High-performing leaders drive results — but at what cost?

In today’s healthcare landscape, executive and clinical leaders are under pressure to lead through complexity, increase productivity, and maintain high standards — all while navigating burnout, disengagement, and stress within themselves and their teams.

As a physician, educator, and certified energy leadership coach, I help healthcare leaders perform at their highest level — without sacrificing their well-being or their team’s culture in the process.

At Transforming Healthcare Coaching, we partner with healthcare executives and leaders to:

Improve personal and leadership performance under pressure
Manage stress in high-stakes environments
Lead with clarity, confidence, and emotional intelligence
Build team cultures that are engaged, resilient, and aligned
Prevent burnout through systems-level mindset and energy shifts

Our coaching programs combine evidence-based frameworks and assessments with our team’s deep healthcare experience — empowering leaders to show up with purpose, manage complexity with grace, and model the kind of leadership that drives organizational transformation.

This is more than burnout recovery — it’s about renewing the energy for powerful leadership, and it ripples across departments, teams, and, in turn, health systems.

We believe that everyone on the healthcare team can benefit from a coach: physicians, nurses, pharmacists, dentists, social workers, executives, management, OT/PT, RD, RT! Imagine a healthcare team and system that actually works for you, the people caring for others, rather than setting you and your colleagues up for burnout.

Whether you're a Chief Medical Officer, emerging leader, or overseeing professional development in your organization, we can help your leaders become the kind of people others want to follow — especially when the pressure is highest.

Together, we can transform healthcare, one person at a time.®

👉 Let’s connect in the DMs to schedule a strategy call!

More fun facts about me:
Simulationist
VitalTalk Distinguished Faculty
Single mom
Peloton junkie
Foodie
Yogi
Ted Lasso fan girl
Future philanthropist

Lillian Emlet

What must leaders do in order to built high-performing teams in healthcare?

This week's Transforming Healthcare Coaching ® Healthcare Coaching podcast with Gillian Faith MS, ACC, SHRM-SCP, CPQC we talk about the actions and mindset to create psychological safety.

This month we focus on Awareness.
You cannot change or improve your own performance if you don't have Awareness of where you are, how you are showing up, and how you make people feel.

Find us on YouTube, Apple, Spotify, Amazon Music, Podbean.
#coachinghealthcare #healthcarecoaching #leadershipcoaching #executivecoaching

Contact us on how we support leaders and their teams: 
DM me here inside LinkedIn,
or Book a Call: https://lnkd.in/e9hhwF_t

Klaus Grim, PA-C, CPC

Lillian Liang Emlet, MD MS CHSE CPC ELI-MP

Founder, Transforming Healthcare Coaching® | Executive Coach for Physician Leaders | Elevating Performance, Preventing Burnout, & Building Energized Healthcare Teams | Critical Care Physician | Newsletter & Podcast 👇

Leadership is contagious.

We start off 2026 talking about how you lead YOURSELF, first.

How are you really showing up for yourself?
How are you really role modeling for others?

Check out this week's Transforming Healthcare Coaching ® podcast episode 90 with Klaus Grim, PA-C, CPC where we talk about time, role models, and why self-leadership is fundamental to everything else.

#coachinghealthcare #healthcarecoaching #leadershipcoaching #executivecoaching #clinicianwellbeing 

Check us out on YouTube, Apple, Spotify, Amazon Music, and Podbean.
Please listen and Subscribe!

What to do when the world feels heavy:

Unfortunately, I need to interrupt our usual programming to make a statement.

In healthcare, moral injury occurs very commonly when values of the caregiving profession is misaligned at the individual or systemic level. 

Moral injury occurs when policies, leaders, or systems block clinicians from doing what they believe is ethically required creating a felt betrayal by those with power or condition conditions of care. 

Millions of healthcare professionals witnessed that this week in the United States through the news outlets reporting on the events involving ICE in Minneapolis, Minnesota on January 7, 2026

Let us not forget.
Let us support each other.
In this video, I talk about why accepting and using the energy in a productive way might allow us to truly unify together and find a different way forward.

Curious about moral injury? Look up Wendy Dean, MD important expert body of work on this matter. 

If I remain silent, I am complicit.
I want to be known for which side of history I want to be on, and stand with the many other healthcare professionals and organizations and influencers that have taken a stand. We stand together as healthcare professionals. We care for each other. By not talking about things, we perpetuate an old culture, continued injury, and the system as it is. 

How might you role model something different?

How do we transform our workplaces?

Our guest this week, Annie Wildermuth PhD, PA-C, RD, ACC on Transforming Healthcare Coaching ® podcast, we are aligned on the important role in development for all professions and all levels of leadership: for physicians, nurses, NPs, PAs, pharmacists, and more. 

