Discover and read the best of Twitter Threads about #PedsICU

Most recents (24)

At this stage of the #covid19 pandemic, I have no doubt 🇧🇷#ICU researchers are the best collaborative researchers of the World

Thoughts/thread
👇🏻
2/x
Imagine researching in a middle income country where your president denies what you are researching about.

People aligned to @jairbolsonaro even threatened 🇧🇷Scientists for contradicting with science, the presidencial "health" views
👇🏻

trialsitenews.com/brazilian-rese…
3/x
Brazil is one of the most precious and beautiful regions of the World. It has everything any human being would need to live well, in peace
But also hurts because it is one of the most unequal countries.

Check this for example:

Read 6 tweets
Happy birthday @SCCMPresident! Look forward to hearing your very timely plenary address @SCCMMW

#SCCMSoMe #SCCMMWC20 #pulmcc #PedsICU #COVID19
Nice #COVID19 timeline schematic from @SCCMPresident @sccmmw #SCCMSoMe
Read 14 tweets
To all who responded to our question from 8/20 a big thanks. Here is the answer and a short thread:
First the question: 15-year old with dyspnea, tachycardia, and hypotension. COVID-19 stuff is negative. Whats abnormal in the CVP tracing? Next step in definitive management is?
1) #pedsicu fellows etc. knowledge of what any normal waveform looks like is essential to tackle the abnormal. Don't worry y'all will learn more of this as you go through your fellowship training. Lots of awesome resources out there:- @OPENPediatrics learnpicu.com
2) @pccm_doc has amazing videos in @NEJM. The cincinnatichildrens.org/patients/child… app is a great resource also. I recently found grepmed.com -has phenomenal infographics
Read 20 tweets
🗣️Session 2: WFPICCS Webinars "Taking Stock of Pediatric Intensive Care Research During a Global Public Health Emergency"

Thread 1!

👉We started today with @srinmurthy99 🇨🇦 and no pain, no gain regarding global collaboration!

#PedsICU #WFPICCS20 #COVID19
We know PICU disorders are rare, and with #COVID19 even more...so no time to avoid collaborations

How to do it? Here some tips

@srinmurthy99 🇨🇦

#PedsICU #WFPICCS20 #COVID19
Citing the amazing work from @M_Duffett is a must when looking at global PICU trials!

@srinmurthy99 🇨🇦
#PedsICU #WFPICCS20 #COVID19

Many papers in @PedCritCareMed to dig in!
journals.lww.com/pccmjournal/Ab…

journals.lww.com/pccmjournal/Ab…

journals.lww.com/pccmjournal/Ab…
Read 6 tweets
Cool study in @CDCMMWR about #MISC #PIMSTS in the US

cdc.gov/mmwr/volumes/6…

Taking 570 reported cases (med age 8y, 40% hispanic/latino, 33% black) they performed statistical analysis to break cases down into 3 categories

1/7
Using a method called latent class analysis (a supervised technique maximising differences between classes and minimising differences within classes) they created 3 gruops - the breakdown is interesting so lets take a look!

2/7
Group 1: "Classic" MISC/PIMSTS which is features of muti-organ involvement and shock with only 1/3 patients testing positive on rtPCR

Group 2: High respiratory involvement and vast majority testing positive for SARS-CoV-2 rt PCR

3/7
Read 8 tweets
💔MILESTONE REACHED💔
1/11

Intensive care admissions for kids with #COVID19 have surpassed 1,000 in the USA (n=1,011).

This is an UNDERCOUNT; not all PICUs report their data.

67% of these kids are Hispanic or Black.

#PedsICU @vps_llc #epitwitter

covkidproject.org
💔MILESTONE REACHED💔
2/11

When our team published a research paper on critical illness in children with #COVID19 in April 2020, there had been 74 kids admitted to PICU in the USA.

That seemed like a lot to us back then.

#PedsICU #epitwitter #coronavirus @vps_llc @JPHMPDirect
💔MILESTONE REACHED💔
3/11

Here are time trends in #COVID19 PICU admissions for the 3 largest states. Keep in mind these are UNDERCOUNTS. #Florida #Texas #California

#PedsICU #epitwitter @vps_llc @hospitals4kids @JPHMPDirect @HealthyFla @TexasDSHS @CAPublicHealth @NACCHOalerts
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
In this thread, I'm live-tweeting @sgdambrauskas awesome talk for @AKUGlobal series on #COVID19 in #PedsICU

