The Critical Care Practitioner

This is a podcast aimed at those workng in Critical Care be they Doctors, Nurses or Physiotherapists. Over the years of making the podcast Jonathan has chatted with many other Practitioners in this field from around the world including America, Australia and New Zealand. He discusses their work and reserach and how this has impacted on the patients we care for and how we can help to take this forward. Jonathan has also podcasted from many of the important conferences around the globe- The European Society of Intensive Care, the Intensive Care Society State of the Art Conference in the UK, the North American Association of Critical Care Nurses, the British Association of Critical Care Nurses, and the International Fluid Academy Conference. During these conferences he has had the oppurtunity to meet many of the leaders of the changes in Critical Care treatment. There are now over 160 episodes in the library and he continues to connect this way with others around the world and ensure his audience can learn as he learns. He also has a website at criticalcarepractitioner.co.uk on which there are many resources for others to aid their learning as well as access to his YouTube videos one of which has had over 220,000 views. His mantra has been and continues to be 'As I learn, you learn too'.

Non Invasive Ventilation 11/13/2025

Non Invasive Ventilation 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 of therapy. How to titrate settings, troubleshoot problems, and recognise failure. Common complications and when to escalate to invasive ventilation. Case-Based Learning The episode follows Mr. Harris, a 68-year-old man with severe COPD presenting with type 2 respiratory failure. His clinical deterioration, ABG results (pH 7.25, pCO₂ 9.8 kPa), and work of breathing set the scene for understanding when and why NIV is beneficial. Physiology Essentials Listeners are guided through the impact of airway obstruction, air trapping, hyperinflation, respiratory muscle fatigue, and CO₂ narcosis. NIV’s core actions—improving tidal volume with IPAP and splinting airways with EPAP—are linked directly to these mechanisms. Practical Bedside Framework Start with IPAP 12 cmH₂O / EPAP 4 cmH₂O and FiO₂ around 28%, aiming for SpO₂ 88–92%. Reassure the patient, optimise positioning, secure a comfortable mask seal, and monitor synchrony. Repeat ABG at 1 hour; look for rising pH and falling CO₂. Adjust pressures in small increments if needed while monitoring for leaks, agitation, hypotension, or gastric distension. Monitoring and Escalation Success indicators include reduced respiratory rate, improved alertness, and trending normalisation of pH. Red flags include worsening acidosis, declining consciousness, mask intolerance, or inability to maintain the airway—prompting urgent senior review. Common Complications Facial pressure sores, gastric distension, aspiration risk, anxiety, and haemodynamic compromise are highlighted with practical prevention strategies. Five Golden Rules Recognise early and initiate NIV promptly. Start simple with standard pressures and controlled oxygen. Reassess rapidly with a 1-hour ABG. Escalate quickly if failure criteria develop. Protect the patient with meticulous care and communication. Outcome After an hour of NIV, Mr. Harris’ pH rises to 7.32 and pCO₂ falls to 8.2 kPa, with clear clinical improvement—illustrating the value of timely, well-managed NIV in COPD. Closing The episode reinforces the importance of physiological understanding in delivering confident, effective NIV care at the bedside. /episode/index/show/criticalcarepractitioner/id/39020800

HHS (Hyperosmolar Hyperglycaemic State) 10/31/2025

DKA- Fluids, Potassium and Insulin. 10/24/2025

Hypophosphatemia in Critical Care 10/13/2025

DKA in Critical Care 10/01/2025

Mobilisation in Critical Care- Barriers and Culture 09/24/2025

Episode 1- Mobilisation in the ICU 09/16/2025

Episode 1- Mobilisation in the ICU 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 critical illness. Long-term outcomes: ARDS survivors tracked for five years showed persistent disability and reduced independence. Sedation & delirium: Deep sedation increases delirium risk; mobilisation reduces both incidence and duration. Physiological rationale: Even minimal movement supports cardiovascular tone, respiratory function, circulation, and cognition. Core message: Bedrest is not neutral — it is actively harmful. Mobilisation offers protection for both brain and body. Proof in Practice: The First Mobilisation Trials Feasibility (Morris et al., 2008): Protocol-led mobilisation cut time to first mobilisation (5 vs 11 days), with no increase in adverse events. Landmark RCT (Schweickert et al., 2009): Early PT/OT + daily sedation interruption vs SAT alone. 59% vs 35% regained independence at discharge. Patients had less delirium and spent fewer days ventilated. Implementation (Needham et al.): Demonstrated how embedding mobilisation into daily ICU practice improves outcomes and serves as a model for quality improvement. Core message: Early mobilisation is not only possible — it improves patient-centred outcomes safely. Key Takeaways Bedrest and heavy sedation accelerate weakness, delirium, and disability. Mobilisation is both biologically plausible and clinically effective. Early trials proved feasibility, safety, and functional benefits. Success requires: Lighter sedation targets and daily SATs. Interdisciplinary teamwork (nursing, PT/OT, medical). Structured protocols and safety screens. Overall message: Mobilisation should no longer be an afterthought in ICU. It is a therapeutic intervention — one that supports recovery, preserves dignity, and helps patients walk out of intensive care with more than just survival. /episode/index/show/criticalcarepractitioner/id/38235665

Episode 6: Guidelines and the Future of Sedation in Critical Care 09/12/2025

Episode 5 — Sedation Choices: Benzos, Propofol, Dexmedetomidine 09/03/2025

Episode 4: Sedation Protocols Turning knowledge into practice final 08/27/2025

Episode 4: Sedation Protocols Turning knowledge into practice final We’ve explored the history of sedation in ICU, the impact of daily awakening trials, and the risks of deep sedation. In this episode, we focus on how to embed that evidence into practice — through the use of structured sedation protocols. Protocols don’t just provide guidance; they transform everyday ICU culture, reduce variation in care, and improve outcomes. But implementing them isn’t always easy. This episode explores the why, what, and how of sedation protocols — and the cultural shift they demand. What You’ll Learn in This Episode 🏥 Why protocols were needed: how variation in sedation practices led to prolonged ICU stays and unpredictable patient journeys. 🧪 What makes up a sedation protocol: RASS targets, daily sedation holds, nurse-led titration, and structured decision-making. 📊 Evidence that protocols work: from Brook’s 2000 trial to the PAD guidelines and beyond. 🔄 Barriers to implementation: fear of agitation, staff training gaps, inconsistent documentation, and cultural resistance. 🛠️ Real-world examples: quality improvement projects that boosted compliance and shortened ventilation times. 🎯 Protocols as safety nets: creating safe, evidence-informed defaults while leaving room for clinical judgment. Key References Brook AD, et al. JAMA. 2000. Martin J, et al. Intensive Care Med. 2001. Mehta S, et al. Lancet. 2008. Barr J, et al. Crit Care Med. 2013 (PAD Guidelines). Schmidt GA, et al. ATS/Chest Guidelines. 2016. Mehta S, et al. Crit Care Med. 2012. Ferraioli S, et al. BMJ Open Qual. 2019. Takeaway Message Sedation protocols are not about rigid rules — they’re about shared standards, safety, and empowerment. They help us move from practice variation to consistent, evidence-based care that improves both efficiency and patient outcomes. If your ICU already uses a protocol, engage with it fully. If not, perhaps it’s time to start the conversation /episode/index/show/criticalcarepractitioner/id/37975905