Sustaining critical care delivery in today’s healthcare environment requires more than resilience—it also calls for collective solutions to systemic challenges.

In this episode of the Society of Critical Care Medicine (SCCM) Podcast, Past President Jose L. Pascual, MD, PhD, FRCS(C), FACS, FCCM, elaborates on the session presented during the 2026 Critical Care Congress, Critical Care Under Pressure: Sustaining the Workforce and Infrastructure Amid Rising Demands.

Joined by host Marilyn Bulloch, PharmD, BCPS, FCCM, Dr. Pascual examines the complex forces reshaping critical care, from shrinking ICU capacity and hospital closures to persistent workforce shortages and shifting training pipelines. He highlights concerning trends such as reduced entry into certain critical care pathways, particularly anesthesiology. At the same time, he points to encouraging growth in other pathways, with increasing participation from clinicians in emergency medicine, neurology, and surgery.

The conversation underscores disparities in access to care, particularly for rural and community hospitals. Dr. Pascual explores the tension between the regionalization of specialized care and the need to maintain equitable access across health systems, emphasizing the importance of thoughtful resource distribution and collaboration across institutions. Beyond workforce numbers, the evolution of leadership in critical care is also impactful, including the migration of experienced clinicians into administrative roles and the potential need for cyclical leadership models that maintain clinical engagement.

Meeting these challenges requires innovation and cooperation. Dr. Pascual highlights advancements in education, particularly the expansion of simulation-based training, as critical tools for maintaining competency and improving team performance.

Resources referenced in this episode: 

• 2026 Congress Digital

Sepsis is a global health emergency, with nearly half of all septic patients being children.

In this episode of the Society of Critical Care Medicine (SCCM) Podcast, Samantha Gambles Farr, MSN, NP-C, CCRN, RNFA, speaks with Niranjan Kissoon, MD, MBBS, FRCP(C), FACPE, MCCM, about his Thought Leader presentation at the 2026 Critical Care Congress, Making Sepsis the Next Success Story in Global Health. The panel also discusses how access and equity play a part in how sepsis is treated.

From a global perspective, Dr. Kissoon emphasizes that the most important thing is advocacy and prevention from a governmental level by creating national action plans, making sure the healthcare system is resilient, and utilizing technology and innovation to create better ways of providing care; and from a societal level by educating patients and families about nutrition, hygiene, vaccinations, and seeking care early.

Niranjan Kissoon, MD, MBBS, FRCP(C), FACPE, MCCM, is a professor in the Department of Pediatrics (Pediatrics and Surgery, Emergency Medicine) at the University of British Columbia in Vancouver, British Columbia, Canada. He is the past president of the World Federation of Pediatric Critical and Intensive Care Societies and currently serves as president of the Global Sepsis Alliance. He is cochair of the pediatric Surviving Sepsis Campaign, vice president of the Canadian Sepsis Foundation, and chair of World Sepsis Day and the International Pediatric Sepsis Initiative. He also serves on the Sepsis Alliance USA and the African Sepsis Alliance advisory boards and is also a founding member of the Caribbean Sepsis Alliance.

What is precision medicine, and how should precision medicine be handled in the face of guidelines and protocols?

In this episode of the Society of Critical Care Medicine (SCCM) Podcast, Diane C. McLaughlin, DNP, AGACNP-BC, CCRN, FCCM, speaks with Michael R. Pinsky, MD, FAPS, MCCM, about his Thought Leader presentation at the 2026 Critical Care Congress, The Effective Management of Shock: Moving From Physiology to Guidelines to Precision Medicine and Ultimately Personalized Medicine. The panel also discusses how to titrate care for individual patients.

Protocols and guidelines are the foundation for patient care and are instrumental for having all healthcare professionals on the same baseline when treating patients. Precision medicine involves individualizing care for a specific patient, and Dr. Pinsky emphasizes that guidelines should never supersede an understanding of pathophysiology at the bedside, including observing your patient and paying attention to how individual patients respond to specific treatments. Monitoring the individualized response is required for the best care.

