Advertise on podcast: PRISM Rounds: Pulmonary Critical Care & Sleep Medicine Podcast

Is your patient "fighting the vent," or are they trying to tell you something? In this episode of PRISM Rounds, we move beyond the traditional "Lung-Protective" paradigm to explore the integrated frontier of Lung- and Diaphragm-Protective Ventilation (LDPV). We deep-dive into the physiological evidence showing that patient-ventilator asynchrony isn’t just a nuisance—it’s a mortality signal. Join us as we break down 30 years of research, from the foundational 1997 Foti study to the cutting-edge 2025 breakthroughs in non-invasive, real-time monitoring. We’ll teach you how to identify the "Goldilocks Zone" of respiratory effort—avoiding both the atrophy of over-assistance and the myotrauma of under-assistance. The Clinical Stakes: Why "clusters" of ineffective efforts and double-triggering are predictors of poor outcomes (Blanch 2015, Vaporidi 2017, Sousa 2021). The Toolset: How to perform and interpret bedside maneuvers like Delta Pocc, P0.1, and PMI without needing an esophageal balloon. The 2025 Horizon: A first look at N-Pmus—the future of non-invasive, real-time waveform monitoring (Lv 2025, Tonelli 2025). The Protocol: A step-by-step walk-through of the Dianti (2022) titration strategy for sedation, PEEP, and sweep gas flow. Target Audience: ICU Fellows, Residents, Intensivists, and Respiratory Therapists. Featured Research & LiteratureBelow are the pivotal studies discussed in this episode. Search these titles on PubMed or your institutional library for full-text access: Tonelli, R., et al. (2025) – Assessing inspiratory drive and effort in critically ill patients at the bedside. (Critical Care) Lv, Y., et al. (2025) – Respiratory effort monitoring: a novel, bedside, non-invasive, real-time method. (Critical Care) de Vries, H. J., et al. (2023) – Performance of Noninvasive Airway Occlusion Maneuvers to Assess Lung Stress and Diaphragm Effort. (Anesthesiology) Dianti, J., et al. (2022) – Strategies for lung- and diaphragm-protective ventilation in acute hypoxemic respiratory failure. (Critical Care) Sousa, M., et al. (2021) – Clusters of Double Triggering Impact Clinical Outcomes (EPISYNC Study). (Crit Care Med) Goligher, E. C., et al. (2020) – Lung- and Diaphragm-Protective Ventilation. (AJRCCM) Bertoni, M., et al. (2019) – A novel non-invasive method to detect excessively high respiratory effort ($\Delta P_{occ}$). (Critical Care) Vaporidi, K., et al. (2017) – Clusters of ineffective efforts during mechanical ventilation: impact on outcome. (Intensive Care Med) Blanch, L., et al. (2015) – Asynchronies during mechanical ventilation are associated with mortality. (Intensive Care Med) #CriticalCare #ICU #MechanicalVentilation #LDPV #Pulmonology #MedEd #PRISMRounds #FOAMed #InternalMedicine #FellowshipTraining #VentilatorManagement #DiaphragmProtection

In this episode of PRISM Rounds, we break down a secondary analysis of the CLOVERS trial examining whether crystalloid choice interacts with resuscitation strategy in sepsis. The key finding: balanced crystalloids were associated with lower mortality in a liberal fluid strategy, while normal saline showed lower mortality estimates in a restrictive strategy. This challenges the idea that fluid choice is independent of how we resuscitate. We discuss the physiology, limitations, and what this means for bedside decision-making—especially during early sepsis management. 📄 Article: https://doi.org/10.1016/j.chstcc.2025.100226 Tags #CriticalCare #ICU #Sepsis #FluidResuscitation #CLOVERS #DAISY #BalancedCrystalloids #NormalSaline #Vasopressors #FOAMed #MedEd #FreeMedEd #MedicalEducation #AIinMedicine #AIResearchSummaries #ClinicalResearch #EvidenceBasedMedicine #PulmCrit #EmergencyMedicine #ICUEducation

