Episode 1 A short history of sedation in ICU
The Critical Care Practitioner
Release Date: 08/05/2025
Decompensated Alcohol Related Liver Disease Part 2
The Critical Care Practitioner
We return to our 48-year-old patient: jaundiced, hypotensive, drowsy, and bleeding. In decompensated cirrhosis, every treatment targets a disrupted system — splanchnic vasodilation, portal hypertension, toxin accumulation, and renal hypoperfusion. Although these patients look fluid overloaded, they are effectively hypovolaemic. Start with small aliquots of balanced crystalloid, avoiding 0.9% saline. In hepatorenal syndrome or tense ascites, 20% albumin is key — not just for volume expansion, but for circulatory and anti-inflammatory support. Once volume is optimised, flow must be...
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Decompensated Alcohol Related Liver Disease Part 1
The Critical Care Practitioner
In this episode, I walk through the real-world critical care management of acute decompensated alcohol-related liver disease, using a high-risk ICU case to anchor the discussion. The focus is on understanding the underlying physiology—portal hypertension, rebalanced haemostasis, hepatic encephalopathy, infection, and hepatorenal syndrome—and translating that physiology into clear first-hour priorities at the bedside. Listeners are guided through airway and circulatory decision-making, rational use of albumin, vasopressors, antibiotics, lactulose and rifaximin, and careful blood product...
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Non Invasive Ventilation
The Critical Care Practitioner
This episode offers a structured, bedside-focused exploration of Non-Invasive Ventilation (NIV) for acute hypercapnic respiratory failure in COPD, aligned with NICE NG115 and BTS/ICS 2016 guidance. Aimed at early-career critical care nurses, it breaks the topic down into physiology, practical setup, monitoring, and escalation. Key Topics Covered Mechanisms behind acute-on-chronic hypercapnic respiratory failure in COPD. How NIV improves ventilation, reduces CO₂, and decreases work of breathing. Evidence-based indications for NIV initiation. Practical bedside steps for the first hour...
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HHS (Hyperosmolar Hyperglycaemic State)
The Critical Care Practitioner
HHS (Hyperosmolar Hyperglycaemic State) is the quiet counterpart to DKA. It develops slowly in older type 2 diabetics with residual insulin, leading to extreme hyperglycaemia and dehydration without ketosis. In this 2-hour deep dive, Jonathan explains why HHS kills through water loss and hyperviscosity rather than acid, and how to manage it safely. Key Learning Points: · Pathophysiology: Relative insulin deficiency → no ketones, but relentless osmotic diuresis → hyperosmolarity > 320 mOsm/kg. ...
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DKA- Fluids, Potassium and Insulin.
The Critical Care Practitioner
Diabetic ketoacidosis (DKA) is not just “high blood sugar” — it’s a hormonal storm caused by absolute insulin deficiency and a surge of counter-regulatory hormones. The result is a triad of hyperglycaemia, dehydration, and metabolic acidosis. We follow Sophie, a 23-year-old with type 1 diabetes who arrives with vomiting, Kussmaul breathing, glucose 28 mmol/L, ketones 5.6 mmol/L, and pH 7.08. 🔍 What’s Going Wrong? No insulin → cells can’t use glucose → liver produces more. Glucose spills into urine → osmotic diuresis → 6–8L fluid + electrolyte loss. Fat breakdown...
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Hypophosphatemia in Critical Care
The Critical Care Practitioner
Summary: In this episode, we spotlight a stealthy ICU disruptor — hypophosphataemia. Based on a 2024 narrative review in the Journal of Clinical Medicine, we explore why phosphate matters, how it goes missing in critically ill patients, and why you should care even when it’s just “a little low.” What’s Covered: The vital role of phosphate in energy, oxygen delivery, and muscle function Why hypophosphataemia affects 20–80% of ICU patients Clinical consequences, from muscle weakness to respiratory failure, arrhythmias, and delirium Common causes: refeeding, DKA, diuretics,...
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DKA in Critical Care
The Critical Care Practitioner
What is DKA? – The triad of hyperglycaemia, ketonaemia, and metabolic acidosis (JBDS 2023 definitions). Pathophysiology explained – Insulin deficiency, ketone production, and why potassium is so tricky. Clinical features – Polyuria, dehydration, Kussmaul breathing, acetone breath, and red flags for deterioration. Investigations – Capillary ketones, blood gases, electrolytes, ECG, and screening for precipitants. Management (UK guidelines) – Fluids first, fixed-rate insulin infusion, careful potassium replacement, and always treat the trigger. Pitfalls – Starting insulin...
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Mobilisation in Critical Care- Barriers and Culture
The Critical Care Practitioner
Mobilisation in the ICU raises two big questions: is it safe, and will staff embrace it? In this discussion, Jonathan explores both sides of the story: Safety first: Large prevalence studies show mobilisation is happening, though often inconsistently. A systematic review of 1,800+ sessions found serious adverse events in only 0.6% — most minor and short-lived. Even patients on CRRT can safely mobilise with planning, adequate staff, and the right equipment. Consensus guidelines outline clear safety screens, covering oxygen, ventilator settings, vasopressors, and line security. ...
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Episode 1- Mobilisation in the ICU
The Critical Care Practitioner
Summary For much of critical care history, immobility was the norm: patients were sedated, kept still, and “protected.” But decades of research have revealed the hidden costs — profound muscle wasting, delirium, and long-term disability. Jonathan explores how our understanding of mobilisation in ICU has evolved — from the recognition of harm caused by bedrest, to the first landmark studies proving that early movement is both feasible and beneficial. From Bedrest to Better: Why Mobilise in ICU? ICU-acquired weakness: Patients can lose 15–20% of muscle mass within the first week of...
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Episode 6: Guidelines and the Future of Sedation in Critical Care
The Critical Care Practitioner
Sedation practices in the ICU have evolved dramatically over the past decade — but are we truly following the evidence? In this episode of The Critical Care Practitioner Podcast, Jonathan takes you through the key milestones in sedation guidance, the persistent gap between recommendations and real-world practice, and the emerging shift toward human-centered, wakeful care. What You’ll Learn in This Episode: PAD Guidelines (2013) & beyond: How Barr et al. and later ATS/CHEST summaries shaped modern sedation practice. Where we fall short: Why deep sedation is still common and...
info_outlineIn this episode, I explore how sedation practices in critical care have evolved over time — from the routine use of deep, continuous sedation to the early evidence that challenged it. You'll hear about pivotal studies that revealed the risks of over-sedation, the emergence of structured sedation protocols, and the beginnings of a culture shift toward lighter, more patient-centered care.
Key topics:
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The rise of continuous sedation in early ICU care
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Landmark studies questioning deep sedation
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Early implementation of sedation protocols
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How sedation culture began to change
Kress et al. (1998). The use of continuous i.v. sedation is associated with prolongation of mechanical ventilation.
Brook et al. (2000). A prospective evaluation of empiric versus protocol-based sedation and analgesia.
Novaes et al. (1999). Stressors in ICU: perception of the patient, relatives, and health care team.
Martin et al. (2001). Sedative and analgesic practice in the intensive care unit: the results of a European survey