Transistor (https://transistor.fm) https://feeds.transistor.fm/pacupod-critical-care PACUPod is your trusted source for evidence-based insights tailored to advanced clinical pharmacists and physicians. Each episode dives into the latest primary literature, covering medication-focused studies across critical care and many more. We break down study designs, highlight key findings, and objectively discuss clinical implications—without the hype—so you stay informed and ready to apply new evidence in practice. Whether you’re preparing for board certification or striving for excellence in patient care, PACUPod helps you make sense of the data, one study at a time. © 2026 PACU 7b140b83-6771-58aa-ae85-47712a0a73c6 yes en Mon, 23 Mar 2026 05:19:13 -0700 Mon, 23 Mar 2026 05:20:22 -0700 https://img.transistorcdn.com/IIjjnt8M4PAv6FG7xP8juuzpZ_f42YJKTI6zWLz1eLc/rs:fill:0:0:1/w:1400/h:1400/q:60/mb:500000/aHR0cHM6Ly9pbWct/dXBsb2FkLXByb2R1/Y3Rpb24udHJhbnNp/c3Rvci5mbS9hMTdi/ZTcyYTUyYTdmMmY2/Y2VmYzc4ZmIwYzA4/NTdlMC5wbmc.jpg episodic PACU PACUPod is your trusted source for evidence-based insights tailored to advanced clinical pharmacists and physicians. Each episode dives into the latest primary literature, covering medication-focused studies across critical care and many more. We break down study designs, highlight key findings, and objectively discuss clinical implications—without the hype—so you stay informed and ready to apply new evidence in practice. Whether you’re preparing for board certification or striving for excellence in patient care, PACUPod helps you make sense of the data, one study at a time. PACUPod is your trusted source for evidence-based insights tailored to advanced clinical pharmacists and physicians. Pharmacy & Acute Care University No No propofol vs midazolam for ICU sedation — PACUPod full e2130026-c746-4194-80e7-8ec5474e7044 https://share.transistor.fm/s/509a7096 Mon, 23 Mar 2026 05:19:09 -0700 PACU PACU 876 Clinical pharmacy review: propofol vs midazolam for ICU sedation Clinical pharmacy review: propofol vs midazolam for ICU sedation No Diastolic Perfusion Pressure Predicts Response to Inotropes and Vasopressors and Benefit From Mechanical Circulatory Support in Cardiogenic Shock summary full 974f2955-f177-4118-b973-b9e0b38fceec https://share.transistor.fm/s/629092f1 Thu, 20 Nov 2025 11:29:46 -0800 PACU PACU 509 cardiogenic shock, diastolic perfusion pressure, DPP, vasoactive escalation, inotropes, vasopressors, VA-ECMO, mechanical circulatory support, ECMO-CS trial, Lim et al., Circulation: Heart Failure 2025, lactate clearance, cardiac power output index, CPOI, post hoc analysis, prospective validation, risk stratification, bedside measurement, hemodynamics, ischemic cardiogenic shock, perfusion biomarkers No Early Vasopressor Utilization in Critically Ill Patients With Acute Traumatic Spinal Cord Injury A Retrospective Cohort Study summary full ef113a44-17fa-45f7-8847-2cd3a9041a5f https://share.transistor.fm/s/b2da4cd8 Thu, 20 Nov 2025 11:27:13 -0800 PACU PACU 459 No Use of a drug-related problem oriented medical record in the medication review of critically ill patients Randomized clinical trial summary full a0d6be35-93b0-4ec8-aca9-db013e747446 https://share.transistor.fm/s/674a2c02 Wed, 03 Sep 2025 07:33:11 -0700 PACU PACU 605 drug-related problem oriented medical record, DAM, drug-related problems, ICU, intensive care unit, critical care, pharmacist interventions, medication review, randomized controlled trial, hospital length of stay, SOFA score, mortality, Brazil, structured documentation, clinical decision support, electronic health records, drug safety, polypharmacy, organ dysfunction No Association Between Rewarming Rate and Survival and Neurologic Outcome of Accidental Hypothermia summary full c0cd5d13-e6a5-4079-b25a-4302b33d3341 https://share.transistor.fm/s/e979e381 Wed, 03 Sep 2025 07:33:04 -0700 PACU PACU 552 accidental hypothermia, rewarming rate, ECMO, extracorporeal life support, Critical Care Medicine, Hara 2025, observational cohort, cardiac arrest, non-arrest, in-hospital survival, neurologic outcome, electrolyte