Check out this week's podcast on YouTube, Apple, Spotify, or wherever you like to listen!
Klaus Grim, PA-C, CPC
#coachinghealthcare #healthcarecoaching

Who are the invisible greatest supports for healthcare professionals?

It's the partners, spouses, and significant others.
And it's hard. 
Relationships are stress-tested, chronically, again and again, during training and the practice of medicine. 

So excited that Lisa Muehlenbein, Ph.D. is releasing the insights from her research on the medical marriage, relationships, and bringing a voice and an opportunity for strengthening that bond, giving voice to what it feels like, and providing a different way forward.

Please check out The MedLife Support Podcast on Apple Spotify and anywhere you listen and share with a friend and colleague in healthcare!

#coachinghealthcare #healthcarecoaching #clinicianwellbeing

Expert in Physician and Family Burnout Prevention & Organizational Wellness | Building Supportive Cultures for Healthcare Professionals | Director of Wellness | Physician Family Wellbeing Advocate

I’m excited to share that my podcast—The MedLife Support Podcast— is officially LIVE!

This podcast was created to hold honest, evidence-based conversations about physician burnout—not in isolation, but in the context of physicians, the people behind the white coat, and the systems meant to support them.

The idea for this show grew out of years of academic study in health psychology, doctoral research on physician burnout and the marital relationship from the spouse perspective, and lived experience as part of a physician family. What became increasingly clear is that burnout is not solely an individual issue—it’s relational, systemic, and deeply human.

We’re launching with 12 episodes available now, designed to be listened to individually or binged, offering research-informed insight alongside practical, applicable tools that support physician families and anyone navigating a high-stress profession.

If you are a physician, part of a physician family, or work in physician wellness and healthcare leadership, I hope this podcast serves as a meaningful resource.

The podcast is live and available wherever you listen (link in comments).

#physicianfamilies
#physicianburnout
#physicianwellness
#healthcareleadership
#healthcareculture

Sneak peek! 
Check out Stand Up (for) Doctors! by Kim Downey
An incredible person and force advocating for physician mental health, coaching, and wellbeing.

We interviewed her in 2025 on the Transforming Healthcare Coaching ® podcast: 
Check out her story in the Comments below! ⤵️ 
#coachinghealthcare #healthcarecoaching #clinicianwellbeing

Leadership + Wellbeing (that's where the un-lock lies!)

Doctors are resilient — but resilience doesn’t mean doing it alone.

In this clip from Stand Up (for) Doctors!, Lillian Liang Emlet, MD MS CHSE CPC ELI-MP reflects on how so many physicians found coaching during the pandemic — not because they were weak, but because support helps you move forward faster.

Sometimes, all you need is a quiet “secret Sherpa” walking beside you.

🎧 Full episode drops Tuesday 27 — Episode 145: Coaching, Leadership & Culture Change in Medicine

#PhysicianWellness #StandUpForDoctors #DoctorSupport #MedicalCulture #HealthcareLeadership #PhysicianCoaching #BurnoutRecovery #Episode145 #HealthcarePodcast #YouTubeShorts

Incredible webinar by Katina Sawyer, Ph.D. University of Michigan Center for Positive Organizations today. 

Great tangible take-aways for leaders with practical strategies.

When we coach our pivotal leaders-in-development in healthcare,
Our first foundation is awareness and self-leadership of wellbeing.
If we are not well ourselves as leaders,
It's no wonder that we don't have the capacity for holding the growth, emotions, and performance of our team, colleagues, departments, and patients.

And it's a both/ and:
Individual leadership + wellbeing coaching
Organizational culture, programs, and supports for those leaders.

We need both.
Curious about how we help you as a leader in healthcare? Message me. Let's chat.

And go out and read Drs. Sawyer and Grabarek's new book Leading for Wellness summarizing their organizational research on wellbeing, culture, and leadership. Link in Comments below. Patricia Grabarek, Ph.D.Katina Sawyer, Ph.D.

#coachinghealthcare #healthcarecoaching

There are many high intensity “stressful” specialties…

I should know: I am an intensivist & emergency physician.

I also oversee our wellbeing curriculum & am an executive coach.

I also actively participate in activities that restores & resets my inner compass, emotional capacity, & physical wellbeing: yoga, breathwork, Brain.fm, gratitude practice.

What action, dose, & frequency do you routinely do throughout the day in high intensity specialties?

