PedsCrit

Learning Objectives:

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

1. The physiologic rationale supporting the use of airway pressure release ventilation (APRV) in ARDS. 
2. The patient populations most likely to benefit from APRV.
3. Key published evidence that informs our use of APRV in critical care.
4. An expert approach to managing a patient with APRV.
5. Next steps in research that will direct our understanding of the use of APRV in pediatric critical care.

About our Guest: 

Dr. Palen Mallory is an assistant professor of pediatrics at Duke University and a pediatric intensivist at Duke Children's Hospital. She completed medical school at Virginia Commonwealth University, a pediatric residency at Emory University, and a critical care fellowship at Vanderbilt University. She is interested in respiratory care research, including ECMO, respiratory failure, and ARDS.

Selected References:

1. Mallory, P., & Cheifetz, I. (2020). A comprehensive review of the use and understanding of airway pressure release ventilation. Expert Review of Respiratory Medicine, 14(3), 307–315. https://doi.org/10.1080/17476348.2020.1708719
2. Frawley, P. M., & Habashi, N. M. (2004). Airway pressure release ventilation and pediatrics: Theory and practice. Critical Care Nursing Clinics of North America, 16(3 SPEC. ISS.), 337–348. https://doi.org/10.1016/J.CCELL.2004.04.003
3. Fredericks, A. S., Bunker, M. P., Gliga, L. A., Ebeling, C. G., Ringqvist, J. R. B., Heravi, H., Manley, J., Valladares, J., & Romito, B. T. (2020). Airway Pressure Release Ventilation: A Review of the Evidence, Theoretical Benefits, and Alternative Titration Strategies. Clinical Medicine Insights: Circulatory, Respiratory and Pulmonary Medicine, 14. https://doi.org/10.1177/1179548420903297
4. APRV Guideline - EMCrit Project. (n.d.). Retrieved March 30, 2025, from https://emcrit.org/squirt/aprv/
5. Andrews P, Shiber J, Madden M, Nieman GF, Camporota L, Habashi NM. Myths and Misconceptions of Airway Pressure Release Ventilation: Getting Past the Noise and on to the Signal. Front Physiol. 2022 Jul 25;13:928562. doi: 10.3389/fphys.2022.928562. PMID: 35957991; PMCID: PMC9358044.

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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!

We are so thankful for help from our guests:

Melissa (MJ) Sacco, MD

Andrew Parsons, MD

Learning Objective:

By the end of this podcast, listeners should be able to develop an expert-guided approach to identifying and helping trainees improve deficits in diagnostic reasoning, complex decision-making, and effective communication of complicated clinical situations within the healthcare team.

References:

Parsons AS, Wijesekera TP, Rencic JJ. The Management Script: A Practical Tool for Teaching Management Reasoning. Acad Med. 2020 Aug;95(8):1179-1185. 

Peterson BD, Magee CD, Martindale JR, Dreicer JJ, Mutter MK, Young G, Sacco MJ, Parsons LC, Collins SR, Warburton KM, Parsons AS. REACT: Rapid Evaluation Assessment of Clinical Reasoning Tool. J Gen Intern Med. 2022 Jul;37(9):2224-2229. 

Want to learn more, check out Dr. Parson's book: Clinical Reasoning: Coaching the Struggling Medical Learner

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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!

About our Guest: 

Dr. Omar Alibrahim is a professor of pediatrics at Duke University and a pediatric intensivist at Duke Children's Hospital. He completed his Pediatric Residency and Chief Residency at St. Joseph's Children's Hospital, followed by Pediatric Critical Care Fellowship at the University of Buffalo. He served as the Pediatric Critical Care Division chief, the PICU Medical Director, and the PCCM fellowship Director in Buffalo, NY, for more than 8 years, during which he worked with the pulmonology and respiratory therapy divisions to develop a negative pressure ventilation program for acute respiratory failure. In 2021 Dr. Alibrahim was recruited to Duke Children's Hospital and now serves as the PICU Medical Director and the program director for the Pediatric Critical Care Fellowship. 

