Discover and read the best of Twitter Threads about #PedsCICU

Most recents (17)

Thank you @OwlLabs for collaborating with us… in March 2020 I emailed them asking if they’d be willing to donate an owl to help us with virtual rounding with parents of kids in the #PedsCICU they replied in <2 mins with “how many can we send”?
resources.owllabs.com/case-studies/d…
1/🧵
2/ you see, I had been a family member at @DukeHealth when my mom was inpatient for 8mos in 2019 after a failed bone marrow transplant. Attending rounds to get all the information while working full time was 😵‍💫. So I (a medical professional) often felt confused about the plan
3/ Here we are at Lion King the year before in 2018
Read 16 tweets
1. Tips on successful white board choose your own adventure teaching. A thread. #PedsICU #pedsCICU @JennaMillerKC
2. Critical illness doesn’t start in the ICU. Your learners meet their patient in the clinic or ED.
3. Give them triage vitals.

That’s it. If they don’t ask for it they don’t get it.
Read 10 tweets
I’m a CICU doctor. I’m the CICU director.

But somehow I’ve found myself finishing a week of PICU service. The PICU is wild!

So here’s what I’ve learned and why the PICU is tougher than the CICU.

a thread #PedsICU #pedscicu
1. High turnover

CICU: median length of stay about 3 days. Weekend and night admissions uncommon.

PICU: length of stay felt like about 18 hours. 5 new patients show up overnight.

This was exhausting.
2. Unplanned admissions

CICU: I start hearing about the patient 2 months before they’re born.

PICU: Rolling in off the street like Amazon packages.
Read 8 tweets
𝙏𝙃𝙀 𝙈𝙐𝘾𝙃 𝙁𝙊𝙍𝙂𝙊𝙏𝙏𝙀𝙉 𝙍𝙑

1/5
Dif Approaches to Optimizing PEEP

PEEP and RV Function
Clifford Greyson @SCCM #CCC50

#PedsICU #PedsCICU #PedsCards
2/5

▫️Frank-Starling law is more reflective of LV physiology
▫️ RV normally unstressed at end diastole
▫️ RV maladapts to volume overload overtime
▫️ Distorted RV balloons impedes LV
▫️ RV perfusion occurs during ventricular systole
▫️ Vicious cycle 🔄 of RV dysfunction
3/5

RV afterload affected by
▫️PVR
▫️Pul vascular compliance
▫️LAP

all compromised with excessive PEEP
Read 5 tweets
Here is the #PedsICU #BestOf2020 collection.
Jointly chosen by
@Dr_Hari_Krishna @sgdambrauskas and myself
Pubmed collection 40 articles: bit.ly/pedsicubestof2…
Infographic (clickable PDF) in English: bit.ly/bestof2020eng
Spanish: bit.ly/bestof2020esp
#PedsCICU #NeuroPICU
This will be a bilingual tweetorial in Spanish/English!
Infographics are available in both languages in Tweet #1

El hilo será en Español/Inglés. El resumen infográfico está disponible en los dos idiomas en el primer Tweet
1/What are the outcomes that matter to children, to families and to #researchers/clinicians? @ericka_fink et al & @PostPICU_PALISI investigators identified COS using a delphi process. @CritCareMed bit.ly/381cfq8. Developmental and functional outcomes were important.
Read 44 tweets
#Tweetorial
Llegó colección de lo #Mejor2020 en #PedsICU &
@Dr_Hari_Krishna 🇬🇧@MiguelrrMD 🇪🇸 @sgdambrauskas 🇺🇾

Pubmed: bit.ly/pedsicubestof2…
Versión infográfico español: bit.ly/bestof2020esp
Version inglés: bit.ly/bestof2020eng

#SoMe4MV #neuroPICU #delirium #PedsCICU
English #BestOf2020
The #Bestof2020 #PedsICU pubmed collection will also be available in the FREE #PICCHub app (sponsored by @PICSociety) as the latest monthly #PICUJournalwatch collection:
Download links: Android: play.google.com/store/apps/det…
iOS: apps.apple.com/gb/app/picchub…
3/ La FUNCIÓN como nuevo paradigma
@ericka_fink et al POST #PedsICU investigators & @PALISInet hicieron consenso Delphi
Qué es lo importante como resultados al alta #PedsICU?