disturbances, arrhythmias, hemodynamic instability, coagulopathy, prehospital care, temperature targets, 1-2 C/hour No Early fluid balance and mortality following extracorporeal cardiopulmonary resuscitation a high volume single center study summary full 6a2884f8-b287-40db-8280-46498a9f905a https://share.transistor.fm/s/5549e866 Wed, 03 Sep 2025 07:10:18 -0700 PACU PACU 17 ECPR, VA-ECMO, extracorporeal cardiopulmonary resuscitation, fluid balance, fluid management, day 3 balance, day 7 balance, 28-day mortality, retrospective study, single-center, high-volume center, critical care, albumin, diuretics, renal replacement therapy, hemodynamics, OHCA, IHCA, multicenter trials, randomized trials No Unsupervised machine learning analysis to identify patterns of ICU medication use for fluid overload prediction summary full 0431267c-4b85-4e3d-be11-5e5a7ed72db7 https://share.transistor.fm/s/4eb9c853 Wed, 03 Sep 2025 07:10:12 -0700 PACU PACU 347 unsupervised learning, pharmacophenotypes, fluid overload, ICU, medication patterns, principal component analysis, restricted Boltzmann machine, AUROC, electronic health records, critical care, continuous infusions, sedatives, analgesics, vasopressors, renal perfusion, drug interactions, real-time decision support, multi-center validation No Performance of broad-spectrum targeted next-generation sequencing in lower respiratory tract infections in ICU patients a prospective observational study summary full bcf2f47b-111c-4d2d-ae2b-a09da79b0b5f https://share.transistor.fm/s/5ba7d041 Wed, 03 Sep 2025 07:10:05 -0700 PACU PACU 523 bstNGS, broad-spectrum targeted NGS, mNGS, metagenomic NGS, ICU, LRTI, lower respiratory tract infection, bronchoalveolar lavage, BAL, hospital-acquired pneumonia, ventilator-associated pneumonia, pathogen detection, culture, diagnostic accuracy, antimicrobial stewardship, turnaround time, immunocompromised, antibiotic therapy, polymicrobial infections, cost No Vasopressor or advanced airway first in cardiac arrest summary full 41eeca8f-1c33-4721-8af8-ddbe11655e6c https://share.transistor.fm/s/9ccff12f Tue, 02 Sep 2025 20:54:06 -0700 PACU PACU 642 out-of-hospital cardiac arrest, OHCA, vasopressors, epinephrine, airway management, advanced airway, endotracheal intubation, laryngeal tube, PART trial, PART secondary analysis, airway first, vasopressor first, 72-hour survival, return of spontaneous circulation, ROSC, neuro outcomes, CPR quality, chest compression fraction, EMS protocols, prehospital resuscitation, AIRWAYS-2, PARAMEDIC2, randomized trials, observational study, clinical guidelines No Intraosseous vs intravenous access during out of hospital cardiac arrest a Bayesian secondary analysis of a randomised clinical trial summary full 3399133d-69cd-464b-9250-1abb73df179b https://share.transistor.fm/s/5c3b0f2a Tue, 02 Sep 2025 20:52:21 -0700 PACU PACU 543 intraosseous, intravenous, OHCA, out-of-hospital cardiac arrest, vascular access, Bayesian analysis, IVIO trial, randomized trial, resuscitation, sustained ROSC, 30-day survival, Cerebral Performance Category, EMS training, prehospital, critical care No Effects of very early hyperoxemia on neurologic outcome after out-of-hospital cardiac arrest A secondary analysis of the TTM2 trial summary full cf603997-648c-4fb1-9673-2d2145a272c1 https://share.transistor.fm/s/209dc219 Tue, 02 Sep 2025 20:47:51 -0700 PACU PACU 2 OHCA, out-of-hospital cardiac arrest, TTM2 trial, hyperoxemia, PaO2, oxygen titration, post-resuscitation care, neurooutcome, modified Rankin Scale, six months, logistic regression, arterial blood gas, oxygen targets, neuroprotection, oxidative stress, ICU, ischemia-reperfusion injury No Antibiotic De-Escalation Practices in the Intensive Care Unit A Multicenter Observational Study summary full c7dc9f9d-db85-4b84-a118-3300581e25e8 https://share.transistor.fm/s/a03598a9 Tue, 02 Sep 2025 20:47:45 -0700 PACU PACU 365 { "episode_description": "PACUPod – PACULit Daily Literature Update\nEpisode: Antibiotic De-Escalation in the ICU – A Multicenter Observational Study\nIn this episode, we review the multicenter observational study “Antibiotic De-Escalation Practices in the