Discover and read the best of Twitter Threads about #pedsCICU
Most recents (20)
Llegó colección #PedsICU #BestOf2022 de
@PICJournalWatch seleccionada junto a
@Dr_Hari_Krishna🇬🇧!
Pubmed:bit.ly/PedsICUbestof2…
Infográficos:
English: bit.ly/3i5JiS6
Español: bit.ly/3GAhXAC
#PedsCICU #NeuroPICU #SoMe4MV
Compartir, discutir, cual olvidamos?
@PICJournalWatch seleccionada junto a
@Dr_Hari_Krishna🇬🇧!
Pubmed:bit.ly/PedsICUbestof2…
Infográficos:
English: bit.ly/3i5JiS6
Español: bit.ly/3GAhXAC
#PedsCICU #NeuroPICU #SoMe4MV
Compartir, discutir, cual olvidamos?
Debajo tienen un QR para descargar infográfico y además en el correr de los días continúa un Tweetorial con algunos de los artículos seleccionados para su mejor acceso...
Versión en inglés @PICJournalWatch:
Versión en inglés @PICJournalWatch:
1/ El 2022 se publicaron las 1as guías de Liberación de VM pediátricas en el @ATSBlueEditor
pubmed.ncbi.nlm.nih.gov/36583619/
Aquí hice un resúmen:
Y además hicimos junto a @abusultaneh y @RobyKhemaniMD 2 Podcasts:
pubmed.ncbi.nlm.nih.gov/36583619/
Aquí hice un resúmen:
Y además hicimos junto a @abusultaneh y @RobyKhemaniMD 2 Podcasts:
Thread re: evidence appraisal/paucity of #PedsICU data based on recent @ESPNIC_Society guidelines on IV maintenance fluids
link.springer.com/content/pdf/10… @yourICM
Started by discussions in our monthly #PICUJournalWatch sessions @Bham_Childrens #PedsICU based on @PICJournalWatch
1/
link.springer.com/content/pdf/10… @yourICM
Started by discussions in our monthly #PICUJournalWatch sessions @Bham_Childrens #PedsICU based on @PICJournalWatch
1/
PICO3: The paper states [& I don't disagree]:
In "critically ill children", balanced solutions should be favoured when prescribing *intravenous maintenance* fluid therapy to slightly reduce length of stay:
B Strong consensus
& "in acutely ill children": A Strong consensus 2/
In "critically ill children", balanced solutions should be favoured when prescribing *intravenous maintenance* fluid therapy to slightly reduce length of stay:
B Strong consensus
& "in acutely ill children": A Strong consensus 2/
They add "balanced IV-MFT solutions, the length
of acute care or PICU stay were slightly but significantly decreased in children receiving balanced solutions in a meta-analysis of 5 studies, including 283 patients. mean difference: −0.20 days; 95% CI [−0.33; −0.08], p=0.001 3/
of acute care or PICU stay were slightly but significantly decreased in children receiving balanced solutions in a meta-analysis of 5 studies, including 283 patients. mean difference: −0.20 days; 95% CI [−0.33; −0.08], p=0.001 3/
Today is an exciting day for @pc4quality and @CardiacUnited
We are pleased to share results of our Cardiac Arrest Prevention (CAP) project in @JAMAPediatrics by @bubblesdadee (Jeffrey Alten) #PedsCICU #PedsICU #CHD #CardiacArrestPrevention
Link: jamanetwork.com/journals/jamap…
1/x
We are pleased to share results of our Cardiac Arrest Prevention (CAP) project in @JAMAPediatrics by @bubblesdadee (Jeffrey Alten) #PedsCICU #PedsICU #CHD #CardiacArrestPrevention
Link: jamanetwork.com/journals/jamap…
1/x
It all started with a conversation among the PC4 exec committee many moons ago: What do we want to change about #PedsCICU practice? We proposed cardiac arrest because we thought that preventing CA fundamentally defines excellent CICU care.
2/x
2/x
There was skepticism. Many smart people thought this wasn't possible. Many thought we should try something easier for our first major quality improvement project and get a sure win. Ultimately, we got buy-in to move forward with this CAP project.
3/x
3/x
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/🧵
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
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.
That’s it. If they don’t ask for it they don’t get it.
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
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.
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.
CICU: I start hearing about the patient 2 months before they’re born.
PICU: Rolling in off the street like Amazon packages.
𝙏𝙃𝙀 𝙈𝙐𝘾𝙃 𝙁𝙊𝙍𝙂𝙊𝙏𝙏𝙀𝙉 𝙍𝙑
1/5
Dif Approaches to Optimizing PEEP
PEEP and RV Function
Clifford Greyson @SCCM #CCC50
#PedsICU #PedsCICU #PedsCards
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
▫️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
RV afterload affected by
▫️PVR
▫️Pul vascular compliance
▫️LAP
all compromised with excessive PEEP
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
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
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.
#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
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…
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
@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
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
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
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
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
#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/
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
💥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
#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/
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…
Executive Summary: 2020 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations ahajournals.org/doi/10.1161/CI…
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 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
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
-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
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
This was a busy and difficult time for all!
#EPCCS20
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…
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...
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...
1/9 🅲🅰🆂🅴-🅱🅰🆂🅴🅳 🆃🆄🆃🅾🆁🅸🅰🅻 4
MECHANICAL CIRCULATORY SUPPORT
@ACCinTouch @agtruesdell @ErikOsborn77 @mirvatalasnag #ACCIC #PedsCICU #PedsCards
🔹Background
🔹#PedsICU #ECMO Case
🔹Adult ECMO + #Impella Case
🔹Upcoming Webinar
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
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
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
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
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
🚨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…
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 2/
English 🇬🇧🇺🇸version here!
👇
English 🇬🇧🇺🇸version here!
👇
@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
Surely this colection is incomplete. Many good studies have been published during the past 2019. Feel free to share with us!
#PedsICU #BestOf2019
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
1/10
Pearl 2: hypoxemia is a better indication with better prognosis than hypotension (I.e. shunt issues are better than cardiac dysfunction) #jpccim2019 3/10
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 👇🏻