In this episode of PRISM Rounds, we break down the CORAL randomized clinical trial published in JAMA evaluating nalbuphine extended-release for chronic cough in idiopathic pulmonary fibrosis (IPF). In this episode, we discuss: The magnitude of cough reduction (~50–60% vs ~17% placebo)Why objective cough monitoring changes trial designDose-response and patient-reported outcomesSafety of a κ-opioid agonist / μ-antagonist strategyWhat this means for pulmonary and critical care practiceThis is one of the first trials to show a strong, clinically meaningful signal for treating IPF-associated cough—an area of major unmet need. 📄 PubMed (CORAL Trial): https://pubmed.ncbi.nlm.nih.gov/38265368/ 📄 JAMA Article: https://jamanetwork.com/journals/jama/fullarticle/10.1001/jama.2025.26179 PRISM Rounds is an audio journal club designed for clinicians who want high-yield, bedside-relevant discussions of new evidence. Tags #FOAMed #CriticalCare #Pulmonary #IPF #InterstitialLungDisease #ILD #ChronicCough #JAMA #RCT #EvidenceBasedMedicine #MedEd #MedicalPodcast #ICU #Respiratory #PulmCrit #JournalClub #Pharmacology #Opioid #Nalbuphine #ClinicalTrials #Healthcare #Medicine #Physicians #MedTwitter #PodcastMedicine #ATS #ERS

In this episode of PRISM Rounds, we break down the 2026 Surviving Sepsis Campaign Guidelines and what they actually mean at the bedside. We focus on the major shifts shaping modern sepsis care: individualized fluid resuscitation, earlier vasopressor use, antimicrobial stewardship, and the move away from rigid protocol-driven management toward precision-informed decision-making. This episode highlights how experienced intensivists are likely to interpret these recommendations in real-world practice and what clinicians should do differently tomorrow. For ICU, ED, and pulmonary/critical care clinicians seeking a high-yield, practical update on sepsis management. Link: https://pubmed.ncbi.nlm.nih.gov/41869847/ Tags #CriticalCare #Sepsis #SepticShock #ICU #FOAMed #PulmCrit #EmergencyMedicine #IntensiveCare #MedEd #MedicalEducation #Guidelines #SurvivingSepsis #SSC #Resuscitation #Shock #Hemodynamics #Fluids #Vasopressors #Antibiotics #Stewardship #Norepinephrine #ICUrounds #JournalClub #PRISMRounds

In this episode of PRISM Rounds, we review the HI-PEITHO trial and its accompanying editorial, both published in The New England Journal of Medicine, and examine their implications for the contemporary management of intermediate-risk pulmonary embolism.The discussion focuses on a clinically consequential subgroup of patients with acute pulmonary embolism who are hemodynamically stable yet demonstrate right ventricular dysfunction, myocardial injury, and signs of physiologic distress. We analyze the trial design, inclusion criteria, primary composite outcome, and safety results, with particular attention to the finding that ultrasound-facilitated catheter-directed thrombolysis was associated with a lower risk of early clinical deterioration, driven largely by a reduction in cardiorespiratory decompensation rather than a demonstrated mortality benefit.We also discuss how these data may influence multidisciplinary Pulmonary Embolism Response Team deliberations, especially when evaluating whether selected patients with intermediate-risk PE may benefit from earlier catheter-based intervention rather than continued observation with anticoagulation alone. The episode places HI-PEITHO in the broader context of prior thrombolysis literature, evolving reperfusion strategies, and the persistent tension between preventing hemodynamic collapse and avoiding bleeding complications.Key topics include patient selection, interpretation of the primary end point, safety considerations, the role of physiologic distress in escalation decisions, and the likely effect of this trial on real-world PERT practice.Primary Article: https://pubmed.ncbi.nlm.nih.gov/41910345/Editorial:https://pubmed.ncbi.nlm.nih.gov/41910345/This episode is intended for educational purposes only and should not be construed as medical advice. Audio is generated using AI voices.Tags#PulmonaryEmbolism #IntermediateRiskPE #VenousThromboembolism #Thrombosis #CriticalCare #IntensiveCare #PulmonaryCriticalCare #EmergencyMedicine #Cardiology #PERT #CatheterDirectedTherapy #Thrombolysis #UltrasoundFacilitatedThrombolysis #EvidenceBasedMedicine #JournalClub #NEJM #MedicalEducation #AcademicMedicine #ClinicalTrials #Resuscitation #AcuteCareMedicine #HospitalMedicine #FOAMed #FOAMcc #PRISMRounds #HI-PEITHO he