Learning Objectives: 

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

1. Critique the physiologic rationale for negative pressure ventilation (NPV) in acute respiratory failure.
2. Understand the experience of introducing a novel form of respiratory support in a PICU.
3. Describe the stepwise escalation of NPV settings often used in acute respiratory failure.

References:

1. Derusso, M., Miller, A. G., Caccamise, M., & Alibrahim, O. (2024). Negative-Pressure Ventilation in the Pediatric ICU. Respiratory Care, 69(3), 354–365. https://doi.org/10.4187/RESPCARE.11193
2. Hassinger AB, Breuer RK, Nutty K, Ma CX, Al Ibrahim OS. Negative-Pressure Ventilation in Pediatric Acute Respiratory Failure. Respir Care. 2017 Dec;62(12):1540-1549. doi: 10.4187/respcare.05531. Epub 2017 Aug 31. PMID: 28860332.
3. Deshpande SR, Maher KO. Long term negative pressure ventilation: Rescue for the failing fontan? World J Cardiol. 2014 Aug 26;6(8):861-4. doi: 10.4330/wjc.v6.i8.861. PMID: 25228965; PMCID: PMC4163715.

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 Guest: 

Dr. Omar Alibrahim is a professor of pediatrics at Duke University and a pediatric intensivist at Duke Children's Hospital. He completed his Pediatric Residency and Chief Residency at St. Joseph's Children's Hospital, followed by Pediatric Critical Care Fellowship at the University of Buffalo. He served as the Pediatric Critical Care Division chief, the PICU Medical Director, and the PCCM fellowship Director in Buffalo, NY, for more than 8 years, during which he worked with the pulmonology and respiratory therapy divisions to develop a negative pressure ventilation program for acute respiratory failure. In 2021 Dr. Alibrahim was recruited to Duke Children's Hospital and now serves as the PICU Medical Director and the program director for the Pediatric Critical Care Fellowship. 

Learning Objectives: 

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

1. Critique the physiologic rationale for negative pressure ventilation (NPV) in acute respiratory failure.
2. Understand the experience of introducing a novel form of respiratory support in a PICU.
3. Describe the stepwise escalation of NPV settings often used in acute respiratory failure.

References:

1. Derusso, M., Miller, A. G., Caccamise, M., & Alibrahim, O. (2024). Negative-Pressure Ventilation in the Pediatric ICU. Respiratory Care, 69(3), 354–365. https://doi.org/10.4187/RESPCARE.11193
2. Hassinger AB, Breuer RK, Nutty K, Ma CX, Al Ibrahim OS. Negative-Pressure Ventilation in Pediatric Acute Respiratory Failure. Respir Care. 2017 Dec;62(12):1540-1549. doi: 10.4187/respcare.05531. Epub 2017 Aug 31. PMID: 28860332.
3. Deshpande SR, Maher KO. Long term negative pressure ventilation: Rescue for the failing fontan? World J Cardiol. 2014 Aug 26;6(8):861-4. doi: 10.4330/wjc.v6.i8.861. PMID: 25228965; PMCID: PMC4163715.

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 Guest: 

Kyle Rehder, MD, is a Professor of Pediatrics at Duke University and a pediatric intensivist at Duke Children's Hospital, where he serves as the Vice-Chair of Pediatric Education. He completed his medical school, residency, and chief residency at UNC-Chapel Hill, followed by his fellowship at Duke University. His research is focused on team development and evaluation of advanced respiratory support in the PICU.

Learning Objective:

Develop an expert-based approach to diagnosing and managing common presentations of patient-ventilator asynchrony in the PICU.

