Critically ill patients receiving mechanical ventilation require analgesia and sedation. At present, propofol remains the most widely used sedative for intubated/ventilated patients. Recent trials have suggested that dexmedetomidine may reduce delirium and the duration of mechanical ventilation compared with other sedative medications. In fact, recent SCCM guidelines suggest the use of dexmedetomidine over propofol in intubated patients. In this podcast, we discuss a recent randomized trial that compared the effectiveness and safety of a dexmedetomidine-based sedation strategy with a propofol-based sedation strategy in mechanically ventilated critically ill patients.

Approximately 75% of patients older than 65 years of age are seen in an ED within 6 months of their death. While palliative care teams are now present in many hospitals in the US, they are often not present 24/7 or in resource-limited settings. As such, there may be an opportunity to improve palliative care in the ED by providing palliative care education to ED team members. In this podcast, we review the recently published PRIM-ER trial, which evaluated the impact of a robust primary palliative care intervention on hospital admission rates in 29 EDs across the US.

Sepsis results in more than 250,000 deaths each year in the United States. Resuscitation of the septic patient centers on timely recognition, early antibiotic administration, appropriate fluid administration, source control, and vasopressor administration for those with inadequate mean arterial pressures. At present, norepinephrine is the recommended first-line vasopressor for sepsis. Current guidelines then recommend vasopressin as the second-line vasopressor agent, but the optimal timing of its initiation remains unknown. In this podcast, we discuss a recent article on the use of a machine learning tool for vasopressin administration to optimize short- and long-term outcomes in patients with sepsis.