Septic shock remains one of the deadliest conditions in intensive care, with mortality near 40% and no widely adopted therapy that directly targets a defined sepsis biology. In this episode of PRISM Rounds, we break down the Tigris trial, the phase 3 randomized study of polymyxin B haemoadsorption in endotoxic septic shock, published in The Lancet Respiratory Medicine on March 23, 2026. We cover the biology of endotoxin-driven shock, the role of the Endotoxin Activity Assay (EAA), why the 0.60–0.89 range mattered so much for treatment selection, and how the investigators used a Bayesian framework informed by prior data from EUPHRATES. We then examine the results, including a 95.3% posterior probability of benefit at 28 days, 99.4% at 90 days, and an estimated number needed to treat of 6.5. Most importantly, we ask the bedside question: does this change practice now, or is it an important signal that still needs confirmation and regulatory follow-through? Full text: https://doi.org/10.1016/S2213-2600(26)00047-0ClinicalTrials.gov: https://clinicaltrials.gov/study/NCT03901807PubMed: https://pubmed.ncbi.nlm.nih.gov/41887242/ Disclosure: Funded by Spectral Medical; conflicts are discussed in the episode. PRISM Rounds is an independent educational podcast and does not provide medical advice. #CriticalCare #Sepsis #SepticShock #IntensiveCare #ICU #PulmonaryCriticalCare #EmergencyMedicine #InternalMedicine #PrecisionMedicine #ClinicalTrials #EvidenceBasedMedicine #MedEd #FOAMed #MedicalPodcast #Healthcare #Medicine #Physician #MedStudent #ResidentLife #Nursing #RespiratoryTherapy

In this episode of PRISM Rounds, we review the NEJM IMPALA-2 trial evaluating inhaled molgramostim for autoimmune pulmonary alveolar proteinosis (PAP). This phase 3 randomized trial showed improved pulmonary gas transfer (DLCO) and quality of life with inhaled GM-CSF compared to placebo, with a favorable safety profile. We break down the pathophysiology, trial design, and what this means for moving beyond whole-lung lavage in PAP. Article: https://pubmed.ncbi.nlm.nih.gov/40834301/ Editorial: https://pubmed.ncbi.nlm.nih.gov/40834306/ Tags: #CriticalCare #Pulmonary #ICU #FOAMed #MedEd #MedicalPodcast #PRISMRounds #NEJM #ClinicalTrials #EvidenceBasedMedicine #PAP #PulmonaryAlveolarProteinosis #GMCSF #Molgramostim #RareDisease #RespiratoryMedicine #ICUEducation #MedTwitter #HealthcareEducation #JournalClub

In this episode of PRISM Rounds, we review the R2D2 ICU randomized trial (JAMA, March 2026) evaluating restrictive vs liberal physical restraint strategies in mechanically ventilated ICU patients.Bottom line: less restraint did not improve delirium or coma—but it also did not increase harm.We break down the trial design, key results, and the bedside implications for sedation strategy, delirium prevention, patient safety, and ICU culture. This is a practice-challenging study that questions routine restraint use while emphasizing individualized, patient-centered care.Key themes: delirium, sedation, safety vs harm, ICU workflow, ethics, and bedside decision-making.PubMed search links:R2D2 ICU Trial: https://pubmed.ncbi.nlm.nih.gov/41841304/ Editorial: https://pubmed.ncbi.nlm.nih.gov/41841296/ Tags#FOAMed #FOAMcc #FOAMICU #MedEd #MedTwitter #CriticalCare #ICU #IntensiveCare #PulmCrit #Resus #JournalClub #EvidenceBasedMedicine #EBM #MedicalEducation #ClinicalTrials #JAMA #Delirium #Sedation #MechanicalVentilation #Ventilator #PatientSafety #ICUculture #Restraints #AirwayManagement #ARDS #Sepsis #HospitalMedicine #EmergencyMedicine #EMCrit #ICUrounds #BedsideTeaching #PCCM #PulmonaryCriticalCare #TraineeEducation #MedPodcast #CriticalCareMedicine #Intensivist #NeuroICU #AcuteCare #MedicalPodcast

