Pediatrica intensiva: Art & Science of Pediatric Critical Care

In the second episode of our Fontan at 50 short season with @PCICS, Dr. Peter Laussen (Boston Children's Hospital) joins Greg and Deanna Tzanetos for the long view on how the Fontan evolved and where it's heading next. Peter traces the procedural arc — atriopulmonary, lateral tunnel, fenestration, extracardiac conduit — and the physiology behind each shift: PAs in continuity, early staging of the...

The first in a 4 part collaboration with PCICS (the Pediatric Cardiac Intensive Care Society) honoring 50 plus years of the Fontan-Kreutzer Operation and asking "How did we get here, and where are we going?" This episode features Dr. Tom Glenn  from Texas Children's Hospital.  Dr Glenn has an extraordinarily valuable perspective as both a pediatric cardiologist at a world leading centre and someon...

Airway management remains the single highest risk time for our patients in pediatric ICU.  Different studies of pediatric airway management report first pass success as low as 50%. Rates of severe desaturation as high as 20%, and significant rates of cardiac arrest ranging from two to 15% in the 30 minute peri intubation window alone. A difficult airway might be anticipated or unanticipated and is...

This season is  about airway management or airways that scare me and this episode, we discuss the respiratory unstable patient or the patient who's a "physiologically difficult airway" because they have bad lungs. We were incredibly lucky to have the amazing Robi Khemani from CHLA, a world expert on respiratory disorders in #pedsICU, join us and be able to share his thoughts. It's not just about p...

Children with complex airway surgery are airways that truly scare us. Though a small number of patients in pedsICU, they can stay a long time and are at risk of death and morbidity from their underlying conditions, co-existing conditions, their treatment and ICU acquired problems. Managing these patients requires a high level of understanding, communication and teamwork between ENT/ORL, ICU, anest...

Airway Management remains the single highest risk time for our patients in pedsICU & pedsCICU. We've known about problems for long time, but finally gaining attention, new ways of thinking & new ways to use drugs & devices- there's a lot more gray then there used to be. We'll discuss resuscitation and airway management in child with cardiac disease or hemodynamic instability, introduce the concept...

What are the pediatric #ECMO scenarios that even experts struggle with? "Challenging Pediatric ECMO Scenarios" Special Collaboration w @PCICS @ECMOPedi and @PedsIntensiva 3 cases covering what our expert hosts and panelists all decided were three of the HARDEST scenarios to deal with: 1. VA ECMO for respiratory support; 2. L heart decompression on VA ECMO &; 3. "Inadequate" VV ECMO support Feat. i...

Airway management remains the single highest risk time for our patients in pediatric ICU. We've known about these problems for a long time, but they're finally gaining the attention they deserve with registry projects and multicenter studies, new ways of thinking that move away from old dogmas and new ways to use our drugs and devices. One of the groups with the highest rates of peri intubation ca...

Culture and Practice Change are a vital element to implement ICU based rehabilitation in the pediatric ICU - because even when we know what to do it can be really hard to get our large and diverse teams on board and manage resource limitations, change fatigue and differing views. Here, experts from around the world discuss how they implemented change in their units - using everything from quality...

Long term & technology dependent aka "chronic critically ill" #pedsICU patients with Dr Rob Graham @BostonChildrens @karen_choong @drgregkelly @drpetaalexander Our #ICUrehab season focussed on preventing PICU morbidities & improving recovery. Our successes in #pedsICU mean that most kids survive & we increasingly see survivors with chronic complex conditions, either in ICU or frequently readmitted...

There is a growing awareness of the broad range of problems that patients and their families can face after a stay in the #pedsICU which is now known as Post Intensive Care Syndrome - pediatrics Nurse researcher and clinician Joseph Manning developed the PICS-p framework and has deep experience in following up these patients and families after they leave the ICU Pediatrica Intensiva season 3 is gu...

Analgesia and/or Sedation is provided to almost all the patients in the #pedsICU but it is something that often lacks precision. In this episode we speak to intensivist Prof Jayashree Muralidharan, #pedsICU nurse Sharon Prior and pharmacist Jonathon Wong Pediatrica Intensiva season 3 is guest edited by Professor Karen Choong from McMaster University in Hamilton, Canada and co hosted by Drs Greg Ke...

Delirium is a hugely important topic in the #pedsICU with up to 90% of some patient populations being affected and impacts on disease severity, length of stay and quality of life, even months after discharge. It is related to underlying disease, but also to the drugs and abnormal environment that we expose our patients to. Chani Traube and Deb Long are two of the foremost experts on pediatric deli...