References: 

Flynn, B. C., Miranda, H. G., Mittel, A. M., & Moitra, V. K. (2022). Stepwise Ventilator Waveform Assessment to Diagnose Pulmonary Pathophysiology. Anesthesiology, 137(1), 85–92. https://doi.org/10.1097/ALN.0000000000004220

Patient-Ventilator Dyssynchrony • LITFL • CCC Ventilation

Citation:

Rehder K, Hodges Z, Shanklin A. Patient-Ventilator Asynchrony. PedsCrit. Online Podcast. 04/2025. https://www.pedscrit.com/patient-ventilator-asynchrony-with-dr-kyle-rehder/ 

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!

Thanks to Dr. Abhinav Totapally who is a pediatric intensivist at Nicklaus Children's Hospital in Miami and Dr. Brian Bridges, the Division Chief of Pediatric Critical Care Medicine at the Medical University of South Carolina in Charleston for joining us for this series. 

Check out their paper published in PCCM in January 2025

Learning Objectives:

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

1. The rationale supporting and the limitations of using VA ECMO for children with refractory septic shock.
2. Patient selection in the use of VA ECMO for children with refractory septic shock.
3. The benefits and risks of common cannulation strategies for VA ECMO in children with refractory septic shock.
4. An expert approach to supporting children with refractory septic shock on VA ECMO.

Reference:

Totapally A, Stark R, Danko M, Chen H, Altheimer A, Hardison D, Malone MP, Zivick E, Bridges B. Central or Peripheral Venoarterial Extracorporeal Membrane Oxygenation for Pediatric Sepsis: Outcomes Comparison in the Extracorporeal Life Support Organization Dataset, 2000-2021. Pediatr Crit Care Med. 2025 Jan 23.

Citation: Totapally A, Bridges B, Shanklin A, Hodges Z. VA ECMO in Refractory Septic Shock. PedsCrit. Online Podcast. 03/2025. https://www.pedscrit.com/va-ecmo-in-refractory-septic-shock-part-1/ 

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!

Thanks to Dr. Abhinav Totapally who is a pediatric intensivist at Nicklaus Children's Hospital in Miami and Dr. Brian Bridges, the Division Chief of Pediatric Critical Care Medicine at the Medical University of South Carolina in Charleston for joining us for this series. 

Check out their paper published in PCCM in January 2025

Learning Objectives:

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

1. The rationale supporting and the limitations of using VA ECMO for children with refractory septic shock.
2. Patient selection in the use of VA ECMO for children with refractory septic shock.
3. The benefits and risks of common cannulation strategies for VA ECMO in children with refractory septic shock.
4. An expert approach to supporting children with refractory septic shock on VA ECMO.

Reference:

Totapally A, Stark R, Danko M, Chen H, Altheimer A, Hardison D, Malone MP, Zivick E, Bridges B. Central or Peripheral Venoarterial Extracorporeal Membrane Oxygenation for Pediatric Sepsis: Outcomes Comparison in the Extracorporeal Life Support Organization Dataset, 2000-2021. Pediatr Crit Care Med. 2025 Jan 23.

Citation: Totapally A, Bridges B, Shanklin A, Hodges Z. VA ECMO in Refractory Septic Shock. PedsCrit. Online Podcast. 03/2025. https://www.pedscrit.com/va-ecmo-in-refractory-septic-shock-part-1/ 

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 guest:

Ilyse Genser is a pediatric neurologist and the associate program director of the pediatric neurology combined residency program at Children's National Hospital. She is originally from Westchester, New York, where she attended medical school at New York Medical College. She then completed her general pediatrics training at Brown University in Providence, Rhode Island, and came to Washington, D.C., to complete her child neurology training at Children's National Hospital.

 Learning Objective:

Develop an expert-guided approach to choosing appropriate neuroimaging techniques for critically ill children.

