Interprofessional Critical Care Network (ICCN) Podcast

Turning brain-injured adults prone raised intracranial pressure by about 5 mmHg on average in a pooled analysis of small studies, and the rise reversed after turning back. This episode covers what a systematic review of 10 studies with invasive pressure monitoring measured, why its very low certainty evidence says nothing yet about outcomes, and what the team can agree on before the turn.

In this episode

* Across 8 studies with 120 patients, intracranial pressure rose by an average of 5.06 mmHg when patients were turned prone, with a 95 percent confidence interval of 2.05 to 8.06 and substantial differences between studies.

* In the 5 studies that measured pressure after turning back, the change from baseline was minus 0.41 mmHg, and cerebral perfusion pressure did not change meaningfully during proning.

* Every study that reported systemic oxygenation found it improved, and brain tissue oxygen rose in the 4 studies that measured it.

* Proning was stopped because of rising pressure in a pooled 8.89 percent of patients across 6 studies, and the thresholds that triggered stopping were not consistently reported.

* Every patient had invasive intracranial pressure monitoring, none of the included studies was designed to show that proning improves survival or neurological recovery, and the authors rated the certainty of evidence as very low.

Chapters

(00:00) Cold open

(00:36) What they did

(02:00) Key numbers

(03:55) What it does not show

(05:17) Bedside takeaways by discipline

(06:45) Teaching pearl

(07:02) Close

Read the full article: https://iccn.substack.com/p/turning-the-injured-brain-face-down?utm_source=podcast&utm_medium=audio&utm_campaign=q4_paid

Sources

* Meyer A, Overbeek R, Mühlhausen L, et al. Prone positioning in neurocritical care patients with invasive intracranial pressure monitoring: a systematic review and meta-analysis. Neurocrit Care. 2026. doi:10.1007/s12028-026-02667-0. PMID: 42844551.

* Grasselli G, Calfee CS, Camporota L, et al. ESICM guidelines on acute respiratory distress syndrome: definition, phenotyping and respiratory support strategies. Intensive Care Med. 2023;49(7):727-759. doi:10.1007/s00134-023-07050-7. PMID: 37326646; PMCID: PMC10354163.

* Asehnoune K, Rooze P, Robba C, et al. Mechanical ventilation in patients with acute brain injury: a systematic review with meta-analysis. Crit Care. 2023;27(1):221. doi:10.1186/s13054-023-04509-3. PMID: 37280579; PMCID: PMC10242967.

ICCN publishes one article a day for ICU clinicians. $8 a month or $80 a year, with a 7-day free trial.

This episode is for educational purposes for healthcare professionals. It is not medical advice, a clinical guideline or a standard of care. Clinical decisions must be individualized by qualified clinicians.

Hosted by Javier Amador-Castaneda, BHS, RRT, FCCM. Voices rendered with AI text-to-speech from a script written and reviewed by ICCN.

This is a public episode. If you'd like to discuss this with other subscribers or get access to bonus episodes, visit iccn.substack.com/subscribe

Inside the BaSICS trial, serum chloride rose about 2 mmol/L more with 0.9 percent saline than with Plasma-Lyte 148 by day 2, and the gap was larger when kidney function was reduced. This episode covers what a randomization-anchored analysis of 3,482 ICU patients measured, what it cannot show about outcomes, and where the hidden chloride load sits for pharmacists, nurses, respiratory therapists and dietitians.

In this episode

* By day 2, among 2,721 BaSICS participants with paired values, serum chloride rose 2.15 mmol/L more with saline than with Plasma-Lyte 148, with a 95 percent confidence interval of 1.76 to 2.53.

* Saline recipients had received 145.7 mmol more study-fluid chloride by day 2, giving 1.47 mmol/L per additional 100 mmol in the randomized comparison, while the observational slope within the saline arm was about 0.31 mmol/L per 100 mmol.

* The modeled difference between the fluids on day 2 was about 3.0 mmol/L at an eGFR of 30 and about 1.8 mmol/L at an eGFR of 90.

* Fluid accounted for 0.7 percent of the modeled variation in serum chloride, while the patient’s starting chloride alone accounted for about 47 percent.

* The analysis measured biochemistry over 3 days and did not test kidney outcomes or survival, and the randomized effect belongs to the assigned fluid as a whole, not to chloride alone.

