PRISM Rounds: Pulmonary Critical Care & Sleep Podcast
PRISM Rounds is a clinical review series by the PRISM research team. Every other week, it breaks down a high-impact Pulmonary, Critical Care, or Sleep article into three segments: The Blueprint (study design and methodology), The Math (demystifying statistics), and The "So What?" (real-world bedside implications). The podcast bridges the gap between the journal and the clinic/ICU, helping listeners interpret trials quickly and skip the noise.
Episodes
S01E50: The MARCH Trial, When ICU Mucoactives Cause Harm Without Benefit
Should mechanically ventilated patients with difficult-to-clear secretions routinely receive carbocisteine or nebulized hypertonic saline?In this episode of PRISM Rounds, we examine the MARCH randomized trial, which enrolled 1,956 patients across 71 UK intensive care units. Neither intervention shortened mechanical ventilation or improved major clinical outcomes. However, carbocisteine increased c
S01E49: VICTORY Trial, High-Dose Vitamin C in Severe Burns
In this episode of PRISM Rounds, we review the VICTORY randomized clinical trial, published in JAMA on June 10, 2026, testing high-dose intravenous vitamin C in patients with severe burn injury.The trial randomized adults with deep second- or third-degree burns involving at least 20% total body surface area to high-dose IV vitamin C or placebo. VICTORY was stopped early for futility and harm. Vita
S01E48 | Bicarbonate During In-Hospital Cardiac Arrest : The BIHCA Trial
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 bicar
S01E47 | SODa-BIC: Sodium Bicarbonate for Metabolic Acidosis and Shock
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 bicarbona
S01E46 | ARISE FLUIDS: Early Vasopressors or More Fluids in Septic Shock?
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 e
S01E45: PROMINE Trial: Ketamine vs Propofol for ICU Intubation
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-
S01E44: Remote Rehab After the ICU — The iRehab Trial
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 s
S01E43 | EDTA for CVADs: Can a Line Lock Reduce ICU Catheter Complications?
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 patients
S01 Bonus Episode01: Prevent and Reverse Heart Disease — A Patient-Friendly Book Review
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
S01E42: Auto-Adjusted NIV in OHS - The Pickwick Titration Trial
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 adjusted N
S01E41: EIT-Guided PEEP in ARDS — Precision Ventilation or Too Much Titration?
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 mortalit
S01E40 | Balanced Fluids vs Saline in Pediatric Septic Shock: Why Adult ICUs Should Care
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 reduce
S01E39 | The FAST Trial - Rapid AST for Gram-Negative Bacteremia
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
S01E38 | Portable TB Testing — MiniDock MTB and Diagnostic Equity
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-lim
S01E37 | The HIT Trial: Is "Good Enough" Better for Hyponatremia Correction?
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 ResultsLab Normalization: The targeted algorithm was highly effective at "fixing the number," reaching no
S01E36| The "Goldilocks Zone": A Masterclass in Lung- and Diaphragm-Protective Ventilation (LDPV)
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 morta
S01E35 | Choosing Fluids in Sepsis: Does Strategy Change Everything?
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 choic
S01E34 | CORAL Trial: Nalbuphine for IPF Cough — A Real Signal?
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 designDose-response and patient-reported outcomesSafety of a κ-opioid ag
S01E33 | Surviving Sepsis Campaign 2026 — From Protocols to Precision
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 highligh
S01E32: HI-PEITHO and the Management of Intermediate-Risk Pulmonary Embolism
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 demonstr
S01E31 | Filtering Endotoxin in Septic Shock — Is Tigris a Practice Changer?
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 cover t
S01E30 | Inhaled GM-CSF for PAP — Is This the End of Whole-Lung Lavage?
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 moving
S01E29 | Restraints Don’t Fix Delirium: R2D2 ICU Trial (JAMA 2026)
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 pre
S01E27 | Apixaban vs Rivaroxaban in Acute VTE: The COBRRA Trial
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 rates
S1E28: SOHO Trial — HFNC vs Standard Oxygen in AHRF
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#FOAMe
S01E26: TETON-2 and IPF — Does Inhaled Treprostinil Change Practice?
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 t
S01E25: Earlier Cardiometabolic Risk in South Asian Adults
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
S01E24: VASST Revisited — Vasopressin, Norepinephrine, and the Timing Question in Septic Shock
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
S01E23 ARISS Trial: Chasing Albumin ≥3.0 in Septic Shock—Does It Help?
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 significant
S01E22 Stroke Alert Teaching Rounds: What’s New in the 2026 AHA/ASA AIS Guideline
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 tenectepl
S01E21 Acute Pulmonary Embolism: 2026 AHA/ACC Multisociety Guideline
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 about
S01E20 PreVent 2 and Subglottic Secretion Drainage After Emergency Intubation (Lancet Respir Med)
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 i
S01E19 PROMIZING: PAV+ vs PSV for Ventilator Liberation
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
S01E18 Selective Digestive Decontamination: What SuDDICU Actually Shows
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
S01E17 Bedside Lung Maps: Electrical Impedance Tomography (EIT) for ARDS, PEEP, and Proning
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
S01E16 Dopamine vs Norepinephrine in Shock: SOAP II — A Historical Deep Dive
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
S01E15 Central Sleep Apnea: AASM 2025 Guideline—What to Use (and Avoid) in Real Patients
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” recom
S01E14 BICARICU-2: Bicarbonate for Severe Acidemia + AKI
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
S01E13 Hypopnea Scoring and OSA in Women
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
S01E12 HYPERION: Sotatercept in Early PAH
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
S01E11 ANDROMEDA-SHOCK 2, the Return of Capillary Refill
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
S01E10 Mask vs NIV: The 3-Minute Preoxygenation Playbook to Avoid the Crash
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
S01E09 Adjunctive Glucocorticoids in CAP: The SONIA Pragmatic RCT
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 context
S01E08 Ketamine vs Etomidate for RSI in Critical Illness
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
S01E07 Automated Ventilation vs Human Experts in ACTiVE
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
S01E06 Managing Shock Without Arterial Lines: EVERDAC
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,
S01E05 EGFR-Mutated NSCLC Update — FLAURA2 Overall Survival + Sacituzumab Tirumotecan After TKI Resistance
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
S01E04 The LIBERATE-D Trial: Conservative vs. Conventional Dialysis Strategies
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.
S01E03: Can Mindfulness, Coaching, and Peer Support Reduce Physician Burnout? (Systematic Review & Meta-Analysis)
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): htt
S01E02 Timing Matters in Sepsis: Community-Onset vs Hospital-Onset (Machine Learning Insights)
Episode titleTiming 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 cen
S01E01 Vitamin C in Sepsis: The ASTER Phase 2b Trial
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
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