Trauma ICU Rounds

• Episode 54: Frailty, Geriatric Trauma & TBI with Dr. Bellal Jospeh

  In this episode we sit down with the Chief of Trauma, Surgical Critical Care, Burns,  & Acute Care Surgery at the University of Arizona, Dr. Bellal Joseph, who share with us his thoughts and research findings on hot topics including frailty, geriatric trauma, leadership, and more.Timestamps:00:12  Introductions01:30  What is frailty? Your physiologic NOT chronologic body.06:58  Injured elderly trauma patients can have good outcomes07:30  Trauma specific frailty index10:48  Failure to rescue13:57  Geriatricians and the trauma surgeons 15:08  4Ms-What Matters, Mobility, Mentation, Medication16:48  Geriatric cohorting/wards22:24  ACS geriatric centers of excellence 29:35  Brain Injury Guidelines (BIG)38:17  The importance of teamwork & servant leadership40:28  Imposter syndrome43:19  Leadership considerations45:25  Final thoughtsReferences:Joseph B, Friese RS, Sadoun M, Aziz H, Kulvatunyou N, Pandit V, Wynne J, Tang A, O'Keeffe T, Rhee P. The BIG (brain injury guidelines) project: defining the management of traumatic brain injury by acute care surgeons. J Trauma Acute Care Surg. 2014 Apr;76(4):965-9. doi: 10.1097/TA.0000000000000161. PMID: 24662858.Joseph B, Obaid O, Dultz L, Black G, Campbell M, Berndtson AE, Costantini T, Kerwin A, Skarupa D, Burruss S, Delgado L, Gomez M, Mederos DR, Winfield R, Cullinane D; AAST BIG Multi-institutional Study Group. Validating the Brain Injury Guidelines: Results of an American Association for the Surgery of Trauma prospective multi-institutional trial. J Trauma Acute Care Surg. 2022 Aug 1;93(2):157-165. doi: 10.1097/TA.0000000000003554. Epub 2022 Mar 28. PMID: 35343931.vJoseph B, Pandit V, Haider AA, Kulvatunyou N, Zangbar B, Tang A, Aziz H, Vercruysse G, O'Keeffe T, Freise RS, Rhee P. Improving Hospital Quality and Costs in Nonoperative Traumatic Brain Injury: The Role of Acute Care Surgeons. JAMA Surg. 2015 Sep;150(9):866-72. doi: 10.1001/jamasurg.2015.1134. PMID: 26107247.Joseph B, Pandit V, Sadoun M, Zangbar B, Fain MJ, Friese RS, Rhee P. Frailty in surgery. J Trauma Acute Care Surg. 2014 Apr;76(4):1151-6. doi: 10.1097/TA.0000000000000103. PMID: 24662884.Orouji Jokar T, Ibraheem K, Rhee P, Kulavatunyou N, Haider A, Phelan HA, Fain M, Mohler MJ, Joseph B. Emergency general surgery specific frailty index: A validation study. J Trauma Acute Care Surg. 2016 Aug;81(2):254-60. doi: 10.1097/TA.0000000000001120. PMID: 27257694.Support the show

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• Episode 53: Insights into Modern Critical Care with Dr. Jean-Louis Vincent: Part II

  In this episode, we talk all things critical care the one and only, Dr. Jean-Louis Vincent aka. JLV.  This episode is a MUST listen. We touch upon the evolution of early goal directed therapy, measures of fluid responsiveness, optimizing oxygen delivery, and the importance of integrating data points versus examining  them in isolation when caring for our critically ill and injured patients. This and MUCH MUCH more in arguably one of my favorite episodes to date!!Timestamps00:00 Introduction01:21 What happened to SG catheters and should we use them?04:05 What decreases mortality in critical care patients?05:30 When to transfuse critical care patient? Use your brain! 08:55 Measures of tissue perfusion and fluid responsiveness09:36 JLV breaks down the Rivers trial10:36 Recent EGDT papers 10:54 How to optimize O2 delivery? Late ScVO2, dob challenge, and fluid challenges13:21 Dynamic measures of fluid responsiveness13:46 CVP as a relative value15:14 Passive leg raising (PLR) as a measure of fluid responsiveness21:20 JLV's take on therapeutic nihilism24:45 Don’t isolate; integrate!26:46 Navigating the future of critical care – JLV’s thoughts on AI in the ICU29:55 Rapid fire hot topics in the ICU – Yes or No -Metabolic cocktail-Corticosteroids for septic shock-Albumin and Lasix or Lasix alonePCT/CRP and sepsis/AbxResources:International Symposium on Intensive Care and Emergency Medicine (ISICEM):https://www.isicem.orgISICEM Chats Platform:https://www.isicem.org/e-chat/index.asp          Articles:Passive leg raising:five rules, not a drop of fluid! https://ccforum.biomedcentral.com/articles/10.1186/s13054-014-0708-5The fluid challengehttps://ccforum.biomedcentral.com/articles/10.1186/s13054-020-03443-yBlood lactate levels in sepsis: 8 questionsVincent JL, Bakker J. Blood lactate levels in sepsis: in 8 questions. Curr Opin Crit Care. 2021 Jun 1;27(3):298-302. doi: 10.1097/MCC.0000000000000824. PMID: 33852499.We should avoid the term "fluid overload"https://ccforum.biomedcentral.com/articles/10.1186/s13054-018-2141-7EGDT in the Treatment of Severe Sepsis and Septic Shockhttps://www.nejm.org/doi/full/10.1056/nejmoa010307A Randomized Trial of Protocol-Based Care for Early Septic Shockhttps://www.nejm.org/doi/full/10.1056/nejmoa1401602Support the show

