Discover and read the best of Twitter Threads about #PedsICU

Most recents (24)

#POCUS y #SoMe4MV en #PedsICU
🔊en Ventilación Mecánica 🫁

Abro hilo, iniciamos, y abiertos los comentarios:
Esta información tuvimos el gusto de compartirla en el IV Curso Internacional de Medicina Intensiva Pediátrica dentro del XVI Congreso Internacional de Medicina Intensiva organizado por la @sopemi_org.
Gracias por la invitación. Ahora si, entremos en materia.
Los objetivos planteados en tres puntos:
Relacionar el Ultrasonido Pulmonar (LUS) y la Ventilación Mecánica (VM).
Conocer guías y monitoreo que nos ofrece el POCUS en VM y mencionar elementos evaluables por LUS.
Read 56 tweets
❗ 09-SEPT-2021 UPDATE ❗

Our new trend chart shows cumulative #COVID19 mortality rates for kids 0-17 years.

The sharp ⬆️ in August was driven by 30 non-white deaths
(vs. 10 white deaths).

Death rate 2.5x ⬆️ in non-whites.

#epitwitter #PedsICU
❗ 09-SEPT-2021 UPDATE ❗
Lowest #COVID19 death rate is in 2-year olds, with infants 17x more likely to die. Death rate in 19 year olds similar to infants.

#epitwitter #PedsICU
❗ 09-SEPT-2021 UPDATE ❗

Time trends for age groups confirm lowest #COVID10 death rates in kids 1-11 years old, highest in infants and older teens.

#epitwitter #PedsICU
Read 6 tweets

Please be advised that the @CDCgov covid tracker trend data on #COVID19 by age in Texas are WRONG. CDC draws case data from their case line data file, and TX has reported age on only 3% of total cases.

CDC graphic is inadequately footnoted and does not disclose the very low case count behind their trend chart.

Their chart displays no new cases in TX in past 4 months!

@CDCgov should remove this highly inaccurate graphic from their website.

COVKID Project estimates child/teen cases in TX every week using total cases from TX dashboard, and % child/teen from Harris County. Thank you @hcphtx for doing the job your state health dept has neglected! 🙏🏽
Read 9 tweets
❗ 23-AUG-2021 UPDATE ❗

Latest data updates on #COVID19 vaccinations, cases, hospitalizations, deaths, and disparities are posted on our dashboards.

#epitwitter #PedsICU @Cleavon_MD @DrEricDing @RheaBoydMD
❗ 23-AUG-2021 UPDATE ❗

Average daily incidence of #COVID19 in children/teens ⬆️ to 40.4/100,000 this week. Cumulative cases = 5.6 million. Image
❗ 23-AUG-2021 UPDATE ❗

Highest current #COVID19 incidence persists in the US South, Southwest, and Pacific Northwest - also Indiana/Illinois. Image
Read 15 tweets

#COVID19 incidence (new case) data are now updated through 13-Aug-2021.

Average daily incidence rate (DIR) ⬆️ to 33.4/100,000

Total cumulative cases > 5.4 million

(we include >500K TX cases that CDC and AAP don't count)

The map on the left shows *cumulative* incidence of #COVID19 in kids since the pandemic began.

The map on the right shows *current* DIR.
#epitwitter #PedsICU @Cleavon_MD @Arrianna_Planey @GYamey @drkomanduri

Incidence of #COVID19 in kids⬆️in every single state in the past week. (See next tweet for more on AL)

>50% ⬆️in 15 states across all regions.
@gradydoctor @WesElyMD @Adamhill1212 @ashishkjha @BhadeliaMD
Read 8 tweets
❗️❗️13-AUG-2021 UPDATE❗️❗️

#COVID19 hosp data for kids have been updated.

For children and 18-19 year olds, hosp admit rates are at highest point since Sept 2020 (no good data prior to that date.)

Confirmed cases only - suspected not included here.… Image
❗️❗️13-AUG-2021 UPDATE❗️❗️

Same for current pediatric hosp census - highest ever!
>1200 kids with #COVID19 in hosp TODAY.