Chapters

(00:00) Cold open

(00:40) What they did

(02:01) Key numbers

(03:56) What it does not show

(05:27) Bedside takeaways by discipline

(06:58) Teaching pearl

(07:12) Close

Read the full article: https://iccn.substack.com/p/every-liter-is-a-chloride-dose?utm_source=podcast&utm_medium=audio&utm_campaign=q4_paid

Sources

* Zampieri FG, Maia IS, Machado FR, Cavalcanti AB. Chloride load and serum chloride in critically ill adults: a randomization-anchored analysis of the BaSICS trial. Ann Intensive Care. 2026;16:100191. doi:10.1016/j.aicoj.2026.100191

* Liu L, Cai B, He B. Balanced crystalloid versus saline for resuscitation in adult sepsis: a systematic review and meta-analysis. Front Med (Lausanne). 2026;13:1906761. doi:10.3389/fmed.2026.1906761

* Gelbenegger G, Shapiro NI, Zeitlinger M, et al. Lactated Ringer’s or Normal Saline for Initial Fluid Resuscitation in Sepsis-Induced Hypotension. Crit Care Med. 2025;53(5):e1140-e1144. doi:10.1097/CCM.0000000000006601

* Wan X, Deng F, Bai X, et al. Dysregulated serum chloride and clinical outcomes in critically ill adults: A systematic review and meta-analysis. PLoS One. 2025;20(12):e0337560. doi:10.1371/journal.pone.0337560

* Zhou D, Cao F, Zhang L, et al. Impact of fluid creep on volume and chloride load in critically ill adults: a prospective study on its prognostic significance and association with MAKE30. Ren Fail. 2025;47(1):2549773. doi:10.1080/0886022X.2025.2549773

* Hardenberg JB, Kunz JV, Rubarth K, et al. Pre-emptive use of glucose 5% as the standard drug solvent reduces hypernatremia in critically ill patients. Clin Kidney J. 2024;17(11):sfae328. doi:10.1093/ckj/sfae328

* Rahimi P, Tontu F, Khoundabi B, et al. Balancing Chloride and Glucose in Critical Illness: A 10 Year Study on Diluent Strategies and ICU Outcomes. J Clin Med. 2025;14(23):8573. doi:10.3390/jcm14238573

ICCN publishes one article a day for ICU clinicians. $8 a month or $80 a year, with a 7-day free trial.

This episode is for educational purposes for healthcare professionals. It is not medical advice, a clinical guideline or a standard of care. Clinical decisions must be individualized by qualified clinicians.

Hosted by Javier Amador-Castaneda, BHS, RRT, FCCM. Voices rendered with AI text-to-speech from a script written and reviewed by ICCN.

This is a public episode. If you'd like to discuss this with other subscribers or get access to bonus episodes, visit iccn.substack.com/subscribe

After open cardiac surgery, the first resuscitation from a postoperative cardiac arrest usually worked, yet 36.4 percent of the patients who arrested died before discharge, and the clearest factor tied to death was organ dysfunction that had already appeared before the arrest. This episode covers a single-center analysis of 9,946 cardiac surgery patients, what it cannot show, and what each discipline can watch for in the days before an arrest.

In this episode

* Of 9,946 patients who underwent cardiac surgery at one center from early 2012 through May 2019, 162 had a postoperative arrest, an incidence of 1.6 percent, and 59 of them, 36.4 percent, did not survive to discharge.

* The first resuscitation restored circulation in 139 patients, 85.8 percent, but 36 of them died later in the stay.

* Any new major organ dysfunction before the arrest was associated with about 7-fold higher odds of in-hospital death, an adjusted odds ratio of 7.08 with a 95 percent confidence interval of 2.92 to 17.16.

* 13 patients went on ECMO after the arrest and 4 survived to discharge, a number from a heavily selected group that cannot be used to deny or justify support for an individual patient.

* The evidence is observational: the study did not measure time to escalation and tested no intervention, so it shows where to look, not what works.

