Sharon Y Irving on ‘early enteral #nutrition: timing is more important than initial volume’

Starting with what is early enteral nutrition... definitions are vague 👇 but generally within 24hrs is recommended

#PedsICU #WFPICCS20 Need to consider the metabolic response of critical illness on #nutrition - this is multi factorial

But it’s key to remember that this response is not predictable, will vary with the illness and hard to assess

#PedsICU #WFPICCS20

Suchitra Ranjit discusses multimodal monitoring during #sepsis to help decode the physiological diagnosis and personalise therapy

Opening message is that cardiac output is difficult to assess at the bedside

#PedsICU #WFPICCS20 MAP is often used as a proxy of CO - is this reasonable?

There is not a strong relationship between them in post-cardiac surgical children

#PedsICU #WFPICCS20

Hector Wong discusses the clinical application of biomarkers in #sepsis

Starts with how can biomarkers help us...

#PedsICU #WFPICCS20 A great picture showing how the aim of biomarkers is to allow precision medicine - but you need to understand the concept of enrichment first!

#PedsICU #WFPICCS20 #Sepsis

Joe Carcillo discusses clinical phenotypes & outcomes of #sepsis

He says mortality was reduced in the emergency department by protocols using early antibiotics/fluids

Yet some children who end up on #PedsICU develop multiorgan failure despite following protocols

#WFPICCS20 Four clinical phenotypes have been associated with progressive multiorgan failure in #sepsis

All of these phenotypes end with macrophage activation syndrome.

Research is going on to target therapies against each phenotype (eg, TAMOF with plasma exchange)

#PedsICU #WFPICCS20

Steven E. Wolf now talks about #PedsICU #airway #burns

Airway burns is something I always worry about. Looking forward to his insights in this topic

#WFPICCS20 #PedsAnes Airway probs can occur from:
- direct burns
- inhalation injury (10-20% of all burns pts)
- trauma from other injuries
- 3rd spacing oedema during fluid resuscitation
- long term intubation (eg subglottic stenosis)

#PedsICU #PedsAnes #WFPICCS20

Prof. Bettina Vom Dessauer now talks about the #burns patient as a critically ill patient with systemic problems.

#PedsICU #WFPICCS20 Outcomes in #burns patient associated with:
- early admission to hospital
- care in a specialised burns unit
- control of infections
- early nutrition

These children are often healthy before the injury and this results in the whole homeostasis being altered

#PedsICU #WFPICCS20

Catching up on #burns patients on the #PedsICU - first up Steven E. Wolf discussing specialised burns care by the surgical team

He starts by discussing the ultimate goals of paediatric burn care:
- no deaths
- no scars
- no pain

We are improving but not there yet

#WFPICCS20 ‘Burns are as bad as they are going to get at the start; they can only get better - burns are different to chronic diseases’ - Steven E. Wolf, burns surgeon/Intensivist

#PedsICU #WFPICCS20

Watching Dr Trung Nguyen discussing the indications and outcomes of therapeutic plasma exchange in #PedsICU #WFPICCS20

A thread to follow.... Within plasma there can be molecules that are harmful/toxic that you may want to remove, without removing the rest of the blood molecules...

Three options exist to purify blood 👇

#PedsICU #WFPICCS20

Allan Doctor discusses the functional assessment of haemostasis and anticoagulation therapy during critical illness

#PedsICU #WFPICCS20 let’s look at normal #coagulation system #physiology...

New ways of thinking at a cellular level moves from the classic intrinsic and extrinsic a pathway to a cell based process consisting of:
- Initiation
- amplification phase
- propagation phase

#PedsICU #WFPICCS20

@DrOliverKaram moves on to talk about #platelet transfusion in the #PedsICU

He starts by telling us platelets are stored at room temperature for 5-7 days and this means they are a risk of infection source

#WFPICCS20 When are platelet transfusions indicated? Expert recommendations exist... but do we follow them?

#PedsICU #WFPICCS20

@DrOliverKaram talks to us about plasma products @WFPICCS #wfpiccs20 #PedsICU

Not all plasma products are created equally: some still have residual cells, and some are better than others... When is plasma indicated?

Major trauma is a clear indiction.

But use in prophylactic head injuries seems to worsen development of lesions

Use of plasma products in children is associated with multiorgan dysfunction - do you really need to give this?

#PedsICU #WFPICCS20

Next up: social media in #PedsICU - delivered by @PedCritCareMed #SoMe editor @SapnaKmd

This really is important - it is a huge tool for medical education!

#WFPICCS20 #SoMe allows us to have a network of people - for me, it’s opened my eyes about the #PedsICU world and educated me huge amounts and made so many international connections

#WFPICCS20 @SapnaKmd

Opening talk @WFPICCS is ‘protective lung ventilation’ by Robinder Khemani

Much data is from the adult ARDSNet work demonstrating 6ml/kg is optimal data for adults

#PedsICU #WFPICCS20 However - limited #PedsICU data for #pARDS and some data suggests higher tidal volumes in children may have better survival.

But this is not an RCT data...and some data shows higher driving pressure is associated with increased mortality...

#WFPICCS20

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

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

#EPCCS20

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

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

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

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

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

Now @lyvonnetume answering the question for feeding children (or not) when they are on non-invasive ventilation...

It’s not should we... it should be how do we feed...

#PedsICU #EPCCS20 What does the data say already on the topic of feeding #PedsICU patients on non-invasive ventilation?

@lyvonnetume #EPCCS20