In this episode of the Society of Critical Care Medicine (SCCM) Podcast, host Elizabeth H. Mack, MD, MS, FCCM, speaks with Anil Sachdev, MD, FICCM, of the Institute of Child Health, Sir Ganga Ram Hospital in New Delhi, India about his team’s study, “Transpulmonary Pressure-Guided Mechanical Ventilation in Severe Acute Respiratory Distress Syndrome in the PICU: Single-Center Retrospective Study in North India, 2018–2021,” published in the March 2025 issue of Pediatric Critical Care Medicine.

Dr. Sachdev explains the development and implementation at his institution of a protocol for transpulmonary pressure (TPP) monitoring in pediatric patients with severe acute respiratory distress syndrome. His team compared outcomes of patients receiving TPP-guided ventilation with those receiving conventional mechanical ventilation. Study findings suggested that TPP monitoring enabled the use of higher positive end-expiratory pressure with greater clinician confidence, resulting in improved oxygenation.

Study limitations included small sample size and challenges of equipment availability, cost, and obtaining parental consent. The study was conducted in part during the COVID-19 pandemic, which further constrained resources and study participation.

The discussion concludes with Dr. Sachdev’s insights into practical challenges of TPP monitoring, including inserting delicate esophageal catheters in infants and young children and the necessity of correct catheter position for accurate readings.

Resources referenced in this episode:

• Transpulmonary Pressure-Guided Mechanical Ventilation in Severe Acute Respiratory Distress Syndrome in the PICU: Single-Center Retrospective Study in North India, 2018–2021 (Sachdev A, et al. Pediatr Crit Care Med. 2025;26:e354-e363).

In this episode of the Society of Critical Care Medicine (SCCM) Podcast, host Kyle B. Enfield, MD, FCCM, speaks with Garrett McDougall, MS, MSc, and Ben Forestell, MD, of McMaster University about their recent study, “Direct Laryngoscopy Versus Video Laryngoscopy for Intubation in Critically Ill Patients: A Systematic Review, Meta-Analysis, and Trial Sequential Analysis of Randomized Trials,” published in the November 2024 issue of Critical Care Medicine. The study included 20 randomized controlled trials encompassing 4569 patients to investigate whether video laryngoscopy (VL) offers advantages over direct laryngoscopy (DL) for intubation in critically ill patients.

A key finding of the study was that VL probably improves first-pass success rates and reduces the risk of esophageal intubation and dental injury. These benefits extend across the spectrum of operator experience, especially among novice operators but also among seasoned operators.

Drs. McDougall and Forestell discuss findings that surprised them, such as seeing equal benefit for standard VL and hyperangulated VL devices. Additionally, no clear benefits were found for patients who were intubated emergently with VL as compared to those who underwent elective intubation.

The discussion covers what could be next for resuscitation and airway research in critically ill patients. There may be more to learn about scenarios involving difficult airways, soiled airways, and emergent versus elective intubation. More research on device characteristics could also provide important insights.

To wrap up, the guests underscore the importance of maintaining both VL and DL proficiency since DL can be a more appropriate choice for some patients.

Resources referenced in this episode:

• Direct Laryngoscopy Versus Video Laryngoscopy for Intubation in Critically Ill Patients: A Systematic Review, Meta-Analysis, and Trial Sequential Analysis of Randomized Trials (McDougall GG, et al. Crit Care Med. 2024;52:1674-1685).

In this episode of the Society of Critical Care Medicine (SCCM) Podcast, host Marilyn N. Bulloch, PharmD, BCPS, FCCM, speaks with Christy C. Forehand, PharmD, BCCCP, FCCM, about retaining highly skilled pharmacists in the ICU setting. Dr. Forehand, a clinical pharmacy specialist and residency program director at Augusta University Medical Center and the University of Georgia College of Pharmacy, shares evidence-based insights and personal reflections on how pharmacist retention directly impacts quality and safety in patient care.

The conversation highlights growing concerns around burnout and attrition among ICU pharmacists, underscoring how their involvement improves clinical and economic outcomes—ranging from medication safety and reduced ventilator days to optimized transitions of care.

Drawing on American College of Clinical Pharmacy (ACCP) publications and American Society of Health-System Pharmacists (ASHP) guidance, Dr. Forehand outlines strategies for building retention plans that prioritize recognition, advancement opportunities, career mentorship, and structural supports such as protected administrative time. She emphasizes how institutional practices such as improved scheduling, remote work models, and role-specific stipends can prevent burnout while reinforcing team trust and efficiency.

Resources referenced in this episode:

• SCCM’s Leadership, Empowerment, and Development (LEAD) Program, which supports professional development

• Rewards, Recognition, and Advancement for Clinical Pharmacists (Bondi DS, et al. J Am Coll Clin Pharm. 2023;6:427-439)