Originally posted in April of 2023, we are sharing this episode of Critical Matters again as Dr. Sergio Zanotti's discussion about the long journey to healing and recovery for those who've survived critical illness in the ICU remains pertinent and important. This conversation features Dr. Margaret Herridge, Professor of Medicine, Senior Scientist in Critical Care and Respiratory Medicine at the University of Toronto. Dr. Herridge is also Director of Critical Care Research. Director of the RECOVER Program, and Clinical Director of the Grace RECOVER Program for Chronic Critical Illness, in the University Health Network, Toronto, Canada.

Additional Resources:
Outcomes after Critical Illness. M. Herridge and E. Azoulay: https://pubmed.ncbi.nlm.nih.gov/36884324/

Neuropsychological sequelae and impaired health status in survivors of severe acute respiratory distress syndrome. Hopkins RO, et al: https://pubmed.ncbi.nlm.nih.gov/10390379/
One-year outcomes in survivors of the acute respiratory distress syndrome. Herridge m, et al: https://pubmed.ncbi.nlm.nih.gov/12594312/

Long-term cognitive impairment after critical illness. Pandharipande PP, et al: https://pubmed.ncbi.nlm.nih.gov/24088092/

The RECOVER Program: disability risk groups and 1-year outcome after 7 or more days of mechanical ventilation. Herridge M, et al: https://pubmed.ncbi.nlm.nih.gov/26974173/

Determinants of long-term outcome in ICU survivors: results from the FROG-ICU study. Gayat E, et al: https://pubmed.ncbi.nlm.nih.gov/29347987/

Symptoms of anxiety and depression in family members of intensive care unit patients. Pochard F, et al: https://pubmed.ncbi.nlm.nih.gov/11588447/

Books Mentioned in this Episode:
Bel Canto. By Ann Patchett: bit.ly/3nWs7Vp
Commonwealth. By Ann Patchett: bit.ly/43pWSCt

Outcomes after critical illness

April and Alicia diving back into the headlines with a chilling twist! This episode, hear some of the latest healthcare news (and personal encounters) about all things creepy, crawly, and cutting-edge. From new-age cadaver labs to advancements in freeze-dried blood, these innovations are as fascinating as they are frightening. Spoiler alert: maybe skip this one if you're scared of bugs!

Healthcare headlines - Spooky edition

Fluid overload is a common problem in critically ill patients. In this episode, Dr. Sergio Zanotti discuss recognizing and managing fluid overload in the ICU with guest Dr. Michael J. Connor, Jr., a practicing intensivist and nephrologist. Dr. Connor is a Professor and Senior Physician of Critical Care Medicine & Nephrology at the Divisions of Pulmonary, Allergy, Critical Care, and Sleep Medicine and Renal Medicine at Emory University School of Medicine. Additionally, he serves as the director of critical care nephrology at the Emory Critical Care Center at Grady Memorial Hospital.

Additional resources
European Society of Intensive Care Medicine Clinical Practice Guideline on fluid therapy in adult critically ill patients: Part 3- fluid removal at de-escalation phase. Intensive Care Med 2025: https://pubmed.ncbi.nlm.nih.gov/40828463/ 

Optimizing Fluid Therapy in the Critically Ill. International Fluid Academy website – 2025: https://www.fluidacademy.org/2025/01/17/optimising-fluid-therapy-in-the-critically-ill-introduction-to-7d/ 

Fluid overload in the ICU: evaluation and management. R. Claure-Del Granado and R. L. Mehta. BMC Nephrology 2016: https://pubmed.ncbi.nlm.nih.gov/27484681/

Books and music mentioned in this episode:
Think Again: The Power of Knowing What You Don’t Know. By Adam Grant: https://bit.ly/4gZvz9c

RUSHMERE. By Mumford & Sons: https://bit.ly/473FzKc

Fluid Overload in the ICU

In this episode, Dr. Sergio Zanotti discusses the administration of vasopressor agents through peripheral intravenous lines (or what we refer to as “peripheral vasopressors”). 
He is joined by Dr. Elizabeth Munroe, a practicing pulmonary/critical care physician and an Assistant Professor of Pulmonary and Critical Care at Intermountain Health in Salt Lake City, Utah. Her research interests include evidence-based resuscitation practices in early sepsis and septic shock, vasopressor administration practices, peripheral vasopressor use, and clinical trials, particularly novel, pragmatic clinical trial designs. 

Additional resources:
Peripheral Vasopressor Use in Early Sepsis-Induced Hypotension. ES Munroe, et al. JAMA Network 2025: https://pubmed.ncbi.nlm.nih.gov/40864467/  

Early Restrictive or Liberal Fluid Management for Sepsis-Induced Hypotension. Shapiro NI, et al. CLOVERS Trial. New Engl J of Med 2025: https://pubmed.ncbi.nlm.nih.gov/36688507/ 

Overview of Peripheral Vasopressor Use in an Academic Health System. D Shyu, et al. Ann Am Thorac Soc 2025: https://pubmed.ncbi.nlm.nih.gov/40126143/ 

Safety of peripheral intravenous administration of vasoactive medication. J Cardenas-Garcia, et al. J Hosp Med 2015: https://pubmed.ncbi.nlm.nih.gov/26014852/ 

Books mentioned in this episode:
Ending Medical Reversal- Improving Outcomes, Saving Lives. By Vinayak K. Parsad, et al: https://bit.ly/4nhCNam


Peripheral vasopressors

Patients may hear their clinician, but do they really understand them? In this episode, April and Alicia tackle the myths and misunderstandings surrounding health literacy. From mixed messages to medical jargon, they test each other's knowledge on the facts, fictions, and ways clearer communication can transform care.

