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Ken Tegtmeyer, MD, FCCM, FAAP 🇺🇸

2 Feb, 11 tweets, 9 min read

Next up Joel Feih, PharmD from Froedtert Hospital at MCW in Milwaukee on B12 and Methylene Blue in refractory vasodilatory shock #CCC50 #PedsICU

Feih: Methylene Blue #CCC50 #PedsICU

Feih: Methylene Blue has been studied for prophylaxis in high risk vasoplegic syndrome following CPB #CCC50 #PedsICU

Feih: also worked if given after CPB #CCC50 #PedsICU

Feih: side effects worse if given late #CCC50 #PedsICU

Feih: on to Hydroxycobalamine #CCC50 #PedsICU

Feih: most of the data is from case reports, and dosing and administration is greatly varied in the reports. most also got methylene blue. #CCC50 #PedsICU

Feih: one study compared Methylene Blue to B12 in cardiac surgery patients, but retrospective. Both drugs worked. No difference #CCC50 #PedsICU

Feih: our study, monotherapy vs. combo no difference for MAP goal #CCC50 #PedsICU

Feih: combo therapy may allow slight decrease in other vasopressor use #CCC50 #PedsICU

Feih: conclusions, bottom line is the data is limited. Be worried about G6PD and concomitant serotoninergic syndromes #CCC50 #PedsICU

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Ken Tegtmeyer, MD, FCCM, FAAP 🇺🇸

@pccm_doc

2 Feb

Sevransky: rationale for Vitamin C in sepsis and shock #CCC50 #PedsICU

Sevransky: CITRIS-ALI #CCC50 #PedsICU 167 patients with Sepsis AND ARDS for < 24 hours.

Sevransky: it did raise Vitamin C levels but didn't modify SOFA or other scores. But interventional group had a lower mortality (not a primary outcome measure of the study though, one of 46 secondary measures) #CCC50 #PedsICU Billiard analogy of calling your shot -

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Ken Tegtmeyer, MD, FCCM, FAAP 🇺🇸

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@KhannaAshishCCM

@KhannaAshishCCM reviewing stuff that I knew once upon a time... #CCC50 #PedsICU RAAS

Khanna: Is renin the new lactate? #CCC50 #PedsICU

Khana: case report of high renin vasodilatory shock in a COVID patient on VV ECMO aaa #CCC50

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Ken Tegtmeyer, MD, FCCM, FAAP 🇺🇸

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2 Feb

Douglas White (UPMC): ICU triaging both on saving most lives and those with longest life expectancy, even based on SOFA scores invariably will bias against patients of color, or lower SES #CCC50 #PedsICU

White: 4 strategies for ICU triage that promote equity

White: Arizona as an example, some hospitals were overburdened, others had empty beds. Arizona surgeline addressed this to coordinate and facilitate transfer 5000 patient transfer so they didn't need to triage. #CCC50 #PedsICU

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Ken Tegtmeyer, MD, FCCM, FAAP 🇺🇸

@pccm_doc

2 Feb

Katri Typpo presenting the basic science arm of the Peds Year in Review (it's not all SARS-CoV2) #CCC50 #PedsICU

Typpo: looking at mechanism of Cytokine Release Syndrome in CAR-T therapy #CCC50 #PedsICU by Liu at al Blocking GSDME may prevent CRS

Typpo: an animal model of Inhaled Vitame E Acetate and EVALI-like Lung injury #CCC50 #PedsICU

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Ken Tegtmeyer, MD, FCCM, FAAP 🇺🇸

@pccm_doc

2 Feb

Bembea presenting clinical arm of Year in Review, MIS-C, ARDS, here the PARDIE study #CCC50 #PedsICU

@SapnaKmd

Bembea: PARK-PICU study looking at physical rehab point prevalence in the US from @SapnaKmd et al #CCC50 #PedsICU

Bembea: Canadian and European versions of PARK-PICU showed some similarities but some noticiable differences #CCC50 #PedsICU

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Ken Tegtmeyer, MD, FCCM, FAAP 🇺🇸

@pccm_doc

2 Feb

The legend Ann Thompson, MD, MHCPM, MCCM talking about her career in #PedsICU, including offering herself up as chief at Pittsburgh 6 months out of fellowship. #CCC50 #PedsICU (her caveat was that the division was 2 people with one fellow, 7 nurses, 10 PICU beds)

Dr. Laura Evans, FCCM asking Dr. Thompson about that transition from fellowship to leadership, the growth of the program. Dr. Thompson relying back on her guidance from Drs Raphaelly and Downes at CHOP who mentored her. "Holding on by your fingertips" at times. #CCC50 #PedsICU

Dr. Thompson points out that having a strong team helped them persevere. (A team of course that she built over the years). #CCC50 #PedsICU

Read 15 tweets

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