Discover and read the best of Twitter Threads about #PedsCards
Most recents (11)
My first attempt at a tweetatorial. A🧵 on pulmonary overcirculation
#FOAMed #cardiotwitter #pedscards #CHD @cardionerds @UofLPeds @UofLPedsCCM 1/20
#FOAMed #cardiotwitter #pedscards #CHD @cardionerds @UofLPeds @UofLPedsCCM 1/20
The term pulmonary overcirculation or overcirculation gets used a lot when discussing kids with CHD, usually without a specific set of criteria. If a patient is not progressing as expected, is hospitalized, or has a complication frequently overcirculation is blamed. 2/20
But what is really occurring when we refer to overcirculation? In a structurally normal 🫀, the pulmonary and systemic circuits work in series. The blood flow to the 🫁 (Qp) is the same as it is to the body (Qs). 3/20
Post-COVID vaccine myocarditis: a #tweetorial from a pediatric cardiologist
First off this complication is reasonably scary for parents deciding whether or not to vaccinate their kids. I do hope that this 🧵 helps clarify the data and dispel some myths.
First off this complication is reasonably scary for parents deciding whether or not to vaccinate their kids. I do hope that this 🧵 helps clarify the data and dispel some myths.
Myocarditis is inflammation or swelling of the heart muscle and can lead to dysfunction. Many ways to diagnose it, but gold standard is visualizing the inflammation on cardiac MRI.
In some data sets, it can be over-represented if the definition is an ⬆️troponin (🫀protein) alone
In some data sets, it can be over-represented if the definition is an ⬆️troponin (🫀protein) alone
Post-vaccine myocarditis is rare but most common in males age 12-17 years (0.0067% in this group and 0.001% overall) & occurs a median of 3.5 days after the 2nd vax
Big BUT…
Almost 7x less common than myocarditis after an infection with COVID in this same group (0.045%)
Big BUT…
Almost 7x less common than myocarditis after an infection with COVID in this same group (0.045%)
🔟 No mention of 2020 could possibly ignore the effects of the global pandemic on research, patient care, and the way we share knowledge. #COVID19 #ACC21 
9⃣ Imaging indices correlate with prognosis.
- Transplant/VAD-free survival correlates with MPI-DTI z-score
- Left atrial strain correlates with PCWP and helps identify graft rejection/failure
#ACC21
- Transplant/VAD-free survival correlates with MPI-DTI z-score
- Left atrial strain correlates with PCWP and helps identify graft rejection/failure
#ACC21
𝙏𝙃𝙀 𝙈𝙐𝘾𝙃 𝙁𝙊𝙍𝙂𝙊𝙏𝙏𝙀𝙉 𝙍𝙑
1/5
Dif Approaches to Optimizing PEEP
PEEP and RV Function
Clifford Greyson @SCCM #CCC50
#PedsICU #PedsCICU #PedsCards
1/5
Dif Approaches to Optimizing PEEP
PEEP and RV Function
Clifford Greyson @SCCM #CCC50
#PedsICU #PedsCICU #PedsCards
2/5
▫️Frank-Starling law is more reflective of LV physiology
▫️ RV normally unstressed at end diastole
▫️ RV maladapts to volume overload overtime
▫️ Distorted RV balloons impedes LV
▫️ RV perfusion occurs during ventricular systole
▫️ Vicious cycle 🔄 of RV dysfunction
▫️Frank-Starling law is more reflective of LV physiology
▫️ RV normally unstressed at end diastole
▫️ RV maladapts to volume overload overtime
▫️ Distorted RV balloons impedes LV
▫️ RV perfusion occurs during ventricular systole
▫️ Vicious cycle 🔄 of RV dysfunction
3/5
RV afterload affected by
▫️PVR
▫️Pul vascular compliance
▫️LAP
all compromised with excessive PEEP
RV afterload affected by
▫️PVR
▫️Pul vascular compliance
▫️LAP
all compromised with excessive PEEP
Here is the #PedsICU #BestOf2020 collection.
