Osler Podcasts

CPD Homes will be introduced to Australian-registered doctors in 2024, but what are they for, and what do they mean for you? Chair of the Medical Board of Australia, Dr Anne Tonkin, joins Todd to talk about what lies ahead.See omnystudio.com/listener for privacy information.

Mechanical ventilation is indeed a lifesaving intervention.  However, it is clear that positive pressure ventilation itself has the potential to cause harm.  Novel approaches to ventilation aim to minimise this risk, and one such strategy is the incorporation of oesophageal pressure monitoring.   Tai Pham is a staff intensivist in Paris and an assistant professor at Paris Saclay university.  He completed a PhD in public health where he focussed on respiratory physiology and mechanical ventilation, and is a member of the executive committees for Lung Safe and Wean Safe studies.See omnystudio.com/listener for privacy information.

If you've worked in ICU for very long, you'll recognise the scenario where a patient who is weaning from mechanical ventilation goes into pulmonary oedema.  This syndrome is referred to as weaning induced pulmonary oedema, or WIPO. Dr Rui Shi currently works as an intensivist in the surgical ICU of the First Affiliated Hospital at Sun Yet Sen University in China. Rui has a strong interest in haemodynamic monitoring in critical care in which she has done a PhD, and she joins Todd to talk about this fascinating clinical problem. See omnystudio.com/listener for privacy information.

The ultimate outcome for patients who are resuscitated from cardiac arrest depends heavily on the neurological damage that results from a low flow state.  Prevention of further damage during this phase is one of the core goals of post resuscitation care. In recent years, a multitude of research papers have been produced which examine various aspects of this approach, including oxygenation and blood pressure targets.  One alternative strategy may be to increase cerebral blood flow by allowing mild therapeutic hypercapnoea, an approach studied in the recently released TAME trial.  Principle investigator of the study, Glenn Eastwood, joins Todd on the podcast to discuss the key features and results from this important trial.See omnystudio.com/listener for privacy information.

This podcast comes to you from the 2023 ANZICS Clinical Trials Group Noosa meeting. ECMO (extracorporeal membrane oxygenation) is steadily embedding itself into modern critical care medicine.   Does it have a role in pre-hospital setting for patients with refractory cardiac arrest? In this podcast, we are joined by Aidan Burrell to talk about the SHERPA trial.See omnystudio.com/listener for privacy information.

Non invasive ventilation is steadily establishing itself as a crucial component of the critical care armoury.  While many patients can tolerate it, some require sedation. Wisam Al-Bassam is a staff specialist at Monash Medical center and Victorian Heart hospital.  Wisam is passionate about education and research, and his research interests include mechanical ventilation and sedation in ICU.  He joins Todd to talk about the role of dexmedetomidine in patients on non invasive ventilation in the ICUSee omnystudio.com/listener for privacy information.

DKA causes a serious disturbance of fluid and electrolyte balance.However, it is said that more complications are caused by our management than by the disease itself.  This is no more apparent than in our management of the patient's fluids. Professor Bala Venkatesh is a world renowned intensive care researcher and he joins Todd to discuss the BEST-DKA trialSee omnystudio.com/listener for privacy information.

Sometimes the failing heart needs support, and inotropic agents are often instituted ahead of other measures such as ECMO But is there a best agent? Antoine Kimmoun is a professor of Critical Care Medicine at the University of Lorraine, France, and he joins Todd to discuss these important agents.See omnystudio.com/listener for privacy information.

This podcast comes to you from the 2022 LIVES Conference in Paris Disseminiated intravascular coagulation is the endpoint of a range of different conditions, including sepsis.  How does this important clinical condition evolve, and what can we do about it? Mirjam Bachler is a senior post doc researcher in surgery at the Department of Anaesthesiology and Intensive care Medicine at Innsbruck, Austria.  Her key interests are coagulation in critical care, particularly after inflammatory diseases. She joins Todd to talk about DIC in sepsis.See omnystudio.com/listener for privacy information.

Cardiac arrest causes neurological injury through a sustained period of hypoxia and ischaemia.  It has long been thought that avoiding further hypoxia could save vulnerable brain tissue, leading to the common practice of deliberate hyperoxygenation. However, recent research has suggested this approach may in fact be harmful. Paul Young is an Intensivist and critical care researcher from Wellington in New Zealand, and he joins me to discuss an upcoming study which will further explore this issue, LOGICALSee omnystudio.com/listener for privacy information.

This podcast comes to you from the 25th Annual Noosa meeting of the ANZICS Clinical Trials Group. It is now well recognised that mechanical ventilation, while potentially lifesaving, also causes damage to the lung in its own right.  Careful setting of the ventilator is crucial to avoiding lung injury.  While plateau pressure ceilings have been recommended for many years, research attention is now turning towards driving pressure. Neil Ferguson is the head of critical care at the University Health Network and Mt Sinai  Health Systems in Toronto, and has an extensive research history in critical care ventilationSee omnystudio.com/listener for privacy information.