Looking at you emergency medicine, trauma surgery, critical care (adult and peds) nurses, APPs, & physicians…


#coachinghealthcare #healthcarecoaching #clinicianwellbeing

Chief Well-being Officer: Michigan Medicine, Wife, mom to three, views my own and not necessarily representative of those of my employer

View Elizabeth Harry MD DipABLM’s profile

If you’ve ever wondered why “just cap the hours” hasn’t reliably fixed resident burnout, this new JAMA Network Open study is a helpful reset. In a national sample of 540 residents in high-burnout specialties (mean ~65 hours/week), work hours were not significantly associated with burnout—but were associated with higher stress (and higher self-perceived competency milestones).  

🔗https://lnkd.in/gjb9BdEc

🚫Stress ≠ Burnout (and the distinction matters)

This paper reinforces something we often blur in day-to-day conversations:
	•	Stress is often a situational, time-limited response to demands.
	•	Burnout is a pathologic, chronic occupational syndrome—classically involving exhaustion, cynicism/depersonalization, and reduced sense of accomplishment—that can emerge after prolonged, intense stress in a mismatched system.  

The headline implication

If longer hours track with stress but not burnout, then burnout prevention can’t be “hours-only.” It has to include what happens during those hours: workload design, supervision, meaning, team function, EHR/communication burden, and culture.  

🧘‍♀️Evidence-based stress-reduction interventions (Lifestyle Medicine–aligned)

Not as a substitute for systems fixes—but as protective capacity while we redesign the work:
	•	Mindfulness/meditation training (including app-supported options) to reduce perceived stress and improve emotion regulation.  
	•	Breathwork / downshifting protocols (e.g., 2–5 minutes of slow breathing) to rapidly reduce physiologic arousal.
	•	Movement snacks (10-minute brisk walk, stairs, mobility) to blunt stress reactivity and improve mood.
	•	Sleep protection as a clinical skill: consistent wind-down, light/caffeine timing, and—when needed—CBT-I approaches for insomnia.
	•	Social connection on purpose: a “micro-dose” of belonging (text a co-resident, debrief with a teammate, ask for a 2-minute check-in).
	•	Cognitive reappraisal / self-compassion: brief reframes that reduce threat appraisal (“This is hard and it’s temporary; what’s my next best step?”).

Bottom line: Stress is a signal; burnout is a systems diagnosis. If we treat them as interchangeable, we’ll keep prescribing the wrong fix.

What’s one change you’ve seen that reduces stress during the shift (not just after it)?

#PhysicianWellBeing #MedicalEducation #Residency #Burnout #Stress #LifestyleMedicine #Mindfulness #WorkDesign #CognitiveLoad #HealthcareLeadership American College of Lifestyle Medicine ACGME

Open article: Stress and Burnout in Residency Training by jamanetwork.com

Did you know we have a free medTHRIVE® Connect community where we host webinars, book clubs, and content for healthcare professionals to Transform Health Relationships to Inspire Vision and Energy (THRIVE)? 

Link to sign up for our little community in Comments below: 
It's a space for practicing healthcare professionals and administrators/ managers who want to develop themselves, so that they can develop others. It's for people who see themselves as leaders-in-development.
It's for people who want a healthier healthcare workforce.
And it starts with us.

Our February webinar is from my dear LinkedIn friend and colleague, who does amazing work with families and children as a social worker, and also a force for good in relationships through her company Just Jax Advising. Please welcome our first 2026 webinar with Jackie Hallberg, LMSW (yes you know her from LinkedIn Wishful Wednesdays that's hosted with Damian Kinsey IYKYK) as she talks about the good, the bad, the ugly about what healthy and unhealthy relationships look like.

In healthcare, we need to recognize it, and we need to know when to get professional guidance and help. As leaders, it's also a signal to nurture them and ensure the foundations for you and your team are strong. 

Streaming Live on LinkedIn, YouTube, Facebook, and in our medTHRIVE® Connect Circle community on the app.

#coachinghealthcare #healthcarecoaching #clinicianwellbeing

View Lillian Liang Emlet, MD MS CHSE CPC ELI-MP’s profile

Dating & Relationships: Real Talk for Healthcare Leaders

Relationships can be invisible strengths for the healthcare workforce; or it can be a major stressor and signal in the health of your organization. Let's get real about relationships.

Dating & Relationships: Real Talk for Healthcare Leaders

Are you a leader who asks for feedback?

I am always surprised by how few people in positions of leadership routinely ask for feedback:
At the end of a shift, meeting, week, or month.

If you don't get data triangulated from people you trust:
People whose opinions you care about,
People who can give a fair assessment and useful critique,
People who you respect.

Grateful for all the feedback I've received over the last 20 years.

Check out this week's Transforming Healthcare Coaching ® with Gillian Faith MS, ACC, SHRM-SCP, CPQC where we talk about micro-actions that leaders can take. 