Jointly chosen by
@Dr_Hari_Krishna @sgdambrauskas and myself
Pubmed collection 40 articles: bit.ly/pedsicubestof2…
Infographic (clickable PDF) in English: bit.ly/bestof2020eng
Spanish: bit.ly/bestof2020esp
#PedsCICU #NeuroPICU
Jointly chosen by
@Dr_Hari_Krishna @sgdambrauskas and myself
Pubmed collection 40 articles: bit.ly/pedsicubestof2…
Infographic (clickable PDF) in English: bit.ly/bestof2020eng
Spanish: bit.ly/bestof2020esp
#PedsCICU #NeuroPICU
This will be a bilingual tweetorial in Spanish/English!
Infographics are available in both languages in Tweet #1
El hilo será en Español/Inglés. El resumen infográfico está disponible en los dos idiomas en el primer Tweet
Infographics are available in both languages in Tweet #1
El hilo será en Español/Inglés. El resumen infográfico está disponible en los dos idiomas en el primer Tweet
1/What are the outcomes that matter to children, to families and to #researchers/clinicians? @ericka_fink et al & @PostPICU_PALISI investigators identified COS using a delphi process. @CritCareMed bit.ly/381cfq8. Developmental and functional outcomes were important.
3rd regular episode of @pedsintensiva, podcast that bridges the gap btw literature & practice for #pedsICU
CPR & #ECMO in Single V patients w Ravi Thiagarajan Division Chief of Cardiac ICU @bostonchildrens
Tweetorial 👇
tinyurl.com/CPRandECMOsing…
#pedscards #pedsCICU #CHD
CPR & #ECMO in Single V patients w Ravi Thiagarajan Division Chief of Cardiac ICU @bostonchildrens
Tweetorial 👇
tinyurl.com/CPRandECMOsing…
#pedscards #pedsCICU #CHD
@BostonChildrens Single V pts are ++ risk for arrest & #ECMO support
Many pts die & more have morbidity, even in best centers
Prevention of arrest is more important & effective than rescue CPR/ECMO – great work by @pc4quality in making prevention sexy!
#pedsICU #pedscards #pedsCICU #CHD
Many pts die & more have morbidity, even in best centers
Prevention of arrest is more important & effective than rescue CPR/ECMO – great work by @pc4quality in making prevention sexy!
#pedsICU #pedscards #pedsCICU #CHD
@BostonChildrens @pc4quality ECPR (extracorporeal-CPR) is only ever as good as the CPR you get beforehand
Getting a pt onto #ECMO is busy but don’t forget the prime importance of good quality CPR w minimal interruptions on the way there
#pedsICU #pedscards #pedsCICU #CHD
Getting a pt onto #ECMO is busy but don’t forget the prime importance of good quality CPR w minimal interruptions on the way there
#pedsICU #pedscards #pedsCICU #CHD
#PedsICU #PedsCICU #PedsCards Drawing attention to this @pc4quality study by @JustinElhoff and Martina Steurer-Miller (needs a handle!) and team....1/x
Relationship between gestational age and outcomes after congenital heart surgery pubmed.ncbi.nlm.nih.gov/33080235/
Relationship between gestational age and outcomes after congenital heart surgery pubmed.ncbi.nlm.nih.gov/33080235/
This is one of those great studies where we followed the data and found something that was interesting to us, worthy of follow-up, and potentially actionable. In addition to studying the relationship between gestational age and outcome after #CHD surgery...2/x
We looked at the association between corrected gestational age and outcome. We frequently struggle to determine the "right" time to take a premature patient with CHD to the operating room. On the one hand, we want them to achieve sufficient organ maturity...3/x