This podcast comes to you from the 2022 LIVES Conference in Paris Sudden cardiac arrest in the community has historically had a poor prognosis.  Improvements in prehospital care and post resuscitation interventions have raised hopes that overall survival has improved.  But has it? Tommaso Scquizzato is a researcher in the fields of cardiac arrest and resuscitation science at San Raffaele Hospital in Milan, Italy and member of the European resuscitation council BLS Science and Education Committee   You can follow Tommaso on twitter too - @tscquizzatoSee omnystudio.com/listener for privacy information.

Managing bleeding in a patient with severe trauma is a complex process, with multiple interventions occurring in parallel. Derek Kleinveld is an anesthesiology resident at the Erasmus MC in Rotterdam, The Netherlands, and a post-doc researcher with an interest in Trauma Induced Coagulopathy.  He joins Todd to discuss haemostatic resuscitation in trauma.See omnystudio.com/listener for privacy information.

There has been an intense focus on the nutritional needs of ICU patients in recent years, but what happens to them when they go to the wards?This important question is now the subject of interest for highly regarded critical care dietitians and researchers Lee-anne Chapple and Emma Ridley.See omnystudio.com/listener for privacy information.

It is well known that critical illness often features a pro-catabolic state, which can lead to muscle atropy and long term functional deficits.  Early mobilisation has been thought to slow the rate of muscle loss, and potentially improve these outcomes. Professor Carol Hodgson is Head of the Division of Clinical Trials and Cohort Studies, School of Public Health and Preventive Medicine, at Monash University in Melbourne, Australia. She joins Todd on the podcast to talk about the recently released TEAM trial. This is another great interview from the 2022 ANZICS CTG meeting in NoosaSee omnystudio.com/listener for privacy information.

How important is AKI in trauma?  Can we predict which patients will be affected?  What can we do to stop it? These questions and many more have troubled intensive care clinicians as they care for patients after severe trauma.  Dr Anatole Harrois joins Todd on the podcast to talk all-things AKI in traumaSee omnystudio.com/listener for privacy information.

In traumatic brain injury, the lung and the brain are caught in a complex interplay, where the challenges of managing one can affect the other. Chiara Robba is a consultant in Neuro and General Intensive Care at Policlinico San Martino, Genova.  She has a PhD in neuroscience and is the current chair of the NeuroICU section of the ESICM.  Chiara joins Todd to discuss her thoughts on this important issue.See omnystudio.com/listener for privacy information.

Ventilation is known to cause injury to the lungs in its own right, but now it is becoming clear that the respiratory effort of the patient may also contribute to ongoing pulmonary damage. Antonio Pesenti joins Todd to discuss what we know, and the future of research in this area.See omnystudio.com/listener for privacy information.

The SuDDICU trial is now in print.  This long awaited trial explored the merits of Selective Digestive Decontamination (SDD), and in parallel studied its potential impact on the local microbiology resistance patterns. After over 15 years of work, principle investigator Ian Seppelt joins Todd on the podcast to discuss the trial, the results, and what it all meansSee omnystudio.com/listener for privacy information.

COVID-19 is a multisystem disease, and cardiac injury has been identified as a major contributor to the pathology. Antoine Vieillard-Baron is an intensivist and researcher from Boulogne in France, and he joins the podcast to talk about key echocardiographic patterns of disease found in COVID-19See omnystudio.com/listener for privacy information.

Thrombotic microangiopathies are uncommon disorders, and can result in significant patient morbidity.  With the introduction of effective new therapies, the outlook for those suffering from these diseases is increasingly optimistic. Elie Azoulay is a professor of medicine, intensivist and board member of the French National Reference Centre for Thrombotic Microangiopathies.  See omnystudio.com/listener for privacy information.

Surgical site infections are a dreaded complication of all surgery, no more so than in cardiothoracics.  Antibiotics at the time of surgery has an established role in the prevention of infections, but the duration of therapy remains contentious. The CALIPSO trial will explore different approaches to this question, and chief investigator Trisha Peel joins Todd on the podcast to discuss the issue.See omnystudio.com/listener for privacy information.

Does my patient need bolus IV crystalloid fluids?This is a conundrum faced on a daily basis for clinicians working in the ICU.  As time goes by, more evidence of the harm fluids do becomes available, so how can we be sure the fluids we give benefit our patients?Xavier Monnet is an intensivist and fluids researcher, and he joins Todd on the podcast to discuss fluid responsiveness.See omnystudio.com/listener for privacy information.

