PedsCrit

Bradley Fuhrman, MD completed his training in pediatrics followed by fellowships in cardiology and neonatology at the University of Minnesota where he went on to found the first PICU and serve as the Chief of critical care at that institution. He has also served as the associate director of the PICU at Children’s Hospital of Pittsburgh, Division Chief of Critical Care at Children’s Hospital Buffalo and Physician-in-Chief at El Paso Children’s Hospital. His career in pediatric critical care exceeds 40 years. He has many peer-reviewed publications with a research career that is focused in cardiac and respiratory physiology. He is also the co-author of Fuhrman and Zimmerman’s Pediatric Critical Care.

Learning Objectives:

By the end of listening to this 2-part series, learners should be able to discuss clinically relevant cardiopulmonary interactions and a fundamental clinical approach to optimizing cardiopulmonary mechanics in patients with:

1. Spontaneous (negative pressure) respirations with severe work of breathing 
2. Septic shock
3. Mechanical (positive pressure) ventilation
4. Pulmonary hypertension with right ventricular systolic dysfunction
5. Left ventricular systolic dysfunction
6. Right ventricular diastolic dysfunction
7. Single ventricle Fontan circulation

References:

Bronicki RA, Penny DJ, Anas NG, Fuhrman B. Cardiopulmonary Interactions. Pediatr Crit Care Med. 2016 Aug;17(8 Suppl 1):S182-93. doi: 10.1097/PCC.0000000000000829. PMID: 27490598.

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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!

Jerry Zimmerman, M.D, PhD, FCCM is a Professor of Pediatrics at the University of Washington and the former Chief of the Division of Critical Care Medicine and the Director of the Pediatric Intensive Care Unit at Seattle Children’s Hospital. He is a past president of the Society of Critical Care Medicine. Dr. Zimmerman is the co-editor of the textbook Pediatric Critical Care and is an accomplished researcher. He was a charter principal investigator in the Pediatric Acute Lung Injury and Sepsis Investigators (PALISI) network and is a co-principal investigator for the Stress Hydrocortisone in Pediatric Septic Shock (SHIPSS) trial that we will discuss later in this episode. 

Learning Objectives:

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

1. The physiologic rationale supporting and opposing the use of corticosteroids in septic shock.
2. The high-quality clinical evidence supporting and opposing the use of corticosteroids in septic shock.
3. The current practice patterns among pediatric intensivists in prescribing corticosteroids in septic shock.
4. The clinically relevant side effects associated with corticosteroids in septic shock.
5. Future research of corticosteroids in septic shock with emphasis on the Stress Hydrocortisone in Pediatric Septic Shock (SHIPSS) study.

Key reference:

Zimmerman, Jerry J. MD, PhD, FCCM. A history of adjunctive glucocorticoid treatment for pediatric sepsis: Moving beyond steroid pulp fiction toward evidence-based medicine. Pediatric Critical Care Medicine: November 2007 - Volume 8 - Issue 6 - p 530-539

Other references: 

 PMID: 32058370 
 PMID: 20228689 
 PMID: 29979221 
 PMID: 29490185 
 PMID: 29347874 
 PMID: 27695824 
 PMID: 18184957 
 PMID: 12186604 

Send us Fan Mail

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!

Jerry Zimmerman, M.D, PhD, FCCM is a Professor of Pediatrics at the University of Washington and the former Chief of the Division of Critical Care Medicine and the Director of the Pediatric Intensive Care Unit at Seattle Children’s Hospital. He is a past president of the Society of Critical Care Medicine. Dr. Zimmerman is the co-editor of the textbook Pediatric Critical Care and is an accomplished researcher. He was a charter principal investigator in the Pediatric Acute Lung Injury and Sepsis Investigators (PALISI) network and is a co-principal investigator for the Stress Hydrocortisone in Pediatric Septic Shock (SHIPSS) trial that we will discuss later in this episode. 

Learning Objectives:

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

1. The physiologic rationale supporting and opposing the use of corticosteroids in septic shock.
2. The high-quality clinical evidence supporting and opposing the use of corticosteroids in septic shock.
3. The current practice patterns among pediatric intensivists in prescribing corticosteroids in septic shock.
4. The clinically relevant side effects associated with corticosteroids in septic shock.
5. Future research of corticosteroids in septic shock with emphasis on the Stress Hydrocortisone in Pediatric Septic Shock (SHIPSS) study.

