Saving Lives Podcast: Critical Care w/eddyjoemd

Albumin is one of those topics where everyone has an opinion, but very few people actually look at the cost-benefit data. In this lecture, I’m breaking down why the 5% albumin you’re hanging might be a waste of money, and where the 25% concentration actually moves the needle in septic shock and cardiac surgery.
In this episode, we cover: The "Cool" Science: Where does this stuff come from? (Cold Cohn Fractionation). The Price Tag: Why your hospital administrator cringes when you order it.Sepsis & Septic Shock: What the SAFE and ALBIOS trials actually showed vs. the "statistical gymnastics" used to find a benefit.Cardiac Surgery: Does it help the kidneys or hurt them? (Comparing ALBICS-AKI and HAS-FLAIR II). The Lasix Combo: Is there a real mortality benefit to the albumin-lasix "concoction"?Citations: All data points have PubMed IDs listed in the slides. Please read these for yourself. Disclaimer: This is for educational purposes only and is not medical advice. I’m an ICU physician, but I’m not your physician.
Timestamps:0:00 Intro & Disclaimers 1:45
How Albumin is made (and why the glass bottles?) 4:30
Electrolyte breakdown: Sodium and Chloride concerns 6:00
The actual cost vs. Saline/LR 9:15
Why our patients' albumin levels drop in the first place 12:30
Sepsis survival: The statistical gymnastics 16:00
Septic Shock & 20% Albumin 19:00
Early Resuscitation: Should you wait 6 hours?22:30
Cardiac Surgery: The AKI controversy 26:15
Albumin & Lasix: Does it actually work? 29:00
Final Verdict: Is 5% Albumin dead?

Citations: https://eddyjoemd.com/albumin-in-critically-ill/

The Vasopressor & Inotrope Handbook
Amazon: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://amzn.to/47qJZe1⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ (Affiliate Link)
My Store: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://eddyjoemd.myshopify.com/products/the-vasopressor-inotrope-handbook⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ (Use "podcast" to save 10%)

A new prospective multicenter cohort of 250 patients with shock examines the safety and outcomes of peripheral vasopressor administration. Extravasation events were rare and clustered only after several days of infusion, while norepinephrine use and simple physiologic markers correlated with survival. In this episode, I translate the findings into bedside guardrails—which sites and gauges to use, how to monitor, and when to pivot to a central line.
The Vasopressor & Inotrope Handbook
Amazon: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://amzn.to/47qJZe1⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ (Affiliate Link)
My Store: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://eddyjoemd.myshopify.com/products/the-vasopressor-inotrope-handbook⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ (Use "podcast" to save 10%)
Citation:
Petros A, Melkie A, Kotiso KS, Kebede D, Oljira CF, Assefa Gemechu F, Yusuf H, Abebe S, Ashagre A, Bekele A, Yohannes A, Etesa EK, Bedru M, Gebremariam TH. Peripheral line for vasopressor administration: Prospective multicenter observational cohort study for survival and safety. PLoS One. 2025 Oct 13;20(10):e0333275. doi: 10.1371/journal.pone.0333275. PMID: 41082535; PMCID: PMC12517475.

