Critical Matters

In this, Dr. Sergio Zanotti discusses the management of invasive candidiasis in critically ill patients. Invasive candidiasis is frequent in critically ill patients and is associated with high mortality and morbidity. He is joined by Dr. Max Adelman, a practicing critical care and infectious disease physician at Houston Methodist Hospital. Dr. Adelman is an Assistant Professor of Medicine at Weill Cornell Medical College. Dr. Adelman’s clinical interests include bacteremia, hospital-acquired infections, immunocompromised hosts, multidrug-resistant organisms, and septic shock.
Additional Resources:
Invasive candidiasis in critically ill patients: Fundamental concepts and future directions. Perez MA, Hoffman WJ, Perez JC, and Adelman MH. CHEST 2026.
Empirical Micafungin Treatment and Survival Without Invasive Fungal Infection in Adults With ICU-Acquired Sepsis, Candida Colonization, and Multiple Organ Failure: The EMPIRICUS Randomized Clinical Trial. JAMA 2016.
Global guideline for the diagnosis and management of candidiasis: an initiative of the ECMM in cooperation with ISHAM and ASM. THE LANCET- Infectious Diseases 2025.
Books and Music mentioned in this episode:
Four Thousand Weeks: Time Management for Mortals. By Oliver Bukerman.
Lonesome Drifter. By Charlie Crockett.

In this episode, Dr. Zanotti discusses the Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock 2026. He is joined by Dr. Hallie Prescot and Dr. Bram Rochwerg. Dr. Hallie Prescott is an Associate Professor in Pulmonary & Critical Care Medicine at the University of Michigan and a staff physician at the Ann Arbor Veterans Affairs Healthcare System. She serves as co-chair of the international Surviving Sepsis Campaign Guidelines. Dr. Bram Rochwerg is an associate professor and critical care physician at McMaster University in Hamilton, Ontario, Canada. He is co-vice-chair of the Surviving Sepsis Campaign Adult Guidelines.
Additional Resources:
Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock 2026. Crit Care Medicine 2026
Executive Summary: Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock 2026. Crit Care Medicine 2026
SCCM Point-of-Care (POC) APP:
https://play.google.com/store/apps/details?id=org.sccm.mobl&hl=en
https://apps.apple.com/us/app/sccm-poc/id1079591546
Books and music mentioned in this episode:
William Osler: A Life in Medicine. By Michael Bliss
Blood Poison: The Untold Story of Sepsis. By Parsa Shahinpoor
Album: Bloodline Artist: Mon Rovia

In this episode, Dr. Sergio Zanotti discusses emergency management and resuscitation of patients with left-sided Impella support. We will base our discussion on a recently published United Kingdom multisociety consensus statement. Our guests for this episode are two of the authors of this consensus statement.
Dr. Zanotti is joined by Dr. Waqas Akhtar, a consultant at Guy's & St Thomas' NHS Foundation Trust in the United Kingdom. Dr. Akhtar completed full postgraduate certification in Cardiology, Intensive Care & General Internal Medicine with a particular interest in cardiogenic shock, heart transplantation, and mechanical circulatory support. He is also joined by Dr. Vasileios Panoulas, a consultant cardiologist at Royal Brompton & Harefield NHS Trust and honorary senior clinical lecturer at Imperial College London. He has clinical expertise that encompasses both general and interventional cardiology.
Additional resources:
UK multisociety consensus statement on the emergency management and resuscitation of patients with left-sided Impella support: https://heart.bmj.com/content/early/2025/12/17/heartjnl-2025-326896
Microaxial Flow Pump or Standard Care in Infarct-Related Cardiogenic Shock. DanGer Shock Investigators: https://www.nejm.org/doi/full/10.1056/NEJMoa2312572
Effect of Microaxial Flow Pump on Hemodynamics in STEMI-Related Cardiogenic Shock. DanGer Shock Investigators: https://www.jacc.org/doi/abs/10.1016/j.jacc.2025.04.062
Long-Term Outcomes of the DanGer Shock Trial. DanGer Shock Investigators: https://pubmed.ncbi.nlm.nih.gov/40888722/
Music mentioned in this episode:
Unlearning. By Teddy Swims.
Minute a Moment. By Myles Smith.
Sable, Fable. By Bon Iver.

In this episode Dr. Sergio Zanotti discusses the recently released Clinical Practice Guideline for the Evaluation and Management of Acute Pulmonary Embolism in Adults. This guideline is a report of the American College of Cardiology / American Heart Association Joint Committee on Clinical Practice Guidelines. He is joined by Dr. Mark Creager, the lead author and chair of the writing committee for these guidelines. Dr. Creager is Professor of Medicine and Professor of Surgery at the Geisel School of Medicine at Dartmouth. A past president of the American Heart Association, he is an internationally recognized leader in vascular and cardiovascular medicine with more than 400 scientific publications.

Additional resources:
2026 AHA/ACC/ACEP/CHEST/SCAI/SHM/SIR/SVM/SVN Guideline for the Evaluation and Management of Acute Pulmonary Embolism in Adults: A Report of the American College of Cardiology / American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation 2026: https://www.ahajournals.org/doi/10.1161/CIR.0000000000001415

Surgical Management and Mechanical Circulatory Support in High-Risk Pulmonary Embolisms: Historical Context, Current Status, and Future Directions: A Scientific Statement From the American Heart Association. Circulation 2023: https://www.ahajournals.org/doi/10.1161/CIR.0000000000001117

Antithrombotic Therapy for VTE Disease: Second Update of the CHEST Guideline and Expert Panel Report. CHEST 20: https://journal.chestnet.org/article/S0012-3692(21)01506-3/fulltext

Books mentioned in this episode:
Team of Rivals: The Political Genius of Abraham Lincoln. By Doris Kearns Goodwin: https://bit.ly/4skCS0c

Alexander Hamilton. By Ron Chernow: https://bit.ly/4rFuxTw

Vascular Medicine: A Companion to Braunwald’s Heart Disease. By Mark Creager et al.: https://bit.ly/4uHZ4Dc

In this episode, Dr. Sergio Zanotti discusses a structured approach to ECMO emergencies, focusing on recognizing cardiac arrest, organizing the team response, and early ECMO troubleshooting to support key life-saving interventions. He is joined by Dr. Waqas Akhtar, a consultant at Guy's & St Thomas' NHS Foundation Trustin the United Kingdom. Dr. Akhtar completed full postgraduate certification in Cardiology, Intensive Care & General Internal Medicine, with a particular interest in cardiogenic shock, heart transplantation, and mechanical circulatory support

Additional resources:
British societies guideline on the management of emergencies in patients on extracorporeal membrane oxygenation. Waqas Akhtar, et al. Intensive Care Med 2025: https://pubmed.ncbi.nlm.nih.gov/41051555/

UK multisociety consensus statement on the emergency and resuscitation of patients with left-sided Impella support. Waqas Akhtar, et al. BMJ Journals 2026: https://heart.bmj.com/content/early/2025/12/17/heartjnl-2025-326896

Books mentioned in this episode:
His Dark Materials Series: The Golden Compass; The Subtle Knife; The Amber Spyglass: https://bit.ly/4cmSXgB