In this episode, Peter and Leon, recording at the College of Intensive Care Medicine's Conference in Tasmania, Australia, discuss advancements in precision medicine with Dr. Pratik Sinha from Washington University in St. Louis.

Dr Pratik trained in both Emergency and Intensive Care Medicine, but only works clinically as an intensivist. He runs a research program that seeks to change the way we identify and classify critically ill patients, by using a combination of novel biological measurements and state of the art data science approaches.

The conversation delves into how critical care medicine currently operates, emphasizing the need to shift from supportive care to more personalized approaches using biological measuring systems, big data, and novel data science techniques. They discuss identifying patient subgroups using machine learning algorithms and protein biomarkers, revealing phenotypes like hyper and hypo-inflammatory responses. The discussion covers the practical challenges of implementing these technologies, the importance of rigorous testing, and the future implications for intensive care. The speakers highlight the necessity of prospective clinical trials and broader accessibility of these advanced diagnostic tools to improve patient outcomes.

00:00 Introduction and Opening Remarks

00:34 Diving into Precision Medicine

01:35 Elevator Pitch for Medical Research

02:10 Understanding Patient Complexity

04:12 Biological Measurements and Data Science

10:37 Challenges in Modern Medicine

17:08 Future of Medical Research and AI

21:20 Concluding Thoughts and Future Prospects

In this episode of the Critical Care Commute podcast, Dr. Smith discusses the multifaceted future of critical care medicine, touching on economic, political, and technological challenges.

The conversation delves into the role of artificial intelligence in enhancing healthcare, the importance of clinician well-being, and the need for a human touch in medicine.

The discussion also explores personal interests, travel experiences, and the ethical implications of AI in clinical practice, emphasizing the balance between technology and human interaction.

Guests: Drs Marcus Peck and Jonny Wilkinson.

Chapters

00:00 The Future of Critical Care Medicine

02:40 Artificial Intelligence in Healthcare

05:38 Human Factors and Clinician Well-being

08:22 Economic Challenges in Healthcare

11:09 The Role of Politics in Healthcare

14:13 The Turing Test and AI's Evolution

16:41 Personal Interests and Travel Experiences

19:57 AI's Impact on Clinical Practice

22:38 Ethical Considerations of AI in Medicine

25:19 The Future of AI and Human Interaction

The Power of Kindness in Healthcare: A Conversation with Dr. Suzanne Crowe. In this episode, Peter Brindley and Leon Byker speaks with Dr. Suzanne Crowe, pediatric intensivist and president of the Medical College of Ireland, at the College of Intensive Care meeting in Tasmania, 2025.

They explore the significant impact of kindness on patient outcomes, emphasizing its vital role in healthcare. Dr. Crow highlights the necessity of incorporating kindness as a core practice, noting that it reduces mistakes, improves diagnostic accuracy, and fosters better cooperation from patients. They discuss the effectiveness of empathy training and the importance of leadership in fostering a culture of kindness within healthcare systems. Dr. Crow also shares practical tips for healthcare professionals on how to demonstrate kindness in daily interactions, such as sitting beside patients and offering comforting gestures.00:00 Introduction and Guest Welcome00:34 The Power of Kindness in Healthcare01:24 Defining and Recognizing Kindness02:20 Microdosing Kindness in Practice03:19 Teaching and Modeling Kindness03:54 Empathy Training and Its Importance05:07 Challenges and Barriers to Kindness06:57 Kindness in Patient Interactions09:27 Systemic Kindness and Leadership17:17 Empathy Training Techniques19:00 Conclusion and Final Thoughts

Join Peter Brindley and Leon Byker as they host David Bertoni, an ED physician and ECMO clinical lead, and Jorian 'Joe' Kippax, a trauma specialist and reservist, for an incredible story of a remote river rescue in Tasmania.

The team responds to a distress call from a trapped rafting party in the Franklin River, one of Tasmania's most remote and formidable areas. The rescue involves complex logistical challenges, a field amputation, and the use of ECMO technology amidst perilous conditions. The patient, after 20 hours trapped in frigid water, undergoes a harrowing yet successful rescue and recovery. This episode offers a gripping recount of teamwork, medical ingenuity, and human resilience.00:00 Introduction and Guest Overview00:40 Setting the Scene: Remote River Rescue01:39 The Rescue Operation Begins03:13 Challenges and Techniques in the Rescue07:25 Field Amputation and Extraction18:35 Transport and ECMO Preparation23:20 Hospital Arrival and ECMO Procedure26:18 Patient Recovery and Reflections30:45 Conclusion and Final Thoughts

In this episode, we welcome Professor Mervyn Singer, author of Sepsis 3.0. Sepsis remains one of the most complex and deadly conditions in critical care. In this conversation,Professor Singer shares his perspectives on the shifting landscape of sepsis treatment, the role of antibiotics, steroids, metabolic interventions, and the future ofprecision medicine.

