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6 Oct, 11 tweets, 11 min read
Lynne Latten now talking about #PedsICU #nutrition considerations in #COVID19 children

10 tips about to follow....

#EPCCS20
Tip 1: use standard guidelines - not much needs to change in #COVID19 #PedsICU

#EPCCS20
Tip 2: Carry out a good nutritional assessment

#COVID19 risks worse with higher BMI

#PedsICU #EPCCS20 #nutrition
Tip 3: Feed cautiously using usual protocols in children with #COVID19 #PedsICU

Protocolised feeding is a good thing for all children!

#EPCCS20
Tip 4: Ensure correct nutritional requirements are calculated and given

Schofield equation the best to do this.

This is why we need our #dieticians on #PedsICU

#EPCCS20 #Nutrition
Tip 5: Choose the correct feed

Increasing calorie content of feed can reduce volume given - important in those with fluid overload and #pARDS

#PedsICU #EPCCS20 #Nutrition
Tip 6: Enteral feeding is best!

We are reminded that NGT insertion is an AGP... #COVID19

#Nutrition #PedsICU #EPCCS20
Tip 7: use of residual gastric contents to guide feeding - again reminded this is an AGP!

#COVID19 #PedsICU #EPCCS20
Tip 8: sometimes enteral feeding fails and we need to use TPN - but don’t start too soon!

#PedsICU #EPCCS20 #Nutrition
Tip 9: Use of supplements... need to ensure correct amounts given, but no evidence high doses protect or cure #COVID19

#PedsICU #EPCCS20 #Nutrition
Final tip 10: don’t forget after #PedsICU admission - nutritional care doesn’t stop there...

#EPCCS20 #Nutrition

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More from @MJGriksaitis

Michael Griksaitis Profile picture
6 Oct
Next is Prof Elizabeth Draper discussing the data reported and modelling from the UK on #COVID19 data in #PedsICU

#EPCCS20
Roles included:
* modelling #PedsICU bed requirement in the #COVID19 pandemic to ensure enough #PICU beds
* report real time #COVID cases & #PIMSTS in kids

This is helpful data for us to learn and adapt to this disease

#EPCCS20
The number of children admitted to #PedsICU with #COVID19 followed the same wave as adults, but obviously lower numbers. Starting to slowly increase again....

#EPCCS20
Read 4 tweets
Michael Griksaitis Profile picture
6 Oct
Prof Mike Levin talking to us about the #physiology and #immunology of #COVID19 and #PIMSTS in #PedsICU

Generally children had a mild disease phenotype - then as the pandemic progressed more inflammatory disorders were seen and a new condition was created: PIMS-TS

#EPCCS20 ImageImageImage
Further investigation of the #COVID19 inflammatory response found 3 phenotypes - all had coronary artery disease, but not all needed #PedsICU

#EPCCS20 ImageImage
The new disease when compared to Kawasaki disease:
- higher CRP
- younger age
- higher ferritin
- lower lympocytes
- lower albumin
- lower haemoglobin

Shock patients:
- higher troponin
- higher BNP
- higher CRP

#PedsICU #COVID19 #EPCCS20 ImageImage
Read 7 tweets
Michael Griksaitis Profile picture
6 Oct
Dr Patricia Weir next talks about long term volunteering in Malawi #PedsICU

The impact of long term volunteering is different to short term missions

#EPCCS20
Dr Weir then talks about is #PedsICU set up in LMIC the right use of resources?

She feels yes - by promoting this there is a knock on effect: adult ICU then improves, the HDU’s then improve, equipment and skills can be shared

#EPCCS20
Short term vs long term missions have different impacts in LMIC

#PedsICU #EPCCS20 Image
Read 4 tweets
Michael Griksaitis Profile picture
6 Oct
Mike English is prof of international child health & discusses emergency care in LMIC

He poses: what care is most critical to add to LMIC? (rather than asking what critical care is there)

The things people need is much simpler than what people want to give

#PedsICU #EPCCS20
In LMIC in addition to needing the basic equipment - you need staffing!

Trying to introduce advanced technology before getting the basics is not helpful

You need to train the staff for context (e.g. not training staff in ventilators if they don’t have them)

#EPCCS20 #PedsICU
In addition to equipment and staff you then need to think of team work, especially in overwhelmed LMIC systems:
- operational functions (e.g. triage)
- Handovers
- checking kit

This is so important and things we often take for granted

#PedsICU #EPCCS20
Read 4 tweets
Michael Griksaitis Profile picture
6 Oct
Martha Curley now discussing year of the #nurse and inspiring the future work force: what a year 2020 has been for nurses.

Without nursing staff the response to the #COVID19 pandemic would have failed

They are the key part of healthcare.

#PedsICU #EPCCS20
Prof. Curley now describes the role of the #nurse in #research - and feels the priority should be going back to make sure our health care settings are designed to help and heal and comfort patients

We should not be harming patients by being in the hospital

#PedsICU #EPCCS20
To achieve nursing research we need to create a platform that allows this!

We are lucky @SotonChildHosp #PedsICU that we have @Katystearn1Katy @donnaaust1n @UHS_PICResearch @RDsouthampton @southamptonCRF who support nursing research - & teaching how to do it! #EPCCS20
Read 4 tweets
Michael Griksaitis Profile picture
6 Oct
Next is Luise Marino - our amazing academic dietician @SotonChildHosp #PedsICU - talking about refeeding syndrome
The most common risks for re-feeding syndrome are shown in this slide below...

The full review by Dr Marino et al can be found here:
pm.amegroups.com/article/view/5…

#PedsICU #Nutrition #EPCCS20
What is the pathophysiology of re-feeding syndrome...?

Associated with 5-7 days of starvation and then a sudden increase in electrolytes and insulin causes the problems

#PedsICU #Physiology #EPCCS20 #Nutrition
Read 6 tweets

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