#coachinghealthcare #healthcarecoaching #leadershipcoaching #executivecoaching

Expectations. Anticipation. 

Pre-determined ideas influence the lens by which we see the world.

This week's Transforming Healthcare Coaching ® podcast with Vicki Landers PT DPT MHA ACC we talk about the awareness and insight that healthcare leaders must carry inside themselves...so that they can open up possibilities in how they deal with people, find solutions, and create opportunities.

Find us on YouTube, Apple, Spotify, Amazon Music, and Podbean.
#coachinghealthcare #healthcarecoaching

Let me know which book we should feature for medTHRIVE Book Rounds book club for Q4!

Some really great potentials on this list curated by organizational psychologist Adam Grant  

#leadershipcoaching #coachinghealthcare #healthcarecoaching

Open article: The New Books to Refresh Your Thinking in 2026 by open.substack.com

The New Books to Refresh Your Thinking in 2026

On this edition of Transforming Healthcare Coaching ® The Thriving Healthcare Leader newsletter, Gillian Faith MS, ACC, SHRM-SCP, CPQC reminds us of an important coaching practice and concept for leaders that deal with conflict or opposing viewpoints within their teams.

Polarity mapping and polarity coaching perspectives can help all of us be more comfortable with the pro/ con of perspectives and find a way to resolve them. 

Would love to hear people's perspectives on finding the "both/and" on your teams in healthcare. Comment below!

#coachinghealthcare #healthcarecoaching #leadershipcoaching #executiveleadership

View newsletter: The Thriving Healthcare Leader

Polarities in teamwork arise when members hold opposing views on interdependent issues, such as when individual autonomy versus collective goals exist

Open article: Cohesive Teams  - Shifting from Polarities to Creative Solutions by Lillian Liang Emlet, MD MS CHSE CPC ELI-MP • 4 min read

Cohesive Teams  - Shifting from Polarities to Creative Solutions

So excited to be part of the Healthcare Businesswomen’s Association #Pittsburgh! 
If you are local the region: Check out this great event at the end of the month!
Maria Abunto, MD, MPH, MBA Mpande Mwape RN, MSN, MBA Cecily Tibbs Peters Kiran Cherlakola

Strategy and Transformation | Community and Stakeholder Engagement

We are 3️⃣ weeks out from our first Healthcare Businesswomen’s Association #Pittsburgh event of 2026... and you're invited! 

🗓️ Date: Friday, January 30, 2026
🕕 Time: 6pm - 9pm 
📍 Location: 118 Mervis Hall - Katz Graduate School of Business (3950 Roberto & Vera Clemente Drive, Pittsburgh, PA 15260)

🔗 Register here: https://bit.ly/4juiRR1 
🆓 No registration fee!

This will be an engaging evening of first hand stories of entrepreneurial paths from a dynamic panel, moderated by our own Maria Abunto, MD, MPH, MBA, featuring:

🟣 Anna Li – CEO & Founder, Korion Health
🟣 Jenny Yu, MD FACS – Founding Managing Partner, Sixth House; Clinical Advisor, VitVio; Entrepreneur in Residence, University of Connecticut
🟣 Haylee Massaro – Associate Teaching Professor, Carnegie Mellon University, Heinz College of Information Systems and Public Policy 
🟣 Wei Yu – Counsel, Intellectual Property & Technology, Dentons Cohen & Grigsby
🟣 Sue Cohen – Associate Professor of Organizations & Entrepreneurship, University of Pittsburgh Katz Graduate School of Business

#HBAMidAtlantic #HBAPittsburgh #HBAimpact

My word for 2026 is: sustainable (growth strategy)

If you didn't already know,
In addition to the Transforming Healthcare Coaching ® The Thriving Healthcare Leader newsletter with Gillian Faith MS, ACC, SHRM-SCP, CPQC
I also have a Substack where I reflect and integrate cognitive science, leadership principles, and life reflections and build in public.

Feel free to check out my reflections as we start off 2026 and return from our team retreat.

Interested in staying in the loop for all our content: newsletter, podcast, free webinars, LinkedIn livestreams: all in the same place? 

FREE medTHRIVE® Connect 
(community inside the Circle app so you can take us on the go!) is where that is! 

Link in Comments below. ⤵️

Open article: Dropping Grapes: Pruning With Intention by open.substack.com

A new year means a new vision,
And new action towards what might be.
Here we share some actionable steps for leaders of all professions to engage and explore with their teams an empowered future.
#coachinghealthcare #healthcarecoaching

We are just a DM away! Let's chat about where you want your teams to move towards!

