Approximately 75% of patients older than 65 years of age are seen in an ED within 6 months of their death. While palliative care teams are now present in many hospitals in the US, they are often not present 24/7 or in resource-limited settings. As such, there may be an opportunity to improve palliative care in the ED by providing palliative care education to ED team members. In this podcast, we review the recently published PRIM-ER trial, which evaluated the impact of a robust primary palliative care intervention on hospital admission rates in 29 EDs across the US.

Sepsis results in more than 250,000 deaths each year in the United States. Resuscitation of the septic patient centers on timely recognition, early antibiotic administration, appropriate fluid administration, source control, and vasopressor administration for those with inadequate mean arterial pressures. At present, norepinephrine is the recommended first-line vasopressor for sepsis. Current guidelines then recommend vasopressin as the second-line vasopressor agent, but the optimal timing of its initiation remains unknown. In this podcast, we discuss a recent article on the use of a machine learning tool for vasopressin administration to optimize short- and long-term outcomes in patients with sepsis.

Both NIV and HFNC are used to treat patients with acute respiratory failure. Current guidelines recommend NIV for acute respiratory failure caused by COPD and acute cardiogenic pulmonary edema. However, NIV may be hard for some patients to tolerate. When compared to low-flow oxygen therapy, HFNC has been shown to improve oxygenation, improve alveolar recruitment, and enhance clearance of secretions. HFNC may be easier to use and tolerate than NIV, but there remains uncertainty regarding the effectiveness of HFNC compared to NIV for acute hypoxemic respiratory failure. In this podcast, we discuss the RENOVATE trial that sought to compare HFNC with NIV on rates of intubation in patients with acute respiratory failure.