Early Mobilization in the #pedsICU with groundbreaker Sapna Kudchadkar from Johns Hopkins Early Mobilization is enormously important because while survival continues to increase, so do the numbers of children who leave PICU with a new functional limitation. Survival is not enough anymore - it's all about the quality of survival Pediatrica Intensiva season 3 is guest edited by Professor Karen Choon...

Survival in PICU continues to increase around the world. The hidden cost of this is ever increasing numbers of children with severe, sometimes lifelong, problems from their critical illness and intensive care stay. Joining us as a guest editor for this season is one of the world experts on this topic - Professor Karen Choong from McMaster University in Hamilton, Canada. The episodes for this seaso...

6th regular episode of Pediatrica Intensiva with Aparna Hoskote, consultant in cardiac ICU at Great Ormond St Hospital London. The time around the stage 1 procedure is the time of the highest mortality for single ventricle patients, up to 15%. What we do in the #pedsICU really matters for these patients but there is very little high quality evidence to inform our practice. Consequently, practice v...

5th regular episode of Pediatrica Intensiva with Peta Alexander from Boston Children's, Mike Clifford from Royal Children's Melbourne & Greg Kelly from Westmead Children's Sydney. The interstage is a time of incredibly high mortality despite the fact it only lasts a few months. These patients can get sick for a variety of reasons between the mundane and the catastrophic - management is tricky and...

4th regular episode of Pediatrica Intensiva with Liz Crowe - Senior PICU Social Worker Having a child with single ventricle disease is an extraordinarily stressful time for the child, the family, and the staff who are involved. Liz Crowe is a world expert on these matters with over 20 years experience clinical work and a recently completed PhD on grief, resilience and wellbeing. Hosts: Dr Greg Kel...

3rd regular episode of Pediatrica Intensiva with Dr Ravi Thiagarajan -  Division Chief of Cardiovascular Critical Care at Boston Children's Hospital Patients with single ventricle heart disease are a very high risk group for cardiopulmonary arrest and requirement for ECMO support. Arrest and CPR is not inevitable and we are increasingly finding ways to prevent it, as well as manage the CPR and ECM...

2nd regular episode of Pediatrica Intensiva with Dr Mike Seed, division head of cardiology from Sick Kids and also a fully qualified cardiac radiologist. Patients with otherwise normal hearts can tolerate single residual lesions fairly well, but in single ventricle patients they are often associated with major adverse outcomes. Modern management involves aggressive monitoring for and intervention...

1st regular episode of Pediatrica Intensiva with Dr Peter Laussen, cardiac intensivist & anaesthesiologist from Boston Children's Hospital who is one of the world's most experienced people at dealing with borderline left heart patients, one of the toughest groups of critical congenital heart patients. These patients are tricky because of issues with terminology, testing, management and differences...

A podcast that aims to bridge the gap between literature and practice for pediatric critical care clinicians. Hosted by Drs  Peta Alexander, cardiologist & intensivist at Boston Children's Hospital;  Mike Clifford, intensivist & anaesthetist at Royal Children's Melbourne and  Greg Kelly, intensivist at Westmead Children's Hospital, Sydney, Australia Second season on Single Ventricle Patients featu...

Surviving COVID19 in NYC feat. Sam Parnia (intensivist at NYC Langone) & Liz Crowe (social worker & world-leading resilience expert). At the time of recording in April 2020, only Wuhan, Italy and NYC had sizeable COVID-19 epidemics. We knew it was going to be bad, but we weren't sure how we were going to cope. In this conversation we focussed on the personal characteristics that enable us to find...

3rd interview between Pediatrica intensiva team and Drs Giovanna Colombo and Lorenzo Grazioli at the epicentre of the Italian outbreak in Bergamo, Italy. At the time of recording in early April 2020, Italy was  still at the peak of their crisis and New York and other places was starting to see a sizeable number of cases. Link to written podcast summary here: https://twitter.com/PedsIntensiva/statu...

Pediatrica Intensiva episode 2. Italian intensivists Gio Colombo & Lorenzo Grazioli report from Bergamo, Italy, 2 weeks into their enormous epidemic of COVID-19, the first outbreak outside Wuhan, China. Link to written summary: https://twitter.com/PedsIntensiva/status/1242087069221965824?s=20 Find and follow Pediatrica Intensiva on Twitter here: https://twitter.com/PedsIntensiva