@Cleavon_MD @WesElyMD @SapnaKmd @DrZoeHyde @dgurdasani1 @EricTopol @DrEricDing @Arrianna_Planey #epitwitter #PedsICU… Image
❗️❗️13-AUG-2021 UPDATE❗️❗️

In the past week, #Alabama kids had the highest rate of new hosp admits for severe #COVID19

Latest trends for every state:…

#tweetiatrician #PedsICU @hospitals4kids
@GYamey @DrTomori @yoncabulutmd @DrEricDing Image
Read 8 tweets
❗️12-AUG-2021 UPDATE❗️ 1/7

Latest data from NCHS reveal disturbing racial/ethnic disparities in #COVID19 mortality among kids and young adults.

We've tried to be more phone-friendly, but still best viewed on a larger screen. Expanded dashboard:
❗️12-AUG-2021 UPDATE❗️ 2/7

Of 353 reported deaths, 28% were white, & 72% were non-white, mostly Hispanic & Black children.

Caveat: NCHS death counts are << CDC-Atlanta counts due to different data sources & reporting lags. #epitwitter
More info: Image
❗️12-AUG-2021 UPDATE❗️ 3/7

#COVID19 death rate disparities for kids 0-17 are very high. Rate ratios (95% CI) with whites as the referent:

Indigenous RR = 6.2 (2.5-15.7)
Black RR = 3.0 (2.2-4.0)
Hispanic RR = 2.6 (2.0-3.3)
Asian RR = 1.5 (0.9-2.6) Image
Read 7 tweets
#POCUS con USPed Latinoamérica🌎

En #SabadosdePOCUS Roberth González Cardiólogo Pediatra de 🇵🇪 nos habló de #Ecocardiografía en el Paciente #Critico en #Pediatria.

¿Quieres saber un poco de qué trato?

Abrimos 🧵 👩‍⚕️👨‍⚕️
Comentarios iniciales #PedsICU:

No vemos internamente la interacción cardiopulmonar. El #POCUS ha cambiado eso.
Dicha interacción regularmente había sido estudiada por separado.
La integración ❤️-🫁Pulmón debe ser siempre en contexto.

Algo que le sirvió mucho al Dr. Roberth: la #Fisiología, su funcionamiento.

Ojo, este dato se ha mencionado mucho en nuestras sesiones. El #POCUS en verdad te ayuda a mejorar tus conocimientos básicos, cuando ves lo que tanto estudiaste.
Read 21 tweets
The COVKID team has a new research study out today in @AMJPublicHealth, as part of a special issue called "When Dying Really Counts:"

Out-of-Hospital COVID-19 Deaths: Consequences for Quality of Medical Care and Accuracy of Cause of Death Coding

We found that 🇺🇸children (younger than 18 years) were most likely (30.5%) and elders aged 64 to 74 years were least likely (10.4%) to die out of hospital or in the emergency department from #COVID19.

Why does dying from #COVID19 in the ED matter? Isn't that technically "in the hospital?"

No, it's not. Patients who die in the ED were critically ill before they arrived. They accessed medical care too late!

Some thoughts on possible reasons at the end of this thread.

Read 16 tweets
♦️ 26-July-21 Update ♦️ 1/10

#COVID19 in 🇺🇸 kids has surpassed 5 million cases.

Long thread explaining why our case counts are higher (& more accurate!) than counts reported by @AmerAcadPeds

Also: latest rising trends in incidence & hospitalizations Image
♦️ 26-July-21 Update ♦️ 2/10

The @AmerAcadPeds puts out a weekly #COVID19 report on kids that draws on the exact same state health department dashboards as we do.

BUT - we include estimates of missing data from TX and NY, and AAP does not.

♦️ 26-July-21 Update ♦️ 3/10

Both TX & NY (state) do NOT report cumulative case counts of #COVID19 for kids on their dashboards!

That's 2 of the 4 largest states w/ MISSING DATA.

NYC does report (thanks @nycHealthy !) but they cover only 1/2 the state's pop.

Read 10 tweets
Ecocardiografía desde Ventana Subxifoidea🫀

En nuestros #SabadosdePOCUS tuvimos de invitado a @areinamo21 🇻🇪 radicando en 🇺🇲, Cardiólogo Pediatra con estudios en Cuidados Cardiovasculares.