Michael R. Pinsky, MD, FAPS, MCCM, is a professor of critical care medicine, bioengineering, and anesthesiology at the University of Pittsburgh in Pittsburgh, Pennsylvania, USA. He is also Docteur Honoris Casusa at the Université René Descartes Paris V School of Medicine in Paris, France. In 2012, he became one of the first 20 critical care physicians to receive a Master of Critical Care Medicine (MCCM) from SCCM. He is currently an emeritus (honorary) at UPMC. At the University of Pittsburgh, he is vice-chair emeritus for the Department of Critical Care Medicine and a faculty member at the Center for Critical Care Nephrology and the Center for Military Medicine Research.

Resources referenced in this podcast:

• The Effective Management of Shock: Moving From Physiology to Guidelines to Personalized Medicine

In this episode of the Society of Critical Care Medicine (SCCM) Podcast, Diane C. McLaughlin, DNP, AGACNP-BC, CCRN, FNCS, FCCM, is joined by Aarti Sarwal, MD, FAAN, FNCS, RPNI, FCCM, and Brian L. Erstad, PharmD, FCCP, FASHP, MCCM, to discuss the 2026 guidelines for neuromuscular blockade in adult patients with acute respiratory distress syndrome.

The guidelines, “Society of Critical Care Medicine Guidelines for the Administration of Neuromuscular Blockade in Adults With Acute Respiratory Distress Syndrome,” were published in the March issue of Critical Care Medicine.

Drs. Sarwal and Erstad discuss how the evidence in two key trials, ACURASYS and PETAL-ROSE, has helped shape the recommendations provided in the SCCM guidelines. Despite how influential these trials were in shaping the recommendations, only conditional recommendations were made due to low or very low quality of evidence. The lack of evidence proved to be a driving factor in including a call to action in the guidelines. Future research priorities largely revolve around precision medicine and finding more patient-specific interventions to improve patient outcomes.

Aarti Sarwal, MD, FAAN, FNCS, RPNI, FCCM, is a professor of neurology and the division chair of neurocritical care at Virginia Commonwealth University (VCU) School of Medicine in Richmond, Virginia, USA. She is also an associate editor of Critical Care Medicine, secretary of the American Society of Neuroimaging, and director of VCU-Wake Forest neuro-ultrasound courses. Brian L. Erstad, PharmD, FCCP, FASHP, MCCM, is a tenured professor and interim dean at the University of Arizona R. Ken Coit College of Pharmacy in Tucson, Arizona, USA. He is also a center investigator for the Center for Health Outcomes, a member of the BIO5 Institute and Comprehensive Center for Pain & Addiction and Pharmacoeconomics Research Center, and a codirector for the Arizona Clinical and Translational Research Graduate Certificate Program.

Resources referenced in this podcast:

• Society of Critical Care Medicine Guidelines for the Administration of Neuromuscular Blockade in Adults With Acute Respiratory Distress Syndrome

• Early Neuromuscular Blockade in the Acute Respiratory Distress Syndrome

• Neuromuscular Blockers in Early Acute Respiratory Distress Syndrome

Older adults consist of approximately half of the patients in the ICU, with that number expected to grow in the coming decades.

In this episode of the Society of Critical Care Medicine (SCCM) Podcast, host Marilyn N. Bulloch, PharmD, BCPS, FCCM, is joined by Bram Rochwerg, MD, MSc(Epi), FRCPC, FCCM, and Lauren E. Ferrante, MD, MHS, to discusses new guidelines on caring for older adults in the ICU and the difficulties in finding research that focuses on those patients.

The guidelines, “Society of Critical Care Medicine Guidelines on Caring for Older Adults in the ICU,” will be published in an upcoming issue of Critical Care Medicine.

The panel details the process and methodology behind the guidelines, the dearth of studies focusing on older patients in the ICU, and the difficulty of finding studies that enroll older adults who are on multiple medications. The guidelines offer two conditional recommendations and offer priorities for aging-friendly research topics to help provide stronger guidance in the future.

Bram Rochwerg, MD, MSc(Epi), FRCPC, FCCM, is an associate professor, intensivist, and researcher based at McMaster University in Hamilton, Ontario, Canada, who focuses on intravenous fluid use in sepsis, the role of corticosteroids in acute hypoxemic respiratory failure, and clinical practice guideline methodology. Lauren E. Ferrante, MD, MHS, is an associate professor of medicine in the section of pulmonary, critical care, and sleep medicine at the Yale School of Medicine; director of the operations core of the Yale Claude D. Pepper Older Americans Independence Center; and an attending physician in the medical intensive care unit at Yale-New Haven Hospital in New Haven, Connecticut, USA.