The development of antimicrobial agents is one of the most influential achievements of modern medicine. However, where once we thought the days of sepsis deaths could be numbered, antimicrobial resistance has given us pause for pessimism. Professor Jan De Waele is a surgery-trained intensivist and clinical researcher from Ghent, Belgium, working on several aspects of optimizing antimicrobial use in the ICU, including Antimicrobial Stewardship.See omnystudio.com/listener for privacy information.

The pathophysiology of ARDS is complex and remains incompletely understood.  However, it is clear that ARDS is not simply a disease of the alveoli. Understanding the pathological basis of ARDS will assist in the development of new therapies for this potentially fatal disease. One such avenue is the role of thrombolysis.  Professor Anders Aneman and Dr Lucy Coupland are leaders of a new program of research looking at this potential intervention.See omnystudio.com/listener for privacy information.

The impact of resuscitation strategies on the gut is often neglected, as attention to circulatory and respiratory support takes priority. Leading ICU dietitian Varsha Asrani joins Todd to chat about the implications of gut ischaemia for the longterm recovery of our patients. See omnystudio.com/listener for privacy information.

Healthcare is a difficult industry to advance in.  Many of us are time-poor and there is little structure to training and learning outside formal college training programs.  Many clinicians are therefore turning to coaching and mentoring for answers.  These concepts are familiar to many in business, but they are only now working their way into mainstream healthcare. In this podcast, Rita Holland joins Todd to discuss the potential benefits of coaching in healthcare See omnystudio.com/listener for privacy information.

Traumatic brain injury is a significant problem, affecting patients of all ages across the globe.  Despite this, relatively little hard evidence supports the interventions commonly used in practice. Research in this area remains challenging, with many barriers to the traditional large-scale randomised controlled trial.  Perhaps alternative sources of evidence are required. In this podcast from the 24th annual ANZICS-CTG meeting in Noosa, Toby Jeffcote joins Todd to discuss these limitations, and how "big data" may provide the solution. See omnystudio.com/listener for privacy information.

In 2002, the critical care world was rocked by a pair of studies released simultaneously in the New England Journal of Medicine, which found that therapeutic hypothermia improved neurological outcomes for unconscious survivors of cardiac arrest. In the almost 20 years that have followed, several trials have produced conflicting results, culminating in the TTM-2 trial released in 2021, which seems to have finally put the issue to rest – cooling to 33 degrees Celsius is no better for patients than 37.5. Niklas Nielsen is Prof Anaes / CC at Lund University in Sweden, and the principle investigator of the TTM-2 trial, and he joins me on the podcast to discuss what's next for hypothermia research. See omnystudio.com/listener for privacy information.

Plasmapheresis can be a life saving intervention in a number of ICU conditions.  Two potential methods are available – centrifugal plasmapheresis and membrane therapeutic plasma exchange.  But what do we know about the applicability, utilisation and complications of the latter? On this episode, Todd is joined by Mitul Chavda and Alpesh Patel, who recently published 6 years worth of prospective data from their service, run from the Flinders Medical Centre in South Australia.   Baxter Healthcare has provided an educational grant to sponsor this podcast. The content was developed independently of Baxter Healthcare and opinions expressed are those of the presenting healthcare professionals.   See omnystudio.com/listener for privacy information.

In this episode of the Careers in Health podcast, Todd chats to Rheumatologist Graeme Jones See omnystudio.com/listener for privacy information.

Part 2 of this interview with CLIP-2 chief investigator Michael Reade explores the structure of CLIP-2, some of the challenges the project has had to overcome, and the workings of a non-inferiority trial. See omnystudio.com/listener for privacy information.

Platelets are a critical component of haemostatic resuscitation, but there are significant challenges involved in their use, most notably, their short shelf life. Could frozen platelets be the answer? Michael Reade is an anaesthetist, intensivist and clinical researcher from the University of Queensland and the Australian Defence Force, and he joins Todd to discuss his research program in this area, known as CLIP See omnystudio.com/listener for privacy information.

Ketamine is regarded as a bit of a wonder drug in emergency and critical care areas, but is it all that it's cracked up to be. Andrew Casamento is an Intensivist  / Emergency Physician at the Northern, Austin, Warringal Private and Bendigo Hospitals in Victoria, and is the author of a recent review of the role of ketamine in mechanically ventilated ICU patients.  He joins Todd on the podcast to discuss some of the important points. See omnystudio.com/listener for privacy information.

Bronchiolitis is a considerable portion of the workload of paediatric ICUs.  As an inflammatory disease process, treatment with corticosteroids may have benefit, and the alpha effects of adrenaline may reduce secretions.  However, evidence remains sparse, while international guidelines are conflicting. Ben Gelbart is a paediatric intensivist from the Royal Children's Hospital in Melbourne, and he joins the podcast to chat about a recently released paper on which he was the lead author, which explore the role of these two agents.   This is the second interview from our podcast series from the 2022 Noosa meeting of the ANZICS CTG See omnystudio.com/listener for privacy information.