Critically important topic #Zentensivist #ICURehab #BacktoBasics #DoNoHarm
Defining iatrogenic via @sgdambrauskas #PedsICU
Critical Illness is an iatrogenic disorder- @sgdambrauskas highlights an important perspective by John Marshall in @CritCareMed #PedsICU
Read 16 tweets
A #Tweetorial on Blood Gas Analysis (adapted from my WKRP in Cincinnati style method of teaching blood gases).
Blood gas interpretation is something that is initially very confusing, is usually poorly taught, comes up hourly in the #pedsICU and #ICU and will be on every exam for the rest of your life.
But it doesn't have to be that complicated and this method will get you through 99.99% of blood gas interpretation and serves as a good foundation to learn those exceptions. (So don't @ me!)
Read 27 tweets
New Research—First Europe-wide study of 582 children & adolescents confirms #COVID19 predominately causes mild disease and fatalities are very rare (4 deaths, <1%).

thelancet.com/journals/lanch…
This #ptbnet study primarily captured data from children & adolescents who were seen or managed within the hospital setting, and so the study population is likely to primarily represent individuals at the more severe end of the disease spectrum of #COVID19
In this cohort of n=582, 48 (8%) required #pedsICU admission, 25 (4%) mechanical ventilation (median duration 7 days, IQR 2–11), 19 (3%) inotropic support, and one (<1%) #ECMO.
Read 4 tweets
Does the time taken by the transport team to reach the bedside of a critically ill child impact on their outcome? A thread of key findings from our newly published @DEPICT_Study research investigating the transports of >9,000 children #PedsICU [1/7]
If a child is critically ill & in a hospital without a paediatric intensive care unit, a transport team is sent to collect them. Teams aim to arrive with the child within three hours, a standard set by @PICSociety & decided by expert consensus [2/7]
But, is the three hour target appropriate? Well, currently ~87% of the time the target is met, so we can’t say much about those children who have to wait longer. But there seems to be no evidence that arriving faster is better for the child in terms of survival [3/7]
Read 7 tweets
1/A short recollection about compassion and moral distress in a #pedsicu that turned into an adult ICU for #COVID19 patients. This is my personal experience and there are no patient identifiers.
Thread.
2/I’m asked, almost daily now, how it felt to look after Adult ICU patients in full PPE when you I’ve been looking after children for the last 15-ish years. Intensive care is a funny old beast. We are accustomed to death and the possibility of death on a daily basis.
3/We look him in the eye, we play chess with him and in #pedsicu roughly 9 times out of 10 we win (based on last PICANET data here cutt.ly/0yMvV3t).

That is our comfort zone.
Read 38 tweets
A short thread on using #online #education following my own experience in moving to this for #PedsICU teams @UHSFT @SotonChildHosp & our #medical #students @UoS_Medicine @unisouthampton

Hope this helps.... #MedEd
TIP 1:
Be kind to yourself

This is knew. It feels different. Recognise this will take time for you to adapt. Learners realise this and have been delighted people have taken the effort to teach and be innovative
TIP 2:
Learn your platform

Practice with the resource you are using before the session. Discover:
- chat room
- interactive whiteboard
- screen share
- raise hand/question function
- break out small group function
- mute & camera functions
Read 12 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
1/Which fluid is more appropriate in patients with hyperkalaemia 0.9% saline or Hartmann’s?
A #pedsicu thread:
How much K+ does Hartmann’s solution and 0.9% Saline solution contain respectively ?
2/ Hartmann’s solution has 4mmo/L of K+
0.9% saline has no K+ content.
So with that in mind, which one do you think is safer to use in a patient with hyperkalaemia (lets assume that's someone with a K+ more ore equal to 5.5mmol/L)
3/
There is a very common misconception that Hartmann’s solution(aka) Ringer’s lactate is contraindicated in patients with hyperkalaemia. We are challenged on this almost weekly when we get pedicu referrals @NWTStransport
Read 26 tweets
Short thread on vent mode preference differences between #PedsICU and adult ICU land because I’ve seen some references to each that aren’t exactly right. Namely SIMV vs Assist Control. #covid19
First misunderstanding: SIMV can’t trigger the vent without PS. That was true with IMV. Set rate, every 60/R seconds a breath was delivered. The S part, for synchronized, introduced a window where patient can trigger, if no trigger, then breath is delivered #COVID19 #PedsICU
It’s not the same as assist control, where every trigger delivers a breath, but it approximates it. #PedsICU #covid19
Read 8 tweets
Thanks to @cdc we’re now calling it MIS-C. #MISC (can’t have hyphens in hashtags).
MIS-C Tweetorial: Here’s recent alert from CDC regarding this multisystem inflammatory syndrome in children (MIS-C, or #PIMSTS on #medtwitter). emergency.cdc.gov/han/2020/han00…. This Kawasaki-like syndrome was noted about 4 weeks after #COVID peak in Italy #PedsICU
CDC named it MIS-C, diagnosed by:
✅T>38 for 24hrs
✅⬆️CRP, ESR, ferritin, procal, or IL-6, etc
✅>=2 organ system dysfxn
✅no other infxn/reason for sxs
✅recent #COVID19 or just exposure (many are PCR-, variable serology)
Read 14 tweets
The "mysterious pediatric coronavirus illness" resembling Kawasaki Disease (KD) and toxic shock syndrome (TSS) has been in the news recently. From a current pediatrics resident and soon-to-be #PedsICU fellow, let's talk a little bit about it. (Thread).