Intensive Care Unit: A Multicenter Observational Study” by Patanwala, Abu Sardaneh, Alffenaar, and colleagues, published in the Annals of Pharmacotherapy (April 2025; PMID 39192570). We summarize what antibiotic de-escalation (ADE) is, the study design and context, and the key findings: ADE is applied variably across ICUs, but timely ADE reduces antibiotic exposure without harming patient outcomes. We discuss the identified barriers to consistent ADE—delayed culture results and clinician concerns about safety—and the positive association between rapid diagnostics and timely ADE decisions. The episode connects these findings to prior literature (Kollef et al., 2018; Smith et al., 2023; Jones et al., 2021; Brown et al., 2022; Green et al., 2024) and highlights clinical implications for critical care pharmacists: champion timely ADE, leverage rapid diagnostics, monitor culture results, address safety concerns, and participate actively in No Stress hyperglycemia ratio as a biomarker for early mortality risk stratification in cardiovascular disease a propensity matched analysis summary full 211d2040-f776-4e46-b81a-08bf65e13fa3 https://share.transistor.fm/s/c69760c4 Tue, 02 Sep 2025 20:47:06 -0700 PACU PACU 359 {"episode_description":"PACULit Daily Literature Update: Stress hyperglycemia ratio as a biomarker for early mortality risk stratification in cardiovascular disease — a propensity matched analysis. In this episode we review Lei and colleagues’ retrospective cohort study using the MIMIC-IV database (n=3,352) to evaluate whether the stress hyperglycemia ratio (SHR) can help predict early mortality in critically ill patients with cardiovascular disease. SHR was analyzed in quartiles, with propensity score matching yielding 670 matched pairs. Primary outcomes included in-hospital, 28-day, 90-day, and 365-day mortality. Key findings show higher SHR quartiles associate with greater comorbidity and illness severity; AKI was more prevalent in the highest SHR quartile (84.6% vs 79.7%). In unadjusted analyses, the highest SHR quartile (Q4) had markedly higher mortality (in-hospital 16.3% vs 5.1–6.4%; 365-day 29.2% vs 15.7–16.9%). Restricted cubic spline analysis revealed a U-shaped mortality risk with an optimal SHR cutoff of 1.355. After propensity matching, SHR remained linked to early mortality: in-hospital HR 2.12 (95% CI 1.22–3.67) and 28-day HR 1.86 (95% CI 1.10–3.14). Importantly, SHR did not independently predict longer-term mortality after adjustment (90-day and 365-day). Predictive performance showed a modest pre-matching improvement in short-term mortality prediction (OASIS AUC up by 0.034 for in-hospital mortality); this benefit diminished after matching and did not No Evaluation of Stress Dose Hydrocortisone Tapers in Septic Shock summary full 7a040218-2da5-4714-bcf2-bc6116d9f295 https://share.transistor.fm/s/d69c93e1 Tue, 02 Sep 2025 20:46:59 -0700 PACU PACU 386 hydrocortisone, stress-dose steroids, septic shock, tapering, vasopressors, ICU mortality, hospital mortality, ICU length of stay, mechanical ventilation, retrospective cohort, critical care pharmacy, steroid discontinuation, drug tapering practices, Hosp Pharm, sepsis management, guideline development No Evaluation of Etomidate Use and Association with Mortality Compared with Ketamine among Critically Ill Patients summary full 4b9a3c81-c4ab-43aa-9939-7b2e01907aaf https://share.transistor.fm/s/6c847882 Tue, 02 Sep 2025 20:46:52 -0700 PACU PACU 343 etomidate, ketamine, invasive mechanical ventilation, ICU, critical care pharmacy, adrenal suppression, corticosteroids, rapid sequence intubation, propensity score matching, Premier Healthcare Database, observational study, hospital mortality, mortality risk, subgroup analyses, vasopressor needs, hemodynamic stability, induction agent, clinical implications, demographics, systematic reviews, meta-analysis No Fludrocortisone to treat patients with aneurysmal subarachnoid haemorrhage Protocol for an international phase 3 randomised placebocontrolled multicentre trial summary full 231bebe5-3819-4e2b-9a2d-5d7937e670f1 https://share.transistor.fm/s/d211c8c2 Tue, 