¿Quieres saber algo de lo que aprendimos en #POCUS esta sesión?
Abrimos 🧵... #PedsICU Image
Importante conocer la ventana, dónde se realiza, cómo agarrar la sonda, en qué situaciones nos es bastante útil y saber sus #Pros y #Contras.

Queremos verte crecer juntos, recuérdalo. Image
No sólo en #PedsICU se realiza. También #Neonatologia se beneficia de su visualización.
La Ventana Subxifoidea se consideraba la "Ventana del Intensivista o Urgenciólogo".
Su 📜 papel principal: evaluación rápida hemodinámica. Image
Read 8 tweets
👉 Lessons I learned on & about #MedTwitter

A 🧵 about my journey exploring what’s beyond being #professional as a 🩺 #SoMe user

#TLDR: Aim for fulfilled & happy & kind ➕ a healthier 🪢 with technology 📱💻
🤔 why I made this 🧵?

I was asked to give a talk: 'How to be professional on social media' at #ESPNIC2021 for #YoungESPNIC and other participants of the congress

❗️But I felt we could be aiming for so much more than #Professional

So here we are👇
Experts talk about #SoMe as a non-binary thing: it isn’t like you use it or not, because it’s already everywhere. Others say it is actually harder to ignore it.

👥 If you come aboard, do it mindfully
⛔️ Staying out intentionally is an option
⚠️ Avoid the half-in/half-out state
Read 24 tweets
Lately, I’ve been reflecting a lot of how much racism has affected our understanding of the pathophysiology of asthma in children. And how the pandemic has exposed just how wrong so many of the underlying assumptions were. A thread 🧵 1/11
Some background. Asthma is the most common chronic disease in children, affecting 1 in 7 children at some point during childhood. Each year approximately 10,000 children/year are admitted to a #PedsICU with severe asthma. 2/11
Severe asthma exacerbations disproportionately affect BIPOC children, with higher rates of hospitalization, ICU admission and intubation. 3/11
Read 11 tweets
@KBrookeGolisch Ha, ok!

In spring of 2014, I was an aspiring pediatric surgeon (and a categorical surgical intern) wondering whether surgery was for me. I liked taking care of sick surgical patients, but didn’t love the rest - the culture.
@KBrookeGolisch Prior to being an intern, I wasn’t sure how much this stuff mattered. I thought I could handle most things, which wasn’t untrue.

But I fantasized about leaving. I even wrote myself a letter through @futureme that winter, timed for my graduation from surgical residency…

@KBrookeGolisch @futureme I discussed considering leaving with my family. My dad (also a physician) said two things that helped me make my decision:
1) if you don’t love it now, you’re not going to love it in 40 years
AND (when I protested that - well, I was kind of good at being a surgical resident)…
Read 17 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
“Yesterday I was clever so I wanted to change the world.
Today I am wise so I’m changing myself.” - Rumi

beautiful individually can be amazing together

“we need to become more conscious of our unconscious biases” a mentor once said

at the time I thought that’s surely an oxymoron!
but on reflection, that’s 🎯
Who’s in the room?
Who has access?
How we do things around here?

Patrick Voss
Read 3 tweets
I am sharing some points I raised on the kickoff event of @ESPNIC_Society's #mentorship programme.

(a practical🧵, not only for #YoungESPNIC or #PedsICU folks)
💪🦾 Having a mentor is a real opportunity, but the success of this relationship highly depends on the effort you put in as a mentee. 💪🏾💪🏻
Before the first meeting, take ⏳ & 🤔:
❓ Why did you join the program?
❓ Where are you professionally?
❓ Are you looking for general mentoring right now or rather need help in a specific domain?
❓ Do you respond best to gentle guidance or prefer something more structured?
Read 20 tweets
In the 1st multi-centre study from England, we identified factors that increase the likelihood of children needing #CPR in #PedsICU. Children from Black & Asian ethnic backgrounds were more likely to require CPR
@Picstato @rgfeltbower @RameshK49951542 @BarneyUoB
Cardiopulmonary arrests are a major contributor to mortality and morbidity in #PedsICU. Understanding the epidemiology and risk factors for #CPR may inform quality improvement #QI initiatives.…
We aimed to identify incidence and factors associated with variability of incidence of #CPR in #PedsICU by performing a retrospective cohort analysis on data from #PICANet with @PICSTato @rgfeltbower @RameshK49951542 @BarneyUoB
Read 11 tweets
One podcast, two #rehablegend, season 3 episode 1 @PedsIntensiva