Our guest on this podcast is Dr Emma Ridley, Manager of the ICU Nutrition Program at the Monash University ANZICS Research Centre.  She joins me Todd to chat about her survey of nutritional practice in Australasian ICUs, known as Nutrients, presented at the 2022 ANZICS-CTG conference in Noosa. See omnystudio.com/listener for privacy information.

Delirium and sleep deprivation are known to go hand in hand in the ICU. Could melatonin, a readily available, safe and cheap hormonal therapy, improve sleep, and thereby delirium, in a general population of ICU patients? Lead investigator of the recently released ProMEDIC study Dr Brad Wibrow joins Todd to discuss the results of his study. See omnystudio.com/listener for privacy information.

In this Careers in Health podcast, Todd chats to Ear, Nose and Throat surgeon, Dr David McIntosh See omnystudio.com/listener for privacy information.

Interstitial Lung Disease is like a black box for many intensivists.  The complexity of the pathology seems to be only matched by the complexity of the diagnostic classification, and the drug names used to treat them.   James Lindstrom is a dual trained intensivist and respiratory physician in Geelong, Australia, and he joins me to explore some of the issues related to ILD in the ICU See omnystudio.com/listener for privacy information.

It has been said that more people suffer harm from our management of diabetic ketoacidosis than those that do from the disease itself. So how do we avoid these pitfalls in the emergency department? Adan Atriham is an emergency physician from Houston, Texas See omnystudio.com/listener for privacy information.

Unstable patients with tachyarrhythmias may need urgent cardioversion in the emergency department. Dr Eleni Salakidou is a specialist in emergency medicine at the University General Hospital of Heraklion, and she joins Todd on the podcast to share her tips for safe and successful cardioversion. See omnystudio.com/listener for privacy information.

Necrotising fasciitis is a scary disease for even the most experienced of emergency physicians. Dr Michael Gleenberg is an emergency physician and Residency Director at the Assuta Ashdod University Hospital in Israel, and he joins Todd to discuss the identification and management of this important disease process See omnystudio.com/listener for privacy information.

In this episode of the Careers in Health podcast, Todd chats to ophthalmologist, Dr Madeleine Adams See omnystudio.com/listener for privacy information.

Medication errors are a significant challenge to the safety of patients.  Pre-filled syringes represent an opportunity to prevent errors related to medication preparation, and may have additional cost and efficiency savings. Dr Rhys Thomas is an anaesthetist and the Quality and Safety Fellow at John Hunter Hospital in New South Wales.  He joins Todd to share his experiences with pre-filled syringes   Baxter Healthcare has provided an educational grant to sponsor this podcast. The content was developed independently of Baxter Healthcare and opinions expressed are those of the presenting healthcare professional. See omnystudio.com/listener for privacy information.

Many doctors will take leadership positions during their careers, but the skills required to succeed in these roles do not come naturally to all. Hash Abdeen is the Chair of the Council of Doctors in Training for the Australian Medical Association.  He joins Todd on the podcast to chat about his experience in leadership positions, how junior doctors can enhance their skills, and what the AMA CDT is doing to support this. See omnystudio.com/listener for privacy information.

In this episode of the Careers in Health podcast, Todd interviews Dr Sophia Velosa, an endocrinologist with a special interest in Obstetric Medicine See omnystudio.com/listener for privacy information.

The stress of exams, clinical practice, finances and major life events takes a toll on junior doctors.  The added burden of COVID-19 has pushed many to the edge. Tahnee Bridson is an inspiring young doctor who saw an opportunity to help by establishing a peer-to-peer support group, known as Hand 'n' Hand. She joins Todd on the podcast to chat about the project   If you would like to access the serviced provided by Hand 'n' Hand, or are interested in becoming a support facilitator, follow the link below   https://www.handnhand.org.au/join   See omnystudio.com/listener for privacy information.

The critically ill bleeding patient who is taking novel oral anticoagulant medications is a difficult clinical challenge. Dr Barbra Backus is an emergency physician from The Netherlands, and she joins Todd to discuss some of the important issues in managing this problem. See omnystudio.com/listener for privacy information.

In this episode, Todd chats to geriatrician Dr John Endacott See omnystudio.com/listener for privacy information.

Acute cardiogenic pulmonary oedema is a common presenting complaint in the emergency department. Dr Roberto Cosentini is an emergency physician from Bergamo in Italy.  He joins Todd to discuss the use of NIV in the management of these patients. See omnystudio.com/listener for privacy information.

Transcutaneous pacing is an important emergency skill.  In this podcast, senior emergency medicine trainee Dr Tim Balfour joins Todd to discuss the indications for pacing, describe the process of applying and adjusting it, and share some tips and tricks for its use. See omnystudio.com/listener for privacy information.