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Challenging management dogma where evidence is non-existent, weak, or outdated: part II.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Challenging management dogma where evidence is non-existent, weak, or outdated.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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54:28
Adult congenital disease in the ICU
Due to advancements in medical and surgical care, the survival of patients with congenital conditions into adulthood has dramatically increased. However, as these individuals transition to adulthood, their unique physiology, chronic complications, and evolving care needs create significant challenges for their management when they are admitted to adult intensive care units (ICUs). This episode will discuss adult congenital disease in the ICU. Dr. Zanotti is joined by Dr. Cameron Dezfulian, a pediatric and adult critical care physician. He is the director of the Adult Congenital Heart Disease Program Development for the Section of Critical Care at Texas Children's Hospital and a faculty member at Cardiothoracic Critical Care at Baylor St. Luke's Medical Center. He is also a Senior Faculty member at Baylor College of Medicine in Houston, Texas.
Additional resources:
ACC/AHA 2008 Guidelines for the Management of Adults With Congenital Heart Disease. Circulation 2008: https://www.ahajournals.org/doi/pdf/10.1161/CIRCULATIONAHA.108.190690
Special Considerations in Critical of the Congenital Heart Disease Patient. E Neethling, et al. Can J Cardiol. 2023: https://pubmed.ncbi.nlm.nih.gov/36682483/
Management of the Critically Ill Adult with Congenital Heart Disease. WB Kratzert, et al. J Cardiothorac Vasc Anesth 2018: https://pubmed.ncbi.nlm.nih.gov/29500124/
Adults with childhood-onset chronic conditions admitted to US pediatric and adult intensive care units. J Edwards, et al. J Crit Care 2015: https://pubmed.ncbi.nlm.nih.gov/25466316/
Down Syndrome. MJ Bull. N Eng J Med 2020. https://www.nejm.org/doi/full/10.1056/NEJMra1706537
Books and Music mentioned in this episode:
The Bible: https://bit.ly/3EK4LL6
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1:07:54
Lessons from the wrong side of the heart
February 7-14 marks the observance of Congenital Heart Disease Awareness Week. In this podcast episode, Dr. Sergio Zanotti provides a unique perspective on adult congenital heart disease, drawing from his journey as a lifelong patient. He offers reflections shaped by his own experiences with complex adult congenital heart disease, including insights gained from a recent medical procedure that granted him a firsthand view of patient care in the ICU.
Additional resources:
ACC/AHA 2008 Guidelines for the Management of Adults With Congenital Heart Disease. Circulation 2008: https://www.ahajournals.org/doi/pdf/10.1161/CIRCULATIONAHA.108.190690
The Bell Curve. By Atul Gawande. The New Yorker 2004: https://www.newyorker.com/magazine/2004/12/06/the-bell-curve
Website for the Adult Congenital Heart Association: https://www.achaheart.org/
Books and music mentioned in this episode:
Montaigne. By Stefan Zweig: https://bit.ly/4gEOVP2
The Heart. A Novel. By Maylis De Kerangal: https://bit.ly/41ehqin
The Essays: A Selection (Penguin Classics). By. Michel de Montaigne: https://bit.ly/3EvFwvW
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51:57
Optimizing renal replacement therapy in the ICU
Acute kidney injury is a frequent complication of critical illness, and a subgroup of these patients will require renal replacement therapy. In this episode. Dr. Sergio Zanotti discusses optimizing renal replacement therapy in the ICU. He is joined by Dr. Michael J. Connor, Jr., a practicing intensivist and nephrologist. He is a professor and senior physician of critical care medicine and nephrology at the Divisions of Pulmonary, Allergy, Critical Care, & Sleep Medicine and Renal Medicine at Emory University School of Medicine. In addition, he is the director of critical care nephrology at the Emory Critical Care Center at Grady Memorial Hospital.
Additional resources:
Delivering optimal renal replacement therapy to critically ill patients with acute kidney injury. Wald R, et al. Intensive Care Med 2022: https://pubmed.ncbi.nlm.nih.gov/36066597/
Initiation Strategies for Renal-Replacement Therapy in the Intensive Care Unit. AKIKI Study Group. N Engl J Med 2016: https://pubmed.ncbi.nlm.nih.gov/27181456/
Effect of Early vs Delayed Initiation of Renal Replacement Therapy on Mortality in Critically Ill Patients with Acute Kidney Injury. ELAIN Trial. JAMA 2016: https://pubmed.ncbi.nlm.nih.gov/27209269/
Timing of Renal-Replacement Therapy in Patients with Acute Kidney Injury and Sepsis. IDEAL-ICU Investigators. N Eng J Med 2018: https://pubmed.ncbi.nlm.nih.gov/30304656/
Timing of Initiation of Renal-Replacement Therapy in Acute Kidney Injury. STARRT-AKI Investigators. N Engl J Med 2020: https://pubmed.ncbi.nlm.nih.gov/32668114/
Comparison of two delayed strategies for renal therapy initiation for severe acute kidney injury. AKIKI 2 Trial. Lancet 2021: https://pubmed.ncbi.nlm.nih.gov/33812488/
Books and Music mentioned in this episode:
The Invisible Life of Addie LaRue. By V.E. Schwab: The Invisible-Life-Addie-LaRue
Moon Music. By Coldplay: Moon-Music-Coldplay
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1:12:15
Rational Fluid Therapy
In this episode, Dr. Sergio Zanotti discusses rational fluid therapy. He is joined by Dr. Adrian Wong, a practicing intensive care medicine and anesthesia physician. Dr. Wong is a consultant and clinical lead at King’s College Hospital, London. He also serves as a committee member for the Intensive Care Society FUSIC, examiner for the European Diploma of Intensive Care Medicine, on the executive committee of the International Fluid Academy.
Additional resources:
Intravenous fluid therapy in the perioperative and critical care setting” Executive summary of the International Fluid Academy (IFA). Malbrain ML, et al. Ann. Intensive Care 2020: https://pubmed.ncbi.nlm.nih.gov/32449147/
Multidisciplinary expert panel report on fluid stewardship: perspectives and practice. Malbrain ML, et al. Annals of Intensive Care 2023: https://pubmed.ncbi.nlm.nih.gov/37747558/
The emerging concept of fluid tolerance: A position paper. Kattan E, et al. Journal of Critical Care 2022: https://pubmed.ncbi.nlm.nih.gov/35660844/
Everything you need to know about derescuscitation. Malbrain ML, et al. Intensive Care Med 2022: https://pubmed.ncbi.nlm.nih.gov/35932335/
Start with Why. TED Talk presented by Simon Sinek: https://simonsinek.com/videos/ted-talks/
Books mentioned in this episode:
Thinking Fast and Slow. By Daniel Kahneman: https://amzn.to/4hicUoj
Start with Why: How Great Leaders Inspire Everybody to Take Action. By Simon Sinek: https://bit.ly/42hzt8n
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