PedsCrit

About our Guest: 

Debra Regier, M.D., Ph.D.,  is the chief of Genetics and Metabolism at Children's National Hospital in Washington, DC. Before transitioning to clinical medicine, Dr. Regier was a biochemist. She came to CNH as a combined pediatric genetics resident and later completed a metabolic fellowship at NIH and served as Children's National's medical genetics program director. 

Dr. Regier’s current work in educational outcomes research has led to federal, industry, and philanthropic funding of almost two million dollars. She has received multiple awards for her impact on rare disease education across the country and is the president-elect of the Society of Inherited Metabolic Disorders. 

Learning Objectives:

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

1. List the three main metabolic pathways and describe how they work together to make ATP

2. Describe the science behind the main diagnostic tests for inborn errors of metabolism

3. Explain the presenting symptoms and initial management of common, life-threatening inborn errors of metabolism. 

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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. Kristen Smith is the PICU medical director, critical care fellowship program director, and director of the nurse practitioner program at the University of Michigan C.S. Mott Children’s Hospital. She received her medical degree from the University of Toledo and completed her pediatric residency at Akron Children’s Hospital, followed by a critical care fellowship at Johns Hopkins. Dr. Smith’s research is focused on the long-term outcome of Pediatric Intensive Care Unit (PICU) survivors.

Dr. Carly Schmidt is a critical care fellow at the University of Michigan C.S. Mott Children’s Hospital. She received her medical degree from Case Western University and completed her pediatric residency at Brown University, where she also served as chief resident. Carly is interested in the intersection of the PICU and the community via transport medicine, advocacy, and outcomes. 

Learning Objectives:

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

1. Neuroprotective measures that should be provided to all pediatric patients with severe traumatic brain injury (TBI).
2. An expert, guideline-directed approach to managing a child with increased intracranial pressure due to severe TBI.

Reference:
Kochanek PM, Tasker RC, Bell MJ, Adelson PD, Carney N, Vavilala MS, Selden NR, Bratton SL, Grant GA, Kissoon N, Reuter-Rice KE, Wainwright MS. Management of Pediatric Severe Traumatic Brain Injury: 2019 Consensus and Guidelines-Based Algorithm for First and Second Tier Therapies. Pediatr Crit Care Med. 2019 Mar;20(3):269-279.

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. Kristen Smith is the PICU medical director, critical care fellowship program director, and director of the nurse practitioner program at the University of Michigan C.S. Mott Children’s Hospital. She received her medical degree from the University of Toledo and completed her pediatric residency at Akron Children’s Hospital, followed by a critical care fellowship at Johns Hopkins. Dr. Smith’s research is focused on the long-term outcome of Pediatric Intensive Care Unit (PICU) survivors.

Dr. Carly Schmidt is a critical care fellow at the University of Michigan C.S. Mott Children’s Hospital. She received her medical degree from Case Western University and completed her pediatric residency at Brown University, where she also served as chief resident. Carly is interested in the intersection of the PICU and the community via transport medicine, advocacy, and outcomes. 

Learning Objectives:

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

1. Neuroprotective measures that should be provided to all pediatric patients with severe traumatic brain injury (TBI).
2. An expert, guideline-directed approach to managing a child with increased intracranial pressure due to severe TBI.

Reference:
Kochanek PM, Tasker RC, Bell MJ, Adelson PD, Carney N, Vavilala MS, Selden NR, Bratton SL, Grant GA, Kissoon N, Reuter-Rice KE, Wainwright MS. Management of Pediatric Severe Traumatic Brain Injury: 2019 Consensus and Guidelines-Based Algorithm for First and Second Tier Therapies. Pediatr Crit Care Med. 2019 Mar;20(3):269-279.

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!

Stuart Goldstein, MD is a Professor of Pediatrics at the University of Cincinnati, where he serves as the Clark D. West Endowed Chair. He is a practicing pediatric nephrologist at Cincinnati Children’s where he also is the Director for the Center for Acute Care Nephrology and the Medical Director for the Pheresis Service. Dr Goldstein is the Founder and Principal Investigator for the Prospective Pediatric Acute Kidney Injury Research Group and has evaluated novel urinary AKI biomarkers in the pediatric critical care setting. 

Dr. Katherine Melink (at time of recording) is currently finishing her residency at Cincinnati Children's Hospital where she was able to conduct research in biomarkers for the prediction of kidney injury in critically ill children (particularly in the CICU). Her exposure to CRRT under physicians like Dr. Goldstein at Cincinnati Children's has served as a motivating factor to participate in this episode! She is excited to start PICU fellowship at Boston Children's Hospital in July.