The new year always brings a flurry of reflection guides, goal-setting workshops, and resolutions that sound beautiful in January and sometimes are a 

Open article: Visioning an Ideal Future State by Lillian Liang Emlet, MD MS CHSE CPC ELI-MP • 5 min read

Jackie Hallberg, LMSW, Charles Caldwell and 8 other attendees

Amplification.
Learning.
Growth.

People who podcast also listen to podcasts.
Perhaps we are auditory learners.
Succeed in Medicine is a graat podcast check it out!
Grateful to have been interviewed by Bradley Block, MD  back in 2024

Host and Creator of the Succeed in Medicine Podcast | CEO of Doctor Podcast Network | Otolaryngologist - Head and Neck Surgeon | Partner at ENT and Allergy Associates | Medical Expert Witness

🎉 500 Episodes! 🎉

Half a thousand conversations.
Hundreds of stories, lessons, and breakthroughs.
One truth: the journey of being a physician is never linear — but it’s always worth talking about.

Grateful for every listener, every guest, every honest conversation.

Episode 500 marks a powerful moment with Dr. Danielle Ofri exploring how physicians survive medical mistakes without losing themselves. It’s a fantastic conversation! Enjoy.

🎧 Episode 500: https://buff.ly/DQWaJ35

Yass Josh Hartzell, MD, MS-HPEd, FACP, FIDSA! 
Amy Lafko would agree! Look forward to this year 2026 where we will be featuring both of your books in the medTHRIVE® Connect free Book Rounds book club! 

(Link to Transforming Healthcare Coaching ® favorite books in the comments below)

"Take care of your people so they can take care of the mission."
#leadershipcoaching #executivecoaching #coachinghealthcare #healthcarecoaching

View Josh Hartzell, MD, MS-HPEd, FACP, FIDSA’s profile

Love your players, love your staff, love your employees, or love your teammates.


The message is always the same.

Take care of your people so they can take care of the mission. 

Photo from College Football Hall of Fame

#WEARE!

Proud alum: former Resident Assistant in Residence Life at Penn State.
It's where I found my volunteering and leadership beginnings.
Asian-American organizations, Omicron Delta Kappa, Student Health Services

Proud to be Episode 74 on the People of Penn State Podcast in 2025
#coachinghealthcare #healthcarecoaching #leadershipcoaching

View company: Penn State Alumni Association

For the 100th episode of The People of Penn State podcast, we went straight to the Symbol of Our Best, the Nittany Lion.

Meet Mason Reber, the 54th Nittany Lion. For the past three years, Mason has proudly carried one of Penn State’s most iconic traditions. As he prepares to graduate in just a few days, he reflects on his journey behind the suit, his most unforgettable moments, and what it truly means to be part of the Penn State family.

Tune in to hear his story, and help us celebrate 100 episodes of Penn Staters making an impact.

https://lnkd.in/gkSCPEiF

As the CEO of the Interprofessional Critical Care Network (ICCN) and a dedicated Respiratory Care Practitioner, my journey in healthcare has been driven by a passion for improving patient outcomes and a belief in the power of collaboration. 

With a background that includes roles at Columbia University Irving Medical Center, Memorial Sloan Kettering Cancer Center, The Mount Sinai Hospital, and the Hospital of the University of Pennsylvania, I've been fortunate to work alongside some of the most talented professionals in the field.

My academic foundation was laid at Gwynedd Mercy University, where I graduated with honors in Respiratory Care. This education set the stage for a career committed to the well-being of patients facing complex respiratory challenges. My areas of interest includes ventilator and airway management, acute respiratory distress syndrome, cardiopulmonary resuscitation, and comprehensive patient assessment, always with a focus on compassionate care.

At ICCN, I'm proud to be part of a team that's dedicated to enhancing our offerings and driving innovation in critical care. I value the opportunity to learn from every project and encounter, believing that continuous improvement is key to our success. My involvement in professional societies, such as the Society of Critical Care Medicine is a testament to my commitment to learning and growing with my peers.

Recognition, such as the Presidential Citation Award from SCCM, serves as a reminder of what we can achieve together, and I'm honored to be a Fellow of the American College of Critical Care Medicine. Sharing knowledge through national lectures and publications is not just a duty but a privilege, allowing me to contribute to the ongoing conversation on how to best care for our patients.

My service in the United States Army taught me the value of resilience and teamwork, qualities that I bring to my role every day. I am continually inspired by the dedication of those I work with and am committed to leading ICCN in a way that honors our shared goal: to deliver patient-centered care that makes a real difference

Javier Amador-Castañeda

🫁 Is Alveolar Recruitment a Pressure Problem… or a Time Problem?

For years, lung recruitment in ARDS has been framed as a question of how much PEEP we apply.

But experimental evidence tells a more nuanced story:

Alveolar stability depends not only on pressure—but on how long that pressure is applied.

