This is a chat with Rowan Grieves who works in Belfast about her journey to become an ACCP and the hurdles she had to overcome when starting this new role.

This is a chat with Tamas Szakmany about the paper 'Impact of early tracheostomy versus late or no tracheostomy in nonneurologically injured adult patients: a systematic review and meta analysis' and his editorial 'When more could mean less intervention: the tale of tracheostomy timing in critical illness'

This is a chat with Professor John Laffey about the WEAN_SAFE study. 

Weaning from mechanical ventilation in intensive care units across 50 countries (WEAN SAFE): a multicentre, prospective, observational cohort study

A discussion with Michelle about the recent paper she played a part in discussing the conversation s we have, or don't about Do No Resuscitate orders.

The experiences of adult patients, families, and healthcare professionals of CPR decision-making conversations in the United Kingdom: A qualitative systematic review.

Brigitta and colleagues have just published 'The rate and assessment of muscle wasting during critical illness: a systematic review and meta-analysis.'

Some important and interesting discussion points.

My good friend and colleague Rob Fenwick (@robfenwick) and I chatted about the article he was involved in "Productivity of Advanced Clinical Practitioners in Emergency Medicine: A 1-year dual-centre retrospective analysis"

Rob is an Advanced Clinical Practitioner in the West Midlands in the Emergency Medicine department. He is also one of the members of the fabulous podcast The Resus Room (@TheResusRoom) which I highly recommend!

This is a discussion with Dr Mark Ramzy, an EM and Critical Care Doctor in Pittsburgh. 
His infographic on the various options open to us in the treatment of the patient with ARDS caught my eye on twitter so I managed to chat to him about it.

This is a discussion I had with several others on Facebook Live about setting up and the use of ICU Follow Up Clinics. Some of those on the panel were new to it and some had existing clinics so shared valuable information.

Kimberley Begg presented her poster at the recent virtual BACCN 2020 conference. She is a keen user of in situ simulation in her department and has set up a program to make it effective. We can all learn something from this.

A conversation between Zudin Puthucheary, Senior lecturer and consultant in intensive care medicine, Julia Hadley, also a consultant in critical care and lead for the Royal London guidelines for tracheostomy in the COVID patient and Dr Brendan McGrath who is the national clinical lead for the same. 

I was very lucky to be contacted by Dr Zudin Puthucheary, Senior Lecturer and Consultant in Intensive Care Medicine, who asked me to record this conversation between himself and Dr Jim Buckley, Consultant in Intensive Care medicine, and Dr Brijesh Patel, Clinical Senior Lecturer and Consultant in Cardiothoracic Intensive Care. 

This discussion focuses on what is potentially the early stages of the crisis the NHS is about to face. Lots of great insights to take away!

This a an audio version of the espresso teaching on the BACCN website which you can find here- https://www.baccn.org/about/covid-19-nurse-educational-resource-centre/espresso-virtual-education/

This is a conversation I had with Jon White (@TechNurseJon) and Kelley Reep (@reepRN) about their new Twitter chats and the aims and objectives of them. We also wax lyrical about the benefits of Twitter as a whole!

One of my colleagues, Rachel Williams (@rawbubbles9), and her team are working very hard to get the patients moving and then hopefully home sooner whilst on the wards. This involves a number of methods including reindeer!

Pressure Injuries at Intensive Care Unit Admission as a Prognostic Indicator of Patient Outcomes 

 ©2019 American Association of Critical-Care Nurses doi:https://doi.org/10.4037/ccn2019530

This is a chat with the lead author of this paper Dr William McGee.

"Pre-existing pressure injuries can serve as a predictive clinical marker for longer hospitalization and increased odds of mortality, especially when other data aren’t available, according to a study published in the June issue of Critical Care Nurse.

 The research team from Baystate Medical Center in Massachusetts found that pressure injuries that were present upon admission to the ICU could be used to quickly and objectively identify patients who may require additional care. The statistical analysis revealed that pressure injuries were associated with significantly longer hospital lengths of stay, regardless of mortality outcome. Among patients with pressure injuries at admission, mechanical ventilation and dialysis were more common, as was the overall severity of illness. Readmission to the ICU during the same hospitalization occurred more frequently for patients with pressure injuries."

In this episode Bryan discusses some of the issues with pain, agitation and delirium with the pharmacist Komal Pandya. 

We all try to understand how to help our patients and sometimes get it wrong, but lets continue to work hard to improve.

 Jakob SM, Ruokonen E, Grounds RM, et al. Dexmedetomidine vs midazolam or propofol for sedation during prolonged mechanical ventilation: two randomized controlled trials. Jama. 2012;307(11):1151-60.

https://www.ncbi.nlm.nih.gov/pubmed/22436955

Mehta S, Burry L, Cook D, et al. Daily sedation interruption in mechanically ventilated critically ill patients cared for with a sedation protocol: a randomized controlled trial. Jama. 2012;308(19):1985-92.

https://www.ncbi.nlm.nih.gov/pubmed/?term=mehta+2012+sedation+interuption

Pandharipande PP, Pun BT, Herr DL, et al. Effect of sedation with dexmedetomidine vs lorazepam on acute brain dysfunction in mechanically ventilated patients: the MENDS randomized controlled trial. Jama. 2007;298(22):2644-53.

https://www.ncbi.nlm.nih.gov/pubmed/18073360

Riker RR, Shehabi Y, Bokesch PM, et al. Dexmedetomidine vs midazolam for sedation of critically ill patients: a randomized trial. Jama. 2009;301(5):489-99.

https://www.ncbi.nlm.nih.gov/pubmed/?term=sedcom+2009

Shehabi Y, Howe BD, Bellomo R, et al. Early Sedation with Dexmedetomidine in Critically Ill Patients. The New England journal of medicine. 2019;380(26):2506-17.

https://www.ncbi.nlm.nih.gov/pubmed/31112380

Dr Paul Hughes Webb chats with me about how we define aneamia and what we can do about it for our patients.