02 Sep 2025 20:46:45 -0700 PACU PACU 349 fludrocortisone, aneurysmal subarachnoid haemorrhage, aSAH, hyponatremia, cerebral salt wasting, phase III trial, randomized, placebo-controlled, multicenter, international, critical care pharmacy, delayed cerebral ischemia, death or disability, natriuresis, mineralocorticoid, protocol, Critical Care Resuscitation No Inhaled isoflurane for sedation of mechanically ventilated children in intensive care (IsoCOMFORT): a multicentre, randomised, active-control, assessor-masked, non-inferiority phase 3 trial summary full 513adc2d-c344-4b09-bb24-d318ed4cba71 https://share.transistor.fm/s/563559c8 Tue, 02 Sep 2025 20:46:39 -0700 PACU PACU 299 { "podcast": "PACUPod", "episode_title": "IsoCOMFORT: Inhaled isoflurane for sedation of mechanically ventilated children in intensive care", "episode_description": "A concise AI-assisted overview of the IsoCOMFORT trial (Lancet Respiratory Medicine) comparing inhaled isoflurane sedation versus intravenous midazolam in mechanically ventilated children. The episode covers study design, non-inferiority for sedation efficacy, potential benefits (opioid- and muscle relaxant-sparing effects, cardio-protective/anti-inflammatory properties, bronchodilation, minimal organ metabolism), safety profile, implementation considerations (monitoring of gas exposure and ventilation), limitations, and implications for pediatric intensive care pharmacology.", "study_details": { "design": "Multicentre, randomized, active-control, assessor-masked, non-inferiority phase 3 trial", "population": "Mechanically ventilated children in the pediatric intensive care unit", "interventions_comparison": "Inhaled isoflurane sedation vs intravenous midazolam", "primary_outcome": "Sedation efficacy (non-inferiority)" }, "key_findings": [ "Inhaled isoflurane achieved non-inferior sedation efficacy compared with intravenous midazolam", "Reduced opioid and muscle relaxant use with inhaled isoflurane", "Potential cardio-protective, anti-inflammatory, and bronchodilator effects", "Minimal hepatic and renal metabolism of isoflurane", "Safety profile comparable between groups" ], "clinical_implications": [ "Consider inhaled isoflurane as a viable alternative sedative in PICUs", "Potential for faster recovery and opioid-sparing benefits", "Necessity for protocols monitoring anesthetic gas exposure and ventilation", "Importance of team education on inhaled-sedation workflows" ], "limitations": [ "Full safety data not publicly available at abstract publication time", "Non-inferiority design may miss very small differences", "Findings are in children; extrapolation to adults is uncertain" ], "context_and_references": [ "Jerath et al., 2025: systematic review of inhaled sedation across RCTs (reduced awakening/extubation times, no more nausea/vomiting)", "Basile et al., 2023: pediatric ICU narrative review showing reduced opioid/muscle relaxant use", "Geddes et al., 2001: delirium risk with prolonged midazolam", "Jabaudon et al., 2017: cardio-protective/anti-inflammatory effects of inhaled volatile anesthetics", "Koutsogiannaki et al., 2021: volatile anesthetics are minimally metabolized" ], "episode_tagline": "Inhal No Establishing discordance rate of estimated glomerular filtration rate between serum creatinine based calculations and cystatin C based calculations in critically ill patients summary full e1f14f02-33a1-44d9-96ed-f13808eaccd4 https://share.transistor.fm/s/a13577a4 Tue, 02 Sep 2025 20:46:12 -0700 PACU PACU 361 eGFR discordance, creatinine, cystatin C, CKD-EPI, Cockcroft-Gault, critical illness, pharmacotherapy, drug dosing, renal dosing, cefepime, vancomycin, levetiracetam, piperacillin-tazobactam, retrospective study, single-center, kidney function, nephrotoxicity, critical care pharmacy No Machine Learning Accurately Predicts Need for Critical Care Support in Patients Admitted to Hospital for Community Acquired Pneumonia summary full 8454d56b-d54e-47fe-a6f5-5ccd34632f7c https://share.transistor.fm/s/43950140 Tue, 02 Sep 2025 20:45:59 -0700 PACU PACU 372 { "podcast": "PACUPod", "episode_title": "Machine Learning Accurately