In this episode of PRISM Rounds, we break down the new NEJM 2026 COBRRA trial comparing apixaban vs rivaroxaban for acute venous thromboembolism (VTE). Bottom line: in this randomized head-to-head trial, apixaban reduced clinically relevant bleeding compared with rivaroxaban (3.3% vs 7.1%; RR 0.46), including lower major bleeding (0.4% vs 2.4%), with similar observed recurrent symptomatic VTE rates (1.1% vs 1.0%) over 3 months. NEJM trial: Castellucci LA, Chen VM, Kovacs MJ, et al. Bleeding Risk with Apixaban vs. Rivaroxaban in Acute Venous Thromboembolism. N Engl J Med. 2026;394:1051-1060. DOI: 10.1056/NEJMoa2510703. PubMed: https://pubmed.ncbi.nlm.nih.gov/?term=10.1056%2FNEJMoa2510703 NEJM editorial: Moores LK. The COBRRA Trial — Ending the Venous Thromboembolism Safety Toss-up. N Engl J Med. 2026. DOI: 10.1056/NEJMe2600525. PubMed: https://pubmed.ncbi.nlm.nih.gov/?term=10.1056%2FNEJMe2600525 Tags #PRISMRounds #MedicalPodcast #MedPodcast #JournalClub #FOAMed #MedEd #EvidenceBasedMedicine #NEJM #JAMA #JAMAInternalMedicine #VTE #VenousThromboembolism #DVT #DeepVeinThrombosis #PE #PulmonaryEmbolism #Apixaban #Rivaroxaban #DOAC #DOACs #Anticoagulation #Thrombosis #Bleeding #BleedingRisk #Hematology #ThrombosisResearch #InternalMedicine #HospitalMedicine #CriticalCare #ICU #PulmCrit #EmergencyMedicine #EM #CardiovascularMedicine #Pharmacy #ClinicalResearch #RCT #RandomizedTrial #PragmaticTrial #COBRRA #PulmonaryCriticalCare #Trainees #Residents #Fellows #MedTwitter #ClinicianEducation #PracticeChanging #NEJMArticle #AcuteVTE

We break down the 2026 NEJM SOHO trial: high-flow nasal oxygen did not improve 28-day mortality, but it did modestly reduce intubation in acute hypoxemic respiratory failure. We also unpack the NEJM editorial on why mortality may be the wrong endpoint for this kind of ICU support strategy.Trial: https://pubmed.ncbi.nlm.nih.gov/41841715/Editorial: https://pubmed.ncbi.nlm.nih.gov/41841707/Tags#FOAMed #FOAMcc #CriticalCare #ICU #PulmCCM #EmergencyMedicine #RespiratoryFailure #HFNC #HighFlowNasalCannula #AHRF #ARDS #Intubation #MechanicalVentilation #NEJM #JournalClub #MedEd #EvidenceBasedMedicine #EMCrit #RespiratoryCare #AirwayManagement

In this episode of PRISM Rounds, we break down the March 2026 New England Journal of Medicine trial Inhaled Treprostinil for Idiopathic Pulmonary Fibrosis. We review what the trial showed, what it did not prove, how to interpret the FVC signal, the clinical-worsening endpoint, tolerability, and what this means for intensivists, pulmonologists, fellows, residents, and ILD clinicians.We also place the study in context with the earlier INCREASE trial in pulmonary hypertension due to interstitial lung disease. This episode is built for busy clinicians who want practical bedside translation, key teaching points, and concise evidence-based discussion with light professional banter.Full article linksTETON-2 PubMed: https://pubmed.ncbi.nlm.nih.gov/41812190/TETON-2 NEJM: https://www.nejm.org/doi/full/10.1056/NEJMoa2512911INCREASE PubMed: https://pubmed.ncbi.nlm.nih.gov/33440084/INCREASE NEJM: https://www.nejm.org/doi/full/10.1056/NEJMoa2008470Tags#CriticalCare #ICU #Pulmonary #PulmCrit #SleepMedicine #InternalMedicine #Pulmonology #RespiratoryMedicine #IntensiveCare #MedicalEducation #MedEd #FOAMed #FOAMcc #MedTwitter #JournalClub #EvidenceBasedMedicine #MedicalPodcast #PodcastMedicine #IPF #IdiopathicPulmonaryFibrosis #ILD #InterstitialLungDisease #PulmonaryFibrosis #PulmonaryHypertension #PHILD #Treprostinil #InhaledTreprostinil #NEJM #LungDisease #CriticalCareMedicine #AcademicMedicine #BoardReview #Fellowship #Residency #TeachingRounds #ClinicianEducation #RespiratoryFailure #PulmonaryResearch

