PedsCrit

Dr. Whyte-Nesfield is a Critical Care attending at Children’s National Hospital in Washington, DC. She completed her medical degree in her home country of Grenada at St. George’s University, and her fellowship in Pediatric Critical Care at Penn State Health Children’s Hospital, PA. Mekela’s research interest is the role of parent and child traumatic stress management in improving long term outcomes of children in the PICU; she ran a multi-center prevalence study during her fellowship. She is also interested in advanced ventilator modes and educating the next generation of intensivists about pulmonary physiology.

Objectives:
After listening to this episode, listeners should be able to:

1. Define indications for intubation in a patient with asthma.
2. Review adjunct therapies, including high-dose steroids, mag, epi, terbutaline, isoproterenol, aminophylline, isoflurane, and manual decompression of the chest.
3. Identify the physiologic and logistic rationale supporting each mode of mechanical ventilation in asthma (PRVC vs PCPS).
4. Identify the benefits and risks of paralyzing an intubated asthmatic.
5.  Discuss the relationshiop between static compliance, dynamic compliance, and reversible bronchoconstriction.  
6. Describe the complications of mechanical ventilation in asthma, including indications for ECMO.

References:

1. Manual external chest compression reverses respiratory failure in children with severe air trapping. Pediatric Pulmonology, 56(12), 3887–3890. https://doi.org/10.1002/ppul.25689
2.  Mechanical ventilation of the intubated asthmatic: How much do we really know? *. Pediatric Critical Care Medicine, 5(2), 191–192. https://doi.org/10.1097/01.CCM.0000113929.14813.51
3. Volatile Anesthetic Rescue Therapy in Children With Acute Asthma. Pediatric Critical Care Medicine, 14(4), 343–350. https://doi.org/10.1097/PCC.0b013e3182772e29
4. Pressure-controlled ventilation in children with severe status asthmaticus*. Pediatric Critical Care Medicine, 5(2), 133–138. https://doi.org/10.1097/01.PCC.0000112374.68746.E8
5. Endotracheal intubation and pediatric status asthmaticus: Site of original care affects treatment*. Pediatric Critical Care Medicine, 8(2), 91–95. https://doi.org/10.1097/01.PCC.0000257115.02573.FC

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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!

Dr. Whyte-Nesfield is a Critical Care attending at Children’s National Hospital in Washington, DC. She completed her medical degree in her home country of Grenada at St. George’s University, and her fellowship in Pediatric Critical Care at Penn State Health Children’s Hospital, PA. Mekela’s research interest is the role of parent and child traumatic stress management in improving long term outcomes of children in the PICU; she ran a multi-center prevalence study during her fellowship. She is also interested in advanced ventilator modes and educating the next generation of intensivists about pulmonary physiology.

Objectives:
After listening to this episode, listeners should be able to:

1. Define indications for intubation in a patient with asthma.
2. Review adjunct therapies, including high-dose steroids, mag, epi, terbutaline, isoproterenol, aminophylline, isoflurane, and manual decompression of the chest.
3. Identify the physiologic and logistic rationale supporting each mode of mechanical ventilation in asthma (PRVC vs PCPS).
4. Identify the benefits and risks of paralyzing an intubated asthmatic.
5.  Discuss the relationshiop between static compliance, dynamic compliance, and reversible bronchoconstriction.  
6. Describe the complications of mechanical ventilation in asthma, including indications for ECMO.

References:

1. Manual external chest compression reverses respiratory failure in children with severe air trapping. Pediatric Pulmonology, 56(12), 3887–3890. https://doi.org/10.1002/ppul.25689
2.  Mechanical ventilation of the intubated asthmatic: How much do we really know? *. Pediatric Critical Care Medicine, 5(2), 191–192. https://doi.org/10.1097/01.CCM.0000113929.14813.51
3. Volatile Anesthetic Rescue Therapy in Children With Acute Asthma. Pediatric Critical Care Medicine, 14(4), 343–350. https://doi.org/10.1097/PCC.0b013e3182772e29
4. Pressure-controlled ventilation in children with severe status asthmaticus*. Pediatric Critical Care Medicine, 5(2), 133–138. https://doi.org/10.1097/01.PCC.0000112374.68746.E8
5. Endotracheal intubation and pediatric status asthmaticus: Site of original care affects treatment*. Pediatric Critical Care Medicine, 8(2), 91–95. https://doi.org/10.1097/01.PCC.0000257115.02573.FC

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. Yehya is a graduate of the University of California at Berkeley and the University of California at Los Angeles School of Medicine. After completing pediatrics training at Children’s Hospital of Los Angeles, he completed his pediatric critical care fellowship at Children’s Hospital of Philadelphia (CHOP), and joined the faculty after graduation in 2011. He is currently an Assistant Professor of Anesthesiology and Critical Care and Pediatrics at the Perelman School of Medicine at the University of Pennsylvania and an attending physician in the pediatric intensive care unit at CHOP.

