Discover and read the best of Twitter Threads about #pedsicu

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Ventilación Mecánica en Reanimación Cardiopulmonar en Pediatría

¿Podemos ocupar el ventilador en paro?

#PedsICU & #SoMe4MV
No es algo nuevo. En 2017 se realiza una encuensta en profesionales de la salud (prehospitalario). La mayoría, médicos. Podras ver el % de dispositivo utilizado por los encuestados.
Existe amplia variabilidad, aún, en cuanto a frecuencia respiratoria, objetivo de PaO2 y PaCO2. Image
Si mi paciente #Pediátrico cae en paro ¿podría ocupar el VM durante la reanimación?

Las guías, aún dejan al clínico el tiempo adecuado para considerar la intubación. Primordial mantener la Oxigenación y ventilar a razón de 20-30 veces por minuto. Image
Read 18 tweets
Hoy se cumplen seis años del fallecimiento de mi hijo menor, Mateo.
Mateo murió a las doce horas de haber ingresado a un CTI pediátrico #ucip #PedsICU.
Hace seis años se me desdibujaba rápidamente la imagen prejuiciosa de que los médicos que atendían en este tipo de unidades, creían ser dioses que todo lo saben y todo lo pueden (era la única explicación lógica que encontraba a que alguien pudiera elegir esa especialidad médica).
Hace seis años me encontré con un equipo de personas con calidad y calidez humana, que hicieron lo imposible por Mateo, con mucho respeto, compasión, pero sobre todo, con mucho amor.
Read 10 tweets
“Ten tips to optimize #vasopressors use in the critically ill patient with #hypotension.” #IntensiveCare #MedTwitter #CardioTwitter #sepsis #FOAMed #FOAMcc #CriticalCare #EmergencyMedicine #PedsICU #ICU #EMCCM
📚 Intensive Care Med (2022) 48:736–739
1. Set goals of mean or diastolic blood pressures.
2. Individualize the arterial pressure targets goals.
3. Vasopressors induce an endogenous fluid recruitment and may limit positive fluid balance.
4. Reassess fluid status and cardiac output after initiation of vasopressors
5. Consider agents with a different mechanism of action as a second line agent.
6. Consider adding hydrocortisone in patients on high doses of vasopressors.
7. Vasopressin is an option in patients with right ventricular failure.
8. There is no maximal dose of vasopressors.
Read 4 tweets
@NileshMehtaMD up next to discuss what’s new in #ICUNutrition guidelines and how he has interpreted them. #SCCM2023
Mehta: Reminder of the hierarchy of evidence. #SCCM2023 #ICUNutrition
Mehta: guidelines must have clinical context. #SCCM2023 #ICUNutrition
Read 16 tweets
@VirusesMDPI #PedsICU fragile children, immunosuppressed patients, transplant recipients,or with onco-hematological, pulmonary, or cardiac comorbidities, might benefit from early treatment as soon as +ve #COVID test or asymptomatic…
Read 4 tweets
As part of the @ILCOR_org Pediatric life support taskforce we reviewed evidence for accuracy of tests for predicting GOOD neurological outcome following #Cardiacarrest in children
🧵of key DRAFT recommendations.

#Pedsicu #NeuroPICU
#Prediction of good neurological outcome is a key role for #PedsICU clinicians in #postarrestcare phase of #chainofsurvival.
Improving prognostic #uncertainty may help clinicians choose treatments, counsel families, and answer accurately, "Will my child be OK?“
The #PLS taskforce conducted a #systematicreview of literature reporting prognostic tests used in children after cardiac arrest.
Four types of tests were evaluated:
*Clinical examination
*Blood biomarkers
*Brain Imaging
#PedsICU #NeuroPICU #CPR
Read 17 tweets
Llegó colección #PedsICU #BestOf2022 de
@PICJournalWatch seleccionada junto a
#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:
1/ El 2022 se publicaron las 1as guías de Liberación de VM pediátricas en el @ATSBlueEditor
Aquí hice un resúmen:
Y además hicimos junto a @abusultaneh y @RobyKhemaniMD 2 Podcasts:

Read 25 tweets
👉🏻Today let's enjoy the remarkable Q&A with #ESPNIC Young Investigator Award winner @cr_vishwa 💥🤓 #PedsICU
Q: Congratulations on your award! 👏🏻🙌🏻 Can you tell us a little about yourself?
A: I'm a Paediatric Intensivist from India. (...)
(...) Currently, I am working as a Senior Specialist in a PICU at the Aster Hospital, Bangalore. It was really an honour to present our study at #EAPS2022. All credits to the PICU team of PGIMER, Chandigarh. I am deeply humbled that we got this prestigious award.
Q: You won the first prize for ESPNIC young investigator, can you tell us a little about the work that won this award? #YoungESPNIC
Read 7 tweets
Q&A🧵with ESPNIC @Medtronic Research Grant winner @DrMartiPons 🚀
Good luck to their group with this promising project!
Here is the full interview👇 ImageImageImage
Q: Congratulations on your award! Can you tell us a little about yourself?
A: I'm a senior paediatric intensivist at @SJDbarcelona_es. Research-wise I have a strong interest in respiratory physiology & mechanical ventilation, including NIV & LTV. I am also a former chair of the @ESPNIC_Society Respiratory Failure section.
Read 9 tweets
“Doctors are calling on the Biden administration to declare an emergency in response to an “alarming surge” of children hospitalized with respiratory syncytial virus and flu this season.”…

This is a crisis #pedsTwitter #RSV #Flu #Covid_19 #GetVaccinated
Read 5 tweets
Thread re: evidence appraisal/paucity of #PedsICU data based on recent @ESPNIC_Society guidelines on IV maintenance fluids… @yourICM

Started by discussions in our monthly #PICUJournalWatch sessions @Bham_Childrens #PedsICU based on @PICJournalWatch
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/ Image
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/ Image
Read 16 tweets
I was charge nurse in our PICU yesterday and I’m still recovering.

I’m trying to remember that all the hustle and good we can do counts, for every patient we can care for.

But I’m still trying to shake the overwhelming distress connected to the role of #pedsICU charge rn. /1
Tight bed space, even tighter nurse and respiratory therapist staffing.

If a patient needs ICU care and we can’t take them, it’s distressing to deny admission.

If I can do the pressured coordination to transfer one out and hustle one in, I know my staff are exhausted. /2
But we have to do it and I have to push it, no matter how fried I know any individual might be. I want to support them, give them breathing room, but I…have so little to offer.

I bring chips in case people need comfort food to quickly refuel. I brew coffee, make it strong.

Read 6 tweets
28-AUG-2022 UPDATE

Incidence of #COVID19 in 🇺🇸 kids increased 10% during the week ending 26-AUG-2022. More than 17,000 new cases every day; ADIR = 21.8/100,000.

#epitwitter #PedsICU #LongCovidKids Image
28-AUG-2022 UPDATE

The highest #COVID19 new daily incidence rates for kids are concentrated in the #Southeast. Image
28-AUG-2022 UPDATE

States with adverse trends ( ⬆️ incidence) of #COVID19 in kids for the week ending 26-AUG-22 are red/orange on the map. Image
Read 23 tweets

In this 🧵, we update #COVID19 incidence, hospitalizations, deaths, and disparities for 🇺🇸 children and adolescents.

Please share this 🧵 #epitwitter #PedsICU #tweetiatrician #SARSCoV2 #Omicron #LongCovidKids
2/25 Image
3/25 Image
Read 25 tweets
The big impact of a disease in little kids. Characteristics & Outcomes of Multisystem Inflammatory Syndrome in the #PedsICU. Great work @kindly_kel @picudoc13 @DrKenRemy1 @RBC_PICU @MKleinBiostats @JanineZeeCheng @ColinRogerson5 @AlexRotta @caseymccluskey…
#MIS_C is a clinical syndrome of systemic inflammation that occurs 4–6 weeks after exposure to #SARSCoV2 affecting the heart, lungs, kidneys, brain, skin, and GI system. Review by @MontyMazer @yoncabulutmd @nina_brodsky @drsturge @RBC_PICU @DrKenRemy1…
In this paper, we used the @vps_llc to track trends in #MIS_C in 115 #pedsICU’s since the beginning of the pandemic, and compared outcomes over time (and by strain). Of the 145,580 children admitted to the PICU, 1,338 children (0.9%) were admitted with #MISC.
Read 9 tweets
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

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.

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.

Read 14 tweets
Members of the @ESPNIC_Society recently published exciting findings from their international survey about pain management🤓 The paper is available open access in @BioMedCentral 👇🏻🚀…

We caught up with lead author @MarcoDaverioMD to ask a few questions🧵👇🏻
Q: @MarcoDaverioMD, why did you & the team decide to do this survey?