🔬 What the data show

Using in vivo alveolar microscopy, investigators compared:

• High PEEP (24 cmH₂O) with conventional expiratory times
vs

• Shortened expiratory duration (expiration terminated at ~75% of peak expiratory flow)

The results were striking:

🔹 In non-dependent lung regions, both strategies prevented alveolar collapse
🔹 In dependent lung regions, short expiratory time outperformed high PEEP
🔹 High PEEP alone failed to stabilize alveoli in mass-loaded lung regions
🔹 Short expiratory duration preserved recruitment without increasing mechanical power

🧠 Why this matters

Increasing PEEP:

• Adds mechanical energy
• May increase mechanical power
• Does not guarantee recruitment, especially in dependent lung

Shortening expiratory time:

• Alters the pressure–time relationship
• Stabilizes alveoli using existing energy
• May reduce regional stress without added power

This distinction helps explain why:

• PEEP trials show mixed outcomes
• Mechanical power alone fails to predict VILI
• Dependent lung injury persists despite “lung-protective” settings

📌 Take-home message

Recruitment is not just a pressure phenomenon—it’s a pressure–time interaction.

Time may be the most underutilized variable in lung protection.

👇 Question for the ICU community

Should we be thinking less about how high PEEP is—and more about how long alveoli remain open during expiration?

Let’s discuss.

As always, don’t forget to like, share, and subscribe. See you on the other side!

Gary Nieman

Javier Amador-Castañeda, BHS, RRT, FCCM, PNAP

View newsletter: One Article a Day Challenge

By: Gary Nieman Why this question matters Mechanical ventilation strategies in acute lung injury and ARDS have evolved substantially over the past two

Open article: Which is More Effective at Recruiting Alveoli: Positive End Expiratory Pressure (PEEP)
or Expiratory Duration? by Javier Amador-Castañeda, BHS, RRT, FCCM, PNAP • 4 min read

Which is More Effective at Recruiting Alveoli: Positive End Expiratory Pressure (PEEP)
or Expiratory Duration?

🚨 PEEP Raises Mechanical Power in Everyone… But in Some ARDS Patients it May Lower the Mechanical Load per Aerated Lung Unit

We’ve all seen it: you increase PEEP, and mechanical power (MP) climbs. Many clinicians interpret that as “more VILI risk.”

This physiologic study challenges that reflex—and explains why recruitability is the missing variable.

What they did (real ICU physiology, controlled settings)

A reanalysis of 20 early COVID-19 ARDS patients within 24 hours of intubation, under neuromuscular blockade, volume control, VT 6 mL/kg PBW, constant flow, with a decremental PEEP trial (15→5 cmH₂O) and direct EELV measurement to quantify recruitment and FRC.

The headline finding

✅ Absolute mechanical power increased linearly with higher PEEP by ~+1 J/min per cmH₂O, from 20 [16–23] J/min at PEEP 5 to 31 [28–33] J/min at PEEP 15—regardless of recruitability.

But here’s the key shift:

When they normalized MP to aerated lung volume (FRC + recruited volume)…

🔻 In low recruitability patients, normalized MP increased with higher PEEP (+0.43 J/min/L per cmH₂O, p<0.001).
🔺 In high recruitability patients, normalized MP decreased with higher PEEP (−0.33 J/min/L per cmH₂O, p<0.001).

In plain English:

PEEP can raise total power yet reduce the “power burden” per aerated unit—if it recruits lung.

What best predicted who benefited?

Recruitment metrics were strongest:

- Recruited volume/FRC (R²=0.75)
- R/I ratio (R²=0.69)

Meanwhile, compliance and PaO₂/FiO₂ were weaker predictors (R²=0.40 and 0.33).

Why this matters

This may explain why large datasets sometimes show inconsistent outcome associations when we interpret absolute mechanical power without considering who actually recruits.

Important caution (straight from the paper’s limitations)

This is a small physiologic cohort and not powered for clinical outcomes, so it does not prove outcome benefit—only provides mechanistic insight into how energy may be redistributed with PEEP.

✅ Take-home:

PEEP ≠ automatic harm via mechanical power. The direction of risk likely depends on recruitability—and the R/I ratio may be the most practical bedside signal for that.

👇 Question for the ICU community:

Are you using a recruitability assessment (like R/I ratio) to guide PEEP—or still relying mostly on PaO₂/FiO₂ and compliance?

As always, don’t forget to like, share, and subscribe. See you on the other side!

