Dr. Nicole Glaser is the Chief of Pediatric Endocrinology and a professor of Pediatrics at UC Davis Children's Hospital. She is recognized as an international expert in pediatric diabetic ketoacidosis (DKA), an important complication of diabetes in children. She has led many of the key multi-center studies that guide DKA management. She has also been involved in the development of several national and international guidelines for DKA management in children that guide current practice worldwide.

Learning Objective:

By the end of this podcast, listeners should be able to discuss an expert guided approach to the identification and management of children with hyperosmolar DKA.

Key reference: 

Glaser N, Fritsch M, Priyambada L, Rewers A, Cherubini V, Estrada S, Wolfsdorf JI, Codner E. ISPAD clinical practice consensus guidelines 2022: Diabetic ketoacidosis and hyperglycemic hyperosmolar state. Pediatr Diabetes. 2022 Nov;23(7):835-856.

Questions, comments or feedback? Please send us a message at this link (leave email address if you would like us to relpy) Thanks! -Alice & Zac

Support the show

How to support PedsCrit:
Please complete our Listener Feedback Survey
Please rate and review on Spotify and Apple Podcasts!
Donations are appreciated @PedsCrit on Venmo , you can also support us by becoming a patron on Patreon. 100% of funds go to supporting the show.

Please remember that all content during this episode is intended for educational and entertainment purposes only. It should not be used as medical advice. The views expressed during this episode by hosts and our guests are their own and do not reflect the official position of their institutions. If you have any comments, suggestions, or feedback-you can email us at [email protected]. You can also check out our website at http://www.pedscrit.com. Thank you for listening to this episode of PedsCrit!

Enid Martinez, MD is a Senior Associate in Critical Care at Boston Children’s Hospital, and an Assistant Professor of Anaesthesia at Harvard Medical School. She is the Director of the Pediatric Critical Care Nutrition Program in the Division of Critical Care Medicine and Principal Investigator for a clinical-translational research program on gastrointestinal function and nutrition in pediatric critical illness.

Learning Objectives:

By the end of this podcast, listeners should be able to:

1. Recognize the impact of nutritional status on outcomes of critically-ill children.
2. Describe the key aspects of the metabolic stress response in critical illness.
3. Discuss a clinical approach to accurately estimating and prescribing nutrition in critically-ill children.
4. Reflect on an expert’s approach to managing aspects of nutrition in critically-ill children where there may not be high-quality evidence. 

Selected references:

Mehta et al. Guidelines for the Provision and Assessment of Nutrition Support Therapy in the Pediatric Critically Ill Patient: Society of Critical Care Medicine and American Society for Parenteral and Enteral Nutrition. JPEN J Parenter Enteral Nutr. 2017 Jul;41(5):706-742. doi: 10.1177/0148607117711387. Epub 2017 Jun 2. PMID: 28686844. 

Fivez et al. Early versus Late Parenteral Nutrition in Critically Ill Children. N Engl J Med. 2016 Mar 24;374(12):1111-22. doi: 10.1056/NEJMoa1514762. Epub 2016 Mar 15. PMID: 26975590.

Questions, comments or feedback? Please send us a message at this link (leave email address if you would like us to relpy) Thanks! -Alice & Zac

Support the show

How to support PedsCrit:
Please complete our Listener Feedback Survey
Please rate and review on Spotify and Apple Podcasts!
Donations are appreciated @PedsCrit on Venmo , you can also support us by becoming a patron on Patreon. 100% of funds go to supporting the show.

Please remember that all content during this episode is intended for educational and entertainment purposes only. It should not be used as medical advice. The views expressed during this episode by hosts and our guests are their own and do not reflect the official position of their institutions. If you have any comments, suggestions, or feedback-you can email us at [email protected]. You can also check out our website at http://www.pedscrit.com. Thank you for listening to this episode of PedsCrit!