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• Season 3 Trailer

  It's been a while! We are coming to you from our new studio in Victoria on Vancouver Island, BC. This Season is PACKED with incredible content, interviews and educational pearls designed to improve the quality of care that you are deliver daily at the bedside to your patients and their loved ones.Support the show

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• Episode 52: Insights into Modern Critical Care with Dr. Jean-Louis Vincent: Part I

  In this episode, we discuss the overarching importance of AVOIDING iatrogenic harm in the ICU with arguably one of the world's leading experts in critical care medicine, the one and only, Dr. Jean-Louis Vincent aka. JLV.Tune in as Dr. Vincent shares with us the importance of having a systematic, problem-based approach to patient care delivery which, of course, involves giving our patients a FAST HUG every day!Time Stamps:2:10 LA Critical Care and Differences between Europe versus USA4:04 COVID, Modern tech and bedside care5:32 ICU Rounds – How I do it6:00 Team Based ICU Care 7:56 Modern advances in critical care9:55 Problem-based approach in the ICU13:18 FAST HUGS14:00 Feeding14:36 Analgesia & Sedation15:46 Thromboembolic prophylaxis16:25Head of the bed elevated17:17Ulcer prophylaxis19:22Glucose control20:48 Tube feeds, yes? Ulcer ppx , no.22:30 OutroSupport the show

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• Episode 51 - Persistent Inflammation, Immunosuppression & Catabolism Syndrome (PICS) with Dr. Scott Brakenridge

  "Getting patients resuscitated through sepsis, septic shock, and hemorrhagic shock is not the end...it's the beginning."In this episode, Dr. Brakenridge from Harborview Medical Center joins us to discuss PICS and the impact of this syndrome on our critically ill and injured patients and their families. Also referred to as the Post-Intensive Care Syndrome, Dr. Brakenridge shares with us the evolution and results of translational research into this now well-recognized morbid condition which often occurs in the setting of chronic critical illness. From the importance of breaking  the cycle of "sepsis recidivism" to the. application of the SCCM A to F bundle, this episode is a MUST listen for those of us taking care of patients in the ICU.TIME STAMPS00:12  Introduction01:46  What is PICS? The role of chronic critical illness (CCI)05:13  Phenotypes vs. endotypes06:47  The role of biomarkers in PICS08:50  When does acute critical illness turn into CCI?10:14  Risk factors for PICS15: 07  Prognostication and determining patient trajectory18:32  The Glue Grant Experience: Genomics of Injury22:48  Hemorrhagic shock resuscitation: Then and now25:33  Sepsis recidivism & avoiding secondary insults 29:08 ICU delirium31:55  The role of early mobilization32:41  The impact of catabolism in sepsis34:50  Is there a role for anabolic steroids to counteract PICS?37:52  What's ahead in terms of PICS translational research?39:44  Cytokine and immunomodulator therapies41:49  Final thoughtsRECOMMENDED READINGSBrakenridge SC, Wang Z, Cox M, Raymond S, Hawkins R, Darden D, Ghita G, Brumback B, Cuschieri J, Maier RV, Moore FA, Mohr AM, Efron PA, Moldawer LL. Distinct immunologic endotypes are associated with clinical trajectory after severe blunt trauma and hemorrhagic shock. J Trauma Acute Care Surg. 2021 Feb 1;90(2):257-267. Efron PA, Mohr AM, Bihorac A, Horiguchi H, Hollen MK, Segal MS, Baker HV, Leeuwenburgh C, Moldawer LL, Moore FA, Brakenridge SC. Persistent inflammation, immunosuppression, and catabolism and the development of chronic critical illness after surgery. Surgery. 2018 Aug;164(2):178-184. doi: 10.1016/j.surg.2018.04.011. Epub 2018 May 26. Sauaia A, Moore FA, Moore EE. Postinjury Inflammation and Organ Dysfunction. Crit Care Clin. 2017 Jan;33(1):167-191. Stortz JA, Murphy TJ, Raymond SL, Mira JC, Ungaro R, Dirain ML, Nacionales DC, Loftus TJ, Wang Z, Ozrazgat-Baslanti T, Ghita GL, Brumback BA, Mohr AM, Bihorac A, Efron PA, Moldawer LL, Moore FA, Brakenridge SC. Evidence for Persistent Immune Suppression in Patients Who Develop Chronic Critical Illness After Sepsis. Shock. 2018 Mar;49(3):249-258. Support the show

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