He also challenges some long-standing dogmas and emphasizes the importance of individualized care over rigid guidelines.

Key Topics and Chapters:

The Evolution of Sepsis Management

• Historical perspectives on sepsis treatment
• Earlier recognition and intervention leading to improved outcomes

Current Challenges and Research Directions

• Organ dysfunction and recovery in sepsis
• The importance of metabolic manipulation and mitochondrial function

The Role of the Immune System in Sepsis

• Understanding hyper- and hypo-inflammatory responses
• Steroid use in critical illness—when it works and when it doesn’t

Antibiotics in Sepsis: How Soon, How Long, and How Much?

• The changing approach to antibiotic timing and duration
• The impact of microbiome disruption and antibiotic toxicity
• Rethinking the one-hour antibiotic rule

Lessons from COVID-19 and Their Impact on Sepsis Research

• The importance of phenotype-driven treatments
• Missed opportunities in clinical trials and biobanking

The Beta-Blocker Debate in Sepsis

• Potential benefits in selected patients
• The challenge of distinguishing compensatory tachycardia from harmful sympathetic overdrive

Rethinking Fever Management

• Is fever protective or harmful?
• When to treat and when to leave it alone

Guidelines vs. Individualized Care

• The balance between evidence-based medicine and clinical expertise
• The dangers of rigid mandates and protocols

This engaging discussion provides a fresh perspective on the current state and future of sepsis management, emphasizing the need for precision medicine, nuanced clinical decision-making, and ongoing research.

References:

1. Im Y, Kang D, Ko RE, et al. Time-to-antibiotics and clinical outcomes in patients with sepsis and septic shock: a prospective nationwide multicenter cohort study. Crit Care. 2022;26(1):19. Published 2022 Jan 13. doi:10.1186/s13054-021-03883-0 Here
2. Sakkat A, Alquraini M, Aljazeeri J, Farooqi MAM, Alshamsi F, Alhazzani W. Temperature control in critically ill patients with fever: A meta-analysis of randomized controlled trials. J Crit Care. 2021;61:89-95. doi:10.1016/j.jcrc.2020.10.016 Here
3. Hasegawa D, Sato R, Prasitlumkum N, et al. Effect of Ultrashort-Acting β-Blockers on Mortality in Patients With Sepsis With Persistent Tachycardia Despite Initial Resuscitation: A Systematic Review and Meta-analysis of Randomized Controlled Trials. Chest. 2021;159(6):2289-2300. doi:10.1016/j.chest.2021.01.009 Here

Dr. Shannon Fernando is an intensivist at Lakeridge Health and a prolific researcher with over 150 publications. Known for his work in outcomes-based research across critical care, he joins us to discuss long-term outcomes after cardiogenic shock.

About the Episode:

This episode is part of our cardiovascular critical care series and explores what happens after the ICU for patients who survive cardiogenic shock. We unpack quality of life, functional outcomes, mental health, and the hidden burdens on both patients and caregivers. Dr. Fernando provides key data insights from his large cohort studies and shares reflections from ICU follow-up clinics. We also dive into the challenges of prognostication and how to communicate realistic expectations to families.

Topics Covered

Defining Long-Term Outcomes:

• Beyond survival: functional independence, mental health, cognition, and system resource use.

Key Findings from Ontario Cohort

• 42% of cardiogenic shock survivors require increased levels of care

• 15% die within a year post-discharge

• Modest impact of revascularization or mechanical support on long-term outcomes

Morbidity and Quality of Life

• Loss of independence and inability to return to work

• High incidence of PTSD, depression, and caregiver burden

• Delayed functional recovery and unmet expectations

Prognostic Factors and Predictive Markers

• Frailty as a key indicator

• Pre-existing mental health as a predictor of post-ICU mental health outcomes

• In-hospital arrest characteristics: rhythm, downtime, comorbidities

ICU Follow-Up Clinics

• Value in knowledge translation and emotional support

• Real-world insights on functional recovery and patient satisfaction

• Common patient sentiment: gratitude mixed with trauma

• Communication with Families

• Avoiding value imposition

Emphasizing trajectory over fixed timelines

• Balancing hope with realism

Rethinking Endpoints in Research

• Limitations of 28-day mortality

• Need for patient-centered, long-term functional outcomes

• Trajectory-based data over snapshot metrics

• Knowledge Translation as the Intervention

Equipping clinicians and patients with realistic expectations

• Normalizing psychological responses

• Shaping future research directions around lived experience

In this episode, recorded live at CCCF 2024, we sit down with Dr. Emilie Belley-Côté, a cardiac intensivist, researcher, and clinical trialist from McMaster University, to unpack cardiogenic shock: the SCAI classification.