Enid Martinez, MD is a Senior Associate in Critical Care at Boston Children’s Hospital, and an Assistant Professor of Anaesthesia at Harvard Medical School. She is the Director of the Pediatric Critical Care Nutrition Program in the Division of Critical Care Medicine and Principal Investigator for a clinical-translational research program on gastrointestinal function and nutrition in pediatric critical illness. 

Learning Objectives:

By the end of this podcast, listeners should be able to:

1. Recognize the impact of nutritional status on outcomes of critically-ill children.
2. Describe the key aspects of the metabolic stress response in critical illness.
3. Discuss a clinical approach to accurately estimating and prescribing nutrition in critically-ill children.
4. Reflect on an expert’s approach to managing aspects of nutrition in critically-ill children where there may not be high-quality evidence. 

Selected references:

Mehta et al. Guidelines for the Provision and Assessment of Nutrition Support Therapy in the Pediatric Critically Ill Patient: Society of Critical Care Medicine and American Society for Parenteral and Enteral Nutrition. JPEN J Parenter Enteral Nutr. 2017 Jul;41(5):706-742. doi: 10.1177/0148607117711387. Epub 2017 Jun 2. PMID: 28686844. 

Fivez et al. Early versus Late Parenteral Nutrition in Critically Ill Children. N Engl J Med. 2016 Mar 24;374(12):1111-22. doi: 10.1056/NEJMoa1514762. Epub 2016 Mar 15. PMID: 26975590.

Questions, comments or feedback? Please send us a message at this link (leave email address if you would like us to relpy) Thanks! -Alice & Zac

Support the show

How to support PedsCrit:
Please complete our Listener Feedback Survey
Please rate and review on Spotify and Apple Podcasts!
Donations are appreciated @PedsCrit on Venmo , you can also support us by becoming a patron on Patreon. 100% of funds go to supporting the show.

Please remember that all content during this episode is intended for educational and entertainment purposes only. It should not be used as medical advice. The views expressed during this episode by hosts and our guests are their own and do not reflect the official position of their institutions. If you have any comments, suggestions, or feedback-you can email us at [email protected]. You can also check out our website at http://www.pedscrit.com. Thank you for listening to this episode of PedsCrit!

Learning Objectives:

By the end of this podcast, listeners should be able to:

1. Describe the pathophysiology associated with anticholinergic toxidrome
2. List the initial workup and management that every TCA ingestion patient should receive 
3. Discuss best practices for initial resuscitation in TCA ingestions 

About our Guest: 

Dr. Joshua Nogar is an emergency medicine physician and toxicologist at Northwell Health and an associate professor of emergency medicine at Hofstra University. He is also the chief of the division of Medical Toxicology and the program director of the Toxicology Fellowship at North Shore University Hospital & Long Island Jewish Medical Center. 

References: 

1. https://toxandhound.com/category/dantastictox/page/2/ 
2. 2023 American Heart Association Focused Update on the Management of Patients With Cardiac Arrest or Life-Threatening Toxicity Due to Poisoning: An Update to the American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care
3. https://emcrit.org/ibcc/nacb/

Questions, comments or feedback? Please send us a message at this link (leave email address if you would like us to relpy) Thanks! -Alice & Zac

Support the show

How to support PedsCrit:
Please complete our Listener Feedback Survey
Please rate and review on Spotify and Apple Podcasts!
Donations are appreciated @PedsCrit on Venmo , you can also support us by becoming a patron on Patreon. 100% of funds go to supporting the show.

Please remember that all content during this episode is intended for educational and entertainment purposes only. It should not be used as medical advice. The views expressed during this episode by hosts and our guests are their own and do not reflect the official position of their institutions. If you have any comments, suggestions, or feedback-you can email us at [email protected]. You can also check out our website at http://www.pedscrit.com. Thank you for listening to this episode of PedsCrit!