In this episode of PRISM Rounds, we review the 2026 Journal of the American Heart Association study by Pedamallu et al., with additional perspective from JAMA Medical News. Using MASALA and MESA cohort data, the study found that South Asian adults in the United States had a higher midlife burden of prediabetes, hypertension, and dyslipidemia, and by age 55 had the highest estimated probability of diabetes among the groups studied.We discuss the clinical implications for earlier cardiovascular risk recognition, the limitations of BMI-based reassurance, and why these findings support more proactive prevention conversations while larger interventional studies are still needed.PubMed linksOriginal study: https://pubmed.ncbi.nlm.nih.gov/41669952/JAMA perspective: https://pubmed.ncbi.nlm.nih.gov/41823955/#PRISMRounds #MedicalPodcast #MedicinePodcast #ClinicalPodcast #AcademicMedicine #FOAMed #MedEd #MedicalEducation #JournalClub #EvidenceBasedMedicine #InternalMedicine #CriticalCare #ICU #PulmonaryCriticalCare #CardiovascularPrevention #CardiometabolicRisk #SouthAsianHealth #PrimaryPrevention #Prediabetes #Hypertension #Dyslipidemia #DiabetesRisk #PopulationHealth #HealthEquity #PreventiveCardiology #MASALA #MESA

In this episode of PRISM Rounds, we revisit the landmark New England Journal of Medicine trial “Vasopressin versus Norepinephrine Infusion in Patients with Septic Shock” from February 28, 2008, along with the accompanying Parrillo editorial. We break down what the VASST trial actually showed, why the overall mortality result was negative, and why the “less severe shock” subgroup still shaped bedside practice for years.Along the way, we discuss why septic shock often does not trigger the same urgency as myocardial infarction, what this trial taught us about vasopressin as an adjunct rather than a rescue pressor, and whether low-dose vasopressin truly increased ischemic complications. This is a practical, teaching-rounds style review for fellows, residents, ICU clinicians, and anyone who wants a clearer bedside translation of one of the classic septic shock papers.PubMed linksVASST trial: https://pubmed.ncbi.nlm.nih.gov/18305265/ Editorial: https://pubmed.ncbi.nlm.nih.gov/18305266/ Tags#CriticalCare #ICU #SepticShock #Sepsis #Vasopressin #Norepinephrine #Pressors #Vasopressor #NEJM #MedicalEducation #FOAMed #PulmCrit #EMCrit #InternalMedicine #PCCM #ResidentEducation #FellowEducation #JournalClub #EvidenceBasedMedicine #PRISMRounds

In this episode of PRISM Rounds, we discuss the ARISS trial: JAMA Network Open (Feb 2026), “Albumin Replacement Therapy in Septic Shock: A Randomized Clinical Trial.” We break down the bedside question: If you replace 20% albumin to maintain serum albumin ≥3.0 g/dL in septic shock, does survival improve? We walk through the study design (multicenter, open-label RCT), the key result (no significant difference in 90-day mortality), what “negative but underpowered” really means, and the practical takeaway for rounds tomorrow: this trial does not support routine albumin replacement just to chase an albumin target—though albumin appeared reasonably safe in this context. PubMed: https://pubmed.ncbi.nlm.nih.gov/41712212/ (Educational content only; not medical advice.) Tags #CriticalCare #ICU #Sepsis #SepticShock #Albumin #Fluids #Resuscitation #Vasopressors #MechanicalVentilation #EvidenceBasedMedicine #JournalClub #FOAMed #JAMANetworkOpen #IntensiveCare #PRISMRounds

Stroke alert at 2 a.m. hits different—so in this episode we run “teaching rounds” on the AHA/ASA 2026 Guideline for the Early Management of Acute Ischemic Stroke, published in Stroke. We translate the biggest updates into what you actually do at the bedside: EMS prenotification and destination decisions, rapid imaging workflows (and what not to delay), IV thrombolysis decisions including tenecteplase vs alteplase within the 4.5-hour window, and how to think about disabling vs non-disabling symptoms when NIHSS looks “low.” Then we shift to endovascular therapy: what “expanded eligibility” means in practice, including selected patients with larger ischemic cores, and a clear stance on basilar artery occlusion thrombectomy in the appropriate window. Finally, we cover the underrated stuff that changes outcomes—glucose and blood pressure targets (including what to stop doing out of habit), plus early complications like dysphagia/aspiration risk. PubMed: https://pubmed.ncbi.nlm.nih.gov/41582814/ Tags #Stroke #AcuteIschemicStroke #Neurology #EmergencyMedicine #CriticalCare #ICU #FOAMed #AHA #ASA #Guidelines #StrokeAlert #Thrombolysis #Tenecteplase #Alteplase #MechanicalThrombectomy #EndovascularTherapy #BasilarArteryOcclusion #LargeVesselOcclusion #NeurocriticalCare #EMS #Telestroke #CTAngiography #BPManagement #GlucoseControl #Dysphagia