Learning Objectives:

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

1. CRRT fundamentals, including how it differs from conventional hemodialysis and the rationale for its use in critically ill pediatric patients.
2. Key differences in ultrafiltration, diffusion, and convection and their clinical applications in CRRT.
3. Patient selection and indications for CRRT (AKI, fluid overload, toxic metabolite/ingestion among others)
4. Key evidence guiding use of CRRT in critically ill children.
5. Components of a CRRT prescription and guiding principles of how to titrate therapy.
6. Pitfalls and complications of CRRT
7. Common anticoagulation strategies in CRRT
8. General principles guiding liberation from CRRT.

Selected references:

Sutherland et al; ADQI 26 Workgroup. Epidemiology of acute kidney injury in children Pediatr Nephrol. 2024 Mar;39(3):919-928. doi: 10.1007/s00467-023-06164-w. Epub 2023 Oct 24. 

Basu et al. Derivation and validation of the renal angina index to improve the prediction of acute kidney injury in critically ill children. Kidney Int. 2014 Mar;85(3):659-67. doi: 10.1038/ki.2013.349. Epub 2013 Sep 18. PMID: 24048379; 

Fuhrman et al; ADQI 26 workgroup. A proposed framework for advancing acute kidney injury risk stratification and diagnosis in children. Pediatr Nephrol. 2024 Mar;39(3):929-939. doi: 10.1007/s00467-023-06133-3. Epub 2023 Sep 5. 

Alobaidi et al. Association Between Fluid Balance and Outcomes in Critically Ill Children: A Systematic Review and Meta-analysis. JAMA Pediatr. 2018 Mar 1;172(3):257-268.

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!

Stuart Goldstein, MD is a Professor of Pediatrics at the University of Cincinnati, where he serves as the Clark D. West Endowed Chair. He is a practicing pediatric nephrologist at Cincinnati Children’s where he also is the Director for the Center for Acute Care Nephrology and the Medical Director for the Pheresis Service. Dr Goldstein is the Founder and Principal Investigator for the Prospective Pediatric Acute Kidney Injury Research Group and has evaluated novel urinary AKI biomarkers in the pediatric critical care setting. 

Dr. Katherine Melink (at time of recording) is currently finishing her residency at Cincinnati Children's Hospital where she was able to conduct research in biomarkers for the prediction of kidney injury in critically ill children (particularly in the CICU). Her exposure to CRRT under physicians like Dr. Goldstein at Cincinnati Children's has served as a motivating factor to participate in this episode! She is excited to start PICU fellowship at Boston Children's Hospital in July.

Learning Objectives:

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

1. CRRT fundamentals, including how it differs from conventional hemodialysis and the rationale for its use in critically ill pediatric patients.
2. Key differences in ultrafiltration, diffusion, and convection and their clinical applications in CRRT.
3. Patient selection and indications for CRRT (AKI, fluid overload, toxic metabolite/ingestion among others)
4. Key evidence guiding use of CRRT in critically ill children.
5. Components of a CRRT prescription and guiding principles of how to titrate therapy.
6. Pitfalls and complications of CRRT
7. Common anticoagulation strategies in CRRT
8. General principles guiding liberation from CRRT.

Selected references:

Sutherland et al; ADQI 26 Workgroup. Epidemiology of acute kidney injury in children Pediatr Nephrol. 2024 Mar;39(3):919-928. doi: 10.1007/s00467-023-06164-w. Epub 2023 Oct 24. 

Basu et al. Derivation and validation of the renal angina index to improve the prediction of acute kidney injury in critically ill children. Kidney Int. 2014 Mar;85(3):659-67. doi: 10.1038/ki.2013.349. Epub 2013 Sep 18. PMID: 24048379; 

Fuhrman et al; ADQI 26 workgroup. A proposed framework for advancing acute kidney injury risk stratification and diagnosis in children. Pediatr Nephrol. 2024 Mar;39(3):929-939. doi: 10.1007/s00467-023-06133-3. Epub 2023 Sep 5. 

Alobaidi et al. Association Between Fluid Balance and Outcomes in Critically Ill Children: A Systematic Review and Meta-analysis. JAMA Pediatr. 2018 Mar 1;172(3):257-268.