Dr. Yehya’s research interests encompass all aspects of pediatric respiratory failure, with a particular emphasis on pediatric acute respiratory syndrome (ARDS) and mechanical ventilation. ARDS consists of sudden, severe flooding of the lungs in response to an inflammatory insult causing difficulty breathing, frequently requiring mechanical ventilation. Sepsis is a leading cause of ARDS in children. His long-term goal is better characterization of ARDS in children and to test therapies designed to improve outcomes. His NIH-funded work is assessing the utility of specific plasma biomarkers in pediatric ARDS, with subsequent proteomic characterization and testing in pre-clinical models. Dr. Yehya has several active studies involving biomarkers, clinical epidemiology, and pathophysiological mechanisms in the field of pediatric ARDS, and is involved in several multicenter and multinational collaborations.

Objectives:

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

1. Understand the role of heated high-flow nasal cannula and non-invasive mechanical ventilation in the management of pediatric acute respiratory distress syndrome (PARDS).
2. Recognize the potential for patient self-inflicted lung injury in PARDS.
3. Recognize high-risk situations when non-invasive mechanical ventilation is relatively contraindicated in favor of intubation and mechanical ventilation.

Acknowledgement:
Thank you to Dr. Nick Bartel for his help in creating learning objectives for this series.

Selected references:

PMID: 10793162
PMID: 25693014
PMID: 15269312
PMID: 30361119
PMID: 17426195
PMID: 31112383
PMID: 25647235
PMID: 19001507
PMID: 32043986
PMID: 15671432

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. Yehya is a graduate of the University of California at Berkeley and the University of California at Los Angeles School of Medicine. After completing pediatrics training at Children’s Hospital of Los Angeles, he completed his pediatric critical care fellowship at Children’s Hospital of Philadelphia (CHOP), and joined the faculty after graduation in 2011. He is currently an Assistant Professor of Anesthesiology and Critical Care and Pediatrics at the Perelman School of Medicine at the University of Pennsylvania and an attending physician in the pediatric intensive care unit at CHOP.

Dr. Yehya’s research interests encompass all aspects of pediatric respiratory failure, with a particular emphasis on pediatric acute respiratory syndrome (ARDS) and mechanical ventilation. ARDS consists of sudden, severe flooding of the lungs in response to an inflammatory insult causing difficulty breathing, frequently requiring mechanical ventilation. Sepsis is a leading cause of ARDS in children. His long-term goal is better characterization of ARDS in children and to test therapies designed to improve outcomes. His NIH-funded work is assessing the utility of specific plasma biomarkers in pediatric ARDS, with subsequent proteomic characterization and testing in pre-clinical models. Dr. Yehya has several active studies involving biomarkers, clinical epidemiology, and pathophysiological mechanisms in the field of pediatric ARDS, and is involved in several multicenter and multinational collaborations.

Objectives:

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

1. Understand the role of heated high-flow nasal cannula and non-invasive mechanical ventilation in the management of pediatric acute respiratory distress syndrome (PARDS).
2. Recognize the potential for patient self-inflicted lung injury in PARDS.
3. Recognize high-risk situations when non-invasive mechanical ventilation is relatively contraindicated in favor of intubation and mechanical ventilation.

Acknowledgement:
Thank you to Dr. Nick Bartel for his help in creating learning objectives for this series.

Selected references:

PMID: 10793162
PMID: 25693014
PMID: 15269312
PMID: 30361119
PMID: 17426195
PMID: 31112383
PMID: 25647235
PMID: 19001507
PMID: 32043986
PMID: 15671432

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. Yehya is a graduate of the University of California at Berkeley and the University of California at Los Angeles School of Medicine. After completing pediatrics training at Children’s Hospital of Los Angeles, he completed his pediatric critical care fellowship at Children’s Hospital of Philadelphia (CHOP), and joined the faculty after graduation in 2011. He is currently an Assistant Professor of Anesthesiology and Critical Care and Pediatrics at the Perelman School of Medicine at the University of Pennsylvania and an attending physician in the pediatric intensive care unit at CHOP.

