In this episode, Dr. Sergio Zanotti focuses on the nuances of mechanical ventilation in patients with severe asthma. Previously, he explored the medical management of acute asthma exacerbations. Today, he takes a deeper dive into ventilatory strategies tailored to this high-risk population. He's joined by Dr. Emily Damuth, a dual-trained emergency medicine and critical care physician. Dr. Damuth is an Assistant Professor of Medicine and Emergency Medicine at Cooper Medical School of Rowan University and practices clinically in both the Emergency Department and Intensive Care Unit at Cooper University Hospital in Camden, New Jersey. She is also an Assistant Program Director for the Critical Care Medicine Fellowship and is actively involved in the ECMO program. A passionate educator, she teaches mechanical ventilation through lectures and simulation and has received multiple teaching awards for her contributions to medical education.
Additional resources:
Links:
Management of Life-Threatening Asthma. O. Garner, et al. CHEST 2022; https://pubmed.ncbi.nlm.nih.gov/35218742/
Extracorporeal Membrane Oxygenation for Refractory Asthma Exacerbations With Respiratory Failure. J. Zakrajsek, et al. CHEST 2023: https://pubmed.ncbi.nlm.nih.gov/36191634/
Ventilator Graphics and Respiratory Mechanics in the Patient With Obstructive Lung Disease. R. Dhand. Respiratory Care 2005: https://pubmed.ncbi.nlm.nih.gov/15691394/
Books mentioned in this episode:
Seabiscuit: An American Legend. By Laura Hillenbrand: https://bit.ly/3EY24pJ
Pisto: The Life of Pete Maravich. By Mark Kriegel: https://bit.ly/3GIarq6
Good Inside: A Practical Guide to Resilient Parenting Prioritizing Connection Over Correction. By Becky Kennedy: https://bit.ly/4iSTnes
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1:15:00
PADIS Guidelines Update
In this episode, Dr. Zanotti discussed the Society of Critical Care Medicine “Focused Update on the Clinical Guidelines for the Prevention and Management of Pain, Anxiety. Agitation/Sedation. Delirium, Immobility, and Sleep Disruption in Adult Patients in the ICU." This is also known as the PADIS Guidelines. He is joined by Joanna L. Stollings, PharmD, a Board-Certified Pharmacotherapy Specialist and a Board-Certified Critical Care Pharmacotherapy Specialist. Joanna is the Medical Intensive Care Unit (MICU) Clinical Pharmacy Specialist at the Vanderbilt University Medical Center. She also served as vice chair for the PADIS Guideline Focused Update and co-authored the guidelines.
Additional resources:
Society of Critical Care Medicine Focused Update on the Clinical Guidelines for the Prevention and Management of Pain, Anxiety. Agitation/Sedation. Delirium, Immobility, and Sleep Disruption in Adult Patients in the ICU. PADIS 2025 Update: https://pubmed.ncbi.nlm.nih.gov/39982143/
Clinical Practice Guidelines for the Prevention and Management of Pain, Agitation/Sedation, Delirium, Immobility, and Sleep Disruption in Adult Patients in the ICU. PADIS 2018 Guidelines: https://pubmed.ncbi.nlm.nih.gov/30113379/
Link to a previous episode of Critical Matters discussing the PADIS 2018 Guidelines: https://soundphysicians.com/podcast-episode/?podcast_id=342&track_id=635606964
Landing page for the Critical Illness, Brain Dysfunction, and Survivorship (CIBS) Center: https://www.icudelirium.org/
Books mentioned in this episode:
The Prophet. By Kahlil Gibran: https://bit.ly/4lA2Jhx
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46:16
TEE in Cardiac Arrest
In this episode, Dr. Sergion Zanotti discusses TEE in cardiac arrest and shock. Critical care clinicians commonly utilize transthoracic echocardiography in the ICU as part of their point-of-care-ultrasonography (POCUS) toolkit. However, there is a growing push to train intensivists in using transesophageal echocardiography (TEE) for cardiac arrest and peri-arrest situations in the ICU. Our guest is Dr. Sara Nikravan, a cardiothoracic anesthesia critical care physician with training in advanced perioperative echocardiography. Dr. Nikravan is an Associate Professor of Cardiothoracic Anesthesiology and Critical Care Medicine at the University of Washington Medical School and practices at the UW Medical Center. She is recognized as an expert and master educator in Critical Care, Perioperative echocardiography, and Point of Care Ultrasound. She has authored numerous peer-reviewed papers and is the guidelines co-chair of the Society of Critical Care Medicine Guidelines on Adult Critical Care Ultrasonography: Focused Update 2024, recently published in Critical Care Medicine.