A: There was a gap of knowledge on this topic, in fact information about the assessment and management of pain and sedation across European #PedsICU are currently unknown.
Q: How do you design a study when you expect serious variability across the answers?🧐

A: Planning is crucial! We tested, validated & modified the questions. Using closed questions we reduced the variability and facilitated the data analysis💪🏻
Read 8 tweets
Part 3 #Illnessdoesntmeanstillness by @SapnaKmd
🔸we have created a culture of immobility
🔸"prolonged bedrest is anatomically and physiologically unsound" JAMA

#SCCM2022 #PedsICU
Goal to change culture
🔸initial cost was multiprofessional investment
🔸"PICU Up" became the common name
🔸Followed AHRQ QI model

#SCCM2022 #PedsICU
Read 12 tweets
Let's talk about Bundled Care of Pediatric Critical Care Patients: Guidelines and Implementation Part 2! We start with Dr. John Berkenbosch talking about choosing the right analgesic/sedation/NMB agent

#SCCM2022 #PedsICU
Underlying disease may cause pain that we cannot well appreciate.

✅Enhancement of sleep should be a goal for its restoration and reduction of delirium.
✅IV opiates strong recommendation to manage moderate to severe pain
❓Need studies comparing opiates
#SCCM2022 #PedsICU
Non-opioid adjunct
Consider use of non opioids both NSAIDS and APAP
Reduced pain scores, and opiate use
#SCCM2022 #PedsICU
Read 14 tweets
My friend and former division chief Dr. Jim Besunder talks about evidence based assessment of pain and agitation #SCCM2022 #PedsICU #PANDEM
Besunder - while self report is the gold standard, the age, acuity and interventions of the #PedsICU patient make this often not useful. Many other tools aren't validated in the population. 2 that work well are Oucher and Wong Baker #SCCM2022
The guidelines recommend using self report tools when possible, the FLACC or COMFORT-B in non-communicative patients. Avoid use of VS alone to assess pain. #SCCM2022 #PedsICU
Read 5 tweets
My next #PedsICU related #SCCM2022 topic is Pediatric TAXI-CAB Guidance. First @nellis discusses aims & general methods to create guidance for plasma & platelet transfusion.

Incredible expert team, but no nurses? Nurses administer🩸products and monitor for adverse events
Semantics of recommendations. #SCCM2022 #PedsICU
#SCCM2022 #PedsICU
Read 4 tweets
"Vaccines only" #COVID19 strategy w removal of other protections makes perfect if you hold 6 beliefs

Each belief WAS reasonable in 2020, yet proved wrong w time. Now, to maintain the idea that things are OK, each of these 6 beliefs must be defended with ever more vigor 🧵
I am completely serious that each belief was reasonable to hold at the start of the pandemic, and I myself held most of them. As we have learned more, I have changed my view, however many people have not and each of these beliefs has become a frontline in its own right - why?
I believe that cognitive dissonance explains a lot

...It is hard for us to admit we were wrong because this causes dissonance in our minds "I am a good person vs. I caused harm / I was wrong"

It is cognitively easier to change facts than to resolve the cognitive dissonance
Read 29 tweets
1/ 🧵An educational #PedsICU thread on P/F ratios and A-a Gradients , our 1st instalment of #PCCSHotTopic run by @PICSociety where we will have a PARDS webinar on 17/3 (free to register,link @ the end) & a podcast with @DrHeidiFlori alongside @PicPod_Podcast
2/ referenced articles with the help of @PICJournalWatch & an educational thread by myself that will aid in understanding the basics referred to in the teaching sessions.
3/ The P/F ratio is a widely used clinical indicator of hypoxaemia, though its diagnostic utility is controversial. What do you understand by P/F ratio and A-a gradient in the context of a hypoxic patient with ARDS?
Read 36 tweets
Had an opportunity to visit few #MTIs in #KPK with the purpose to explore #PedsICU infrastructure & need assessment and collaboration for capacity building. 1/12
Overall basic infrastructure is there and the need is unmet. And there is a desire on ground to build this field of #Pediatrics which is encouraging. The management is excellent and there is an #EHR in place. All these make an excellent starting point. 2/12
We need to keep few facts in mind while embarking on this challenging and but truly rewarding journey of providing quality acute hospital care to #children in #KPK & #Pakistan 3/12
Read 13 tweets

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