PRISM Rounds: Pulmonary Critical Care & Sleep Podcast

In this episode of PRISM Rounds , we discuss the JAMA randomized clinical trial BIHCA , which tested whether routine sodium bicarbonate improves outcomes during adult in-hospital cardiac arrest. Granfeldt and colleagues randomized adults with in-hospital cardiac arrest who had received epinephrine to sodium bicarbonate or placebo. Sustained return of spontaneous circulation occurred in 39% with bi...

In this episode of PRISM Rounds, we discuss the NEJM SODa-BIC trial, a pragmatic, double-blind randomized trial of sodium bicarbonate versus placebo in critically ill adults with metabolic acidosis receiving vasopressors. The trial asked a common ICU question: when a patient in shock has a low pH, does bicarbonate improve outcomes or mainly improve the blood gas? SODa-BIC found that sodium bicarbo...

This week on PRISM Rounds, we discuss ARISE FLUIDS, a pragmatic NEJM trial asking a question every ICU and emergency department team faces: after initial fluid resuscitation in septic shock, should we give more crystalloid or move earlier to vasopressors? In adults with early septic shock, restricted fluids with early vasopressors changed the process of care and was associated with less pulmonary...

In this episode of PRISM Rounds, we discuss the PROMINE trial, a randomized trial comparing ketamine versus propofol for rapid sequence intubation in critically ill adults. Ketamine produced a modestly higher early mean arterial pressure in the first 10 minutes after induction, but the effect was transient and did not translate into a sustained hemodynamic advantage or clear improvement in patient...

Surviving the ICU is not the same as recovering from critical illness. In this episode of PRISM Rounds , we discuss the JAMA iRehab randomized clinical trial, which tested whether a 6-week remote, multicomponent rehabilitation program could improve recovery for ICU survivors after hospital discharge. The primary 8-week quality-of-life endpoint was neutral, but the study showed important signals in...

In this episode of PRISM Rounds , we discuss the JAMA 2026 randomized clinical trial by Ornowska and colleagues testing whether 4% tetrasodium EDTA , or t-EDTA , used as a locking fluid for inactive central venous access device lumens, can reduce CVAD-associated complications in adult ICU patients. This pragmatic, triple-blind, multicenter, cluster-randomized crossover trial included 1468 ICU pati...

In this PRISM Rounds bonus episode, we step away from our usual journal-club format for a patient-facing book review of Prevent and Reverse Heart Disease by Caldwell B. Esselstyn Jr., M.D. This book was published in 2007, and cardiovascular prevention guidelines have evolved since then. But its central message remains practical and motivating: patients are not powerless, and daily food choices can...

In this episode of PRISM Rounds , we discuss the AJRCCM 2026 Pickwick Titration Trial , which asked whether automatically adjusted noninvasive ventilation can match manually adjusted NIV titrated in the sleep lab for ambulatory patients with obesity hypoventilation syndrome. The trial found that auto-adjusted NIV produced similar 12-month improvement in daytime PaCO₂ compared with manually adjuste...

In this episode of PRISM Rounds , we discuss the 2026 AJRCCM EITVent randomized clinical trial and its accompanying editorial. The study asked whether electrical impedance tomography, or EIT, could help clinicians individualize PEEP in adults with moderate to severe ARDS compared with the traditional lower PEEP/FIO2 table. The overall trial was neutral: EIT-guided PEEP did not reduce 28-day mortal...

This week on PRISM Rounds , we discuss the April 2026 New England Journal of Medicine PRoMPT BOLUS trial comparing balanced crystalloids with 0.9% saline in children treated for suspected septic shock. The trial enrolled more than 9,000 children across 47 emergency departments and found no significant difference in major adverse kidney events between balanced fluid and saline. Balanced fluids redu...

In this episode of PRISM Rounds, we review the JAMA FAST randomized clinical trial of rapid antimicrobial susceptibility testing for gram-negative bloodstream infections and the accompanying editorial, “Is FASTer Better?” The trial did not improve the primary DOOR outcome at 30 days, but rapid AST shortened antibiotic modification times and may be most useful when resistant organisms, septic shock...

In this episode of PRISM Rounds , we review the NEJM study of MiniDock MTB , a portable near-point-of-care molecular test for pulmonary tuberculosis using sputum and tongue swabs. The study found that MiniDock MTB outperformed smear microscopy, approached Xpert Ultra performance with sputum swabs, and met WHO near-point-of-care diagnostic accuracy targets. We discuss why this matters for resource-...

Are we treating the monitor or the patient? This episode breaks down the HIT Trial (NEJM Evidence), where 2,173 patients with chronic hyponatremia were randomized to test if intensive sodium correction actually improves clinical outcomes. https://pubmed.ncbi.nlm.nih.gov/41733398/ The Results Lab Normalization: The targeted algorithm was highly effective at "fixing the number," reaching n...

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 mo...

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 choi...

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 design Dose-response and patient-reported outcomes Safety of a κ-opio...

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 highli...

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 demonst...

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 cov...

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 movin...

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 p...

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...

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#FO...

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...

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...