Key reference:

Zimmerman, Jerry J. MD, PhD, FCCM. A history of adjunctive glucocorticoid treatment for pediatric sepsis: Moving beyond steroid pulp fiction toward evidence-based medicine. Pediatric Critical Care Medicine: November 2007 - Volume 8 - Issue 6 - p 530-539

Other references: 

 PMID: 32058370 
 PMID: 20228689 
 PMID: 29979221 
 PMID: 29490185 
 PMID: 29347874 
 PMID: 27695824 
 PMID: 18184957 
 PMID: 12186604 

Send us Fan Mail

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!

About our Guests: 

Dr. Warren Zuckerman is an associate professor of pediatrics as well as the associate director of the pediatric cardiology division at the Columbia University College of Physicians and Surgeons in New York. He completed both his pediatric residency and his cardiology fellowship at Columbia University College of Physicians and Surgeons. He is now a practicing pediatric cardiologist at Morgan Stanley Children’s Hospital. His research interests include pediatric cardiomyopathies, donor- and recipient-related issues surrounding pediatric heart transplantation, and drug therapies for prevention and treatment of graft rejection following heart transplantation.

Gav Apfel is a CICU hospitalist at Columbia University College of Physicians and Surgeons. He completed his residency training at Columbia University College of Physicians and Surgeons and will be joining the Columbia University’s critical care fellowship program in July 2023. He is interested in pursuing a career in cardiac intensive care. 

Learning Objectives:

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

1. Describe the common indications for pediatric heart transplant.
2. Recall the goals of preoperative management of heart failure patients and medical optimization for heart transplant.
3. Recall the general surgical strategies for cardiac implantation. 
4. Recognize the key information provided in surgical and anesthesia handover that will affect postoperative management.
5. Recognize the common and important postoperative complications and develop an approach to their management.
6. Develop a mental framework of the expected postoperative CICU course with a focus on common or important barriers to ICU discharge.
7. Recall important long-term complications of heart transplant with an emphasis on those that might result in critical illness.

Send us Fan Mail

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!

About our Guests: 

Dr. Warren Zuckerman is an associate professor of pediatrics as well as the associate director of the pediatric cardiology division at the Columbia University College of Physicians and Surgeons in New York. He completed both his pediatric residency and his cardiology fellowship at Columbia University College of Physicians and Surgeons. He is now a practicing pediatric cardiologist at Morgan Stanley Children’s Hospital. His research interests include pediatric cardiomyopathies, donor- and recipient-related issues surrounding pediatric heart transplantation, and drug therapies for prevention and treatment of graft rejection following heart transplantation.

Gav Apfel is a CICU hospitalist at Columbia University College of Physicians and Surgeons. He completed his residency training at Columbia University College of Physicians and Surgeons and will be joining the Columbia University’s critical care fellowship program in July 2023. He is interested in pursuing a career in cardiac intensive care. 

Learning Objectives:

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

1. Describe the common indications for pediatric heart transplant.
2. Recall the goals of preoperative management of heart failure patients and medical optimization for heart transplant.
3. Recall the general surgical strategies for cardiac implantation. 
4. Recognize the key information provided in surgical and anesthesia handover that will affect postoperative management.
5. Recognize the common and important postoperative complications and develop an approach to their management.
6. Develop a mental framework of the expected postoperative CICU course with a focus on common or important barriers to ICU discharge.
7. Recall important long-term complications of heart transplant with an emphasis on those that might result in critical illness.

Send us Fan Mail

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!

Megan & Ross Maenius are parents to Mila and patient advocates at Children's Medical Center Dallas. They have an incredible story to tell about their child's journey that may help the next time you are caring for a patient with chronic medical complexity in the pediatric ICU.

Erin Gordon, D.O. is an Associate Professor of Pediatrics at University of Texas Southwestern and an intensivist in the pediatric cardiac intensive care unit. Dr. Gordon is the medical director of the inpatient developmental care program and directly involved in creating an environment that fosters the growth and development of the congenital heart disease population, including parental mental health and resilience. Her passion for patient and family advocacy has led to her desire to bring a louder voice to the concept of a “primary” intensivist.

Learning objectives:

After listening to this episode, learners should be able to:

1. Recognize the parental consequences of children with complex chronic conditions and those requiring a prolonged ICU stay.
2. Recognize aspects of ICU care that limit effective communication between parents/caregivers and clinicians.
3. Discuss strategies to improve communication between parents/caregivers and clinicians including the role of a primary intensivist program.
4. Discuss ways that parents/caregivers and clinicians can partner together to improve the care provided to children in the ICU.

Send us Fan Mail

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!

