PRISM Rounds: Pulmonary Critical Care & Sleep Podcast

In this episode of PRISM Rounds, we revisit the landmark New England Journal of Medicine trial “Vasopressin versus Norepinephrine Infusion in Patients with Septic Shock” from February 28, 2008, along with the accompanying Parrillo editorial. We break down what the VASST trial actually showed, why the overall mortality result was negative, and why the “less severe shock” subgroup still shaped bedsi...

In this episode of PRISM Rounds , we discuss the ARISS trial : JAMA Network Open (Feb 2026) , “Albumin Replacement Therapy in Septic Shock: A Randomized Clinical Trial.” We break down the bedside question: If you replace 20% albumin to maintain serum albumin ≥3.0 g/dL in septic shock, does survival improve? We walk through the study design (multicenter, open-label RCT), the key result ( no signifi...

Stroke alert at 2 a.m. hits different—so in this episode we run “teaching rounds” on the AHA/ASA 2026 Guideline for the Early Management of Acute Ischemic Stroke , published in Stroke . We translate the biggest updates into what you actually do at the bedside: EMS prenotification and destination decisions, rapid imaging workflows (and what not to delay), IV thrombolysis decisions including tenecte...

We walk through the 2026 AHA/ACC/ACCP/ACEP/CHEST/SCAI/SHM/SIR/SVM/SVN guideline for evaluation and management of acute pulmonary embolism in adults (Circulation, 2026). We focus on the guideline’s top take-home messages trainees need on rounds: the new A–E clinical categories for severity/triage, who can be discharged early , who should be hospitalized , when to activate PERT , and how to think ab...

On today’s PRISM Rounds we discuss PreVent 2, the multicenter randomized trial in The Lancet Respiratory Medicine (2025) testing whether a polyurethane cuff + subglottic secretion drainage (PU-EVAC) endotracheal tube improves outcomes after emergency intubation—and what the accompanying editorial argues about the real-world value of subglottic suction devices. We translate the methods and results...

In this PRISM Rounds episode, we break down the PROMIZING randomized trial in the New England Journal of Medicine (2025) comparing proportional-assist ventilation with load-adjustable gain factors (PAV+) versus pressure-support ventilation (PSV) during weaning. We cover the physiology case for PAV+, the pragmatic reasons the primary outcome was neutral, and the most actionable takeaway for ICU tea...

In this episode of PRISM Rounds, Host and Analyst break down the SuDDICU trial from The New England Journal of Medicine (Oct 29, 2025), testing selective digestive decontamination (SDD) in mechanically ventilated ICU patients using a cluster crossover design across 26 ICUs. We cover the headline result—no statistically significant reduction in 90-day in-hospital mortality—then dig into the key mic...

In this episode of PRISM Rounds, we walk through electrical impedance tomography (EIT)—a bedside, radiation-free tool that provides real-time maps of regional ventilation. Using a 2022 Critical Care Medicine narrative review, we focus on practical ICU applications: PEEP titration (recruitment vs overdistension), tracking physiologic response to prone positioning, and recognizing effort-related reg...

In this episode of PRISM Rounds, we revisit the landmark SOAP II randomized trial (New England Journal of Medicine, 2010) at the request of medical students who wanted the “how we got here” story behind modern vasopressor choices. We walk through the trial design and results in 1,679 ICU patients with shock, comparing dopamine vs norepinephrine as first-line vasopressor therapy, then layer in the...

In this episode of PRISM Rounds, two hosts break down the American Academy of Sleep Medicine (AASM) 2025 Clinical Practice Guideline on treating central sleep apnea (CSA) in adults—practical bedside takeaways plus a methods-focused look at evidence certainty. We cover CSA phenotypes (heart failure/Cheyne–Stokes, opioid-associated CSA, treatment-emergent CSA, high altitude), what “conditional” reco...

In this episode, we break down BICARICU-2, a multicenter open-label randomized clinical trial of 4.2% IV sodium bicarbonate in critically ill adults with severe metabolic acidemia (pH ≤7.20) and moderate-to-severe AKI (KDIGO 2–3). We cover the physiology (why acidemia matters), the trial design (and what open label means for dialysis decisions), and the outcomes that should change bedside behavior...

In this episode of PRISM Rounds, we review a 2025 open-access scoping review and commentary in Sleep Science and Practice examining how hypopnea scoring criteria—4% desaturation-only versus 3% desaturation or EEG arousal—can change the apnea–hypopnea index (AHI) and materially shift obstructive sleep apnea (OSA) diagnosis in women. We walk through what the review found across eight studies, why wo...