Intravenous dihydropyridine calcium channel blockers can quietly worsen oxygenation by blunting hypoxic pulmonary vasoconstriction. In this episode, we break down the bedside mechanism, which agents are implicated, who’s at highest risk (post-op atelectasis, obesity, pneumonia, focal ARDS, COPD), how soon it happens, and exactly what to do.
The Vasopressor & Inotrope Handbook
Amazon: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://amzn.to/47qJZe1⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ (Affiliate Link)
My Store: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://eddyjoemd.myshopify.com/products/the-vasopressor-inotrope-handbook⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ (Use "podcast" to save 10%)
Citations:
Weir EK, López-Barneo J, Buckler KJ, Archer SL. Acute oxygen-sensing mechanisms. N Engl J Med. 2005 Nov 10;353(19):2042-55. doi: 10.1056/NEJMra050002. PMID: 16282179; PMCID: PMC2803102.
Weir EK, Olschewski A. Role of ion channels in acute and chronic responses of the pulmonary vasculature to hypoxia. Cardiovasc Res. 2006 Sep 1;71(4):630-41. doi: 10.1016/j.cardiores.2006.04.014. Epub 2006 Apr 27. PMID: 16828723.
Lumb AB, Slinger P. Hypoxic pulmonary vasoconstriction: physiology and anesthetic implications. Anesthesiology. 2015 Apr;122(4):932-46. doi: 10.1097/ALN.0000000000000569. PMID: 25587641.
Timour G, Fréderic V, Olivier S, Shango DN. Nicardipine-induced acute respiratory failure: Case report and literature review. Clin Case Rep. 2023 May 1;11(5):e7186. doi: 10.1002/ccr3.7186. PMID: 37143457; PMCID: PMC10151601.
McMurtry IF, Davidson AB, Reeves JT, Grover RF. Inhibition of hypoxic pulmonary vasoconstriction by calcium antagonists in isolated rat lungs. Circ Res. 1976 Feb;38(2):99-104. doi: 10.1161/01.RES.38.2.99. PMID: 1245025.
Simonneau G, Escourrou P, Duroux P, Lockhart A. Inhibition of hypoxic pulmonary vasoconstriction by nifedipine. N Engl J Med. 1981 Jun 25;304(26):1582-5. doi: 10.1056/NEJM198106253042606. PMID: 7231503.
Kennedy T, Summer W. Inhibition of hypoxic pulmonary vasoconstriction by nifedipine. Am J Cardiol. 1982 Oct;50(4):864-8. doi: 10.1016/0002-9149(82)91246-2. PMID: 7124646.
Chrétien B, Decros JB, Suard F, Dolladille C, Fischer MO, Alexandre J, Descamps R. Hypoxia Associated With Dihydropyridine Calcium Channel Inhibitors: A Pharmacovigilance Study in VigiBase. Clin Pharmacol Ther. 2023 Sep;114(3):686-692. doi: 10.1002/cpt.2970. Epub 2023 Jun 29. PMID: 37309986.
Burghuber OC. Nifedipine attenuates acute hypoxic pulmonary vasoconstriction in patients with chronic obstructive pulmonary disease. Respiration. 1987;52(2):86-93. doi: 10.1159/000195309. PMID: 3671896.
Suard F, Mombrun M, Fischer MO, Hanouz JL, Decros JB, Derville S, Gakuba C, Al Issa G, Menard C, Chretien B, Descamps R. Oxygenation Effects of Antihypertensive Agents in Intensive Care: A Prospective Comparative Study of Nicardipine and Urapidil. Clin Pharmacol Ther. 2025 Mar;117(3):742-748. doi: 10.1002/cpt.3509. Epub 2024 Nov 27. PMID: 39604146.

In this episode of Saving Lives: Critical Care Conversations, we discuss new evidence from the University of Pennsylvania that challenges how we time inotropic therapy in acute decompensated heart failure–related cardiogenic shock.
This retrospective cohort study found that patients who received inotropes within eight hours of meeting SCAI stage C criteria had a 28-day mortality of 17%, compared to 33% in those who received them later. Early inotrope use was also associated with less vasopressor dependence and quicker access to echocardiography and hemodynamic monitoring.
We’ll explore what this means for emergency and critical care practice—how recognizing hypoperfusion early, even in normotensive patients, may improve survival. We’ll also touch on the role of SCAI and SHARC criteria in timely shock identification and management.
Because in cardiogenic shock, the difference between early and delayed therapy might be the difference between life and death.
The Vasopressor & Inotrope Handbook
Amazon: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://amzn.to/47qJZe1⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ (Affiliate Link)
My Store: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://eddyjoemd.myshopify.com/products/the-vasopressor-inotrope-handbook⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ (Use "podcast" to save 10%)
Citation: Greenwood JC, Ratnayake C, Shabbir M, Opitz S, Jang DH, Choi WJ, Panebianco NL, Shofer FS, Augoustides JGT, Bakker J, Wald JW, Abella BS. Timing of inotropic support is associated with mortality in patients with acute decompensated heart failure-associated cardiogenic shock. Intensive Care Med Exp. 2025 Oct 31;13(1):111. doi: 10.1186/s40635-025-00806-z. PMID: 41174190; PMCID: PMC12579036.

In this episode of the Saving Lives Podcast, Eddy Joe breaks down a 2025 Journal of Critical Care study examining how the choice of the internal jugular vein for initial central line placement impacts outcomes when patients later need hemodialysis catheters. You'll learn why using the left IJV first may reduce the need for repeat procedures and complications. Essential insights for optimizing central line strategy in the ICU.
The Vasopressor & Inotrope Handbook
Amazon: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://amzn.to/47qJZe1⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ (Affiliate Link)
My Store: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://eddyjoemd.myshopify.com/products/the-vasopressor-inotrope-handbook⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ (Use "podcast" to save 10%)

Citation: Gharaibeh KA, Abdelhafez MO, Guedze KEB, Siddiqi H, Hamadah AM, Verceles AC. Impact of initial jugular vein insertion site selection for central venous catheter placement on hemodialysis catheter complications. J Crit Care. 2025 Jun;87:155011. doi: 10.1016/j.jcrc.2024.155011. Epub 2025 Jan 3. PMID: 39755012.