Resources referenced in this podcast:

• Society of Critical Care Medicine Guidelines on Caring for Older Adults in the ICU

• Compassionate and Evidence-Based Care (session from the 2026 Critical Care Congress)

• Congress Digital

• Geriatric Knowledge Education Group

• Thought Leader: Why the 4Ms Approach to Critical Care Improves Quality (session from the 2025 Critical Care Congress)

What has changed in the updated 2026 Surviving Sepsis Campaign (SSC) guidelines for children?

In this episode of the Society of Critical Care Medicine (SCCM) Podcast, host Elizabeth H. Mack, MD, MS, FCCM, speaks with pediatric SSC guideline cochairs Scott L. Weiss, MD, MSCE, FCCM, and Pierre Tissieres, MD, DSc, about the latest guideline recommendations for the care of children with sepsis and septic shock. The updated guidelines emphasize the early identification of sepsis, an evolution to a more targeted way of treatment, and a more practical approach to guideline implementation. Other aspects of the previous guidelines, such as lactate measurements, continuous reassessment, and the role of point-of-care monitoring, were reinforced in the 2026 guidelines.

The guidelines, “Surviving Sepsis Campaign International Guidelines for the Management of Sepsis and Septic Shock in Children 2026,” were released in the April issue of Pediatric Critical Care Medicine.

Key updates and new areas of emphasis include:  

• A more nuanced approach to sepsis screening and early recognition 

• New guidance on supplemental oxygen, including limiting hyperoxia and using more conservative oxygenation targets in children with septic shock 

• New patient, intervention, comparison, outcome questions related to immune dysregulation, highlighting an important area for future research 

• New attention to post-sepsis morbidity 

• Greater emphasis on long-term follow-up and risk assessment for children who survive sepsis

Scott L. Weiss, MD, MSCE, FCCM, is division chief of critical care and vice-chair of research at Nemours Children’s Hospital (DuPont)-Delaware and professor of pediatrics and pathology and genomic medicine at the Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, Pennsylvania, USA. Pierre Tissieres, MD, DSc, is a professor of pediatrics and head of Pediatric ICU and Neonatal Medicine at Paris South University Hospitals in Paris, France.

This podcast is sponsored by Vantive. 

At Vantive, our mission to extend lives and expand possibilities starts with a commitment to continuous learning. We are committed to partnering with the medical community to support vital organ therapy innovation grounded in clinical evidence and focused on improving patient outcomes. The recent publication on endotoxic septic shock centers on an evidence-based approach to address clinical challenges in critical care and beyond as highlighted in our press release.

Resources referenced in this podcast: 

• Surviving Sepsis Campaign International Guidelines for the Management of Sepsis and Septic Shock in Children 2026 

• Executive Summary of Society of Critical Care Medicine 2026 Guidelines on the Care and Management of Pediatric and Neonatal Intensive Care Patients at the End of Life 

• International Consensus Criteria for Pediatric Sepsis and Septic Shock

What has changed in the new 2026 Surviving Sepsis Campaign (SSC) guidelines for adults?

In this episode of the Society of Critical Care Medicine (SCCM) Podcast, Kyle B. Enfield, MD, is joined by guideline cochairs Massimo Antonelli, MD, and Hallie C. Prescott, MD, MSc, FCCM, for a practical discussion on the biggest updates in the care of adults with sepsis and septic shock, from appropriate care during transport to the hospital to balancing timely antibiotics with antimicrobial stewardship. The panel also discusses hemodynamic resuscitation, vasopressor selection, global implementation, and the growing recognition that sepsis care does not end at hospital discharge.

The guidelines, “Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock 2026,” were released in the April issue of Critical Care Medicine.

The episode highlights:  

• How the panel graded the evidence 

• New sepsis terminology to address variabilities in how different professions, environments, or cultures refer to specific features of sepsis 

• How the guidelines are shaped to support clinicians practicing in a wide range of care settings, including resource-limited settings

Dr. Antonelli is a professor of anesthesiology and intensive care medicine at Università Cattolica del Sacro Cuore in Rome, Italy, and director of the general intensive care unit at Policlinico A. Gemelli University Hospital. Dr. Prescott is a professor of pulmonary and critical care medicine at the University of Michigan, Ann Arbor, Michigan, USA, and a staff physician at the Ann Arbor Veterans Affairs Healthcare System.