About our guests:

Jeffrey Edwards, M.D is an Associate Professor of Pediatrics at Columbia University and a pediatric intensivist at Morgan Stanley Children’s Hospital in New York. He is an active physician-investigator with clinical and research interests in children with complex chronic conditions and technology-dependence. 

Erin Gordon, D.O. is an Assistant Professor of Pediatrics at University of Texas Southwestern and an intensivist in the pediatric cardiac intensive care unit. Dr. Gordon is the medical director of the inpatient developmental care program and directly involved in creating an environment that fosters the growth and development of the congenital heart disease population, including parental mental health and resilience. Her passion for patient and family advocacy has led to her desire to bring a louder voice to the concept of a “primary” intensivist.

Learning objectives:

After listening to this series of episodes, learners should be able to discuss:

1. The discrepant health-related outcomes of long-stay patients (LSP) and those with complex chronic conditions (CCC) in the PICU.
2. Barriers to delivering effective care to LSPs and those with CCC in the PICU.
3. Strategies to improve continuity of care to LSPs and to those with CCC in the PICU.
4. The rationale and evidence supporting the use of a primary intensivist program in the PICU.
5. Patient eligibility criteria and best practices of a primary intensivist program with an emphasis on equity and minimizing the risk of bias. 
6. Physician specific and healthcare system related strategies to maintaining a successful primary intensivist program.
7. The role of a PICU fellow in providing care similar to a primary intensivist.
8. Next steps in implementation and research of primary intensivists in PICUs.

Send us Fan Mail

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!

About our guests:

Jeffrey Edwards, M.D is an Associate Professor of Pediatrics at Columbia University and a pediatric intensivist at Morgan Stanley Children’s Hospital in New York. He is an active physician-investigator with clinical and research interests in children with complex chronic conditions and technology-dependence. 

Erin Gordon, D.O. is an Assistant Professor of Pediatrics at University of Texas Southwestern and an intensivist in the pediatric cardiac intensive care unit. Dr. Gordon is the medical director of the inpatient developmental care program and directly involved in creating an environment that fosters the growth and development of the congenital heart disease population, including parental mental health and resilience. Her passion for patient and family advocacy has led to her desire to bring a louder voice to the concept of a “primary” intensivist.

Learning objectives:

After listening to this series of episodes, learners should be able to discuss:

1. The discrepant health-related outcomes of long-stay patients (LSP) and those with complex chronic conditions (CCC) in the PICU.
2. Barriers to delivering effective care to LSPs and those with CCC in the PICU.
3. Strategies to improve continuity of care to LSPs and to those with CCC in the PICU.
4. The rationale and evidence supporting the use of a primary intensivist program in the PICU.
5. Patient eligibility criteria and best practices of a primary intensivist program with an emphasis on equity and minimizing the risk of bias. 
6. Physician specific and healthcare system related strategies to maintaining a successful primary intensivist program.
7. The role of a PICU fellow in providing care similar to a primary intensivist.
8. Next steps in implementation and research of primary intensivists in PICUs.

Send us Fan Mail

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. Yurasek is a graduate of the Columbia University College of Physicians and Surgeons. He completed his pediatric residency at Children’s Hospital of Boston followed by a pediatric cardiology fellowship also at Boston Children’s and a PICU fellowship at Massachusetts General Hospital. He is now a CICU attending and the director of critical care simulation at Children’s National Hospital in Washington, DC. 

Objectives for this series:
1. Understand the physiologic considerations that influence preoperative care in the cardiac intensive care unit (CICU).
2. Recall the goals and general steps of operative repair.
3. Recognize the key information provided in post-op handoff that will affect management.
4. Recognize important postoperative complications and develop an approach to their management.
5. Develop a mental framework of the expected postoperative CICU course with a focus on barriers to ICU discharge.

Support the show

Send us Fan Mail

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. Yurasek is a graduate of the Columbia University College of Physicians and Surgeons. He completed his pediatric residency at Children’s Hospital of Boston followed by a pediatric cardiology fellowship also at Boston Children’s and a PICU fellowship at Massachusetts General Hospital. He is now a CICU attending and the director of critical care simulation at Children’s National Hospital in Washington, DC. 

Objectives for this series:
1. Understand the physiologic considerations that influence preoperative care in the cardiac intensive care unit (CICU).
2. Recall the goals and general steps of operative repair.
3. Recognize the key information provided in post-op handoff that will affect management.
4. Recognize important postoperative complications and develop an approach to their management.
5. Develop a mental framework of the expected postoperative CICU course with a focus on barriers to ICU discharge.
Support the show

Send us Fan Mail

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!