Discover and read the best of Twitter Threads about #WFPICCS20
Most recents (15)
#WFPICCS20 Life After Childhood Critical Illness: some of the science cited in the presentation #PICSp #PedsICU
pubmed.ncbi.nlm.nih.gov/29406379/ @maq_curley @janet_rennick
pubmed.ncbi.nlm.nih.gov/29406379/ @maq_curley @janet_rennick
#WFPICCS20 Life After Childhood Critical Illness: some of the science cited in the presentation #PICSp #PedsICU
pubmed.ncbi.nlm.nih.gov/32562629/ @MiguelrrMD @SapnaKmd
pubmed.ncbi.nlm.nih.gov/32562629/ @MiguelrrMD @SapnaKmd
#WFPICCS20 Life After Childhood Critical Illness: some of the science cited in the presentation #PICSp #PedsICU
pubmed.ncbi.nlm.nih.gov/28516470/ @SarahRedsell
pubmed.ncbi.nlm.nih.gov/28516470/ @SarahRedsell
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
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
But it’s key to remember that this response is not predictable, will vary with the illness and hard to assess
#PedsICU #WFPICCS20
The blood flow to the splanchnic & GI tract circulation can be varied during resuscitation and critical illness - all this can lead to impact to the ability to tolerate enteral #nutrition
#PedsICU #WFPICCS20
#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
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
There is not a strong relationship between them in post-cardiac surgical children
#PedsICU #WFPICCS20
What happens when fluid is given in #sepsis?
Again: v weak correlation between CI & MAP
Interestingly almost 50% of patients did not respond to fluid & significant % of patients had a fall in BO/CI!
48% of children needed more inotrope after the fluid
#PedsICU #WFPICCS20
Again: v weak correlation between CI & MAP
Interestingly almost 50% of patients did not respond to fluid & significant % of patients had a fall in BO/CI!
48% of children needed more inotrope after the fluid
#PedsICU #WFPICCS20
Hector Wong discusses the clinical application of biomarkers in #sepsis
Starts with how can biomarkers help us...
#PedsICU #WFPICCS20
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
#PedsICU #WFPICCS20 #Sepsis
The development of AKI is independently associated with morbidity and mortality in #sepsis
Combining this with additional biomarker activity is helpful
#PedsICU #WFPICCS20
Combining this with additional biomarker activity is helpful
#PedsICU #WFPICCS20
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
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
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
Children can have one or more of these phenotypes and some are more common than others.
This data is important when planning #research trials for targeted #sepsis therapies
But also this data has implications for clinical outcomes...
#PedsICU #WFPICCS20
This data is important when planning #research trials for targeted #sepsis therapies
But also this data has implications for clinical outcomes...
#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 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
- 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
#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
- 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
The pathophysiology of #burns patients is multi systemic and occur at a cellular level
What we see clinically is distributive shock.
#PedsICU #WFPICCS20 #physiology
What we see clinically is distributive shock.
#PedsICU #WFPICCS20 #physiology
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
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
#PedsICU #WFPICCS20
Watching Dr Trung Nguyen discussing the indications and outcomes of therapeutic plasma exchange in #PedsICU #WFPICCS20
A thread to follow....
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
Three options exist to purify blood 👇
#PedsICU #WFPICCS20
First is haemofiltration: the limit here is the size of the molecules you want to remove vs the size of the filter membrane...
But it is a technique many #PICU are familiar with for #CRRT
#PedsICU #WFPICCS20
But it is a technique many #PICU are familiar with for #CRRT
#PedsICU #WFPICCS20
Allan Doctor discusses the functional assessment of haemostasis and anticoagulation therapy during critical illness
#PedsICU #WFPICCS20
#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
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
And fibrinolysis is an important part of #coagulation #physiology to prevent excess clot growth and clot break down after healing...
It is this process we accelerate with thrombolysis
#PedsICU #WFPICCS20
It is this process we accelerate with thrombolysis
#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
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
#PedsICU #WFPICCS20
Each 10ml/kg platelet transfusion is associated with a 2% increase in #PedsICU mortality
Ask: do they really need that transfusion?
#WFPICCS20
Ask: do they really need that transfusion?
#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...
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
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
So why are #plasma products given?
You can see some children given just to correct INR - not that big a change obtained overall, but the higher the INR at transfusion the bigger the effect.
#PedsICU #WFPICCS20
You can see some children given just to correct INR - not that big a change obtained overall, but the higher the INR at transfusion the bigger the effect.
#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
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
#WFPICCS20 @SapnaKmd
I’m still really proud to be part of @PedCritCareMed #SoMe panel.... and please do follow each and everyone on this picture as you will see so much #PedsICU content
#WFPICCS20 @SCCM @WFPICCS
#WFPICCS20 @SCCM @WFPICCS
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
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
But this is not an RCT data...and some data shows higher driving pressure is associated with increased mortality...
#WFPICCS20
Should we be using transpulmonary pressure as a measurement rather than driving pressures in #pARDS?
In our unit we don’t measure transpulmonary pressures... but might be worth thinking about
#PedsICU #WFPICCS20 #PedsAnes
In our unit we don’t measure transpulmonary pressures... but might be worth thinking about
#PedsICU #WFPICCS20 #PedsAnes
🗣️Session 2: WFPICCS Webinars "Taking Stock of Pediatric Intensive Care Research During a Global Public Health Emergency"
Thread 1!
👉We started today with @srinmurthy99 🇨🇦 and no pain, no gain regarding global collaboration!
#PedsICU #WFPICCS20 #COVID19
Thread 1!
👉We started today with @srinmurthy99 🇨🇦 and no pain, no gain regarding global collaboration!
#PedsICU #WFPICCS20 #COVID19
We know PICU disorders are rare, and with #COVID19 even more...so no time to avoid collaborations
How to do it? Here some tips
@srinmurthy99 🇨🇦
#PedsICU #WFPICCS20 #COVID19
How to do it? Here some tips
@srinmurthy99 🇨🇦
#PedsICU #WFPICCS20 #COVID19
Citing the amazing work from @M_Duffett is a must when looking at global PICU trials!
@srinmurthy99 🇨🇦
#PedsICU #WFPICCS20 #COVID19
Many papers in @PedCritCareMed to dig in!
journals.lww.com/pccmjournal/Ab…
journals.lww.com/pccmjournal/Ab…
journals.lww.com/pccmjournal/Ab…
@srinmurthy99 🇨🇦
#PedsICU #WFPICCS20 #COVID19
Many papers in @PedCritCareMed to dig in!
journals.lww.com/pccmjournal/Ab…
journals.lww.com/pccmjournal/Ab…
journals.lww.com/pccmjournal/Ab…