En @CritCareMed lo que encontraron con precioso infogràfico
bit.ly/381cfq8
#PedsICU #PICSp
Read 42 tweets
3rd regular episode of @pedsintensiva, podcast that bridges the gap btw literature & practice for #pedsICU

CPR & #ECMO in Single V patients w Ravi Thiagarajan Division Chief of Cardiac ICU @bostonchildrens

Tweetorial 👇

tinyurl.com/CPRandECMOsing…

#pedscards #pedsCICU #CHD
@BostonChildrens Single V pts are ++ risk for arrest & #ECMO support

Many pts die & more have morbidity, even in best centers

Prevention of arrest is more important & effective than rescue CPR/ECMO – great work by @pc4quality in making prevention sexy!

#pedsICU #pedscards #pedsCICU #CHD
@BostonChildrens @pc4quality ECPR (extracorporeal-CPR) is only ever as good as the CPR you get beforehand

Getting a pt onto #ECMO is busy but don’t forget the prime importance of good quality CPR w minimal interruptions on the way there

#pedsICU #pedscards #pedsCICU #CHD
Read 19 tweets
#PedsICU #PedsCICU #PedsCards Drawing attention to this @pc4quality study by @JustinElhoff and Martina Steurer-Miller (needs a handle!) and team....1/x

Relationship between gestational age and outcomes after congenital heart surgery pubmed.ncbi.nlm.nih.gov/33080235/
This is one of those great studies where we followed the data and found something that was interesting to us, worthy of follow-up, and potentially actionable. In addition to studying the relationship between gestational age and outcome after #CHD surgery...2/x
We looked at the association between corrected gestational age and outcome. We frequently struggle to determine the "right" time to take a premature patient with CHD to the operating room. On the one hand, we want them to achieve sufficient organ maturity...3/x
Read 8 tweets
💥Four very important resources to keep for new 2020 PALS guidelines
#PedsICU #PedsCICU #PedsAnes #CPR

1. Pediatrics
2020 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care pediatrics.aappublications.org/content/early/… @PIPSQC
Why new AHA respiratory rate recommendations is 20-30 question?
Supporting paper 👇
2. Ventilation Rates and Pediatric In-Hospital Cardiac Arrest Survival Outcomes pubmed.ncbi.nlm.nih.gov/31369424/
3. Pediatric and neonatal recommendations from @CircAHA Pages 11-14

Executive Summary: 2020 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations ahajournals.org/doi/10.1161/CI…
Read 4 tweets
1st ever regular episode of Pediatrica Intensiva, the podcast that bridges the gap btw literature & practice for #pedsICU

Borderline Left Hearts w @laussen_peter from @BostonChildrens @SickKidsNews, part 1 of Single Ventricle season

Tweetorial👇

apple.co/36FG2EN
Borderline Left Hearts are subset of pts w critical L heart obstruction, best defined as:
1.‘Output of aortic valve inadequate to maintain life’ (so need to maintain duct until 1st intervention) &;
2.Present & need intervention in neonatal period

#PedsICU #PedsCICU #CHD /2
Infants w critical left heart obstruction are on spectrum
-One end: clearly inadequate L heart structures -> single V pathway
-Other end, clearly adequate (even if bit small) -> biV pathway
- Pts in middle are TRICKY (hence this podcast)

#PedsICU #PedsCICU #CHD #pedscards /3
Read 37 tweets
First up is James Fraser, president of @PICSociety discussing the UK #PedsICU response to #COVID19

This was a busy and difficult time for all!

#EPCCS20
#COVID19 data for the admission of children to #PedsICU: cumulative around 100 children

#EPCCS20
Some UK #PedsICU became adult units - around 30% of #PICU beds became used for #COVID19 adults

We were fortunate this was in the summer when #PedsICU was quiet...