Health literacy: Making sense of medicine

In this episode, Dr. Sergio Zanotti discusses the assessment of peripheral perfusion as a tool to guide treatment in septic shock. Specifically, he dives into Capillary Refill Time. He is joined by Dr. Eduardo Kattan, a critical care and anesthesia physician. Dr. Kattan is an Assistant Professor at the Pontificia Catholic University of Chile, where he also serves as Adult Critical Care Program Director and Director of Research and Academics in the Department of Critical Care Medicine. A prolific investigator, he focuses his research on septic shock and medical education. Dr. Rattan is the Co-Principal Investigator of the recently published ANDROMEDA-SHOCK 2 clinical trial.

Additional resources:
Personalized Hemodynamic Resuscitation Targeting Capillary Refill Time in Early Septic Shock. The ANDORMEDA-SHOCK-2 Randomized Clinical Trial. JAMA 2025: https://jamanetwork.com/journals/jama/fullarticle/2840823 

Effect of Resuscitation Strategy Targeting Peripheral Perfusion Status vs Serum Lactate Levels on. 28-Day Mortality Among Patients With Septic Shock. The ANDROMEDA-SHOCK Randomized Clinical Trial. JAMA 2019: https://jamanetwork.com/journals/jama/fullarticle/2724361 

Perspectives on peripheral perfusion assessment. Eduardo Kattan, et al. Curr Opin Crit Care 2023: https://pubmed.ncbi.nlm.nih.gov/37078639/ 

Books mentioned in this episode:
The Little Prince. By Antoine de Saint-Exupery: https://bit.ly/49YcSRJ

The Autumn Ghost: How the Battle Against a Polio Epidemic Revolutionized Modern Medical Care. By Hannah Wunsch: https://bit.ly/4i9PiUf

Capillary Refill Time (CRT)

The holidays are approaching fast, and we at On Call are getting in the spirit of togetherness with a brand new guest! April and Alicia are joined by long-time colleague and friend Saira Ayub, Senior Director for Staffing Services at Sound Physicians. After nine years at Sound, Saira has learned a thing or two about what makes a great clinical team. Tune in to hear her career and leadership journey, hospital staffing philosophy, and even a few holiday hot takes.

Solving the staffing puzzle Ft. Saira Ayub

Happy Thanksgiving! April and Alicia are serving up a brand-new fact or fiction in honor of our favorite food-centered holiday. Is your turkey dinner the reason for your post-dinner food coma? Was the wishbone once used for divination? And just how long should you expect to wait at the emergency room if someone at the table takes a tumble? Tune in--you just might learn something between your laughs.

Pass the facts, hold the fiction

In this episode, Dr. Zanotti discusses the role of Procalcitonin in the ICU. 
He is joined by Dr. Simran Gupta, an infectious disease specialist at Brigham & Women's Hospital in Boston. Dr. Gupta has additional training in Clinical Research, Transplant, and Infectious Disease. She recently published an article on reassessing the role of Procalcitonin in critically ill patients with sepsis. 

Additional resources:
Reassessing Procalcitonin-Guided Antibiotic Therapy in Critically Ill Patients with Sepsis: Lessons from the ADAPT-Sepsis Trial. S. Gupta, et al. Clinical Infectious Disease 2025: https://pubmed.ncbi.nlm.nih.gov/40579227/ 

Biomarker-Guided Antibiotic Duration for Hospitalized Patients With Suspected Sepsis: The ADAPT-Sepsis Randomized Clinical Trial. JAMA 2025: https://pubmed.ncbi.nlm.nih.gov/39652885/ 

Procalcitonin-guided antibiotic therapy may shorten the length of treatment and may improve survival- a systematic review and meta-analysis. M Papp, et al. Crit Care 2023: https://pubmed.ncbi.nlm.nih.gov/37833778/ 

Books and entertainment mentioned in this episode:
Shantaram: A Novel. By Gregory David Roberts: https://bit.ly/4ovVHKX

SHANTARAM – Apple TV series: https://tv.apple.com/us/show/shantaram/umc.cmc.atxsrive40xli3zh3uxjimut

PCT Reassessed

Don't get left out in the cold—April and Alicia are closing out 2025 with one last fact or fiction all about the winter weather! Does your head really let off the most heat? Could going limp prevent a broken wrist on the slopes? And will standing outside in the cold be the next weight loss fad? Put on your coziest socks and tune in for frosty fun!

Fireside facts and frosty fictions

Welcome to On Call, the insightful and engaging podcast hosted by April Burke and Alicia Scheffer two seasoned Sound advanced practice providers with over 15 years of combined experience in healthcare. Join them as they delve into the ever-evolving landscape of healthcare, exploring trending topics that shape the future of medicine, patient care, and the healthcare workforce.
On Call serves as an indispensable resource for healthcare practitioners, administrators, and anyone passionate about transforming the healthcare system for the better. Whether you're a medical professional looking to stay on top of industry trends or a patient seeking to understand the dynamics shaping your care, this podcast promises thought-provoking conversations and valuable takeaways.

Fireside facts and frosty fictions

On Call with April and Alicia