Interprofessional Critical Care Network (ICCN)
Domenico Luca Grieco, Francesca Collino, Irene Steinberg, Gabriele Pintaudi, Antonio Dell'Anna, Mattia Busana, Antonio Pesenti, Patricia Rocco, Luigi Camporota, massimo antonelli, Tommaso Tonetti

Grieco, D.L., Collino, F., Steinberg, I. et al. Lung recruitability determines the impact of PEEP on mechanical power in ARDS. Crit Care (2026). https

Open article: Lung recruitability determines the impact of PEEP on mechanical power in ARDS by Javier Amador-Castañeda, BHS, RRT, FCCM, PNAP • 5 min read

Lung recruitability determines the impact of PEEP on mechanical power in ARDS

🫁 What Does It Mean to Be Ventilated?

We spend our ICU days focused on pressures, volumes, gas exchange, and outcomes.

This editorial asks a different—and uncomfortable—question:

What happens to a person’s sense of self when a machine takes over breathing?

Mechanical ventilation is not just a technical intervention.
It fundamentally alters the way a human being exists in the world.

🔍 Key insight from this perspective piece

Breathing is more than physiology.

Across cultures and philosophy, breath represents connection, agency, and presence.

When ventilation replaces spontaneous breathing:

• Autonomy is suspended
• The lived experience of the body changes
• Patients may experience fear, alienation, and loss of identity—even under sedation
• “Ventilator dyssynchrony” may reflect existential distress, not just mechanics

Survivors often describe ventilation not as “treatment,” but as endurance.

🧠 Why this matters for ICU practice

This article is not anti-ventilation.
It’s a call for ethical and human awareness alongside physiologic rigor.

It reminds us that:

• Survival ≠ preserved personhood
• Numbers cannot fully capture lived experience
• Re-orientation, communication, dignity, and compassion are clinical interventions
• Ventilation supports life—but also reshapes being

📌 The take-home message

Mechanical ventilation saves lives.

But it also transforms what it means to be human in that moment.

As we pursue precision ventilation, lung protection, and better outcomes, this paper challenges us to pursue something equally important:

Human-centered critical care.

👇 Question for the ICU community

How do we better balance physiologic excellence with preserving the patient’s sense of self—during ventilation and after liberation?

Let’s discuss.

As always, don’t forget to like, share, and subscribe. See you on the other side!

Interprofessional Critical Care Network (ICCN)
Thomas Bein

Bein, T., Brodie, D. & Quintel, M. The ontology of being ventilated—a less mechanistic and more holistic understanding. Intensive Care Med (2026). htt

Open article: The ontology of being ventilated—a less mechanistic and more holistic understanding by Javier Amador-Castañeda, BHS, RRT, FCCM, PNAP • 4 min read

The ontology of being ventilated—a less mechanistic and more holistic understanding

🫀 ECMO Saves Lives—But When Things Go Wrong, Seconds Matter

ECMO use has expanded rapidly over the last decade.
What hasn’t kept pace?

Standardized emergency response.

A new national, multi-society guideline tackles one of the most dangerous gaps in ECMO care: how we respond when ECMO emergencies occur.

🔎 What this paper addresses

ECMO emergencies are:

• High-risk
• Time-critical
• Often chaotic
• Managed differently across institutions

Until now, there has been no unified framework for cardiocirculatory emergencies in adult ECMO patients.

This guidance proposes something powerful and familiar:

An ALS-style algorithm—specifically adapted for ECMO.

🧠 Key concepts clinicians should understand

• ECMO emergencies require simultaneous attention to the patient and the circuit

• A dual-team approach (patient team + circuit team) reduces cognitive overload

• Clear role assignment and leadership are essential under stress

• Structured algorithms improve consistency when physiologic reserve is minimal

This is not about replacing clinical judgment—it’s about supporting it when judgment is most vulnerable.

⚠️ Important nuance

The authors are transparent:

• Much of the guidance is expert consensus, not randomized evidence

• The scope focuses on no-flow and low-flow emergencies

• Implementation, training, and simulation will determine real-world impact

But the message is clear:

ECMO emergencies are system problems, not individual failures.

📌 Why this matters now

As ECMO expands beyond highly centralized systems:

• Variability in experience increases
• Emergency preparedness becomes uneven
• Standardization becomes a safety issue—not a luxury

This framework offers a foundation that any ECMO program can adapt, regardless of volume or geography.

👇 Question for the ECMO community

Does your center have a formal, rehearsed ECMO emergency algorithm—or are responses still dependent on who happens to be at the bedside?

Let’s discuss.

As always, don’t forget to like, share, and subscribe. See you on the other side!

