Critical Care Practitioner
Critical Care Practitioner is a podcast hosted by Jonathan Downham, an Advanced Critical Care Practitioner. The show focuses on teaching and sharing knowledge within the critical care field, featuring interviews and discussions on practical topics. It aims to help both new and experienced practitioners learn and improve their skills. The podcast reflects the host's motto: 'As I Learn, You Learn Too.'
Episodes
Arterial Lines: Do we always need them. A chat with Tom (Duracell Bunny)
Tom, one of my colleagues from the Critical Care Outreach Team and I discuss this paper and its findings reaching our own conclusions. Deferring Arterial Catheterisation in Patients with Septic Shock.
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Decompensated Alcohol Related Liver Disease Part 2
We return to our 48-year-old patient: jaundiced, hypotensive, drowsy, and bleeding. In decompensated cirrhosis, every treatment targets a disrupted system — splanchnic vasodilation, portal hypertension, toxin accumulation, and renal hypoperfusion.Although these patients look fluid overloaded, they are effectively hypovolaemic. Start with small aliquots of balanced crystalloid, avoiding 0.9% saline
Decompensated Alcohol Related Liver Disease
In this episode, I walk through the real-world critical care management of acute decompensated alcohol-related liver disease, using a high-risk ICU case to anchor the discussion. The focus is on understanding the underlying physiology—portal hypertension, rebalanced haemostasis, hepatic encephalopathy, infection, and hepatorenal syndrome—and translating that physiology into clear first-hour priori
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 CoveredMechanisms behind acute-on-chronic hypercapnic respira
HHS (Hyperosmolar Hyperglycaemic State)
HHS (Hyperosmolar Hyperglycaemic State) is the quiet counterpart to DKA. It develops slowly in older type 2 diabetics with residual insulin, leading to extreme hyperglycaemia and dehydration without ketosis. In this 2-hour deep dive, Jonathan explains why HHS kills through water loss and hyperviscosity rather than acid, and how to manage it safely.Key Learning Points:· Pathophysiology: Rel
DKA- Fluids, Potassium and Insulin
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Hypophosphatemia in Critical Care
Summary:In this episode, we spotlight a stealthy ICU disruptor — hypophosphataemia. Based on a 2024 narrative review in the Journal of Clinical Medicine, we explore why phosphate matters, how it goes missing in critically ill patients, and why you should care even when it’s just “a little low.”What’s Covered:The vital role of phosphate in energy, […]
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DKA in Critical Care
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Mobilisation in Critical Care- Barriers and Culture
Mobilisation in the ICU raises two big questions: is it safe, and will staff embrace it?In this discussion, Jonathan explores both sides of the story:Safety first:Large prevalence studies show mobilisation is happening, though often inconsistently.A systematic review of 1,800+ sessions found serious adverse events in only 0.6% — most minor and short-lived.Even patients on CRRT can safely mobilise
Episode 1- Mobilisation in the ICU
SummaryFor 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 […]
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Episode 6: Guidelines and the Future of Sedation in Critical Care
Sedation practices in the ICU have evolved dramatically over the past decade — but are we truly following the evidence?In this episode of The Critical Care Practitioner Podcast, Jonathan takes you through the key milestones in sedation guidance, the persistent gap between recommendations and real-world practice, and the emerging shift toward human-centered, wakeful care.What You’ll […]
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Episode 5 — Sedation Choices: Benzos, Propofol, Dexmedetomidine
OverviewIn this episode we explore the three main sedatives used in critical care and how to choose the right agent for the right patient.HighlightsBenzodiazepines: once the workhorse of ICU sedation, but now linked to more delirium and longer ventilation. Still useful in alcohol withdrawal and seizures.Propofol: rapid on/off, easy to titrate, helpful for daily sedation […]
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Episode 4: Sedation Protocols – Turning Knowledge into Practice
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Episode 3: Sedation Depth Why going too deep can hurt.
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CCP Podcast: Episode 2 The sedation hold game changer or risky routine?
