S01E43 | EDTA for CVADs: Can a Line Lock Reduce ICU Catheter Complications?

S01E43 | EDTA for CVADs: Can a Line Lock Reduce ICU Catheter Complications?

In this episode of PRISM Rounds, we discuss the JAMA 2026 randomized clinical trial by Ornowska and colleagues testing whether 4% tetrasodium EDTA, or t-EDTA, used as a locking fluid for inactive central venous access device lumens, can reduce CVAD-associated complications in adult ICU patients. This pragmatic, triple-blind, multicenter, cluster-randomized crossover trial included 1468 ICU patients across 6 Canadian hospitals. The primary composite outcome—CVAD-associated bloodstream infection, catheter occlusion requiring alteplase, or catheter removal due to occlusion—occurred at 13.1 vs 19.9 events per 1000 catheter-days with t-EDTA versus control. The main signal was fewer catheter occlusions requiring alteplase; infection and thrombosis events were uncommon and should not be overinterpreted. Article link: https://jamanetwork.com/journals/jama/fullarticle/10.1001/jama.2026.6025 [https://jamanetwork.com/journals/jama/fullarticle/10.1001/jama.2026.6025?utm_source=chatgpt.com] Tags Critical Care, ICU, Central Line, CVAD, EDTA, t-EDTA, CLABSI, Catheter Occlusion, Alteplase, Venous Thrombosis, Infection Prevention, Vascular Access, JAMA, Randomized Trial, Pulmonary Critical Care, FOAMed, PRISMRounds

S01 Bonus Episode01: Prevent and Reverse Heart Disease — A Patient-Friendly Book Review

In this PRISM Rounds bonus episode, we step away from our usual journal-club format for a patient-facing book review of Prevent and Reverse Heart Disease by Caldwell B. Esselstyn Jr., M.D. This book was published in 2007, and cardiovascular prevention guidelines have evolved since then. But its central message remains practical and motivating: patients are not powerless, and daily food choices can be an important part of reducing cardiovascular risk. This episode is designed especially for physicians and clinicians who want a simple, shareable way to start a food-focused heart-health conversation with patients. We focus on practical steps individuals can take: improving breakfast, building plant-forward meals, stocking healthier foods at home, and making small sustainable changes. Educational only. Not medical advice. Patients should discuss major diet or medication changes with their healthcare team. Tags Cardiovascular prevention, Heart disease, Plant-based diet, Lifestyle medicine, Patient education, Prevent and Reverse Heart Disease, Caldwell Esselstyn, Nutrition, Primary prevention, Secondary prevention, Cholesterol, Coronary artery disease, Food as medicine, PRISM Rounds, Bonus episode

S01E42: Auto-Adjusted NIV in OHS - The Pickwick Titration Trial

In this episode of PRISM Rounds, we discuss the AJRCCM 2026 Pickwick Titration Trial, which asked whether automatically adjusted noninvasive ventilation can match manually adjusted NIV titrated in the sleep lab for ambulatory patients with obesity hypoventilation syndrome. The trial found that auto-adjusted NIV produced similar 12-month improvement in daytime PaCO₂ compared with manually adjusted NIV, while reducing cost and potentially decreasing sleep-lab burden. The accompanying editorial highlights the real-world nuance: CPAP remains first-line for many stable OHS patients with severe OSA, but auto-adjusted NIV may be especially useful when NIV is indicated and access to in-lab titration is limited. Article: https://doi.org/10.1093/ajrccm/aamag018 [https://doi.org/10.1093/ajrccm/aamag018] Editorial: https://doi.org/10.1093/ajrccm/aamag112 [https://doi.org/10.1093/ajrccm/aamag112] This episode is for educational purposes only and is not medical advice. TagsCritical Care, Pulmonary Medicine, Sleep Medicine, Obesity Hypoventilation Syndrome, OHS, Noninvasive Ventilation, NIV, Auto NIV, Auto EPAP, AVAPS, CPAP, PaCO2, Hypercapnia, Sleep Lab, Polysomnography, AJRCCM, Pickwick Titration Trial, PRISM Rounds, Medical Education, Free Open Access Medical Education, FOAMed, AI Generated Medical Education, Research Summary, Journal Club, ICU, Respiratory Therapy, Pulmonary Critical Care

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