This podcast is sponsored by Vantive.

At Vantive, our mission to extend lives and expand possibilities starts with the commitment to continuous learning. We are committed to partnering with the medical community to support vital organ therapy innovation grounded in clinical evidence and focused on improving patient outcomes. The recent publication on endotoxic septic shock centers on an evidence-based approach to address clinical challenges in critical care and beyond as highlighted in our press release.

Resources referenced in this podcast: 

• Executive Summary: Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock 2026 

• Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock 2026 

• Restriction of Intravenous Fluid in ICU Patients with Septic Shock 

• Early Restrictive or Liberal Fluid Management for Sepsis-Induced Hypotension

There is enormous heterogeneity in clinical outcomes and severity of septic shock, with some patients needing only supportive care in the ICU and others progressing to multiorgan system failure and death. How can clinicians identify patients at higher risk of death?

In this episode of the Society of Critical Care Medicine (SCCM) Podcast, host Marilyn Bulloch, PharmD, BCPS, FCCM, is joined by John A. Kellum, MD, FCCM, to discuss high endotoxin activity as a possible endotype for septic shock. Dr. Kellum’s article, “Organ Failure, Endotoxin Activity, and Mortality in Septic Shock,” was published in the September 2025 compendium of Critical Care Explorations. Dr. Kellum is a professor and director of the Center for Critical Care Nephrology, as well as vice chair for the Department of Critical Care Medicine, at the University of Pittsburgh in Pittsburgh, Pennsylvania, USA.

The study used a novel biomarker called the endotoxin activity assay (EAA) to detect endotoxin in the blood. While the EAA is not good at identifying patients who are at risk for sepsis, Dr. Kellum said that, when combined with organ failure, it identifies patients at high risk for endotoxic septic shock. In the study, these patients had a mortality rate of 60%.

Neither the EAA nor the anti-endotoxin therapy is readily available. And, although endotoxic septic shock is rare, occurring in only a quarter of patients with septic shock, Dr. Kellum hopes that, through precision medicine, segmenting this population into treatable subgroups may allow better diagnostics and opportunities to develop or repurpose therapies in the future. This episode is sponsored by Prenosis.

Resources referenced in this episode:

• Organ Failure, Endotoxin Activity, and Mortality in Septic Shock (Molinari  L, et al. Crit Care Explor. 2025;7:e1308)

• Derivation, Validation, and Potential Treatment Implications of Novel Clinical Phenotypes for Sepsis (Seymour CW, et al. JAMA. 2019;321:2003-2017)

• Safety and Efficacy of Polymyxin B Hemoperfusion (PMX) for Endotoxemic Septic Shock in a Randomized, Open-Label Study (TIGRIS) (ClinicalTrials.gov. ID NCT03901807. Last update posted January 9, 2026)

In this episode of the Society of Critical Care Medicine (SCCM) Podcast, host Maureen Madden, DNP, RN, CPNP-AC, CCRN, FCCM, speaks with Javier Varela, MD, MSc, about his study, “Acute Bronchiolitis in Infants on Invasive Mechanical Ventilation: Physiology Study of Airway Closure,” published in the September 2025 issue of Pediatric Critical Care Medicine. The study revealed new insights into airway pathophysiology in infants with severe bronchiolitis who require mechanical ventilation, a population that comprises a substantial portion of winter pediatric intensive care unit (PICU) admissions worldwide. Dr. Varela is an intensivist in the PICU in the Department of Pediatrics at Clínica Alemana de Santiago, in Santiago, Chile.

Differing ventilatory strategies and the heterogeneous phenotypes of bronchiolitis motivated Dr. Varela’s team to investigate airway closure, which was detected in seven of the 12 patients included in the study. Airway opening pressure frequently exceeded the set positive end-expiratory pressure (PEEP) levels—highlighting a potential gap in traditional ventilator management. Dr. Varela explains that respiratory mechanics, particularly driving pressure and respiratory system compliance, can be misinterpreted when airway opening pressure is not considered.

Study limitations included bacterial coinfection in nearly half the patients and the constraints of a single-center design, but Dr. Varela said that these factors did not appear to alter the physiologic observations.

