SCCM Podcast

In this episode of the Society of Critical Care Medicine (SCCM) Podcast, host Maureen Madden, DNP, RN, CPNP-AC, CCRN, FCCM, speaks with Javier Varela, MD, MSc, about his study, “Acute Bronchiolitis in Infants on Invasive Mechanical Ventilation: Physiology Study of Airway Closure,” published in the September 2025 issue of Pediatric Critical Care Medicine. The study revealed new insights into airway pathophysiology in infants with severe bronchiolitis who require mechanical ventilation, a population that comprises a substantial portion of winter pediatric intensive care unit (PICU) admissions worldwide. Dr. Varela is an intensivist in the PICU in the Department of Pediatrics at Clínica Alemana de Santiago, in Santiago, Chile.

Differing ventilatory strategies and the heterogeneous phenotypes of bronchiolitis motivated Dr. Varela’s team to investigate airway closure, which was detected in seven of the 12 patients included in the study. Airway opening pressure frequently exceeded the set positive end-expiratory pressure (PEEP) levels—highlighting a potential gap in traditional ventilator management. Dr. Varela explains that respiratory mechanics, particularly driving pressure and respiratory system compliance, can be misinterpreted when airway opening pressure is not considered.

Study limitations included bacterial coinfection in nearly half the patients and the constraints of a single-center design, but Dr. Varela said that these factors did not appear to alter the physiologic observations.

Although more research is needed before making clinical recommendations, the study established a foundational understanding of airway closure in patients with bronchiolitis and underscores the need for future work on personalized ventilation strategies, PEEP titration, and the potential heterogeneity of airway behavior in this population.

Resources referenced in this episode:

Acute Bronchiolitis in Infants on Invasive Mechanical Ventilation: Physiology Study of Airway Closure (Varela J, et al. Pediatr Crit Care Med. 2025;26:e1096-e1104)

Airway Closure in Acute Respiratory Distress Syndrome: An Underestimated and Misinterpreted Phenomenon (Chen L, et al. Am J Respir Crit Care Med. 2018;197:132-136)

In this episode of the Society of Critical Care Medicine (SCCM) Podcast, host Elizabeth H. Mack, MD, MS, FCCM, speaks with Nadir Yehya, MD, MSCE, an attending physician in the Pediatric Sepsis Program and the Division of Critical Care Medicine at the Children's Hospital of Philadelphia in Philadelphia, Pennsylvania, USA. They discuss Dr. Yehya’s study, “Parent and Provider Perspectives on Short-Term Outcomes of Critically Ill Ventilated Children,” published in the September 2025 issue of Pediatric Critical Care Medicine. The study explores whether widely used composite clinical outcomes such as ventilator-free days truly reflect what families value most when their child is in the pediatric intensive care unit (PICU).

Dr. Yehya discusses how the project emerged from a long-standing question in pediatric critical care research: Are the outcomes we measure in clinical trials aligned with the priorities and lived experiences of families? Because mortality is low in pediatrics, composite short-term outcomes such as ventilator-free days, ICU-free days, and hospital-free days are commonly used. However, little is known about whether these metrics are truly patient- and family-centered.

Using survey data from parents and PICU clinicians, the study found strong agreement between parents and clinicians on the importance of minimizing duration of invasive mechanical ventilation. But parents and clinicians diverged on other short-term outcomes. Families ranked oxygen duration as more important than ICU or hospital length of stay, reflecting concerns about ongoing medical needs, missed work, and the possibility of going home on oxygen. Clinicians prioritized ICU and hospital days over oxygen use. Substantial variation was also found within both groups.

Dr. Yehya highlights the value of feedback from patient and family advisory councils in designing this type of research, explaining that such feedback informed the study’s instrument design and family approach. He calls for deeper investigation into post-discharge recovery, functional outcomes, and long-term developmental trajectories—areas families consistently identify as their greatest concerns.

Resources referenced in this episode:

Parent and Provider Perspectives on Short-Term Outcomes of Critically Ill Ventilated Children (Shannon MM, et al. Pediatr Crit Care Med. 2025;26:e1149-e1153)

In this episode of the Society of Critical Care Medicine (SCCM) Podcast, host Marilyn N. Bulloch, PharmD, BCPS, FCCM, speaks with Olfa Hamzaoui, MD, PhD, professor of intensive care at Robert Debré Hospital in Reims, France, about her Peter Safar Honorary Lecture at the 2025 Critical Care Congress. The conversation centers on tissue perfusion, microcirculation, and shock, with a focus on bridging the gap between bench research and bedside practice.

