Pediatrica intensiva: Art & Science of Pediatric Critical Care

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/status/1248589226259517443?s=20

Find and follow Pediatrica Intensiva on Twitter here:

https://twitter.com/PedsIntensiva

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 science to gossip and merchandise!

Invited guests are Dr Brianna McKelvie from @CHEO, an intensivist with a masters degree in quality science, Dr Matteo DiNardo from Bambino Gesu, who has implemented QI projects in Italy and in low resource settings and Dr Mirjana Cvetkovic @mirjanaxxx @GreatOrmondStreet a cardiac intensivist and anesthetist who has driven change at GOS. Featuring regular hosts @drpetaalexander @BostonChildrens @karen_choong @MCH-childrens @drgregkelly @SCHNkids

No time to listen or want to participate in the discusion? You can find a full Tweetorial of this episode on Twitter @pedsintensiva and our website here

https://pedsintensiva.com/culture-practice-change-in-picu-based-rehabilitation/

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 cardiac arrest is the child with cardiac disease or hemodynamic instability. Recent studies show extraordinary rates of peri intubation cardiac arrest as high as four to 15% in the 30 minute peri-intubation window.

We'll discuss resuscitation and airway management in child with cardiac disease or hemodynamic instability, introduce the concept of the resus spiral staircase and talk about how you can optimize your team, respiratory support and hemodynamics. We cover delayed sequence intubation and that not every patient needs a tube and not every patient needs a tube right now. With better drugs and devices like dexmedetomidine and non-invasive, we've actually opened up a big zone between no support and invasive ventilation. We'll discuss ECMO standby when, how, who, and then finally de-resuscitation and extubation or separation from support.

This is a really big episode, so we've split it into two. This first half covers the resus spiral, team management and monitoring. And in the second episode, we will go into respiratory and hemodynamic support, rescue strategies, including ECMO and finally extubation.

Featuring regular hosts @drpetaalexander @BostonChildrens @karen_choong @MCH-childrens @drgregkelly @SCHNkidsNo time to listen or want to participate in the discusion? You can find a full Tweetorial of this episode on Twitter @pedsintensiva and our website here https://pedsintensiva.com

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 Choong from McMaster University in Hamilton, Canada and co hosted by Drs Greg Kelly (Sydney Children's Hospital Network), Peta Alexander (Boston Children's Hospital) and Mike Clifford (Royal Children's Hospital Melbourne)

No time to listen or want to participate in the discusion? You can find a full Tweetorial of this episode on Twitter https://twitter.com/PedsIntensiva and our website here https://pedsintensiva.com/early-mobilization-in-the-pedsicu-feat-sapna-kudchadkar/

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 not just difficult endotracheal intubation, but also difficulties with mask ventilation. supraglottic airway devices, difficult rescue techniques including front of neck access and physiologically difficult airways, which we covered in previous episodes.

The good news is that the attention our community has been paying to these issues has reduced the rates of endo tracheal intubation (ETI) associated adverse events significantly, but there's still a long way to go. We are joined by Akira Nishisaki from NEAR 4 Kids & CHOP which has been one of the main drivers of improvements in this space for almost 20 years and who has an incredible knowledge of the literature and Doug Atkinson a pediatric anesthesiologist and cardiac intensivist from Boston Children's Hospital.

As always, we focus on how our expert panel do things in practice at their institutions whilst being aware of the evidence.