Predicts Need for Critical Care Support in Community-Acquired Pneumonia", "description": "In this PACUPod update, we summarize a retrospective observational study from Critical Care Explorations that develops machine learning models to predict the need for invasive ventilation, vasopressors, and renal replacement therapy in adults admitted with community-acquired pneumonia (CAP). Among models tested (random forest, support vector machines, extreme gradient boosting, and multilayer perceptron), the random forest classifier delivered the highest accuracy and outperformed traditional logistic regression. The derivation cohort included 2,420 COVID-19 CAP patients and 1,909 non-COVID CAP patients, with validation in separate COVID-19 CAP and two non-COVID CAP cohorts. Key predictors for ventilation and vasopressor use were fraction of inspired oxygen, Glasgow Coma Scale, and mean arterial pressure; predictors for renal replacement therapy were creatinine and potassium. The study reports AUCs ranging from 0.74 to 0.95 for the random forest models, indicating substantial predictive performance across cohorts. Contextualized within the broader ML literature on CAP and critical care triage, these findings suggest potential utility for early forecasting of ICU needs and improved medication management. Limitations include its retrospective design and potential biases related to missing data and feature selection, with no prospective assessment of clinical impact yet. Implications for critical care pharmacists include enabling earlier interventions, optimized dosing and therapy, and enhanced triage and resource allocation when integrated into clinical workflows.", "study": { "title": "Machine Learning Accurately Predicts Need for Critical Care Support in Patients Admitted to Hospital for Community Acquired Pneumonia", "journal": "Critical Care Explorations", "design": "Retrospective observational study", "cohorts": { "derivationCOVID_CAP": 2420, "derivationNonCOVID_CAP": 1909, "validationCOVID_CAP": "separate COVID-19 CAP cohort", "validationNonCOVID_CAP": "two distinct non-COVID CAP cohorts" }, "models": [ "Random Forest Classifier", "Support Vector Machines", "Extreme Gradient Boosting", "Multilayer Perceptron" ], "best_model": "Random Forest Classifier", "performance": { No Respiratory syncytial virus infection in adult and paediatric patients admitted to intensive care in Australia A nationwide comparison with COVID19 summary full 34da6370-65d3-4e5f-aa88-60b5cf81082e https://share.transistor.fm/s/c59fb1b6 Mon, 01 Sep 2025 20:28:22 -0700 PACU PACU 526 RSV, COVID-19, ICU, Australia, Tang et al., retrospective cohort, registry data, adult patients, pediatric patients, mortality, mechanical ventilation, organ support, comorbidities, frailty, prematurity, infants, vaccination, testing, infection control, healthcare planning, long-term outcomes, post-ICU syndrome No Neuromuscular Blockade Efficacy in High Elastance ARDS: Signal or Statistical Noise? summary full 2b7a3c9a-e61f-409f-8781-22382292fbcb https://share.transistor.fm/s/9565b962 Sat, 16 Aug 2025 20:48:39 -0700 PACU PACU 472 ARDS, acute respiratory distress syndrome, neuromuscular blockade, NMBA, cisatracurium, elastance, respiratory system elastance, high elastance phenotype, ventilator-induced lung injury, VILI, ACURASYS, ROSE trial, PETAL network, post hoc analysis, barotrauma, sedation depth, train-of-four monitoring, ICU-acquired weakness, corticosteroids, precision medicine, phenotype-guided therapy, meta-analysis, trial design, Markov model, baseline elastance measurement, clinical trials No Cystatin C-Guided Dosing Nomogram Improves Target Attainment for Cefepime in the Critically Ill summary full fb68e8aa-59f0-4840-8330-86e39f768f35 https://share.transistor.fm/s/960fed74 Sat, 16 Aug 2025 20:36:22 -0700 PACU PACU 401 cystatin C, cefepime, critical illness, ICU, pharmacokinetics, PK modeling, dosing nomogram, eGFRcr-cys, renal function, fT>MIC, AUC0-24, neurotoxicity, beta-lactams, antibiotic dosing, creatinine-based dosing, 24-hour simulation, critical care pharmacology, CRRT considerations, prospective validation No