Chapters

(00:00) Cold open

(00:31) What they did

(01:38) Key numbers

(03:46) What it does not show

(05:22) Bedside takeaways by discipline

(06:58) Teaching pearl

(07:11) Close

Read the full article: https://iccn.substack.com/p/the-arrest-before-the-arrest?utm_source=podcast&utm_medium=audio&utm_campaign=q4_paid

Sources

* Patel PB, Gross CR, Kumar A, et al. Postoperative cardiac arrest after cardiac surgery: Can we improve our rescue rate? JTCVS Open. 2026;33:101956. doi:10.1016/j.xjon.2026.101956

* Sharp JR, Hayes S, Mann S, et al. Twenty-four-hour continuous attending coverage in a dedicated cardiovascular intensive care unit decreases mortality after cardiac surgery. JTCVS Open. 2026;33:101852. doi:10.1016/j.xjon.2026.101852

* Young AM, Strobel RJ, Kaplan E, et al. Delirium is associated with failure to rescue after cardiac surgery. JTCVS Open. 2023;16:464-476. doi:10.1016/j.xjon.2023.08.020

* Hirsch KG, Abella BS, Amorim E, et al. Critical care management of patients after cardiac arrest: a scientific statement from the American Heart Association and Neurocritical Care Society. Circulation. 2024;149(2):e168-e200. doi:10.1161/CIR.0000000000001163

ICCN publishes one article a day for ICU clinicians. $8 a month or $80 a year, with a 7-day free trial.

This episode is for educational purposes for healthcare professionals. It is not medical advice, a clinical guideline or a standard of care. Clinical decisions must be individualized by qualified clinicians.

Hosted by Javier Amador-Castaneda, BHS, RRT, FCCM. Voices rendered with AI text-to-speech from a script written and reviewed by ICCN.

This is a public episode. If you'd like to discuss this with other subscribers or get access to bonus episodes, visit iccn.substack.com/subscribe

In more than 134,000 adult ICU admissions scored both ways, SOFA-2 moved individual patients between severity categories, and patients with the same total under one version still differed in ICU mortality under the other. This episode covers what SOFA-2 changed, the mirror-image matching analyses, the Chinese and Korean validation cohorts, and what each discipline must chart for the new score.

In this episode

* SOFA-2 was built from a modified Delphi process and ICU data from 1,319 ICUs across 9 countries, and it discriminated ICU mortality slightly better than the original score, an area under the curve of 0.79 against 0.77.

* In 134,528 Japanese ICU admissions, mean day-one totals were 5.64 for the original score and 5.81 for SOFA-2, but the brain, respiratory and cardiovascular rows mostly shifted upward and the kidney row moved in both directions.

* Among patients matched on SOFA-2, ICU mortality was 9.0 percent when the original score was at least 2 points higher, 5.7 percent when the scores roughly agreed, and 5.0 percent when SOFA-2 was at least 2 points higher; matched on the original score, the pattern reversed, 3.4 percent, 5.0 percent and 9.5 percent.

* Much of the disagreement ran through organ support: among patients matched on SOFA-2, norepinephrine in half of the patients whose original score ran higher against 4.8 percent of those whose SOFA-2 ran higher, and kidney replacement therapy at 3.7 percent against 7.4 percent.

* Sepsis-3 still defines organ dysfunction with the original score, and no study here measured how many patients would be reclassified as septic, so name the version every time and rebaseline before comparing trends.

Chapters

(00:00) Cold open

(00:58) What they did

(02:56) Key numbers

(05:04) What it does not show

(06:42) Bedside takeaways by discipline

(07:51) Teaching pearl

(08:01) Close

Read the full article: https://iccn.substack.com/p/same-patient-different-sofa?utm_source=podcast&utm_medium=audio&utm_campaign=q4_paid

Sources

* Ono S, Uchino S, Kumaido Y, et al. Patient-level reclassification and discordance between SOFA and SOFA-2: a multicenter ICU study. Crit Care. 2026;30:425. doi:10.1186/s13054-026-06241-0

* Ranzani OT, Singer M, Salluh JIF, et al. Development and Validation of the Sequential Organ Failure Assessment (SOFA)-2 Score. JAMA. 2025;334(23):2090-2103. doi:10.1001/jama.2025.20516

* Ahn S, Kim SM, Park JH, et al. Validation of the updated sequential organ failure assessment (SOFA)-2 score in emergency department septic shock. J Intensive Care. 2026;14:92. doi:10.1186/s40560-026-00921-3

* Liufu R, Cao M, Shi XQ, et al. External validation of SOFA 2 score: a retrospective Chinese cohort study. Ann Intensive Care. 2026;16:100107. doi:10.1016/j.aicoj.2026.100107

* Singer M, Deutschman CS, Seymour CW, et al. The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA. 2016;315(8):801-810. doi:10.1001/jama.2016.0287

ICCN publishes one article a day for ICU clinicians. $8 a month or $80 a year, with a 7-day free trial.

