, and chair of World Sepsis Day and the International Pediatric Sepsis Initiative. He also serves on the Sepsis Alliance USA and the African Sepsis Alliance advisory boards and is also a founding member of the Caribbean Sepsis Alliance.

What is precision medicine, and how should precision medicine be handled in the face of guidelines and protocols?

In this episode of the Society of Critical Care Medicine (SCCM) Podcast, Diane C. McLaughlin, DNP, AGACNP-BC, CCRN, FCCM, speaks with Michael R. Pinsky, MD, FAPS, MCCM, about his Thought Leader presentation at the 2026 Critical Care Congress, The Effective Management of Shock: Moving From Physiology to Guidelines to Precision Medicine and Ultimately Personalized Medicine. The panel also discusses how to titrate care for individual patients.

Protocols and guidelines are the foundation for patient care and are instrumental for having all healthcare professionals on the same baseline when treating patients. Precision medicine involves individualizing care for a specific patient, and Dr. Pinsky emphasizes that guidelines should never supersede an understanding of pathophysiology at the bedside, including observing your patient and paying attention to how individual patients respond to specific treatments. Monitoring the individualized response is required for the best care.

Michael R. Pinsky, MD, FAPS, MCCM, is a professor of critical care medicine, bioengineering, and anesthesiology at the University of Pittsburgh in Pittsburgh, Pennsylvania, USA. He is also Docteur Honoris Casusa at the Université René Descartes Paris V School of Medicine in Paris, France. In 2012, he became one of the first 20 critical care physicians to receive a Master of Critical Care Medicine (MCCM) from SCCM. He is currently an emeritus (honorary) at UPMC. At the University of Pittsburgh, he is vice-chair emeritus for the Department of Critical Care Medicine and a faculty member at the Center for Critical Care Nephrology and the Center for Military Medicine Research.

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In this episode of the Society of Critical Care Medicine (SCCM) Podcast, Diane C. McLaughlin, DNP, AGACNP-BC, CCRN, FNCS, FCCM, is joined by Aarti Sarwal, MD, FAAN, FNCS, RPNI, FCCM, and Brian L. Erstad, PharmD, FCCP, FASHP, MCCM, to discuss the 2026 guidelines for neuromuscular blockade in adult patients with acute respiratory distress syndrome.

The guidelines, “Society of Critical Care Medicine Guidelines for the Administration of Neuromuscular Blockade in Adults With Acute Respiratory Distress Syndrome,” were published in the March issue of Critical Care Medicine.

Drs. Sarwal and Erstad discuss how the evidence in two key trials, ACURASYS and PETAL-ROSE, has helped shape the recommendations provided in the SCCM guidelines. Despite how influential these trials were in shaping the recommendations, only conditional recommendations were made due to low or very low quality of evidence. The lack of evidence proved to be a driving factor in including a call to action in the guidelines. Future research priorities largely revolve around precision medicine and finding more patient-specific interventions to improve patient outcomes.

Aarti Sarwal, MD, FAAN, FNCS, RPNI, FCCM, is a professor of neurology and the division chair of neurocritical care at Virginia Commonwealth University (VCU) School of Medicine in Richmond, Virginia, USA. She is also an associate editor of Critical Care Medicine, secretary of the American Society of Neuroimaging, and director of VCU-Wake Forest neuro-ultrasound courses. Brian L. Erstad, PharmD, FCCP, FASHP, MCCM, is a tenured professor and interim dean at the University of Arizona R. Ken Coit College of Pharmacy in Tucson, Arizona, USA. He is also a center investigator for the Center for Health Outcomes, a member of the BIO5 Institute and Comprehensive Center for Pain & Addiction and Pharmacoeconomics Research Center, and a codirector for the Arizona Clinical and Translational Research Graduate Certificate Program.

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Older adults consist of approximately half of the patients in the ICU, with that number expected to grow in the coming decades.

In this episode of the Society of Critical Care Medicine (SCCM) Podcast, host Marilyn N. Bulloch, PharmD, BCPS, FCCM, is joined by Bram Rochwerg, MD, MSc(Epi), FRCPC, FCCM, and Lauren E. Ferrante, MD, MHS, to discusses new guidelines on caring for older adults in the ICU and the difficulties in finding research that focuses on those patients.

The guidelines, “Society of Critical Care Medicine Guidelines on Caring for Older Adults in the ICU,” will be published in an upcoming issue of Critical Care Medicine.

The panel details the process and methodology behind the guidelines, the dearth of studies focusing on older patients in the ICU, and the difficulty of finding studies that enroll older adults who are on multiple medications. The guidelines offer two conditional recommendations and offer priorities for aging-friendly research topics to help provide stronger guidance in the future.

Bram Rochwerg, MD, MSc(Epi), FRCPC, FCCM, is an associate professor, intensivist, and researcher based at McMaster University in Hamilton, Ontario, Canada, who focuses on intravenous fluid use in sepsis, the role of corticosteroids in acute hypoxemic respiratory failure, and clinical practice guideline methodology. Lauren E. Ferrante, MD, MHS, is an associate professor of medicine in the section of pulmonary, critical care, and sleep medicine at the Yale School of Medicine; director of the operations core of the Yale Claude D. Pepper Older Americans Independence Center; and an attending physician in the medical intensive care unit at Yale-New Haven Hospital in New Haven, Connecticut, USA.

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