ResusX:Podcast

Is Ketamine really the "hemodynamically stable" hero of airway management, or have we been unfairly vilifying Etomidate for decades? The debate over the perfect induction agent for critically ill patients just got a major influx of data that flips conventional wisdom on its head . In this episode, we break down the landmark "RSI" trial, a massive multicenter randomized controlled study involving over 2,300 critically ill adults in EDs and ICUs across the US . The headline results are a shocker: Ketamine did not reduce 28-day mortality compared to Etomidate . Even more surprising? The "hemodynamically neutral" reputation of Ketamine took a hit. Patients randomized to Ketamine actually experienced significantly higher rates of cardiovascular collapse—including hypotension and increased vasopressor needs—during intubation compared to those receiving Etomidate . We unpack what this means for your next shift: why the theoretical fears of Etomidate-induced adrenal suppression didn't translate to patient harm, and why Ketamine might be less forgiving in shock states than we previously thought . Tune in as we dissect the data and discuss whether it’s time to stop hesitating and reach for the Etomidate.

Is the "best of both worlds" actually saving lungs, or just complicating care? Theoretically, combining the powerful pressure support of Non-Invasive Ventilation (NIV) with the comfort and washout mechanisms of High-Flow Nasal Cannula (HFNC) sounds like the ultimate strategy to prevent intubation . But does this physiological synergy actually translate to patient survival? In this episode, we break down a new meta-analysis from the American Journal of Emergency Medicine that pooled data from six RCTs and over 700 adults with Acute Respiratory Failure (ARF) . The researchers investigated whether alternating or combining these devices as an initial strategy is superior to using just one alone . The headline result might surprise you: the study found no significant reduction in intubation rates or mortality compared to monotherapy . However, don't write off the combo just yet—the devil is in the details. We explore a fascinating data split where the efficacy of the combination hinged entirely on lung-protective strategies . We discuss why unchecked tidal volumes during NIV might be masking the benefits of the combination, leading to ventilator-induced lung injury (VILI) . Tune in for a critical look at why "more support" isn't always "smarter support," and how to identify the specific patients who might still benefit from this tag-team approach .

For decades, a single dogma has ruled neurotrauma resuscitation: Never use ketamine in TBI. The historical fear that ketamine spikes intracranial pressure (ICP) has kept one of the most versatile, hemodynamically friendly induction agents on the shelf—but is that fear based on fact or outdated physiology? In this episode, we dissect a massive 2026 systematic review and meta-analysis from the Journal of Critical Care . By analyzing over 6,000 patients across 15 studies—including four RCTs and strictly post-2015 data—this paper puts the "old myth" to the ultimate test . We break down how the researchers compared ketamine against other agents like propofol and etomidate to evaluate hospital mortality, ICP crises, and adverse events in both adult and pediatric populations . The findings are practice-changing. The data reveals zero association between ketamine use and ICP spikes or increased mortality, effectively debunking the classic contraindication . However, the review uncovers a controversial "plot twist": a potential link to hypotension that challenges our assumptions about ketamine's stability in catecholamine-depleted trauma patients . Tune in as we analyze the "study dominance bias" that complicates these hemodynamic results and discuss exactly how this evidence should reshape your airway strategy for the severe TBI patient .

In this episode, we tackle one of the most persistent questions in perioperative care: how low is too low when it comes to hemoglobin in high-risk cardiac patients after major surgery? The long-standing restrictive threshold of 7 g/dL has been considered safe for years, but the TOP Trial challenges that comfort zone. More than 1,400 high-risk veterans were randomized to either a liberal transfusion strategy (Hgb <10 g/dL) or a restrictive one (Hgb <7 g/dL). The primary outcome showed no significant difference in death or major ischemic events. That part was expected. The surprise came in the secondary outcomes. Patients in the restrictive group had nearly double the rate of non-fatal cardiac complications, including new heart failure and dangerous arrhythmias. The liberal strategy cut those complications by almost 40 percent. This episode breaks down what these findings mean for real-world practice, how they challenge current transfusion guidelines, and when you might reconsider your trigger for your most vulnerable post-op patients. If you take care of surgical patients with cardiac risk, this is an episode you cannot skip.

Can a Single Word Change the Culture of an ICU? Burnout is an epidemic in our Intensive Care Units, affecting staff well-being, patient care, and even hospital costs. But what if the solution to this widespread problem was simpler than we think? This week, we’re diving into the Hello Trial, a massive 1:1 cluster-randomized controlled trial conducted across 370 ICUs in 60 countries. Researchers tested a simple, four-week, unit-based intervention designed to promote positive workplace culture and within-team support using tools like posters, email nudges, positive message boxes, and role modeling. The results are practice-changing: The intervention significantly reduced burnout prevalence from 63.3% in the control group to 52.2% in the intervention group (P < 0.001). It improved perceptions of job satisfaction, workplace safety, ethical climate, and patient- and family-centered care. Staff in the intervention arm were less likely to consider changing jobs. They also had lower emotional exhaustion, lower depersonalization, and higher personal accomplishment scores. Here’s the bedside “so what”: A pragmatic, system-level focus on positive communication and team cohesion can rapidly and meaningfully shift your unit’s culture—directly improving staff well-being. Forget the individual-focused, time-draining wellness programs. The answer might be in a simple, collective shift in how we interact. Tune in as we break down the specific components of the Hello intervention and how you can bring this powerful, low-cost strategy to your ICU.