Dr. Nicole Glaser is the Chief of Pediatric Endocrinology and a professor of Pediatrics at UC Davis Children's Hospital. She is recognized as an international expert in pediatric diabetic ketoacidosis (DKA), an important complication of diabetes in children. She has led many of the key multi-center studies that guide DKA management. She has also been involved in the development of several national and international guidelines for DKA management in children that guide current practice worldwide.

Learning Objectives:

By the end of this podcast, listeners should be able to:

• Describe best practices for triaging patients with DKA
• Explain the pathophysiology of acute cerebral edema in DKA
• Describe the evidence and physiologic basis for fluid selection and rate in DKA 
• Describe the evidence supporting insulin infusion rates in pediatric DKA 
• List best practices for lab monitoring in DKA, and how to define when a patient is ready for transition to subcutaneous insulin 

References: 

1. Abramo TJ, Szlam S, Hargrave H, Harris ZL, Williams A, Meredith M, Hedrick M, Hu Z, Nick T, Gonzalez CV. Bihemispheric Cerebral Oximetry Monitoring's Functionality in Suspected Cerebral Edema Diabetic Ketoacidosis With Therapeutic 3% Hyperosmolar Therapy in a Pediatric Emergency Department. Pediatr Emerg Care. 2022 Feb 1;38(2):e511-e518. doi: 10.1097/PEC.0000000000001774. PMID: 30964851.
2. Kuppermann N, Ghetti S, Schunk J, et al. Clinical Trial of Fluid Infusion Rates for Pediatric Diabetic Ketoacidosis. N Engl J Med. 2018;378:2275-2287.
3. Glaser N, Barnett P, McCaslin I, et al. Risk factors for cerebral edema in children with diabetic ketoacidosis. N Engl J Med. 2001;344:264-269.
4. Bergmann KR, Abuzzahab MJ, Perepelista V, Udeogu J, Qiu L, Lammers S, Nickel A, Watson D, Kharbanda A. Improving Emergency Department Care for Children With Medium- and High-Risk Diabetic Ketoacidosis. Pediatrics. 2025 Oct 1;156(4):e2024068959. doi: 10.1542/peds.2024-068959. PMID: 40907982.
5. UC-Davis-Health-Magazine-Fall-2019.pdf

Questions, comments or feedback? Please send us a message at this link (leave email address if you would like us to relpy) Thanks! -Alice & Zac

Support the show

How to support PedsCrit:
Please complete our Listener Feedback Survey
Please rate and review on Spotify and Apple Podcasts!
Donations are appreciated @PedsCrit on Venmo , you can also support us by becoming a patron on Patreon. 100% of funds go to supporting the show.

Please remember that all content during this episode is intended for educational and entertainment purposes only. It should not be used as medical advice. The views expressed during this episode by hosts and our guests are their own and do not reflect the official position of their institutions. If you have any comments, suggestions, or feedback-you can email us at [email protected]. You can also check out our website at http://www.pedscrit.com. Thank you for listening to this episode of PedsCrit!

Steven Shein, MD, FCCM, is the Chief of Pediatric Critical Care at University Hospitals Rainbow Babies & Children’s Hospital in Cleveland, Ohio, and holds the Linsalata Family Distinguished Chair in Pediatric Critical Care and Emergency Medicine. He is also the Co-Director of the PICU Clinical, Basic & Translational Research Program and an Associate Director of the Pediatric Critical Care Medicine Fellowship program. His research focuses on critical bronchiolitis and long-term neuro-cognitive morbidity after critical illness. 

Jatinder Dhami, MD, is a Pediatric Intensivist at University Hospitals Rainbow Babies & Children’s Hospital in Cleveland, Ohio. She completed her pediatrics residency at Penn State in Hershey, PA, and her PICU fellowship at Riley Children's Hospital in Indianapolis, Indiana. She is interested in clinical ethics in pediatric critical illness.

Learning Objective:

By the end of this podcast, listeners should be able to discuss an evidence-based and expert-guided approach to managing critical bronchiolitis.