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. Paul Sue is an associate professor of pediatrics at the Columbia University and Director of the Pediatric Transplant and Immunocompromised Host or “PITCH” Infectious Diseases Program at the Morgan Stanley Children’s Hospital in NY.  He completed his pediatric residency at Jacobi Medical Center at the Albert Einstein College of Medicine in the Bronx, and his fellowship in pediatric infectious diseases at Johns Hopkins University in Baltimore. He then moved to UT Southwestern in Dallas TX, where he served as director of Pediatric ICH ID service for the next 8 years, prior to his recent move back to NY.  His research interests include the impact of invasive fungal and viral infections in the immunocompromised host,  leveraging measures of functional immunity to improve infectious disease outcomes in high-risk patients,  and the emergence of community acquired multidrug resistant (MDR) bacterial infections in immunocompromised children. 

Sara Dong, MD is an adult and pediatric infectious disease physician at Emory University School of Medicine & Children’s Healthcare of Atlanta, where her clinical focus is transplant and immunocompromised host ID.  She earned her MD from the Medical University of South Carolina.  She completed her internal medicine and pediatrics (Med-Peds) residency and chief residency years at Ohio State University Wexner Medical Center and Nationwide Children’s Hospital, followed by Med-Peds ID and Medical Education fellowships at Beth Israel Deaconess Medical Center and Boston Children’s Hospital.  She is the creator and host of Febrile podcast and learning platform, co-host of the ID Puscast podcast, and the program director for the ID Digital Institute.

Learning Objectives

After listening to this episode on invasive candidemia, learners should be able to discuss:

1. Treatment of candidemia in a critically-ill immunocompromised patient.
2. Management of indwelling central catheters in critically-ill patients with candidemia.
3. The role of immune adjuncts (e.g. G-CSF or granulocyte transfusions) in the management of persistent candidemia in an immunocompromised patient.

References:

https://febrilepodcast.com/ 

Pappas PG, Kauffman CA, Andes DR, Clancy CJ, Marr KA, Ostrosky-Zeichner L, Reboli AC, Schuster MG, Vazquez JA, Walsh TJ, Zaoutis TE, Sobel JD. Clinical Practice Guideline for the Management of Candidiasis: 2016 Update by the Infectious Diseases Society of America. Clin Infect Dis. 2016 Feb 15;62(4):e1-50. doi: 10.1093/cid/civ933. Epub 2015 Dec 16. PMID: 26679628; PMCID: PMC4725385.

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. Paul Sue is an associate professor of pediatrics at the Columbia University and Director of the Pediatric Transplant and Immunocompromised Host at the Morgan Stanley Children’s Hospital in NY.  He completed his pediatric residency at Jacobi Medical Center at the Albert Einstein College of Medicine in the Bronx, and his fellowship in pediatric infectious diseases at Johns Hopkins University in Baltimore. He then moved to UT Southwestern in Dallas TX, where he served as director of Pediatric ICH ID service for the next 8 years, prior to his recent move back to NY.  His research interests include the impact of invasive fungal and viral infections in the immunocompromised host,  leveraging measures of functional immunity to improve infectious disease outcomes in high-risk patients,  and the emergence of community acquired multidrug resistant (MDR) bacterial infections in immunocompromised children. 

Sara Dong, MD is an adult and pediatric infectious disease physician at Emory University School of Medicine & Children’s Healthcare of Atlanta, where her clinical focus is transplant and immunocompromised host ID.  She earned her MD from the Medical University of South Carolina.  She completed her internal medicine and pediatrics (Med-Peds) residency and chief residency years at Ohio State University Wexner Medical Center and Nationwide Children’s Hospital, followed by Med-Peds ID and Medical Education fellowships at Beth Israel Deaconess Medical Center and Boston Children’s Hospital.  She is the creator and host of Febrile podcast and learning platform, co-host of the ID Puscast podcast, and the program director for the ID Digital Institute.

Learning Objectives

After listening to this episode on invasive candidemia, learners should be able to discuss:

1. Risk factors associated with invasive fungal infections in critically-ill immunocompromised patients.
2. Common pathogens associated with invasive fungal infections in critically-ill immunocompromised patients.
3. Principles guiding selection of empiric antifungal agents for critically-ill patients at risk of invasive fungal infections.

References:

https://febrilepodcast.com/ 

Pappas PG, Kauffman CA, Andes DR, Clancy CJ, Marr KA, Ostrosky-Zeichner L, Reboli AC, Schuster MG, Vazquez JA, Walsh TJ, Zaoutis TE, Sobel JD. Clinical Practice Guideline for the Management of Candidiasis: 2016 Update by the Infectious Diseases Society of America. Clin Infect Dis. 2016 Feb 15;62(4):e1-50. doi: 10.1093/cid/civ933. Epub 2015 Dec 16. PMID: 26679628; PMCID: PMC4725385.