Dr. Yehya’s research interests encompass all aspects of pediatric respiratory failure, with a particular emphasis on pediatric acute respiratory syndrome (ARDS) and mechanical ventilation. ARDS consists of sudden, severe flooding of the lungs in response to an inflammatory insult causing difficulty breathing, frequently requiring mechanical ventilation. Sepsis is a leading cause of ARDS in children. His long-term goal is better characterization of ARDS in children and to test therapies designed to improve outcomes. His NIH-funded work is assessing the utility of specific plasma biomarkers in pediatric ARDS, with subsequent proteomic characterization and testing in pre-clinical models. Dr. Yehya has several active studies involving biomarkers, clinical epidemiology, and pathophysiological mechanisms in the field of pediatric ARDS, and is involved in several multicenter and multinational collaborations.

Objectives:

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

1. Understand the role of heated high-flow nasal cannula and non-invasive mechanical ventilation in the management of pediatric acute respiratory distress syndrome (PARDS).
2. Recognize the potential for patient self-inflicted lung injury in PARDS.
3. Recognize high-risk situations when non-invasive mechanical ventilation is relatively contraindicated in favor of intubation and mechanical ventilation.

Acknowledgement:
Thank you to Dr. Nick Bartel for his help in creating learning objectives for this series.

Selected references:

PMID: 10793162
PMID: 25693014
PMID: 15269312
PMID: 30361119
PMID: 17426195
PMID: 31112383
PMID: 25647235
PMID: 19001507
PMID: 32043986
PMID: 15671432

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. Yehya is a graduate of the University of California at Berkeley and the University of California at Los Angeles School of Medicine. After completing pediatrics training at Children’s Hospital of Los Angeles, he completed his pediatric critical care fellowship at Children’s Hospital of Philadelphia (CHOP), and joined the faculty after graduation in 2011. He is currently an Assistant Professor of Anesthesiology and Critical Care and Pediatrics at the Perelman School of Medicine at the University of Pennsylvania and an attending physician in the pediatric intensive care unit at CHOP.

Dr. Yehya’s research interests encompass all aspects of pediatric respiratory failure, with a particular emphasis on pediatric acute respiratory syndrome (ARDS) and mechanical ventilation. ARDS consists of sudden, severe flooding of the lungs in response to an inflammatory insult causing difficulty breathing, frequently requiring mechanical ventilation. Sepsis is a leading cause of ARDS in children. His long-term goal is better characterization of ARDS in children and to test therapies designed to improve outcomes. His NIH-funded work is assessing the utility of specific plasma biomarkers in pediatric ARDS, with subsequent proteomic characterization and testing in pre-clinical models. Dr. Yehya has several active studies involving biomarkers, clinical epidemiology, and pathophysiological mechanisms in the field of pediatric ARDS, and is involved in several multicenter and multinational collaborations.

Objectives:

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

1. Understand the role of heated high-flow nasal cannula and non-invasive mechanical ventilation in the management of pediatric acute respiratory distress syndrome (PARDS).
2. Recognize the potential for patient self-inflicted lung injury in PARDS.
3. Recognize high-risk situations when non-invasive mechanical ventilation is relatively contraindicated in favor of intubation and mechanical ventilation.

Acknowledgement:
Thank you to Dr. Nick Bartel for his help in creating learning objectives for this series.

Selected references:

PMID: 10793162
PMID: 25693014
PMID: 15269312
PMID: 30361119
PMID: 17426195
PMID: 31112383
PMID: 25647235
PMID: 19001507
PMID: 32043986
PMID: 15671432

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!

Melinda Cory, M.D., is an Assistant Professor in the Department of Pediatrics at UT Southwestern Medical Center. She earned her medical degree at UT Southwestern, where she also completed her residency in pediatrics. She gained advanced training through fellowships in pediatric cardiology and pediatric critical care medicine at Emory University School of Medicine.

Board certified in pediatrics, pediatric cardiology, and pediatric critical care, she attends in the cardiovascular intensive care unit at Children's Medical Center in Dallas, TX. She is also very active in medical education including serving as the associate program director for the pediatric cardiology fellowship program and helps lead the pediatric critical care simulation team.