1st ever regular episode of Pediatrica Intensiva, the podcast that bridges the gap btw literature & practice for #pedsICU
Borderline Left Hearts w @laussen_peter from @BostonChildrens @SickKidsNews, part 1 of Single Ventricle season
Tweetorial👇
apple.co/36FG2EN
Borderline Left Hearts w @laussen_peter from @BostonChildrens @SickKidsNews, part 1 of Single Ventricle season
Tweetorial👇
apple.co/36FG2EN
Borderline Left Hearts are subset of pts w critical L heart obstruction, best defined as:
1.‘Output of aortic valve inadequate to maintain life’ (so need to maintain duct until 1st intervention) &;
2.Present & need intervention in neonatal period
#PedsICU #PedsCICU #CHD /2
1.‘Output of aortic valve inadequate to maintain life’ (so need to maintain duct until 1st intervention) &;
2.Present & need intervention in neonatal period
#PedsICU #PedsCICU #CHD /2
Infants w critical left heart obstruction are on spectrum
-One end: clearly inadequate L heart structures -> single V pathway
-Other end, clearly adequate (even if bit small) -> biV pathway
- Pts in middle are TRICKY (hence this podcast)
#PedsICU #PedsCICU #CHD #pedscards /3
-One end: clearly inadequate L heart structures -> single V pathway
-Other end, clearly adequate (even if bit small) -> biV pathway
- Pts in middle are TRICKY (hence this podcast)
#PedsICU #PedsCICU #CHD #pedscards /3
First up is James Fraser, president of @PICSociety discussing the UK #PedsICU response to #COVID19
This was a busy and difficult time for all!
#EPCCS20
This was a busy and difficult time for all!
#EPCCS20
1/9 🅲🅰🆂🅴-🅱🅰🆂🅴🅳 🆃🆄🆃🅾🆁🅸🅰🅻 4
MECHANICAL CIRCULATORY SUPPORT
@ACCinTouch @agtruesdell @ErikOsborn77 @mirvatalasnag #ACCIC #PedsCICU #PedsCards
🔹Background
🔹#PedsICU #ECMO Case
🔹Adult ECMO + #Impella Case
🔹Upcoming Webinar
MECHANICAL CIRCULATORY SUPPORT
@ACCinTouch @agtruesdell @ErikOsborn77 @mirvatalasnag #ACCIC #PedsCICU #PedsCards
🔹Background
🔹#PedsICU #ECMO Case
🔹Adult ECMO + #Impella Case
🔹Upcoming Webinar
2/9 EARLY RUNS OF #COVID19 PATIENTS ON #ECMO
Initial discouraging reports from 🇨🇳
Warning of igniting immune storm esp in patients with high IL-6
Nationwide centralization in 🇯🇵 to improve research & quality of evidence
🔹Time to ECMO
🔹Lung compliance
🔹Biomarkers
Initial discouraging reports from 🇨🇳
Warning of igniting immune storm esp in patients with high IL-6
Nationwide centralization in 🇯🇵 to improve research & quality of evidence
🔹Time to ECMO
🔹Lung compliance
🔹Biomarkers
3/9 GUIDANCE DOCUMENTS
Surviving Sepsis Guidelines
🔹VV ECMO for refractory hypoxemia despite optimizing ventilation rescue therapies & proning
🔹Intensive Care Med May 2020
doi:10.1007/s00134-020-06022-5
@AlhazzaniW
FDA Enforcement Policy expanded availability of devices
Surviving Sepsis Guidelines
🔹VV ECMO for refractory hypoxemia despite optimizing ventilation rescue therapies & proning
🔹Intensive Care Med May 2020
doi:10.1007/s00134-020-06022-5
@AlhazzaniW
FDA Enforcement Policy expanded availability of devices
Tweetorial of @AparnaHoskote ‘s fantastic talk on #ecmo pearls for #singleventricle #chd in the #PedsCICU #PedsICU at #jpccim2019. Single ventricle pts have 43% ecmo survival. Several tweets to follow with pearls for how to optimize! @PICS_Conference @PCICS2 @PICSociety
1/10
1/10
Pearl 2: hypoxemia is a better indication with better prognosis than hypotension (I.e. shunt issues are better than cardiac dysfunction) #jpccim2019 3/10