References:

Managing Critical Bronchiolitis David G. Speicher, MD; and Steven L. Shein, MD, FCCM

Zurca et al. Management of Critical Bronchiolitis. Hosp Pediatr. 2023

Plint et al. Epinephrine and dexamethasone in children with bronchiolitis. N Engl J Med. 2009.

Schramm et al. Clinical Examination Does Not Predict Response to Albuterol in Ventilated Infants With Bronchiolitis. Pediatr Crit Care Med. 2017

Shein at al. Antibiotic Prescription in Young Children With Respiratory Syncytial Virus-Associated Respiratory Failure and Associated Outcomes. Pediatr Crit Care Med. 2019.

Gelbart et al. Pragmatic Randomized Trial of Corticosteroids and Inhaled Epinephrine for Bronchiolitis in Children in Intensive Care. J Pediatr. 2022.

Shein et al. Derivation and Validation of an Objective Effort of Breathing Score in Critically Ill Children. Pediatr Crit Care Med. 2019.

Shein SL, Rotta AT. Long-term Neurocognitive Morbidity After a Single Episode of Respiratory Failure in Children. JAMA. 2022.

Questions, comments or feedback? Please send us a message at this link (leave email address if you would like us to relpy) Thanks! -Alice & Zac

Support the show

How to support PedsCrit:
Please complete our Listener Feedback Survey
Please rate and review on Spotify and Apple Podcasts!
Donations are appreciated @PedsCrit on Venmo , you can also support us by becoming a patron on Patreon. 100% of funds go to supporting the show.

Please remember that all content during this episode is intended for educational and entertainment purposes only. It should not be used as medical advice. The views expressed during this episode by hosts and our guests are their own and do not reflect the official position of their institutions. If you have any comments, suggestions, or feedback-you can email us at [email protected]. You can also check out our website at http://www.pedscrit.com. Thank you for listening to this episode of PedsCrit!

Learning Objectives:

By the end of this two-part series, listeners should be able to discuss:

1. The physiologic rationale supporting the use of high-frequency percussive ventilation (Volumetric Diffusive Respiration, or HFPV).
2. Patient populations most likely to benefit from HFPV.
3. Key published evidence that informs our use of HFPV in pediatric critical care.
4. An expert approach to managing a patient with HFPV.
5. Next steps in research that will direct our understanding of the use of HFPV in pediatric critical care.

About our Guest: 

Dr. John Lin is a Professor of Pediatrics at Washington University in St. Louis. He serves as the Critical Care Fellowship Program Director and Medical Director of Respiratory Care at St. Louis Children’s Hospital. His academic interests are aimed at the implementation of specific task-based processes and systems-based interventions that increase team performance. 

References:

1. Butler AD, Dominick CL, Yehya N. High frequency percussive ventilation in pediatric acute respiratory failure. Pediatr Pulmonol. 2021 Feb;56(2):502-508. doi: 10.1002/ppul.25191. Epub 2020 Dec 8. PMID: 33258557; PMCID: PMC7902396.
2. Linda Melchor. (2021, July 22). High-Frequency Percussive Ventilation – Using the VDR, or HFPV-4. Criticalcarenow.Com.
3. Salim, A., & Martin, M. (2005). High-frequency percussive ventilation. Critical Care Medicine, 33(Supplement), S241–S245. https://doi.org/10.1097/01.CCM.0000155921.32083.CE
4. Dominick, C., Nickel, A. J., & Yehya, N. (2022). High Frequency Percussive Ventilation in Viral Bronchiolitis: Do We Need a Standardized Approach to HFPV Management? Https://Home.Liebertpub.Com/Rcare, 67(7), 893–894. https://doi.org/10.4187/RESPCARE.10247
5. White, B. R., Cadotte, N., McClellan, E. B., Presson, A. P., Bennett, E., Smith, A. G., & Aljabari, S. (2022). High-Frequency Percussive Ventilation in Viral Bronchiolitis. Respiratory Care, 67(7), 781–788. https://doi.org/10.4187/respcare.09350

Questions, comments or feedback? Please send us a message at this link (leave email address if you would like us to relpy) Thanks! -Alice & Zac

Support the show

How to support PedsCrit:
Please complete our Listener Feedback Survey
Please rate and review on Spotify and Apple Podcasts!
Donations are appreciated @PedsCrit on Venmo , you can also support us by becoming a patron on Patreon. 100% of funds go to supporting the show.