Interprofessional Critical Care Network (ICCN)
PD Dr. Alexander Supady

Supady, A., Delgado Moya, F.d. & Ortuno, S. Defining a national standard for ECMO emergency care. Intensive Care Med (2026). https://doi.org/10.1007/s

Open article: Defining a national standard for ECMO emergency care by Javier Amador-Castañeda, BHS, RRT, FCCM, PNAP • 4 min read

Defining a national standard for ECMO emergency care

🚨 Mechanical Power Isn’t the Problem — Hazardous Power Is

We often talk about mechanical power as if all delivered energy is equally harmful.

It isn’t.

A recent perspective reframes ventilator-induced lung injury (VILI) with a critical distinction:

Only the portion of elastic power that exceeds alveolar stress tolerance actually causes injury.

This is what the authors call hazardous elastic power.

🔑 The Simplified Concept

Alveoli are injured only when three conditions are met:

1️⃣ Sufficient stress
Elastic pressure exceeds a local alveolar threshold

2️⃣ Sufficient elastic power
Enough energy is delivered per breath

3️⃣ Sufficient vulnerability
Heterogeneous, injured, or unstable lung tissue
If any of these is missing → no injury occurs.

💡 Why This Matters Clinically

• Explains why similar plateau or driving pressures can have very different outcomes

• Explains why lowering VT alone doesn’t always prevent VILI

• Explains why respiratory rate amplifies injury risk

• Shifts the focus from “safe numbers” to patient-specific vulnerability

In ARDS, it’s not about how much power you deliver—it’s where that power goes and which alveoli receive it.

🧠 Take-Home Message

VILI is not caused by power alone.
It occurs when elastic energy repeatedly exceeds the tolerance of vulnerable alveoli.

The future of lung-protective ventilation isn’t a single threshold—it’s precision ventilation.

👇 Question for the ICU community

Should we move beyond static limits (VT, Pplat, DP) toward energy- and vulnerability-based ventilation strategies?

Let’s discuss.

As always, don’t forget to like, share, and subscribe. See you on the other side!

Interprofessional Critical Care Network (ICCN)
Patricia Rocco

Marini, J., Crooke, P. & Rocco, P.R. Mechanical power of ventilation: tracking the damaging component. Crit Care 30, 29 (2026). https://doi.org/10.118

Open article: Mechanical power of ventilation: tracking the damaging component by Javier Amador-Castañeda, BHS, RRT, FCCM, PNAP • 4 min read

Mechanical power of ventilation: tracking the damaging component

🫁 Awake ECMO: Innovation or Selection Bias?

As ECMO programs continue to evolve, one strategy keeps resurfacing—awake ECMO cannulation.

A new study in Journal of Clinical Medicine takes a hard look at outcomes in awake vs. sedated ECMO cannulation for patients with severe COVID-19 ARDS.

The results are intriguing—but demand careful interpretation.

🔍 What the study found

• Awake ECMO was feasible in a highly selected subgroup

• Six-month survival was numerically higher in awake patients

• Awake patients experienced more ventilator-free days

• Most awake patients were eventually intubated

• Sedated patients represented greater baseline severity
This wasn’t a comparison of strategies—it was a comparison of patients.

⚠️ The critical nuance clinicians must not miss
Awake ECMO patients:

• Had lower illness severity
• Required less organ support
• Represented a physiologically distinct population

In other words:

Improved outcomes may reflect who was chosen, not what was done.

🧠 Why this matters

Awake ECMO is not a replacement for mechanical ventilation

It is a bridge strategy that may:

• Reduce early ventilator exposure

• Preserve diaphragm function

• Buy time in carefully selected patients
But it also carries risks:

• Delayed intubation

• Loss of respiratory drive

• Emergent airway management on ECMO

📌 Take-home message

Awake ECMO is promising, but it is not generalizable.
Until prospective trials exist, this approach should remain:

• Protocol-driven
• Highly selective
• Managed by experienced ECMO teams

👇 Question for the community

Should awake ECMO remain a niche strategy—or is it time to formally test it against early intubation in randomized trials?

Let’s discuss.

As always, don’t forget to like, share, and subscribe. See you on the other side!

Interprofessional Critical Care Network (ICCN)

Galante O, Bukhin A, Sagie N, Stavi D, Kasiff Y, Haviv Y, Makhoul M, Soroksky A, Zikri-Ditch M, Fink D, et al. Awake vs. Sedated Cannulation for Extra

Open article: Awake vs. Sedated Cannulation for Extra-Corporeal Membrane Oxygenation in Patients with COVID-19 Induced Acute Respiratory Distress Syndrome by Javier Amador-Castañeda, BHS, RRT, FCCM, PNAP • 4 min read

Awake vs. Sedated Cannulation for Extra-Corporeal Membrane Oxygenation in Patients with COVID-19 Induced Acute Respiratory Distress Syndrome

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