The last podcast from the NTI2019 and this was with other practitioners who all use Social Media to help others learn. This was a great conversation and a great way to wrap up. Thanks NTI I had a great time.

Also wanted to acknowledge the support of the British Association of Critical Care Nurses (BACCN) who, through their grants program, helped make this trip possible.

Maureen A Seckel chatted about some of the studies she had noticed over the last year related to sepsis and I then went on to discuss proning with Danette Mitchell and how she had implemented an education program in her unit.

Also wanted to acknowledge the support of the British Association of Critical Care Nurses (BACCN) who, through their grants program, helped make this trip possible.

Michael H Ackerman and Dr. Tom S. Ahrens chat with me about some of the recent changes in sepsis management. (Spoiler alert- not many to talk about!)

Also wanted to acknowledge the support of the British Association of Critical Care Nurses (BACCN) who, through their grants program, helped make this trip possible.

Brandy Venable and I discuss how we can utilise QR codes to create just in time learning for the staff in critical care.

Also wanted to acknowledge the support of the British Association of Critical Care Nurses (BACCN) who, through their grants program, helped make this trip possible.

What are the heamodynamics we should be concerned with and should we be measuring them?

Also wanted to acknowledge the support of the British Association of Critical Care Nurses (BACCN) who, through their grants program, helped make this trip possible.

Jason developed life threatening sepsis after catching the H1N1 virus. He spent a lot of time in ITU, but then decided to become an ITU nurse. This gives him a unique perspective.

Also wanted to acknowledge the support of the British Association of Critical Care Nurses (BACCN) who, through their grants program, helped make this trip possible.

@onlyintheicu is the twitter handle of a nurse who has experienced some mental health issues including an attempted suicide. She and I  discuss the implications of this increasing problem for ICU staff

Also wanted to acknowledge the support of the British Association of Critical Care Nurses (BACCN) who, through their grants program, helped make this trip possible.

Sometimes handing over our patients problems to another health care provider can be done badly not getting us the response we need. How can we improve that?

Also wanted to acknowledge the support of the British Association of Critical Care Nurses (BACCN) who, through their grants program, helped make this trip possible.

I finally met Sean Dent who posts very regularly on Facebook and Instagram and is also someone I follow and interact with on Twitter. We also chat with Sarah Wells who is trying to help new and junior nurses by supporting them via social media.

Also wanted to acknowledge the support of the British Association of Critical Care Nurses (BACCN) who, through their grants program, helped make this trip possible.

Nicole Kupchik presented some of the key studies of the last year. Here she covers some of them for us with Anna Rodriguez

Also wanted to acknowledge the support of the British Association of Critical Care Nurses (BACCN) who, through their grants program, helped make this trip possible.

Ruth Kleinpell, Teresa Rincon and Denise Ward chat with Bryan Boling about the development of Telehealth in The USA. 

Also wanted to acknowledge the support of the British Association of Critical Care Nurses (BACCN) who, through their grants program, helped make this trip possible.

Jon White chats with Nancy and Gayle about what makes staffing levels safe and how we can ensure that we keep our staff healthy.

Also wanted to acknowledge the support of the British Association of Critical Care Nurses (BACCN) who, through their grants program, helped make this trip possible.

Bryan Boling chats with Daniel and Brandi about some of the liver problems our patients can have at the #NTI2019

Also wanted to acknowledge the support of the British Association of Critical Care Nurses (BACCN) who, through their grants program, helped make this trip possible.

Megan (@nursenoodles) is president elect at the conference this year and in this episode she chats with Jon (@technursejon) about her upcoming work, social media and how she got that Twitter name!

Also wanted to acknowledge the support of the British Association of Critical Care Nurses (BACCN) who, through their grants program, helped make this trip possible.

One of the reasons our patients cannot sleep is because of all the noise we make at night. Is the answer just to make less noise? How can we do this? Will it make a difference?

I chat with Julie Darbyshire (@JLDarbyshire) whose PhD is on this subject to find out more. 

There are now Advanced Practitioners appearing across the world of nursing, physiotherapy and paramedicine to mention just a few.

Here Bryan and I chat with Ruth Kelinpell who is the President of the Society of Critical Care Medicine about how these roles developed, what is happening today and what may happen in the future.

Lots of interesting points raised and some great food for thought.

What happens to our patients after they leave the ICU?

ICU patients are more complex even after discharge. They have a lot of post-discharge needs that make them unique and not every primary care provider is equipped to deal with them. That's why a number of centers are starting to develop ICU recovery clinics that see patients after they are discharged.

Today on the podcast, I'm joined by Dr. Ashley Montgomery-Yates, an attending physician in the Pulmonary and Critical Care Medicine division at the University of Kentucky and director of UK's ICU Recovery Clinic.

Comprehensive care of ICU survivors: Development and implementation of an ICU recovery center. https://www.ncbi.nlm.nih.gov/pubmed/29929705

Models for a Post-Intensive Care Syndrome Clinic - Targeted Goals and Barriers. http://www.learnicu.net/Communications/Critical-Connections/Archives/Pages/Models-for-a-Post-Intensive-Care-Syndrome-Clinic---Targeted-Goals-and-Barriers.aspx

THRIVE Post ICU Clinic Collaborative. https://www.sccm.org/Research/Quality/THRIVE/THRIVE-Post-ICU-Clinic-Collaborative