Although more research is needed before making clinical recommendations, the study established a foundational understanding of airway closure in patients with bronchiolitis and underscores the need for future work on personalized ventilation strategies, PEEP titration, and the potential heterogeneity of airway behavior in this population.

Resources referenced in this episode:

• Acute Bronchiolitis in Infants on Invasive Mechanical Ventilation: Physiology Study of Airway Closure (Varela J, et al. Pediatr Crit Care Med. 2025;26:e1096-e1104)

• Airway Closure in Acute Respiratory Distress Syndrome: An Underestimated and Misinterpreted Phenomenon (Chen L, et al. Am J Respir Crit Care Med. 2018;197:132-136)

In this episode of the Society of Critical Care Medicine (SCCM) Podcast, host Elizabeth H. Mack, MD, MS, FCCM, speaks with Nadir Yehya, MD, MSCE, an attending physician in the Pediatric Sepsis Program and the Division of Critical Care Medicine at the Children's Hospital of Philadelphia in Philadelphia, Pennsylvania, USA. They discuss Dr. Yehya’s study, “Parent and Provider Perspectives on Short-Term Outcomes of Critically Ill Ventilated Children,” published in the September 2025 issue of Pediatric Critical Care Medicine. The study explores whether widely used composite clinical outcomes such as ventilator-free days truly reflect what families value most when their child is in the pediatric intensive care unit (PICU).

Dr. Yehya discusses how the project emerged from a long-standing question in pediatric critical care research: Are the outcomes we measure in clinical trials aligned with the priorities and lived experiences of families? Because mortality is low in pediatrics, composite short-term outcomes such as ventilator-free days, ICU-free days, and hospital-free days are commonly used. However, little is known about whether these metrics are truly patient- and family-centered.

Using survey data from parents and PICU clinicians, the study found strong agreement between parents and clinicians on the importance of minimizing duration of invasive mechanical ventilation. But parents and clinicians diverged on other short-term outcomes. Families ranked oxygen duration as more important than ICU or hospital length of stay, reflecting concerns about ongoing medical needs, missed work, and the possibility of going home on oxygen. Clinicians prioritized ICU and hospital days over oxygen use. Substantial variation was also found within both groups.

Dr. Yehya highlights the value of feedback from patient and family advisory councils in designing this type of research, explaining that such feedback informed the study’s instrument design and family approach. He calls for deeper investigation into post-discharge recovery, functional outcomes, and long-term developmental trajectories—areas families consistently identify as their greatest concerns.

Resources referenced in this episode:

• Parent and Provider Perspectives on Short-Term Outcomes of Critically Ill Ventilated Children (Shannon MM, et al. Pediatr Crit Care Med. 2025;26:e1149-e1153)

In this episode of the Society of Critical Care Medicine (SCCM) Podcast, host Marilyn N. Bulloch, PharmD, BCPS, FCCM, speaks with Olfa Hamzaoui, MD, PhD, professor of intensive care at Robert Debré Hospital in Reims, France, about her Peter Safar Honorary Lecture at the 2025 Critical Care Congress. The conversation centers on tissue perfusion, microcirculation, and shock, with a focus on bridging the gap between bench research and bedside practice.

Dr. Hamzaoui shares insights on current scientific understanding of microcirculation and shock, including research on tools to monitor microcirculation, such as handheld video microscopy. The discussion highlights the utility of capillary refill time as a simple, noninvasive tool for guiding resuscitation. Dr. Hamzaoui advocates for early and repeated echocardiographic assessment in shock management, including during de-resuscitation. She also discusses her 2023 article in Clinical Medicine, which proposed titrating norepinephrine to individualized targets.

This episode offers a compelling look at how emerging tools and research can refine shock management and promote precision care in critical illness.

This podcast is sponsored by Fresenius Kabi.

Resources referenced in this episode: 

• Effects of a Resuscitation Strategy Targeting Peripheral Perfusion Status versus Serum Lactate Levels Among Patients with Septic Shock. A Bayesian Reanalysis of the ANDROMEDA-SHOCK Trial (Zampieri FG, et al. Am J Respir Crit Care Med. 2020;201:423-429)

• The Eight Unanswered and Answered Questions about the Use of Vasopressors in Septic Shock (Hamzaoui O, et al. J Clin Med. 2023;12:4589)

• Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock 2021 (Evans L, et al. Crit Care Med. 2021;49:e1063-e1143)