This episode is for educational purposes for healthcare professionals. It is not medical advice, a clinical guideline or a standard of care. Clinical decisions must be individualized by qualified clinicians.

Hosted by Javier Amador-Castaneda, BHS, RRT, FCCM. Voices rendered with AI text-to-speech from a script written and reviewed by ICCN.

This is a public episode. If you'd like to discuss this with other subscribers or get access to bonus episodes, visit iccn.substack.com/subscribe

New guidance from the American Society of Anesthesiologists says many tube-fed patients with a cuffed airway can keep feeding until they leave for a procedure, and that midnight fasting orders should go. This episode covers the Delphi process behind it, the five fasting branches, the small studies underneath, and what each discipline owns in a protocol.

In this episode

* An 11-expert, 4-round modified Delphi panel reached 82 to 100 percent agreement on the final recommendations, and the 77 clinician members of the society’s critical care committee endorsed them unanimously.

* Many patients with a cuffed endotracheal or tracheostomy tube whose procedure does not touch the airway or require an empty gut can continue feeds until departure to the operating room, for cases done supine, head up, lateral or in lithotomy.

* Planned extubation brings back a fast of about 6 hours; without a secure airway, a confirmed postpyloric tube stops 2 hours before departure.

* The supporting studies are small: 38 patients in the gastric ultrasound study, 222 and 91 in the tracheostomy cohorts, and the 91-patient cohort’s confidence interval cannot rule out harm.

* ICCN adds an insulin plan for every feed hold and a protocol with a named owner for each question.

Chapters

(00:00) Cold open

(00:43) What the guidance did

(02:04) The recommendations that matter

(03:53) What it does not show

(05:57) Bedside takeaways by discipline

(07:22) Teaching pearl

(07:34) Close

Read the full article: https://iccn.substack.com/p/the-cuff-changes-the-fast?utm_source=podcast&utm_medium=audio&utm_campaign=q4_paid

Sources

* Sparling JL, Edmiston T, Nasa P, et al. American Society of Anesthesiologists Guidance on Periprocedural Fasting in Patients Receiving Tube Feeding. Anesthesiol Open. 2026;1(3):e0037. doi:10.1097/ao9.0000000000000037

* Guo X, Jiang L, Jiang S, et al. Enteral nutrition interruption in critically ill patients: a systematic review and meta-analysis of prevalence, causes, and clinical outcomes. Front Nutr. 2026;13:1886962. doi:10.3389/fnut.2026.1886962

* Tang E, Chan AK, Ling L. Effect of Fasting Prior to Extubation on Prevalence of Empty Stomach in Enterally Fed and Mechanically Ventilated Patients. Respir Care. 2024;69(11):1417-1423. doi:10.4187/respcare.11618

* Ekin S, Ceylan İ, Korkmaz HA, et al. Effect of Duration of Pre-Procedure Fasting on Clinical Outcomes in Intensive Care Patients Undergoing Percutaneous Tracheostomy. Med Sci Monit. 2026;32:e950128. doi:10.12659/MSM.950128

* Ekin S, Gülen D, Ceylan İ, et al. Impact of pre-tracheostomy continuous enteral feeding on aspiration pneumonia risk and clinical outcomes: a prospective observational study. BMC Pulm Med. 2026;26(1). doi:10.1186/s12890-026-04548-w

* Hua J, Ju W, Gu Q, et al. Gastrointestinal point-of-care ultrasound for enteral nutrition management in critically ill adults: a scoping review. Front Nutr. 2026;13:1972620. doi:10.3389/fnut.2026.1972620

ICCN publishes one article a day for ICU clinicians. $8 a month or $80 a year, with a 7-day free trial.

This episode is for educational purposes for healthcare professionals. It is not medical advice, a clinical guideline or a standard of care. Clinical decisions must be individualized by qualified clinicians.

Hosted by Javier Amador-Castaneda, BHS, RRT, FCCM. Voices rendered with AI text-to-speech from a script written and reviewed by ICCN.

This is a public episode. If you'd like to discuss this with other subscribers or get access to bonus episodes, visit iccn.substack.com/subscribe

A 2026 analysis of more than 25,000 septic adults in two US critical care databases scored sepsis-induced coagulopathy every day for a week. A score that stayed high marked patients at far higher risk of death. Much of that risk was severity already visible on day one, and the association held after adjustment for it. Early prophylactic heparin was associated with lower mortality, reaching significance in one database but not the other, and the randomized evidence stays neutral. We cover the design, the numbers as reported, what an observational landmark analysis cannot show, and what it means for nurses, pharmacists, advanced practice providers and intensivists.