Whether you're in the ED, cath lab, or ICU, the SCAI (Society for Cardiovascular Angiography and Interventions) stages offer a common language to describe the severity of cardiogenic shock, guide escalation of care, and improve outcomes through structured assessment.

Dr. Belley-Côté walks us through:

• The five SCAI stages (A through E): what they mean and how they’re used.

• How this classification system improves communication between specialties.

• The importance of recognizing patients in pre-shock (Stage B) before they deteriorate.

• Real-world application: how SCAI staging intersects with clinical signs, biomarkers, and hemodynamic monitoring.

• Where the SCAI classification fits in research, including trials evaluating mechanical circulatory support and advanced heart failure therapies.

With Dr. Belley-Côté’s clear explanations and insights from the front lines of cardiac critical care, this episode is essential listening for anyone managing unstable cardiac patients.

In this episode, we’re joined by Dr. James Downar, a leading Canadian voice in palliative and critical care, for a wide-ranging discussion on the emerging role of psychedelics in managing psychological and existential distress.

Psychedelics have gone from fringe to forefront in recent years, and we dig into what that shift might mean for patients facing critical illness or the end of life.

What psychedelics are and how they work

• Substances like psilocybin, LSD, ketamine, and MDMA

• Key effects: altered perception, ego dissolution, and emotional insight

• Risks and benefits in vulnerable populations

Psychedelic-assisted therapy: structure and process

• The three-phase model: preparation, the session itself, and integration

• Micro dosing vs. full therapeutic sessions

• Where current evidence stands

Potential applications in critical care and palliative medicine

• Helping patients process fear, isolation, and suffering

• How psychedelics differ from traditional symptom management tools like opioids

• Limitations in advanced illness due to physiological concerns

Research and implementation challenges

• Problems with study design and placebo controls

• The importance of ‘set and setting’

• Defining success in existential or spiritual distress

Ethical considerations and clinical integration

• Balancing innovation with compassion and caution

• Avoiding reductionism: why psychedelics should complement—not replace—human care

• The future role of these therapies in ICU and palliative settings

Recorded live at the Canadian Critical Care Forum 2024 in Toronto, this episode dives into the complex world of ischemia-reperfusion syndrome — the paradox where restoring blood flow causes further injury. We explore the underlying mechanisms, clinical implications, and future directions in managing this phenomenon.

Joining us for the third time is Prof. Mervyn Singer, ICU physician, researcher, and thought leader in critical care physiology. Known for challenging dogma and making complex science accessible, Prof. Singer unpacks this important topic with clarity and insight.

Dr. Mike Christian is a critical care and pre-hospital medicine specialist with extensive experience in aeromedical transport and military medicine. His diverse career spans work as a paramedic, internal medicine and critical care training, and roles as a flight physician with London Air Ambulance and the Canadian military. He is a leading advocate for integrating interprofessional teams and advancing physician-led pre-hospital care in Canada. Currently, he is involved in the MedResponse BC initiative, which aims to enhance critical care delivery outside of hospitals.

In this episode, Peter and Leon sit down with Mike to explore the evolving landscape of pre-hospital critical care. From his unconventional career path to the integration of AI in emergency response, he shares insights on improving outcomes in pre-hospital medicine and the lessons Canada can learn from global high-performance systems.

Key Topics & Chapters

Mike’s Career Journey

• From paramedic to physician: an unconventional path

• Military and aviation medicine experience
• The shift to leadership in pre-hospital care

Pre-Hospital Critical Care: Canada vs. The World

• How Canada’s HEMS (Helicopter Emergency Medical Services) differs from global models
• Lessons from the UK, Australia, and Denmark
• The role of AI in dispatch and triage

The Role of Physicians in Pre-Hospital Medicine

• The evolving need for physician-led care outside the hospital
• The impact of interprofessional teams on survival rates
• Mentorship, coaching, and cultural change in pre-hospital systems

The Role of the Physician in Pre Hospital Medicine.

• AI-powered dispatch and GoodSAM app in improving CPR and trauma response
• Scoop and run vs. stay and play: What actually saves lives?
• Addressing Canada’s geographical challenges with rural and remote care

Future Directions in Pre-Hospital Medicine

• The rise of telemedicine and virtual ICUs
• Developing triage physicians and training programs
• MedResponse BC: A new model for interprofessional pre-hospital care

Keywords:

Pre-hospital care, critical care transport, HEMS, trauma response, paramedics, physician-led pre-hospital medicine, telemedicine, AI in emergency medicine, interprofessional teams, rural emergency care, GoodSAM app, London Air Ambulance, MedResponse BC.

Links of Interest:

1. CCCF Presentation:  https://youtu.be/MVDHaYaZRSI  (Web view)
2. Recent Publication:  https://doi.org/10.1186/s13049  (Web view)