Please remember that all content during this episode is intended for educational and entertainment purposes only. It should not be used as medical advice. The views expressed during this episode by hosts and our guests are their own and do not reflect the official position of their institutions. If you have any comments, suggestions, or feedback-you can email us at [email protected]. You can also check out our website at http://www.pedscrit.com. Thank you for listening to this episode of PedsCrit!

Learning Objectives:

By the end of this two-part series, listeners should be able to discuss:

1. The physiologic rationale supporting the use of high-frequency percussive ventilation (Volumetric Diffusive Respiration, or HFPV).
2. Patient populations most likely to benefit from HFPV.
3. Key published evidence that informs our use of HFPV in pediatric critical care.
4. An expert approach to managing a patient with HFPV.
5. Next steps in research that will direct our understanding of the use of HFPV in pediatric critical care.

About our Guest: 

Dr. John Lin is a Professor of Pediatrics at Washington University in St. Louis. He serves as the Critical Care Fellowship Program Director and Medical Director of Respiratory Care at St. Louis Children’s Hospital. His academic interests are aimed at the implementation of specific task-based processes and systems-based interventions that increase team performance. 

References:

1. Butler AD, Dominick CL, Yehya N. High frequency percussive ventilation in pediatric acute respiratory failure. Pediatr Pulmonol. 2021 Feb;56(2):502-508. doi: 10.1002/ppul.25191. Epub 2020 Dec 8. PMID: 33258557; PMCID: PMC7902396.
2. Linda Melchor. (2021, July 22). High-Frequency Percussive Ventilation – Using the VDR, or HFPV-4. Criticalcarenow.Com.
3. Salim, A., & Martin, M. (2005). High-frequency percussive ventilation. Critical Care Medicine, 33(Supplement), S241–S245. https://doi.org/10.1097/01.CCM.0000155921.32083.CE
4. Dominick, C., Nickel, A. J., & Yehya, N. (2022). High Frequency Percussive Ventilation in Viral Bronchiolitis: Do We Need a Standardized Approach to HFPV Management? Https://Home.Liebertpub.Com/Rcare, 67(7), 893–894. https://doi.org/10.4187/RESPCARE.10247
5. White, B. R., Cadotte, N., McClellan, E. B., Presson, A. P., Bennett, E., Smith, A. G., & Aljabari, S. (2022). High-Frequency Percussive Ventilation in Viral Bronchiolitis. Respiratory Care, 67(7), 781–788. https://doi.org/10.4187/respcare.09350

Questions, comments or feedback? Please send us a message at this link (leave email address if you would like us to relpy) Thanks! -Alice & Zac

Support the show

How to support PedsCrit:
Please complete our Listener Feedback Survey
Please rate and review on Spotify and Apple Podcasts!
Donations are appreciated @PedsCrit on Venmo , you can also support us by becoming a patron on Patreon. 100% of funds go to supporting the show.

Please remember that all content during this episode is intended for educational and entertainment purposes only. It should not be used as medical advice. The views expressed during this episode by hosts and our guests are their own and do not reflect the official position of their institutions. If you have any comments, suggestions, or feedback-you can email us at [email protected]. You can also check out our website at http://www.pedscrit.com. Thank you for listening to this episode of PedsCrit!

Audrey Miller, MD, is an Attending Neonatologist at Nationwide Children's Hospital and an Assistant Professor of Pediatrics at The Ohio State University College of Medicine. Dr. Miller’s clinical interests focus on bronchopulmonary dysplasia (BPD) and improving outcomes for patients with this disease. Dr. Miller serves as Medical Director for the inpatient BPD unit at Nationwide Children’s. Dr. Miller also serves as chair for the advocacy committee of the international BPD collaborative.