In this episode, I explore the origins and evolution of the daily sedation hold — also known as the spontaneous awakening trial (SAT) — one of the most influential shifts in ICU sedation practice.I unpack the key trials that demonstrated SATs could safely reduce ventilation time and ICU stay, and examines how these findings became standard care. But it's […]
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CCP Podcast: Episode 1 A short history of sedation in ICU
In this episode, I explore how sedation practices in critical care have evolved over time — from the routine use of deep, continuous sedation to the early evidence that challenged it. You'll hear about pivotal studies that revealed the risks of over-sedation, the emergence of structured sedation protocols, and the beginnings of a culture shift […]
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CCP Podcast: Whats an ITU stay like for patients families?
This is a conversation I had with Francesca Trotta, a nurse from Rome who is at the last stages in her PhD. This was at the BACCN conference in Aberdeen in 2024.
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CCP Podcast: Working in war zones and Disaster Areas
This is a chat I had with David Wightwick who is the CEO of UK Med a humanitarian medical aid charity. This happened at the BACCN 2024 conference in Aberdeen.
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Are ACCPs here to stay?
This is a conversation I had with professor Tim Buchman who is Professor of Surgery and founding director at the Emory Centre for Critical Care in the US. We discuss the advent of Advanced Practice in the US and how it will inform the same developments in the UK
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CCP Podcast: AI with Aarti Sarwal
AI is here! How will it effect us and how can we use it to make learning fun with AI, or not use it to help with our work? Aarti gives some easy to understand explanations of the key concepts.
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CCP Podcast: So you want to be an ACCP?
This is a chat with Rowan Grieves, who works in Belfast, about her journey to become an ACCP and the hurdles she had to overcome when starting this new role.
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CCP Podcast- Patient Diaries
This was originally a Facebook livestream with an ex patient- Carol Billian, Christine representing ICU Steps, a group helping support ICU survivors and Peter Nydahl from Germany who also aims to support the same group.
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CCP Podcast- Lung Protective Ventilation- How to improve our practice.
This is a chat I had with Dr Daniel Watkin about his QI project to assess compliance with the guidelines and how they went about improving it. You can find the paper here- 'Beyond Audit: Embracing QI methodology to drive improvements in lung-protective ventilation'
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CCP Podcast: When to do the tracheostomy
This is a chat with Tamas Szakmany about the paper 'Impact of early tracheostomy versus late or no tracheostomy in nonneurologically injured adult patients: a systematic review and meta analysis' and his editorial 'When more could mean less intervention: the tale of tracheostomy timing in critical illness'
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CCP Podcast- Weaning our patients.
This is a chat with Professor John Laffey about the WEAN_SAFE study. Weaning from mechanical ventilation in intensive care units across 50 countries (WEAN SAFE): a multicentre, prospective, observational cohort study
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CCP Podcast: Do Not Resuscitate- the conversations we have.
A discussion with Michelle about the recent paper she played a part in discussing the conversation s we have, or don't about Do No Resuscitate orders. The experiences of adult patients, families, and healthcare professionals of CPR decision-making conversations in the United Kingdom: A qualitative systematic review.
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ICU Acquired Weakness and Muscle Wasting
Brigitta and colleagues have just published 'The rate and assessment of muscle wasting during critical illness: a systematic review and meta-analysis.' Some important and interesting discussion points.
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Podcast- Nutrition management for critically and acutely unwell hospitalised patients with coronavirus disease 2019 (COVID-19) in Australia and New Zealand
Great discussion with Dr Emma Ridley a dietitian from Australia about how they planned to look after the nutritional requirements of COVID patients. A lot of pointers about how we care for their needs when they haven't got COVID too.
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Organ Donation from the Frontline- with Vikki Howarth
Vikki has been a clinical lead for Organ Donation in the past so I spent some time picking her brains about the role of the Organ Donation team and how that affects how we look after our patients. Lots of really valuable insights.
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Proning- The PROSEVA Trial
This study entitled "Prone Positioning in Severe Acute Respiratory Distress Syndrome" was published in 2013 and its aim was to evaluate the effect of early application of prone positioning on outcomes of patients with severe ARDS. It was a multicentre, prospective, randomised controlled trial mainly in French Hospitals. The primary outcome was 28 day mortality. Recruited patients had […]
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CCP Podcast- End Tidal CO2
Let’s improve our understanding of the capnograph. Very valuable when caring for your patient.
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FREE 15 Minute Friday- Intubation- whats all that equipment?