References: 

1. Shulman, J. G., & Abdalkader, M. (2023). Imaging of Central Nervous System Ischemia. http://journals.lww.com/continuum
2. Hakimi, R. (2023). Imaging of Central Nervous System Hemorrhage. http://journals.lww.com/continuum
3. Jordan, J. T., & Gerstner, E. R. (2023). Imaging of Brain Tumors. http://journals.lww.com/continuum
4. Barnette, A. R., Horbar, J. D., Soll, R. F., Pfister, R. H., Nelson, K. B., Kenny, M. J., Raju, T. N. K., Bingham, P. M., & Inder, T. E. (2014). Neuroimaging in the Evaluation of Neonatal Encephalopathy. PEDIATRICS, 133(6), e1508–e1517. https://doi.org/10.1542/peds.2013-4247

Citation: Genser I, Hodges Z, Shanklin A. Neuroimaging for the Pediatric Intensivist. PedsCrit. Online Podcast. 03/2025. https://www.pedscrit.com/neuroimaging-for-the-pediatric-intensivist-with-dr-ilyse-genser-part-1/

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 guest:

Ilyse Genser is a pediatric neurologist and the associate program director of the pediatric neurology combined residency program at Children's National Hospital. She is originally from Westchester, New York, where she attended medical school at New York Medical College. She then completed her general pediatrics training at Brown University in Providence, Rhode Island, and came to Washington, D.C., to complete her child neurology training at Children's National Hospital.

 Learning Objective:

Develop an expert-guided approach to choosing appropriate neuroimaging techniques for critically ill children.

References: 

1. Shulman, J. G., & Abdalkader, M. (2023). Imaging of Central Nervous System Ischemia. http://journals.lww.com/continuum
2. Hakimi, R. (2023). Imaging of Central Nervous System Hemorrhage. http://journals.lww.com/continuum
3. Jordan, J. T., & Gerstner, E. R. (2023). Imaging of Brain Tumors. http://journals.lww.com/continuum
4. Barnette, A. R., Horbar, J. D., Soll, R. F., Pfister, R. H., Nelson, K. B., Kenny, M. J., Raju, T. N. K., Bingham, P. M., & Inder, T. E. (2014). Neuroimaging in the Evaluation of Neonatal Encephalopathy. PEDIATRICS, 133(6), e1508–e1517. https://doi.org/10.1542/peds.2013-4247

Citation: Genser I, Hodges Z, Shanklin A. Neuroimaging for the Pediatric Intensivist. PedsCrit. Online Podcast. 03/2025. https://www.pedscrit.com/neuroimaging-for-the-pediatric-intensivist-with-dr-ilyse-genser-part-1/

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 Guest: 

Dr. Philip C. Spinella is a professor in the Departments of Surgery and Critical Care Medicine and the Director of the Trauma and Transfusion Medicine Research Center at the University of Pittsburgh. He also co-founded the THOR network for trauma and hemostasis research and has as been involved with multiple nationally-funded research programs.

References:

Use of whole blood in pediatric trauma: a narrative review - PubMed (nih.gov)

Fresh whole blood transfusions in coalition military, foreign national, and enemy combatant patients during Operation Iraqi Freedom at a U.S. combat support hospital - PubMed (nih.gov)

Consensus Recommendations for RBC Transfusion Practice in Critically Ill Children From the Pediatric Critical Care Transfusion and Anemia Expertise Initiative - PubMed (nih.gov)

Whole Blood Transfusion - PubMed (nih.gov)

Pediatric traumatic hemorrhagic shock consensus conference recommendations - PubMed (nih.gov)

Early Cold Stored Platelet Transfusion Following Severe Injury: A Randomized Clinical Trial - PubMed (nih.gov)

Precision Platelet Transfusion Medicine is Needed to Improve Outcomes - PubMed (nih.gov)

Just chill—it's worth it! (wiley.com)

Citation: Spinella P, Hodges Z, Shanklin A. From the Battlefield to the Bedside: The Past, Present, and Future of Blood Product Resuscitation. PedsCrit. Online Podcast. 02/2025. https://www.pedscrit.com/from-the-battlefield-to-the-bedside-the-past-present-and-future-of-blood-product-resuscitation-wi/ 

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!