Additional links:
Society of Critical Care Medicine Guidelines on Adult Critical Care Ultrasonography: Focused Update 2024, Crit Care Med 2025: https://pubmed.ncbi.nlm.nih.gov/39982182/
Focused Transesophageal Echocardiography During Cardiac Arrest Resuscitation: JACC Review Topic of the Week. JACC 2020: https://pubmed.ncbi.nlm.nih.gov/32762909/
Landing page for the Resuscitative TEE Project website: https://www.resuscitativetee.com/
Books mentioned in this episode:
The Prophet. By Kahlil Gibran: https://www.amazon.com/dp/998247037X?psc=1&smid=ATVPDKIKX0DER&ref_=chk_typ_imgToDp
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1:01:20
AI in Critical Care
In this episode, Dr. Sergio Zanotti explores one of medicine's fastest-evolving frontiers: artificial intelligence (AI). From predictive analytics to decision-support tools, AI is beginning to influence how we deliver critical care — but what does that actually mean for frontline clinicians? Dr. Zanotti is joined by Dr. Sharad Patel, a critical care physician with additional board certification in nephrology and Echocardiography. He is a Critical Care Intensivist at Cooper University Health Care, the assistant program Director for the Internal Medicine Residency Program, and an Assistant Professor of Medicine at Cooper Medical School of Rowan University. Dr. Patel is deeply interested in applying artificial intelligence and technology at the bedside.
Additional resources:
Landing page for New England Journal of Medicine – AI in Medicine section. A multitude of articles and resources on the topic: https://www.nejm.org/ai-in-medicine
Attention Is All You Need. A Vaswani et al. NIPS 2017: https://proceedings.neurips.cc/paper_files/paper/2017/file/3f5ee243547dee91fbd053c1c4a845aa-Paper.pdf
Artificial Intelligence Courses Online: https://www.coursera.org/courses?query=artificial%20intelligence
UDEMY landing page for AI courses. https://www.udemy.com/AI
Books mentioned in this episode:
Meditations. By Marcus Aurelius (Author), Gregory Hayes (Translator): https://amzn.to/4iLvfLA
Thinking Fast and Slow. By Daniel Kahneman: https://bit.ly/4c6pANu
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1:01:00
Challenging dogma in the ICU (Part II)
In a previous episode, Dr. Sergio Zanotti explored the importance of challenging dogma, particularly when the supporting evidence is weak or absent. Today, he continues that discussion by examining critical care practices that persist despite a lack of strong scientific validation. He's joined by Dr. Mervyn Singer, an internationally recognized leader in critical care medicine. Dr. Singer is a professor of intensive care medicine at University College London and a distinguished clinician, researcher, and educator. Through his research, publications, and dynamic presentations, he has inspired Dr. Zanotti — and countless intensivists worldwide — to think critically, challenge conventions, and push the boundaries of our field.
Additional resources:
Challenging management dogma where evidence is non-existent, weak, or outdated: part II. DA Hofmaennner and M. Singer. Intensive Care Med2024: https://pubmed.ncbi.nlm.nih.go
Challenging management dogma where evidence is non-existent, weak, or outdated. DA Hofmaennner and M. Singer. Intensive Care Med 2022: https://pubmed.ncbi.nlm.nih.gov/35303116/
Biomarker-Guided Antibiotic Duration for Hospitalized Patients with Suspected Sepsis. The ADAPT-Sepsis Randomized Clinical Trial. JAMA 2025: https://pubmed.ncbi.nlm.nih.gov/39652885/
Hyperglycemic Crises in Adults with Diabetes: A Consensus Report. Diabetes Care 2024: https://pubmed.ncbi.nlm.nih.gov/38907161/
Books and music mentioned in this episode.
Influenza: The Hundred-Year Hunt to Cure the 1918 Spanish Flu Pandemic. By. Jeremy Brown: https://amzn.to/3Ftb0mO
Beethoven: 9 Symphonies / Karajan 1963: https://amzn.to/3R1M9ZO
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