In this episode

* In 20,168 MIMIC-IV patients and 5,829 eICU patients, a daily sepsis-induced coagulopathy score over the first 7 ICU days fell into three courses: persistently high, rising then falling, and resolving.

* The persistently high course carried a subdistribution hazard ratio for in-hospital death by day 28 of 1.65 in MIMIC-IV, 95% confidence interval 1.52 to 1.78, and 1.73 in eICU, 1.51 to 1.99, but that group was sicker on day one, with a mean SOFA of 8.81 against 5.50 in the resolving group.

* Prophylactic unfractionated heparin in the first 48 hours was associated with lower mortality in MIMIC-IV, 15.72% against 17.06%, subdistribution hazard ratio 0.908; the eICU estimate of 0.877 did not reach significance, and a 2024 meta-analysis of 3 trials with 426 patients found a neutral risk ratio of 0.86.

* Everything needed to score SIC is drawn every morning: platelets, INR and the SOFA organ component, with a total of 4 or more positive. ICCN recommends scoring it daily and treating a score that will not come down as a prompt for a differential, not a treatment target.

* Keep prophylactic heparin decisions on VTE and bleeding grounds, and do not start therapeutic anticoagulation for sepsis-induced coagulopathy outside a clinical trial.

Read the full article: https://iccn.substack.com/p/the-clotting-score-already-in-your?utm_source=podcast&utm_medium=audio&utm_campaign=q4_paid

Sources

* Cao Y, Wang M, Li Y, et al. Longitudinal sepsis-induced coagulopathy score trajectories and mortality in relation to early prophylactic heparin: a multicentre cohort study. Front Cell Infect Microbiol. 2026;16:1923833. doi:10.3389/fcimb.2026.1923833

* Iba T, Helms J, Levy JH. Sepsis-induced coagulopathy (SIC) in the management of sepsis. Ann Intensive Care. 2024;14:148. doi:10.1186/s13613-024-01380-5

* Totoki T, Koami H, Makino Y, et al. Heparin therapy in sepsis and sepsis-associated disseminated intravascular coagulation: a systematic review and meta-analysis. Thromb J. 2024;22:84. doi:10.1186/s12959-024-00653-0

* Radermacher PB, Fujita B, Vahldieck C. Early systemic heparin exposure is associated with lower mortality, reduced disseminated intravascular coagulation, and fewer thrombotic complications in septic shock. Front Med (Lausanne). 2026;13:1931895. doi:10.3389/fmed.2026.1931895

* Matsuoka T, Yamakawa K, Umemura Y, et al. The transition of the criteria for disseminated intravascular coagulation and the targeted patients in randomized controlled trials over the decades: a scoping review. Thromb J. 2024;22:112. doi:10.1186/s12959-024-00681-w

ICCN publishes one article a day for ICU clinicians. $8 a month or $80 a year, with a 7-day free trial.

This episode is for educational purposes for healthcare professionals. It is not medical advice, a clinical guideline or a standard of care. Clinical decisions must be individualized by qualified clinicians.

Hosted by Javier Amador-Castaneda, BHS, RRT, FCCM. Voices rendered with AI text-to-speech from a script written and reviewed by ICCN.

This is a public episode. If you'd like to discuss this with other subscribers or get access to bonus episodes, visit iccn.substack.com/subscribe

An international registry of 1,010 adults with heart failure-related cardiogenic shock, treated at 16 centers in five countries between 2010 and 2021, found higher 30-day mortality and longer ICU stays in patients who received invasive ventilation, with the same direction of signal even when gas exchange was preserved. The design cannot separate a sicker patient from a harmful intervention. We cover what the study did, the numbers as reported, what an observational registry cannot show, and what it means for respiratory therapists, nurses, pharmacists and intensivists.

In this episode

* 659 of 1,010 patients (65.2%) received invasive ventilation. 30-day mortality was 56.5% with ventilation and 41.1% without; the adjusted hazard ratio was 1.67 (95% confidence interval 1.26 to 2.22).

* The risk followed gas exchange: hazard ratio 1.74 for a PaO2/FiO2 of 100 or less and 1.82 for 101 to 200. Patients with a ratio above 200 trended the same way at 1.39 (0.99 to 1.97, p = 0.06), which did not reach significance.

