Interprofessional Critical Care Network (ICCN) Podcast

About Interprofessional Critical Care Network (ICCN) Podcast

The ICCN Podcast is the daily audio companion to the Interprofessional Critical Care Network. Every weekday morning, two voices walk ICU clinicians through one new study in critical care: what it did, the numbers that matter, what it does not show, and what it means at the bedside for respiratory therapists, nurses, pharmacists, advanced practice providers and intensivists. Episodes run six to eight minutes and are built from the ICCN Flagship article reviewed by the ICCN Editorial Council and Virtual Specialist Board. A longer paid roundup lands on Fridays. Hosted by Javier Amador-Castaneda, BHS, RRT, FCCM, founder of ICCN. For educational purposes for healthcare professionals; not medical advice. iccn.substack.com (https://iccn.substack.com?utm_medium=podcast)

Publisher

Interprofessional Critical Care Network

Category

health & fitness · science

Language

en

Explicit

No

First episode

6 Apr 2026

Latest episode

9 Nov 2026

Latest episodes

7 episodes in the feed.

1. 

   9 Nov 2026

   Same patient, different SOFA: SOFA-2 versus the original organ failure score

   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 (https://iccn.substack.com/subscribe?utm_medium=podcast&utm_campaign=CTA_2)

2. 

   5 Nov 2026

   The cuff changes the fast: fasting rules for tube-fed ICU patients

   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. Get full access to Interprofessional Critical Care Network (ICCN) at iccn.substack.com/subscribe (https://iccn.substack.com/subscribe?utm_medium=podcast&utm_campaign=CTA_4)

3. 

   4 Nov 2026

   The clotting score already in your labs

   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. Get full access to Interprofessional Critical Care Network (ICCN) at iccn.substack.com/subscribe (https://iccn.substack.com/subscribe?utm_medium=podcast&utm_campaign=CTA_4)

4. 

   4 Nov 2026

   The ventilator is not neutral

   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 (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. Get full access to Interprofessional Critical Care Network (ICCN) at iccn.substack.com/subscribe (https://iccn.substack.com/subscribe?utm_medium=podcast&utm_campaign=CTA_4)

5. 

   6 May 2026

   Stop Treating Vasopressors Like Blood Pressure Glue

   READ FULL ARTICLE HERE (https://open.substack.com/pub/iccn/p/stop-treating-vasopressors-like-blood?r=56nlc3&utm_campaign=post&utm_medium=web&showWelcomeOnShare=true) Get full access to Interprofessional Critical Care Network (ICCN) at iccn.substack.com/subscribe (https://iccn.substack.com/subscribe?utm_medium=podcast&utm_campaign=CTA_4)

6. 

   9 Apr 2026

   Pulmonary Atelectasis in Anaesthesia and Critical Care

   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. Get full access to Interprofessional Critical Care Network (ICCN) at iccn.substack.com/subscribe (https://iccn.substack.com/subscribe?utm_medium=podcast&utm_campaign=CTA_4)

7. 

   6 Apr 2026

   Volatile Anesthetics for Critical Care Sedation: Clinical Risks and Benefits

   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. Get full access to Interprofessional Critical Care Network (ICCN) at iccn.substack.com/subscribe (https://iccn.substack.com/subscribe?utm_medium=podcast&utm_campaign=CTA_4)

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