nytimes.com/2020/05/09/hea…
First, what's KD? It's an inflammatory disease that can cause problems with the coronary arteries, which supply the heart muscle. Its cause is unknown, but a viral trigger is one idea. It's also more common than you'd think - every pediatrician has seen it more than once.
Second, what's TSS? It's the effect of an infection (classically staph on the skin) producing a toxin that can make patients really sick and sometimes need an ICU to help keep their blood pressure up. Again, somewhat rare but more common than you'd think.
Read 13 tweets
Ok a few things have been moving in the world of paediatric #COVIDー19 literature

Time for an updated #tweetorial on SARS-CoV-2 infection in children!

#FOAMped #FOAMed #PedsICU #PedsID #IDtwitter

1/12
So there are fewer cases in children. How much fewer?

Children consistently make up <2% of confirmed COVID-19 cases. These are usually ascertained by testing sick people in hospital

US: dx.doi.org/10.15585/mmwr.…
Italy: jamanetwork.com/journals/jama/…
Madrid: jamanetwork.com/journals/jamap…

2/12
COVID-19 is less severe in children, but often is it severe?

From a Chinese cohort 0.6% needed PICU but lots of community testing involved
pediatrics.aappublications.org/content/early/…

US CDC data has 2% of admissions in PICU (limited data)
dx.doi.org/10.15585/mmwr.…

3/12
Read 12 tweets
A #PedsICU story about bronchiolitis that may be helpful to my adult colleagues who are struggling with who and when to intubate for #COVID19.
A caveat to this. I know that COVID isn’t bronchiolitis, but there are lessons from this story that might be helpful.
Bronchiolitis is ubiquitous in the winter and is one of the most common causes of admission to a #PedsICU. Most infections are minor and just seem like a “cold”, especially in adults, older children, and toddlers.
Read 13 tweets
OK, time for a tweet summary of what we know from the paediatric literature about #COVID19 in kids SO FAR

Given the disease has only existed for 3 months, it's quite a lot...

#FOAMPed #PedsICU #IDTwitter

1/7
Kids get MUCH less severe disease than adults. Mortality AND critical illness v. low (close to 0%), confirmed from both China and Italian data

pediatrics.aappublications.org/content/pediat…

jamanetwork.com/journals/jama/…
2/7
Kids PROBABLY acquire the disease less often than adults. Low rates seen in symptomatic cohorts, and in S Korea which had higher rates of population screening.

statista.com/statistics/110…

Japanese contact tracing found lower attack rates in children

medrxiv.org/content/10.110…

3/7
Read 8 tweets
1/39 2nd podcast & tweetorial for Pediatrica Intensiva, the art & science of pediatric intensive care. Here, an update on the realities of battling a tsunami of #COVID19 with intensivists Giovanna Colombo & Lorenzo Grazioli from Bergamo, Italy

#ICU #pedsICU
Here's the link to the recording

podcasts.apple.com/au/podcast/ped…
2/39 But first, a story about 2 real life heroes in the midst of #COVID19. #ICU & #pedsICU docs Giovanna Colombo & Lorenzo Grazioli are working in the epicentre of the outbreak. They’ve seen countless deaths & know that to save many they can’t save all
Read 22 tweets
I spent the afternoon with many @HopkinsMedicine colleagues making #ppe for the staff. I am sharing (with permission) the steps and materials for making faceshields of your own. We are all in this together. ❤️💪🏼 #PPEshortage #ppeisnotoptional #PedsICU #covid19 #ICU #healthcare
@AOC @BarackObama @HillaryClinton @SenSchumer @SenateDems @JoeBiden @3M we need your help! The #PPEshortage is real and many of us are helping make #ppe to keep our colleagues in #healthcare safe. #GetMePPE #ppeisnotoptional #WeNeedPPE
Read 3 tweets
All "Mechanical ventilation for dummies" videos in one thread so we can have a bit of discussion around each topic. All questions encouraged, will try to answer to the best of my knowledge! @lberto_Medina #SoMe4MV #PedsICU
I will dedicate each video to a friend and ask them to help me with the discussion (no pressure). We are learning together, and we are a team!
1. Lung simulator. Here we learn how to build a low cost simulation device to help with our teaching. And who will be better to discuss simulation than my colleague @davidgrantsim!
Read 9 tweets

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