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VTA Symposium Profile picture
@VTA_Symposium
May 6 • 7 tweets • 4 min read Twitter logo Read on Twitter
Midmorning #VTA23 session starting - lots of short talks so expect quick changes in topic! #critcare #FOAMcc
Michael Gentile - Is PARDIE Changing Our View of Paediatric ARDS?
#VTA23 #FOAMcc #critcare
PARDIE stands for Pediatric ARDS Incidence and Epidemiology study. This study is one of the results of the PALISI Conference Group.
doi.org/10.1016/S2213-…
#VTA23
The PALISI group looked at which oxygenation measurements may be used.
Options included:
PF ratio
SF ratio
OI
OSI
They also defined Paediatric ARDS, in 2015 and then again this year in 2023.
doi.org/10.1097/PCC.00…
doi.org/10.1097/PCC.00…
#VTA23
PARDIE looked at 145 PICUs worldwide, 23215 patients. 12270 were on mechanical ventilation.
744 new cases of PARDS were identified, 704 of which had complete data. It was a massive effort in a difficult to study population. #VTA23
PARDIE informed the new PARDS definition by PALISI - PALICC-2.
11 new sections
doi.org/10.1097/PCC.00…
#VTA23 Image
PARDIE take home messages:
PARDS affects 3% of PICU patients. Mortality is 30%. PALICC criteria are more sensitive than Berlin.
PALICC use of OI and OSI is a better predictor of mortality than PF and SF ratios.
However - HFOV, iNO and ECMO were not studied
#VTA23

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More from @VTA_Symposium

VTA Symposium Profile picture
May 6
Anthony Holley speaking on 'Tracheostomy - When and How?'
#VTA23 #critcare #FOAMcc
Why do we put tracheostomies in patients though?
The rationale for a trachy in ICU is that there are respiratory mechanical benefit (compare to a tracheal tube and a native airway). There are many patient care benefits - oral care, feeding, etc...
#VTA23
There are problems, including the potential for real patient harm. Tracheostomy emergencies are a problem. Complications (Immediate, Early and Late) are encountered in 30% of patients. #VTA23
Read 9 tweets
VTA Symposium Profile picture
May 6
Next is Donna Hamel, speaking on 'PEEP Titration and Recruitment'
#VTA23 #critcare #FOAMcc
PEEP is important - it improves oxygenation, and is an essential component of lung protective strategies.
But PEEP also has some problems - it can cause hypotension and increased pulmonary vascular resistance.
So how does one get optimal PEEP?
#VTA23
Optimal PEEP has no clear universal definition.
Maybe we should look for appropriate PEEP - a PEEP value that results in adequate oxygenation with the lowest risk of overdistension.
#VTA23
Read 5 tweets
VTA Symposium Profile picture
May 6
Prof Anthony Holley is speaking next on 'Respiratory Support in the Trauma Patient' #VTA23 #critcare #FOAMcc
The 'trauma' patient is not a single disease entity, but ultimately a mechanism that is characterised by a shared multitude of pathophysiological patterns (TBI, lung contusion, etc...) and interventions (surgery, transfusion) that lead to some common disease processes. #VTA23
These common disease processes include TRALI, ARDS, TIC and many more.
Of concern, ARDS is not uncommon in trauma patients.
#VTA23
Read 6 tweets
VTA Symposium Profile picture
May 6
Next up are two of the Occupational Therapists from CHBAH - Marche van der Heyden and Tiffany Fairbairn - speaking on 'Sensory Stimulation in Critical Care'.
#VTA23 #critcare #FOAMcc
Sensory stimulation is emerging in critical care as a modality to re-establish normal functioning. Our senses are our connection to the world. There are 8 (not 5!) senses - auditory, olfactory, gustatory, visual, tactile/touch, vestibular, proprioception and interoception. #VTA23
The lesser known of these - vestibular, proprioception and interoception - all are key in self-soothing...
Interoception is the sense how different parts of our 'deep' body are feeling. There are a few activities that include all 8 senses - for example eating.
#VTA23
Read 9 tweets
VTA Symposium Profile picture
May 6
Last up for the morning session is John Davies, who is talking about 'Mechanical Ventilation during ECMO: all, some or none'.
#VTA23 #FOAMcc #critcare
Essential to remember the components of lung protective ventilation - tidal volume, plateau pressure, respiratory rate, PEEP, FiO2.
#VTA23
Do the rules of LPV change when the patient is on ECMO.
There is little doubt that (in appropriately selected patients) ECMO has a mortality benefit. Have a look at the CESAR and EOLIA trials:
doi.org/10.1016/S0140-…
doi.org/10.1056/NEJMoa…
#VTA23
Read 7 tweets
VTA Symposium Profile picture
May 6
Next is Prof Ronel Roos, who will be speaking on 'Mobilisation Patients with Extracorporeal Circuits' #VTA23 #critcare #FOAMcc
There are different types of mobilisation.
There can be passive mobilisation or active/assisted exercises. Functional exercises can include standing, sitting, walking, or even a bike (in or out of bed). #VTA23
Alot of this is about setup. Femoral vs upper body cannulisation makes a difference - femoral makes it more difficult. Securing the lines safely is essential, the tubing must be monitored and long enough. #VTA23
Read 5 tweets

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