Nationwide Children's Comprehensive Center for Bronchopulmonary Dysplasia (BPD)

Learning Objectives:

By the end of this podcast, listeners should be able to:

1. Define BPD and describe the underlying pathophysiology, risk factors and clinical trajectory.
2. Develop a clinical approach to mechanical ventilation in infants with BPD.
3. Describe strategies for mitigating compilations and promoting well-being in infants with severe BPD.

Reference:

Miller AN, Kielt MJ, El-Ferzli GT, Nelin LD, Shepherd EG. Optimizing ventilator support in severe bronchopulmonary dysplasia in the absence of conclusive evidence. Front Pediatr. 2022 Nov 24;10:1022743.

Questions, comments or feedback? Please send us a message at this link (leave email address if you would like us to relpy) Thanks! -Alice & Zac

Support the show

How to support PedsCrit:
Please complete our Listener Feedback Survey
Please rate and review on Spotify and Apple Podcasts!
Donations are appreciated @PedsCrit on Venmo , you can also support us by becoming a patron on Patreon. 100% of funds go to supporting the show.

Please remember that all content during this episode is intended for educational and entertainment purposes only. It should not be used as medical advice. The views expressed during this episode by hosts and our guests are their own and do not reflect the official position of their institutions. If you have any comments, suggestions, or feedback-you can email us at [email protected]. You can also check out our website at http://www.pedscrit.com. Thank you for listening to this episode of PedsCrit!

Guillaume Emeriaud MD PhD is a Professor of Pediatrics at the University of Montreal and pediatric intensivist at Sainte Justine Hospital in Montreal, Canada. He is a physician scientist with a particular interest in improving pediatric assisted ventilation. In particular, he has developed expertise in monitoring diaphragmatic function by evaluating the electrical activity of the diaphragm. The results of this work have led to less invasive and more effective assistance for children, notably with the NAVA (neurally adjusted ventilatory assist) mode.

E-mail: [email protected]

Learning Objective: By the end of this podcast, listeners should be able to discuss the physiologic rationale and an expert approach to managing a child with respiratory failure with NAVA.

References:

• Bordessoule, A., Emeriaud, G., Morneau, S. et al. Neurally adjusted ventilatory assist improves patient–ventilator interaction in infants as compared with conventional ventilation. Pediatr Res 72, 194–202 (2012).
• Sindelar R, McKinney RL, Wallström L, Keszler M. Proportional assist and neurally adjusted ventilation: Clinical knowledge and future trials in newborn infants. Pediatr Pulmonol. 2021 Jul;56(7):1841-1849. 
• Lepage-Farrell A, Tabone L, Plante V, Kawaguchi A, Feder J, Al Omar S, Emeriaud G. Noninvasive Neurally Adjusted Ventilatory Assist in Infants With Bronchiolitis: Respiratory Outcomes in a Single-Center, Retrospective Cohort, 2016-2018. Pediatr Crit Care Med. 2024 Mar 1;25(3):201-211.

Questions, comments or feedback? Please send us a message at this link (leave email address if you would like us to relpy) Thanks! -Alice & Zac

Support the show

How to support PedsCrit:
Please complete our Listener Feedback Survey
Please rate and review on Spotify and Apple Podcasts!
Donations are appreciated @PedsCrit on Venmo , you can also support us by becoming a patron on Patreon. 100% of funds go to supporting the show.

Please remember that all content during this episode is intended for educational and entertainment purposes only. It should not be used as medical advice. The views expressed during this episode by hosts and our guests are their own and do not reflect the official position of their institutions. If you have any comments, suggestions, or feedback-you can email us at [email protected]. You can also check out our website at http://www.pedscrit.com. Thank you for listening to this episode of PedsCrit!