Dr. Hamzaoui shares insights on current scientific understanding of microcirculation and shock, including research on tools to monitor microcirculation, such as handheld video microscopy. The discussion highlights the utility of capillary refill time as a simple, noninvasive tool for guiding resuscitation. Dr. Hamzaoui advocates for early and repeated echocardiographic assessment in shock management, including during de-resuscitation. She also discusses her 2023 article in Clinical Medicine, which proposed titrating norepinephrine to individualized targets.

This episode offers a compelling look at how emerging tools and research can refine shock management and promote precision care in critical illness.

This podcast is sponsored by Fresenius Kabi.

Resources referenced in this episode: 

Effects of a Resuscitation Strategy Targeting Peripheral Perfusion Status versus Serum Lactate Levels Among Patients with Septic Shock. A Bayesian Reanalysis of the ANDROMEDA-SHOCK Trial (Zampieri FG, et al. Am J Respir Crit Care Med. 2020;201:423-429)

The Eight Unanswered and Answered Questions about the Use of Vasopressors in Septic Shock (Hamzaoui O, et al. J Clin Med. 2023;12:4589)

Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock 2021 (Evans L, et al. Crit Care Med. 2021;49:e1063-e1143)

In this episode of the Society of Critical Care Medicine (SCCM) Podcast, host Kyle B. Enfield, MD, FCCM, speaks with Sumeet Rai, PhD, FCICM, senior intensivist at Canberra Hospital, about his study, “Pawsitive Care: Canine-Assisted Intervention for Anxiety in ICU Patients and Family Members: A Single-Center, Single-Arm Study,” published in the May 2025 compendium of Critical Care Explorations.

Dr. Rai explains how positive anecdotal experiences of animal therapy in the ICU inspired his team to conduct this study. Guided by infection control protocols, they implemented a program allowing accredited therapy dogs to visit patients and families for 15- to 20-minute sessions. More than 60% of patients and more than 90% of family members had a clinically meaningful reduction in anxiety scores, and patients reported decreased pain. No adverse events were observed, demonstrating the feasibility and safety of this approach.

Dr. Rai addresses the study’s limitations, such as the impracticality of conducting a randomized trial, and highlights the need for research into staff well-being, which appeared to benefit from therapy dog visits. He also underscores the importance of a safety program, including infection control precautions.

This episode offers practical insights for implementing animal therapy programs in the ICU and invites listeners to consider new approaches to improving mental health and well-being for patients, families, and staff.

Resources referenced in this episode: 

Pawsitive Care: Canine-Assisted Intervention for Anxiety in ICU Patients and Family Members: A Single-Center, Single-Arm Study (Cook K, et al. Crit Care Explor. 2025;7:e1258).

In this episode of the Society of Critical Care Medicine (SCCM) Podcast, host Elizabeth H. Mack, MD, MS, FCCM, speaks with Rebecca Mitting, MD, MRCPCH, consultant pediatric intensivist and clinical lead for the PICU at Imperial College Healthcare NHS Trust in London. They discuss Dr. Mitting’s article, “Sedation and Ventilator Weaning Bundle and Time to Extubation in Infants With Bronchiolitis: Secondary Analysis of the Sedation AND Weaning in Children (SANDWICH) Trial,” published in the April 2025 issue of Pediatric Critical Care Medicine.

The SANDWICH trial, conducted in the United Kingdom, evaluated a nurse-led intervention of sedation scoring, goal-based sedation weaning, and protocolized extubation readiness testing. While the original trial demonstrated only a modest reduction in ventilation duration, Dr. Mitting’s subgroup analysis of infants with bronchiolitis found a reduction of median time to successful extubation by approximately 16 to 17 hours.

Dr. Mitting highlights the importance of these findings during the winter season when bronchiolitis drives up PICU occupancy and strain. The critical trade-off between minimizing ventilator days and avoiding extubation failure is discussed, as well as implementation challenges after the COVID-19 pandemic, the importance of protocolized care under resource strain, and future directions for predictive models and personalized strategies to optimize extubation timing.

Listeners will gain practical insights into evidence-based approaches for improving outcomes in infants with bronchiolitis and the broader implications for PICU workflow and patient safety.

Resources referenced in this episode:

Sedation and Ventilator Weaning Bundle and Time to Extubation in Infants With Bronchiolitis: Secondary Analysis of the Sedation AND Weaning in Children (SANDWICH) Trial (Mitting RB, et al. Pediatr Crit Care Med. 2025;26:e423-e431).

Effect of a Sedation and Ventilator Liberation Protocol vs Usual Care on Duration of Invasive Mechanical Ventilation in Pediatric Intensive Care Units: A Randomized Clinical Trial (Blackwood B, et al. JAMA. 2021;326:401-410).