Learning objectives:
After listening to this episode on atrioventricular septal defects, learners should be able to:

1. Recognize the relevant preoperative anatomy that influences operative plan and postoperative care in the cardiac intensive care unit (CICU).
2. Recall the goals and general options for operative repair.
3. Recognize the key information provided in surgical and anesthesia handover that will affect postoperative management.
4. Recognize the common and 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 common or important barriers to ICU discharge.

References:
Atrioventricular Septal Defects. Peter Sassalos MD, Ming-Sing Si MD, Richard G. Ohye MD, Edward L. Bove MD and Jennifer C. Romano MD, MS. Critical Heart Disease in Infants and Children, 50, 606-614.e2

Peterson JK, Setty SP, Knight JH, Thomas AS, Moller JH, Kochilas LK. Postoperative and long-term outcomes in children with Trisomy 21 and single ventricle palliation. Congenit Heart Dis. 2019 Sep;14(5):854-863. doi: 10.1111/chd.12823. Epub 2019 Jul 22. PMID: 31332952; PMCID: PMC7329297.

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. Parisa Kaviany is a former Children’s National Resident, she completed her pediatric pulmonology fellowship at Johns Hopkins and we were lucky enough to get her back as a pulmonologist. Dr. Kaviany’s research interest is health disparities among children with asthma. 

Dr. Maria Arroyo  did her pulmonology fellowship at Children’s National in DC and stayed as an attending, she also works at The HSC Pediatric Center, a subacute care facility in Washington, DC. Dr. Arroyo is THE person you want your patients’ parents to meet when they’re making the tracheostomy decision.

Objectives:
By the end of listening to this episode, learners should be able to:

1. Describe the typical stakeholders involved in a tracheostomy decision.
2. Understand the caregiver, spatial, and technical requirements of living at home with a tracheostomy.
3. Describe the requirements that must be met prior to discharge to an acute care facility.
4. Differentiate the ventilator weans that must take place prior to discharge home vs prior to discharge to an acute care facility. 

Mentioned in this episode:
Family Reflections: a website about deciding about home ventilation
ATS Trach Education PDF: A pediatric tracheostomy education PDF from the American Thoracic Society
Lilly's little lungs: one family's story of going home with a preemie who needs a trach and vent, the account follows her through a successful LTR.

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. Parisa Kaviany is a former Children’s National Resident, she completed her pediatric pulmonology fellowship at Johns Hopkins and we were lucky enough to get her back as a pulmonologist. Dr. Kaviany’s research interest is health disparities among children with asthma. 

Dr. Maria Arroyo  did her pulmonology fellowship at Children’s National in DC and stayed as an attending, she also works at The HSC Pediatric Center, a subacute care facility in Washington, DC. Dr. Arroyo is THE person you want your patients’ parents to meet when they’re making the tracheostomy decision.

Objectives:
By the end of listening to this episode, learners should be able to:

1. Describe the typical stakeholders involved in a tracheostomy decision.
2. Understand the caregiver, spatial, and technical requirements of living at home with a tracheostomy.
3. Describe the requirements that must be met prior to discharge to an acute care facility.
4. Differentiate the ventilator weans that must take place prior to discharge home vs prior to discharge to an acute care facility. 

Mentioned in this episode:
Family Reflections: a website about deciding about home ventilation
ATS Trach Education PDF: A pediatric tracheostomy education PDF from the American Thoracic Society
Lilly's little lungs: one family's story of going home with a preemie who needs a trach and vent, the account follows her through a successful LTR.

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. Laura Ortmann is an Associate Professor in the Department of Pediatrics at the University of Nebraska College of Medicine. She serves as the Medical Director of the Cardiovascular Intensive Care Unit at Children’s Hospital and Medical Center in Omaha, Nebraska. She a CPR researcher and a great medical educator. She is a host on the Healing Hearts Podcast featuring her ongoing cardiac lesions series and produces MedEd videos on YouTube at DrOrtmannCICU. 

After listening to this episode on Tetralogy of Fallot with Pulmonary Stenosis, learners should be able to:

1. Recognize the relevant preoperative anatomy that influences operative plan and postoperative 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 surgical and anesthesia handover that will affect postoperative management.
4. Recognize the common and 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 common or important barriers to ICU discharge.

References:

Ortmann LA, Keshary M, Bisselou KS, Kutty S, Affolter JT. Association Between Postoperative Dexmedetomidine Use and Arrhythmias in Infants After Cardiac Surgery. World J Pediatr Congenit Heart Surg. 2019 Jul;10(4):440-445. doi: 10.1177/2150135119842873. PMID: 31307294.

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!