PRISM Rounds: Pulmonary Critical Care & Sleep Podcast

S01E41: EIT-Guided PEEP in ARDS — Precision Ventilation or Too Much Titration?

In this episode of PRISM Rounds, we discuss the 2026 AJRCCM EITVent randomized clinical trial and its accompanying editorial. The study asked whether electrical impedance tomography, or EIT, could help clinicians individualize PEEP in adults with moderate to severe ARDS compared with the traditional lower PEEP/FIO2 table. The overall trial was neutral: EIT-guided PEEP did not reduce 28-day mortality, ventilator-free days, length of stay, or major safety outcomes. But an important subgroup signal emerged in patients with higher lung recruitability, raising a practical bedside question: should EIT be used selectively to guide precision ventilation rather than as routine daily exhaustive PEEP titration? We discuss the trial design, the “collapse-overdistension crossing point,” the editorial’s caution about repeated recruitment maneuvers and decremental PEEP trials, and how this should influence bedside ventilator thinking in ARDS. Educational only. Not medical advice. AI-generated voices are used and may occasionally mispronounce terms. Trial DOI: https://doi.org/10.1093/ajrccm/aamaf125 [https://doi.org/10.1093/ajrccm/aamaf125] Editorial DOI: https://doi.org/10.1093/ajrccm/aamag012 [https://doi.org/10.1093/ajrccm/aamag012] #PRISMRounds #CriticalCare #PulmonaryCriticalCare #ICU #ARDS #MechanicalVentilation #PEEP #EIT #ElectricalImpedanceTomography #VentilatorManagement #LungProtectiveVentilation #PrecisionVentilation #Recruitability #DrivingPressure #MechanicalPower #PronePositioning #RespiratoryFailure #AJRCCM #EITVent #ClinicalTrials #JournalClub #EvidenceBasedMedicine #FOAMed #MedEd #ICUEducation #AIgeneratedPodcast #FreeOpenAccessMedEd Tags

S01E40 | Balanced Fluids vs Saline in Pediatric Septic Shock: Why Adult ICUs Should Care

This week on PRISM Rounds, we discuss the April 2026 New England Journal of Medicine PRoMPT BOLUS trial comparing balanced crystalloids with 0.9% saline in children treated for suspected septic shock. The trial enrolled more than 9,000 children across 47 emergency departments and found no significant difference in major adverse kidney events between balanced fluid and saline. Balanced fluids reduced hyperchloremia and hypernatremia, but those biochemical advantages did not translate into better kidney outcomes, mortality, or hospital-free days. Although this is a pediatric trial, it is relevant for adult ICU and ED clinicians because it speaks to a familiar bedside question: when we reach for crystalloid early in sepsis, does fluid type meaningfully change patient-centered outcomes? We connect this trial to adult sepsis resuscitation, prior fluid-choice studies, and the broader lesson that “more physiologic” does not always mean “better outcomes.” Article: Balanced Fluid or 0.9% Saline in Children Treated for Septic Shock DOI: https://doi.org/10.1056/NEJMoa2601969 Educational only; not medical advice. This episode uses AI-generated voices. #PRISMRounds #CriticalCare #ICU #EmergencyMedicine #Sepsis #SepticShock #PediatricSepsis #BalancedCrystalloids #NormalSaline #FluidResuscitation #Resuscitation #KidneyOutcomes #MAKE30 #NEJM #EvidenceBasedMedicine #MedicalEducation #FOAMed #FOAMcc #PulmonaryCriticalCare #AIgenerated #AIResearchSummary #FreeMedicalEducation #JournalClub #BedsideMedicine Tags / Hashtags

S01E39 | The FAST Trial - Rapid AST for Gram-Negative Bacteremia

In this episode of PRISM Rounds, we review the JAMA FAST randomized clinical trial of rapid antimicrobial susceptibility testing for gram-negative bloodstream infections and the accompanying editorial, “Is FASTer Better?” The trial did not improve the primary DOOR outcome at 30 days, but rapid AST shortened antibiotic modification times and may be most useful when resistant organisms, septic shock, or ineffective empiric therapy are in play. We discuss why faster lab data alone may not improve mortality unless stewardship, drug availability, and bedside action close the loop. Educational only. Not medical advice. https://pubmed.ncbi.nlm.nih.gov/41999287/ Tags: Critical Care, ICU, Sepsis, Gram Negative Bacteremia, Antimicrobial Stewardship, Antibiotic Resistance, Rapid Diagnostics, AST, Bloodstream Infection, Infectious Diseases, JAMA, FAST Trial, FOAMed, FOMEd, Free Open Access Medical Education, Research Summary, Pulmonary Critical Care, Hospital Medicine, Pharmacy, Microbiology

S01E38 | Portable TB Testing — MiniDock MTB and Diagnostic Equity

In this episode of PRISM Rounds, we review the NEJM study of MiniDock MTB, a portable near-point-of-care molecular test for pulmonary tuberculosis using sputum and tongue swabs. The study found that MiniDock MTB outperformed smear microscopy, approached Xpert Ultra performance with sputum swabs, and met WHO near-point-of-care diagnostic accuracy targets. We discuss why this matters for resource-limited settings, where delayed TB diagnosis, repeat visits, and limited access to molecular testing remain major barriers to care. We also cover the key limitations: lower sensitivity in paucibacillary disease, smear-negative TB, and people living with HIV, plus the need for reflex drug-resistance testing. Educational use only. AI-generated voices may include occasional mispronunciations. Article: https://doi.org/10.1056/NEJMoa2509761 Tuberculosis, TB, pulmonary tuberculosis, MiniDock MTB, point-of-care testing, near-point-of-care diagnostics, molecular diagnostics, tongue swab, sputum swab, Xpert Ultra, smear microscopy, global health, infectious diseases, pulmonary medicine, critical care, resource-limited settings, diagnostic equity, implementation science, public health, NEJM, medical podcast, journal club, evidence-based medicine, FOAMed, FOMEd, Free Open Access Medical Education, PRISM Rounds, AI-generated medical education, AI medical podcast, clinical research summary Tags

S01E37 | The HIT Trial: Is "Good Enough" Better for Hyponatremia Correction?

Are we treating the monitor or the patient? This episode breaks down the HIT Trial (NEJM Evidence), where 2,173 patients with chronic hyponatremia were randomized to test if intensive sodium correction actually improves clinical outcomes. https://pubmed.ncbi.nlm.nih.gov/41733398/ The Results Lab Normalization: The targeted algorithm was highly effective at "fixing the number," reaching normal sodium levels in 60.4% of patients compared to 46.2% in standard care. Clinical Outcomes: Despite better labs, there was no reduction in 30-day mortality or rehospitalization (20.5% vs. 21.8%, p=0.45). Safety: While correction was more aggressive in the intervention group, zero cases of osmotic demyelination syndrome occurred. Bedside Takeaway Standard care is likely "good enough" for moderate hyponatremia in the short term. We discuss the "Good Enough" trap and why pushing for perfect laboratory values doesn't always translate to better patient-centered survival. Tags Hyponatremia Critical Care Pulmonary ICU Internal Medicine Medical Education Electrolytes HIT Trial NEJM Evidence Evidence Based Medicine Intensivist Physician Education