Can stimulating the orexin receptor improve both sleepiness and cataplexy in narcolepsy type 1? In this episode of PRISM Rounds, we examine the First Light and Radiant Light phase 3 trials of oveporexton.

Across two 12-week trials, oveporexton produced substantial improvements in objective wakefulness, patient-reported sleepiness, and cataplexy compared with placebo. We discuss what those changes could mean for patients, why urinary frequency and insomnia matter, and what remains uncertain about long-term safety and comparisons with existing treatments.

Read the trial: https://www.nejm.org/doi/full/10.1056/NEJMoa2601598

Find more episodes at https://www.prismrounds.com and follow PRISM Rounds on Spotify or Apple Podcasts.

Tags

narcolepsy type 1, oveporexton, orexin, hypocretin, cataplexy, excessive daytime sleepiness, sleep medicine, clinical trials, First Light trial, Radiant Light trial, NEJM, PRISM Rounds

Choosing between high-flow nasal cannula, noninvasive ventilation (NIV), CPAP, and conventional oxygen is one of the most common decisions in critical care. The new 2026 American Thoracic Society (ATS) Clinical Practice Guideline provides updated, evidence-based recommendations across the spectrum of acute respiratory failure.

In Season 1, Episode 62 of PRISM Rounds, we examine the guideline published in the American Journal of Respiratory and Critical Care Medicine and explore what its recommendations mean for bedside practice.

We discuss four critical clinical questions:

1. Acute hypoxemic respiratory failure: Why is high-flow nasal cannula strongly recommended over conventional oxygen, and when should clinicians consider NIV or CPAP?

2. Acute hypercapnic respiratory failure: Why does NIV remain first-line therapy, and when might high-flow oxygen be a reasonable alternative?

3. Preoxygenation before intubation: How can HFNC and NIV reduce peri-intubation hypoxemia?

4. Postextubation respiratory support: Which patients benefit from preventive NIV or HFNC, and how can we reduce reintubation?

We also examine the strength and certainty of the evidence, important limitations of network meta-analyses, and the distinction between reducing intubation and improving survival.

The central clinical question: Are we choosing the right respiratory support strategy for the right patient, and recognizing early enough when that strategy is failing?

This episode is designed for intensivists, pulmonologists, emergency physicians, respiratory therapists, critical care fellows, and other clinicians managing acute respiratory failure.

Primary Reference:
Goel NN, Ferreyro BL, et al. Noninvasive respiratory support for adult patients with acute respiratory failure: An official American Thoracic Society Clinical Practice Guideline. American Journal of Respiratory and Critical Care Medicine. 2026;212(9):2135–2158.

https://doi.org/10.1093/ajrccm/aamag302

Listen and subscribe to PRISM Rounds on Apple Podcasts, Spotify, Youtube or visit https://www.prismrounds.com.

Evidence reviewed. Clinical decisions informed.

Tags

ritical Care

Pulmonary Medicine

ATS Guidelines

Noninvasive Ventilation

NIV

High-Flow Nasal Cannula

HFNC

CPAP

Acute Respiratory Failure

Hypoxemic Respiratory Failure

Hypercapnic Respiratory Failure

COPD Exacerbation

Mechanical Ventilation

Preoxygenation

Extubation

Intensive Care Medicine

Evidence-Based Medicine

Clinical Practice Guidelines

Respiratory Therapy

PRISM Rounds

Can therapeutic plasma exchange save lives in acute-on-chronic liver failure, or does it simply delay the inevitable?

In Season 1, Episode 61 of PRISM Rounds, we examine a 2026 randomized controlled trial published in Hepatology evaluating therapeutic plasma exchange in 194 patients with acute-on-chronic liver failure (ACLF).

The findings are striking. Plasma exchange reduced 28-day mortality from 63.9% to 44.3%, an absolute difference of nearly 20 percentage points. However, by 90 days, mortality was similar between groups, and more than 40% of patients could not complete the planned treatment.

We examine the trial's methodology, treatment complications, and clinical implications alongside the 2023 EASL guidelines and a 2025 meta-analysis of plasma exchange in ACLF.

The central question: Does plasma exchange meaningfully alter the course of liver failure, or does it provide a temporary bridge to hepatic recovery or transplantation?

Join us as we explore what this trial should, and should not, change in ICU practice.

Read the primary study:
https://doi.org/10.1097/HEP.0000000000001755

Subscribe to PRISM Rounds on Apple Podcasts, Spotify, or YouTube.

Visit https://www.prismrounds.com for more episodes.

Tags

Critical Care, Intensive Care, Hepatology, Acute-on-Chronic Liver Failure, ACLF, Therapeutic Plasma Exchange, Plasmapheresis, Liver Failure, Liver Transplantation, Randomized Controlled Trial, Evidence-Based Medicine, ICU Research, PRISM Rounds