18 - John Marshall - Getting patients out of the ICU as soon as we can

Are your ICU patients ever in a holding pattern?

Do you aim to liberate your patients from ICU as soon as possible?

Is your caution about moving things forward harmful to our patients?

I don't think we talk often enough about the dangers of conservatism in intensive care. About how if we are cautious in thinking the patient is not quite ready to be extubated, or have the sedation turned off, or stop the antibiotics, then we sometimes don't realize the harm our inaction may cause. A topic you will enjoy hearing about in this interview with Professor John Marshall on the Mastering Intensive Care podcast.

John is a Professor of Surgery at the University of Toronto, and a trauma surgeon and intensivist at St. Michael's Hospital in Toronto, Canada. John has an active clinical research interest in sepsis and ICU-acquired infection, and in the design of clinical trials and outcome measures. He has published more than 325 manuscripts, and 85 book chapters, and is the editor of 2 books. He is the founding chair of the International Forum of Acute Care Trialists (InFACT) – a global network of investigator-led critical care clinical research groups, he is Secretary-General of the World Federation of Societies of Intensive and Critical Care Medicine, and vice-chair of the International Severe Acute Respiratory and Emerging Infections Consortium. He is also past-chair of the International Sepsis Forum, past-President of the Surgical Infection Society, and past-chair of the Canadian Critical Care Trials Group. He has given invited lectures at more than 470 meetings around the world, is a member of seven journal editorial boards, and an Associate Editor of Critical Care Medicine and Critical Care.

In this conversation we also cover topics including:

• Being both a surgeon and an intensivist – and why ICU might be more fun
• Humility and curiosity as the two most important habits for intensivists
• That surgeons seem to own their complications more than intensivists
• The benefits of family member presence on the ICU ward round
• Why we should question everything we do in a provocative dialogue
• How research helps us at the bedside
• The value of collaborative research networks
• The observations that some ICUs can feel joyless
• Withdrawing interventions may not always lead to death
• The time when John was involved in a 4 hour CPR
• If we can't define what an intervention can or cannot do, perhaps we shouldn't do it
• The privilege John feelsto be able to make mistakes that might cost people their lives
• His artistic pursuits outside of medicine (including the story of a rock band)
• The constant feeling of rejection in academia
• The skills required to give a good talk
• How developing academic capital might be the best way to get a job

With this podcast please help me in my quest to improve patient care, in ICUs all round the world, by inspiring all of us to bring our best selves to work to more masterfully interact with our patients, their families, ourselves and our fellow healthcare professionals so that we can achieve the most satisfactory outcomes for all. It would be much appreciated if you could help to spread the word by simply emailing your colleagues or posting on social media.

If you have a comment or a question, let's engage. Whilst my primary goal is to improve patient outcomes by helping us all get better thanks to the inspiring messages of my guests, I also have the goal of building community through Mastering Intensive Care, so people can share their thoughts and their own skills. So leave a comment (on the LITFL episode page or on twitter using #masteringintensivecare), send me an email at andrew@masteringintensivecare.com or engage in the facebook page Mastering Intensive Care.

Thanks for listening. Please go out and do the best you can for your patients.

Andrew Davies