In this episode of PRISM Rounds, we review “Sotatercept for Pulmonary Arterial Hypertension within the First Year after Diagnosis,” published in the New England Journal of Medicine (published online September 30, 2025; issue October 23, 2025). We break down the phase 3 HYPERION trial in newly diagnosed PAH on background double/triple therapy, focusing on the primary composite endpoint of clinical...

In this episode of PRISM Rounds, we journal-club ANDROMEDA-SHOCK 2, a multinational randomized clinical trial testing whether a personalized hemodynamic resuscitation protocol targeting capillary refill time (CRT-PHR) improves outcomes in early septic shock compared with usual care. The primary outcome was a 28-day hierarchical composite of mortality, duration of vital support, and hospital length...

In this episode of PRISM Rounds (S1E10), we break down a JoVE video-protocol on preoxygenation for tracheal intubation in critically ill adults. We compare oxygen-mask strategies (non-rebreather and bag-valve-mask with a PEEP valve) with noninvasive ventilation (NIV/BPAP or ventilator NIV modes).We keep it practical and bedside-focused:Why it works: physiology, denitrogenation, and “safe apnea tim...

Welcome to PRISM Rounds, where we break down one study at a time. This week we review the SONIA trial (a pragmatic randomized clinical trial across Kenyan public hospitals) evaluating whether adjunctive low-dose glucocorticoids added to usual care reduce 30-day mortality in adults hospitalized with community-acquired pneumonia (CAP)—and we pair it with the accompanying NEJM editorial on why contex...

In this episode of PRISM Rounds, we break down the NEJM randomized trial comparing ketamine vs etomidate for induction during emergency tracheal intubation in critically ill adults. We focus on what matters at the bedside: 28-day in-hospital mortality, peri-intubation cardiovascular collapse, and practical workflow implications for ICU/ED physicians, nurses, pharmacists, and respiratory therapists...

Confidence: High (study-specific details reflect only the uploaded JAMA RCT + editorial; no added claims.)Spotify Episode DescriptionA ventilator that adjusts support automatically sounds like the future—but does it improve outcomes patients actually feel? In this PRISM Rounds journal club, two hosts break down the ACTiVE randomized clinical trial comparing closed-loop INTELLiVENT-ASV vs protocoli...

In this PRISM Rounds journal club, we unpack EVERDAC (NEJM)—a multicenter noninferiority randomized trial (n=1,010) asking a deceptively simple ICU question: Do most adults with acute circulatory failure really need an early arterial line, or can we start with cuff-only blood pressure monitoring and “rescue” to an A-line only when safety criteria demand it? We break down the noninferiority design,...

This week on PRISM Rounds, we break down two NEJM trials that reshape decision-making in EGFR-mutated advanced NSCLC—one testing front-line intensification (osimertinib plus platinum–pemetrexed with final overall survival results) and the other addressing post–EGFR-TKI resistance with the Trop-2 antibody–drug conjugate sacituzumab tirumotecan versus platinum–pemetrexed. We then connect the evidenc...

Join us as we break down the LIBERATE-D trial, a provocative study questioning the default thrice-weekly dialysis schedule for AKI-D. We explore how a conservative, indications-only strategy (A-E-I-O-U—and sometimes “why”) was linked to higher kidney recovery at discharge in the unadjusted analysis, and why the accompanying editorial urges caution about robustness and real-world generalizability....

This week we review a systematic review and meta-analysis on individual-focused approaches to physician burnout—including mindfulness programs, professional coaching, and peer support. We break down what the authors found, how strong the evidence is, and what practical takeaways ICU clinicians and trainees can apply—while keeping the discussion relevant for the whole ICU team. Article (PubMed): ht...

Episode title Timing Matters in Sepsis: Community-Onset vs Hospital-Onset (Machine Learning Insights) Hospital-onset sepsis (HOS) is often treated as “the same disease” as community-onset sepsis (COS)—but timing changes the phenotype, the treatment timeline, and outcomes. In this episode of PRISM Rounds (S1 E2) , we break down a retrospective cohort study (2019–2023) from a large academic medical...

In this PRISM Rounds episode, we break down the Phase 2b ASTER trial—a multicenter, randomized, placebo-controlled PETAL Network study testing high-dose IV vitamin C (ascorbate) in adults with suspected/confirmed infection plus shock and/or acute hypoxemic respiratory failure. We review trial design, why enrollment stopped early, the primary outcome (days alive and free of respiratory, renal, and...