Early Mobilization feat. @SapnaKmd & Guest Editor @karen_choong

+ @drpetaalexander, @drgregkelly, Kate Thompson & Mike Clifford @rch…

#ICUrehab #pedsICU @PICU_Up @mch_childrens
@SapnaKmd @karen_choong @drpetaalexander @drgregkelly @rch @PICU_Up @mch_childrens Can we stop children dying without giving them new problems?

Alongside gains in #pedsICU survival is parallel ⤴ in kids who leave w functional limitation– may affect life forever

Some related to illness but some related to what we do– or don’t do

#ICUrehab #rehablegend Image
@SapnaKmd @karen_choong @drpetaalexander @drgregkelly @rch @PICU_Up @mch_childrens #pedsICU has 2 distinct pops:

1.Kids who come in, get better & go. Teams, thoughts, training structured for these minority of bed days
2.Kids who stay > 1 wk – majority of bed days but systems ignore

#ICUrehab #rehablegend, pic @mch_childrens w parent consent Image
Read 48 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
#PedsICU conversations
Just out our paper in @PedCritCareMed led by the fabulous @AnnaZanin_MD 🇮🇹 on the Live Tweeting the Discovery of #COVID19 related Syndrome in Children (#PIMS #MISC)

Nuestro artículo sobre descubrimiento Sínd niños y @Twitter…
Doctors have discussed clinical cases since its inception, COnversations among peers and sharing is key for medicine knowledge advancements

Los médicos siempre conversaron entre ellos y así la medicina avanza

(Rembrandt) #historicmedtwitter… Image
These conversations abled naming of diseases, etc. Unfortunately, many of those inventions/discoveries remained in silos, and massive global dissemination was impossible in real time. Moreover, tracking the origins and giving merits was difficult.
Read 19 tweets
#PICANet annual report 2017-19 was released today.
Key takeaway messages from the annual report are available in the report summary.

1. UK/RoI #PedsICU have around 20k admissions/year and ~140k bed-days/year
2. 96.5% of all admissions survived
3. Deaths in #PedsICU accounted for ~1/6 of all child deaths
4. all UK/RoI PICUs were contained within the "funnel" of the risk-adjusted SMR funnel-plot (i.e., no outliers)
5. Unplanned extubation rates were around 0.5/100 vent days
6. 48h unplanned readmission rates ~1.7%
7. Of the >4000 #PedsICU transfers, >75% were mobilised <60min of the referral.
8. Occupancy rates remained high
9. Nurse-establishment vacancies meant that only 25% of PICUs met recommended standards of whole-time equivalent nurses.
Read 6 tweets
Dr. Cook begins her #CCC50 Lifetime Achievement Award talk with reflection on her own 1st presentation ever as an #ICU fellow- at an @SCCM Congress! She was struck by the interprofessional group of attendees.(Thread)

#NationalWomenPhysiciansDay #WomenInMedicine #clinicalresearch
Her first lesson learned to impart to us.


An early senior researcher said to her early in career:
"I just don't think research is in your future"

Imagine what #CriticalCare world would have lost if she had listened.

#CCC50 #pulmcc #PedsICU
Dr. Cook: Sometimes dialogue is more important than consensus. You have the TRUST YOUR GUT. #CCC50

You're not growing until you're changing. Defining moments for bravery may come along when you least expect them. Be brave. #WomensPhysicianDay #PedsICU #pulmcc #ICU
Read 14 tweets

Dif Approaches to Optimizing PEEP

PEEP and RV Function
Clifford Greyson @SCCM #CCC50

#PedsICU #PedsCICU #PedsCards

▫️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

RV afterload affected by
▫️Pul vascular compliance

all compromised with excessive PEEP
Read 5 tweets

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