We all go grab the essential equipment when we need to intubate the patient. Buts what’s it all for? In this podcast I cover some of this. If you want to join me on FREE 15 Minute Friday go find the Critical Care Practitioner page on Facebook.
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Free 15 Minute Friday- Why have my patients sats dropped?
It could be that they have dropped quickly or slowly. Either way its sensible to have a thought process ready so that you might be able to solve it! This is what I cover in this podcast.
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Why do we intubate
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FREE 15 Minute Friday- Basic Ventilator Screen
A new series which I am hoping to provide weekly taken from the live streams I am running across social media- this weeks topic- the basic ventilator screen. Lets go through some of those buttons.
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FREE 15 Minute Friday- Peak and Plateau Pressures
EA new series which I am hoping to provide weekly taken from the live streams I am running across social media- this weeks topic- Peak and Plateau Pressures. What are they and why does it matter?
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FREE Friday 15 Minutes- PEEP
A new series which I am hoping to provide weekly taken from the live streams I am running across social media- this weeks topic- PEEP.
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Why do we Intubate?
Believe it or not we don't intubate people to put them on a ventilator. Rather we put them on the ventilator because we have had to intubate them. So why do we need to intubate them? Let's work our way through using an ABCDE approach. Airway The patients airway may be compromised. This could be initially supported […]
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CCP Podcast 166: Practitioners on Fire- Ashleigh Lowther
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CCP Podcast 165: Catherine White and ICUSteps
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CCP Podcast 164: Practitioners on Fire – Nathan Griffiths
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CCP Podcast 163: Practitioners on Fire – Kay Murphy
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CCP Podcast 162: Practitioners on Fire – Gareth Ward
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CCP Podcast 161: Practitioners on Fire – Jamie Hyde-Watt
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CCP Podcast 160: Practitioners on Fire – Julie Harper
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CCP Podcast 159: What Matters to Patients and Their Families During and After Critical Illness
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CCP Podcast 158: Practitioners on Fire- Sarah Shipley
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CCP Podcast 157- Michael Rosen- COVID and ICU Survivor
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CCP Podcast 156: Practitioners on Fire- Brigitta Fazzini
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CCP Podcast 155: Registered nurses’ experiences of working in the intensive care unit during the COVID-19 pandemic
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CCP Podcast 154: Practitioners on Fire- Pete Chessum
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CCP Podcast 153: Surviving ICU with Lou Gallie
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CCP Podcast 152: Practitioners on Fire- Joanne Fisher
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CCP Podcast 151:Critically ill patients’ experience of agitation with Samantha Freeman”
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CCP Podcast 150: Practitioners on Fire – Martin Horton
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CCP Podcast 149: Practitioners on Fire – Joanne Brown
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CCP Podcast 148: Practitioners on Fire – Matt Fowler
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CCP Podcast 147: Practitioners on Fire – Rachael Moses
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My Experience of ICU with Carol Billian
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CCC Podcast 146: Practitioners on Fire – Sally Squires
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From the Vault- Mechanical Ventilation with Ollie Poole
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CCp Podcast 145: Practitioners on Fire- Sean Munnelly
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CCP Podcast 144: Suicide and self-harm in adult survivors of critical illness
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CCP Podcast 143: Practitioners on Fire- Robin and Lee
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CCP Podcast 142: Advanced Practice Proving its Worth
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CCP Podcast 141: ARDS- how we treat it.
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CCP Podcast 140: Proning from bench to bedside
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CCP Podcast 139: ICU Follow Up Clinics
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CCP Podcast 138: In Situ Simulation
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CCP Podcast 137: VR and Critical Care. Really?!
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CCP Podcast 136: Delirium with David Aaronovitch
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CCP Podcast 135:COVID-19 and Ethics
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CCP Podcast 134- CCP Podcast 134- COVID 19- When to do that tracheostomy?
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CCP Podcast 133: Ollie Poole and SCCM Guidelines on Mechanical Ventilation in COVID-19
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CCP Podcast 132: COVID- Early Days?
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Preparing to Prone- Courtesy of the BACCN
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CCP Podcast 131: The Rose Trial
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CCP Podcast 130: Twitter Chats
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CCP Podcast 129: APRV- Why you shouldn’t
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CCP Podcast 128: PJ Paralysis!
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