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. Chris Horvat is a pediatric intensivist and informaticist at UPMC Children's Hospital of Pittsburgh. He started his academic career at UNC-Chapel Hill where he got his undergraduate and medical degrees, after which he completed a pediatric residency at Seattle Children's Hospital and a pediatric critical care fellowship at UPMC. Dr. Horvat also completed Pittsburgh’s T-32 Postdoctoral Research Fellowship in Pediatric Neurointensive Care through the Safar Center for Resuscitation Research, during which he earned a master’s in health administration (MHA) from the University of Pittsburgh. In his current work, he aims to utilize a combination of electronic health record-derived datasets, pharmaco-kinetic models, and pharmacogenomic insights to develop advanced clinical decision-support tools to help refine the use of potent sedatives and analgesic medications in the pediatric intensive care unit. He also serves as a clinical informatics leader, helping to deploy randomized, embedded, multifactorial, adaptive platform (REMAP) trials across the UPMC system.

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

1. List the concerns surrounding the pediatric subspecialty workforce and the unique position of PCCM.
2. Describe the modeling performed for each pediatric subspecialty.
3. Describe the future of the PCCM workforce, including the job opportunities that current PCCM fellows can expect and the utility of dual boarding in cardiology.

References

1.     Leslie LK, Orr CJ, Turner AL, et al. Child Health and the US Pediatric Subspecialty Workforce: Planning for the Future. Pediatrics. 2024;153(Supplement 2). doi:10.1542/peds.2023-063678B

2.     Horvat CM, Hamilton MF, Hall MW, McGuire JK, Mink RB. Child Health Needs and the Pediatric Critical Care Medicine Workforce: 2020–2040. Pediatrics. 2024;153(Supplement 2). doi:10.1542/peds.2023-063678G

3.     Fraher E, Knapton A, McCartha E, Leslie LK. Forecasting the Future Supply of Pediatric Subspecialists in the United States: 2020–2040. Pediatrics. 2024;153(Supplement 2). doi:10.1542/peds.2023-063678C

4.     Horak R V., Marino BS, Werho DK, et al. Assessment of physician training and prediction of workforce needs in paediatric cardiac intensive care in the United States. Cardiol Young. 2022;32(11):1748-1753. doi:10.1017/S1047951121004893

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!

Alexander Rotta, MD is a Professor of Pediatrics and the Division Chief of Pediatric Critical Care at Duke University School of Medicine. He is an accomplished intensivist, educator and physician scientist with well over 100 publications with a focus on respiratory care in critically ill children. He authored a review on high-frequency jet ventilation that served as the foundation for today’s episode. 

Learning Objectives:

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

1. The physiologic rationale supporting the use of high frequency jet ventilation (HFJV).
2. Patient populations most likely to benefit from HFJV.
3. Key published evidence that informs our use of HFJV in pediatric critical care.
4. An expert approach to managing a patient with HFJV.

References:

Cheifetz IM, Rotta AT. High-Frequency Jet Ventilation in Pediatric Acute Respiratory Failure. Respir Care. 2021 Feb;66(2):191-198. doi: 10.4187/respcare.08241. Epub 2020 Oct 2. PMID: 33008841.

Miller AG, Scott BL, Gates RM, Haynes KE, Lopez Domowicz DA, Rotta AT. High-Frequency Jet Ventilation in Infants With Congenital Heart Disease. Respir Care. 2021 Nov;66(11):1684-1690. doi: 10.4187/respcare.09186. Epub 2021 Jun 9. PMID: 34108137.

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!

Alexander Rotta, MD is a Professor of Pediatrics and the Division Chief of Pediatric Critical Care at Duke University School of Medicine. He is an accomplished intensivist, educator and physician scientist with well over 100 publications with a focus on respiratory care in critically ill children. He authored a review on high-frequency jet ventilation that served as the foundation for today’s episode. 

Learning Objectives:

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

1. The physiologic rationale supporting the use of high frequency jet ventilation (HFJV).
2. Patient populations most likely to benefit from HFJV.
3. Key published evidence that informs our use of HFJV in pediatric critical care.
4. An expert approach to managing a patient with HFJV.

References:

Cheifetz IM, Rotta AT. High-Frequency Jet Ventilation in Pediatric Acute Respiratory Failure. Respir Care. 2021 Feb;66(2):191-198. doi: 10.4187/respcare.08241. Epub 2020 Oct 2. PMID: 33008841.

Miller AG, Scott BL, Gates RM, Haynes KE, Lopez Domowicz DA, Rotta AT. High-Frequency Jet Ventilation in Infants With Congenital Heart Disease. Respir Care. 2021 Nov;66(11):1684-1690. doi: 10.4187/respcare.09186. Epub 2021 Jun 9. PMID: 34108137.

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!