* Ventilated patients had more cardiac arrests before admission (54.3% against 11.2%) and higher lactate (5.5 against 3.2 mmol/L). The registry did not capture the indication for intubation, ventilator settings, sedation or noninvasive ventilation, so this is an association, not a demonstrated harm.

* In a single-center US cohort of 104 ventilated patients, nearly half were on an FiO2 of 40% or less with a PEEP of 5 cmH2O or less a day after intubation, yet the first spontaneous breathing trial was postponed in 78%, usually for hemodynamic reasons; complications after intubation occurred in 38%, most commonly hypotension.

* ICCN position: name the indication before the induction, plan induction as a hemodynamic event, set PEEP with both ventricles in mind, consider noninvasive support only in carefully selected patients, and start the exit plan on day one.

Read the full article: https://iccn.substack.com/p/the-ventilator-is-not-neutral?utm_source=podcast&utm_medium=audio&utm_campaign=q4_paid

Sources

* Besch L, Kellner C, Sundermeyer J, et al. Invasive ventilation and association with outcomes in heart failure-related cardiogenic shock. Clin Res Cardiol. 2026;115(11):2015-2023. doi:10.1007/s00392-026-02953-z

* El Zarif T, Caraballo C, Victoria-Castro AM, et al. Respiratory support and mortality risk across the spectrum of cardiogenic shock severity. J Soc Cardiovasc Angiogr Interv. 2025;4(12):104043. doi:10.1016/j.jscai.2025.104043

* Sacco A, Montisci A, Tavecchia G, et al. Ventilation strategies in cardiogenic shock: insights from the AltShock-2 registry. Eur J Heart Fail. 2024;26(11):2412-2420. doi:10.1002/ejhf.3409

* Volle K, Merdji H, Bataille V, et al. Ventilation strategies in cardiogenic shock: insights from the FRENSHOCK observational registry. Clin Res Cardiol. 2025;114(10):1311-1323. doi:10.1007/s00392-024-02551-x

* Grubb CS, Tucker G, Bionghi N, et al. Management patterns and outcomes of invasive mechanical ventilation in patients with cardiogenic shock. JACC Adv. 2025;4(10 Pt 1):101916. doi:10.1016/j.jacadv.2025.101916

ICCN publishes one article a day for ICU clinicians. $8 a month or $80 a year, with a 7-day free trial.

This episode is for educational purposes for healthcare professionals. It is not medical advice, a clinical guideline or a standard of care. Clinical decisions must be individualized by qualified clinicians.

Hosted by Javier Amador-Castaneda, BHS, RRT, FCCM. Voices rendered with AI text-to-speech from a script written and reviewed by ICCN.

This is a public episode. If you'd like to discuss this with other subscribers or get access to bonus episodes, visit iccn.substack.com/subscribe

This article provides a comprehensive medical overview of pulmonary atelectasis, specifically addressing its occurrence during anaesthesia and intensive care. The authors describe how mechanical ventilation and surgical drugs frequently trigger lung collapse by altering pressure and reducing functional lung capacity. To combat these risks, the text outlines lung-protective ventilation strategies, such as managing tidal volumes and titrating positive end-expiratory pressure (PEEP). Diagnostic advancements are also highlighted, emphasizing the growing role of lung ultrasound as a practical bedside tool for detecting aeration loss. Ultimately, the source serves as a clinical guide for balancing preventative maneuvers against the potential for ventilator-induced injuries.

This is a public episode. If you'd like to discuss this with other subscribers or get access to bonus episodes, visit iccn.substack.com/subscribe

This academic review examines the expanding role of volatile anesthetics, such as isoflurane and sevoflurane, as alternatives to intravenous sedatives in intensive care units. These inhaled agents offer unique pharmacokinetic benefits, including rapid onset and elimination through the lungs, which allows for precise titration and faster recovery independent of liver or kidney function. Modern delivery devices have made these gases more accessible in the ICU, providing potential organ-protective effects and a reduced risk of the withdrawal symptoms associated with traditional drugs like opioids. However, the text also addresses significant safety considerations, noting that while these agents may shorten ventilation time, some data suggest higher mortality risks and a need for specialized monitoring. Ultimately, the authors argue that volatile sedation is a valuable tool for critically ill patients, provided that clinicians manage risks like cardiovascular depression and maintain strict environmental safeguards.

This is a public episode. If you'd like to discuss this with other subscribers or get access to bonus episodes, visit iccn.substack.com/subscribe