#EPCCS20
Read 4 tweets
Our @pc4quality study just published in @PedCritCareMed is one of my favorites I've ever written. Here's why (trainees and junior faculty take note)...

journals.lww.com/pccmjournal/Fu…
It all has to do with @SydneyRooney5, the amazing @SarnoffCardio fellow I got to work with. She's from @PittPediatrics @CHPPedSDP @ChildrensPGH @residentsofchp

Get to know her name. She's gonna be a mega star...
This study was originally conceived by a colleague at another institution, and @SydneyRooney5 worked on the data management as part of her research fellowship training. She did a great job with that and was going to be a middle author on the paper...
Read 11 tweets
1/9 🅲🅰🆂🅴-🅱🅰🆂🅴🅳 🆃🆄🆃🅾🆁🅸🅰🅻 4
MECHANICAL CIRCULATORY SUPPORT

@ACCinTouch @agtruesdell @ErikOsborn77 @mirvatalasnag #ACCIC #PedsCICU #PedsCards

🔹Background
🔹#PedsICU #ECMO Case
🔹Adult ECMO + #Impella Case
🔹Upcoming Webinar
2/9 EARLY RUNS OF #COVID19 PATIENTS ON #ECMO

Initial discouraging reports from 🇨🇳
Warning of igniting immune storm esp in patients with high IL-6

Nationwide centralization in 🇯🇵 to improve research & quality of evidence
🔹Time to ECMO
🔹Lung compliance
🔹Biomarkers
3/9 GUIDANCE DOCUMENTS

Surviving Sepsis Guidelines
🔹VV ECMO for refractory hypoxemia despite optimizing ventilation rescue therapies & proning
🔹Intensive Care Med May 2020
doi:10.1007/s00134-020-06022-5
@AlhazzaniW

FDA Enforcement Policy expanded availability of devices
Read 9 tweets
If you care for #PedsCICU patients or #CHD patients in the #PedsICU & aren't engaged with PC4, the outstanding recap of the #CardiacArrestPrevention project results by @bubblesdadee is one great example of how you can change your practice & outcomes as a @pc4quality center! 1/3
Significant reduction in #cardiacarrest by this #CollaborativeQI project lead to many lives saved! It's possible to #PreventCardiacArrest! Over 110 of our PC4 family participated in today's call to review the results, which were previously presented at #AHA19 @AHAMeetings!
2/3
Thanks to @TheCHF for their generous support of PC4 & @CardiacUnited for helping us collaborate to change the paradigm in #CHD research! 3/3
Read 3 tweets
🚨Junto a @Dr_Hari_Krishna hicimos selección 🇬🇧🇪🇸de mejores artículos 📑 2⃣0⃣1⃣9⃣ en #PedsICU para @PICJournalWatch

Comparte y comenta!
#Tweetorial acompañante

Lista PDF👉docs.google.com/viewer?a=v&pid…
Infográfico clickeable👉docs.google.com/viewer?a=v&pid…
Pubmed👉ncbi.nlm.nih.gov/sites/myncbi/h…
@Dr_Hari_Krishna @PICJournalWatch @Nopanaden @curso_vm @miguelrdgzrubio @LA_Rednetwork @WFPICCS @SapnaKmd @jramonfernandez @PedCritCareMed @ChrisCarrollMD @pccm_doc 3/ La colección es incompleta. Muchos buenos estudios han sido publicados durante 2019. Ayúdanos a completarla y comparte tus ideas!

Surely this colection is incomplete. Many good studies have been published during the past 2019. Feel free to share with us!

#PedsICU #BestOf2019
Read 30 tweets
Tweetorial of @AparnaHoskote ‘s fantastic talk on #ecmo pearls for #singleventricle #chd in the #PedsCICU #PedsICU at #jpccim2019. Single ventricle pts have 43% ecmo survival. Several tweets to follow with pearls for how to optimize! @PICS_Conference @PCICS2 @PICSociety
1/10
Pearl 1: Timing is important; go on #ecmo electively
#jpccim2019 2/10
Pearl 2: hypoxemia is a better indication with better prognosis than hypotension (I.e. shunt issues are better than cardiac dysfunction) #jpccim2019 3/10
Read 10 tweets
With the help of @PICJournalWatch @harrykchris we though we could put together a collaborative thread with useful #PedsICU resources like apps, websites, blogs and accounts. This thread is open so please don’t hesitate to add yours. Here are mine 👇🏻
Apps:
- I-Perfuse: great tool for anything cardiovascular including #ECMO cannula sizes, equations, a calculator... very useful for #PedsCICU
- Heartpedia: awesome 3D models of heart anatomy. Also great for teaching at the #PedsCICU. And it was created by the great @pccm_doc
Apps continued:
- The Sanford Guide: it costs 25€/year. I’d pay 250€ since I use it everyday in the #PedsICU. Basically everything you need to now about antibiotics and bugs #PedsID.
Read 14 tweets

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