The PicPod

Calum Semple is a respiratory and infectious disease professor in Liverpool. He has been part of the governmental advice team for pandemics since before COVID. We spoke to him in advance of his talk at the 2024 PCCS conference

What is the frequency of pandemics? Is the 1918 Spanish Flu pandemic the last “real” one, or do MARS, SERS, and H1N1 “count”?

What is a W shaped mortality, and why does this matter? Where will the next pandemic pathogen come from? What were the case fatality rates from previous pandemics?

We have heard of MPox: is this a problem?

How important are multi resistant bacteria, and of what relevance is chicken’s drinking water?

What can we do about all this? With novel vaccine technology (remember PicPod 52?), how long would it take to get a vaccine up and running? And then how do we convince the population to take the vaccine? Can we use social influencers and clinic patients?

How important are platform trials? How would digital NHS connectivity help? How useful is the COVID19 enquiry?

And when should we rebuild something which is broken?

Pandemics are not over. There will be more….

CORRECTION: At 12 minutes, Prof. Semple incorrectly refers to the film titled Children of God when he meant to refer to the film Children of Men ((Alfonso Cuarón, 2006).

Nicola Disma, an anaesthetist in Genoa, Italy, is lead author on the European Society of Anaesthesiology and Intensive Care guidelines on airway management in neonates and infants, published in full text here.

We discussed all things airway. Video laryngoscopes: useful, mandatory, or deskilling? “Normal” video blade or hyperangulated?

Oxygen during intubation: does it work, is it useful, how should this be done?

Nasal or oral tubes, what is the evidence, and what are the risks?

Cuffed or uncuffed tubes, what are the risks and benefits, and why would anyone choose an uncuffed tube?

What does it feel like to perform an emergency cricothyroidotomy, and exactly how many years has this aged Harish?

Is ECMO a viable option for airway emergencies?

How can we improve our team workings, and what is safety in these situations?

So many questions asked, some have answers, some don’t (yet). But great to share the knowledge and opinions of Nicola and his excellent research.

What’s the point of evidence? It’s to gain knowledge, so that we can treat our patients better. But what happens when the data is wrong, faked, misleading, or simply made up?

Retraction Watch (www.retractionwatch.com, and @retractionwatch) collates retractions from journals around the world. Their database makes terrifying reading: tens of thousands of papers which have been retracted are all listed, including hundreds of COVID papers. Individual authors have a “leaderboard” (loserboard?) headed by someone with an incredible 194 retractions.

We were lucky enough to speak to Ivan Oransky, one of the leaders of Retraction Watch. It’s a terrifying conversation, where he lays bare the outright fraud in medical publishing.

However, all fraud has drivers and motivations. Why are people pushed towards these staggering opportunities for fraud? Where, or what are the solutions?

Anyone working in medicine can learn from this podcast. Thank you to the Retraction Watch team: please keep up the incredible work.

From the 2023 PediCritiCon conference in Pune, India, I was lucky enough to chat with Bala Ramachandran from Chennai. He gave a great talk on precision medicine, its implications, and what the future may hold.

What’s the difference between personalised medicine and precision medicine? How does it differ to “usual” medicine? What are the tools we can use? Is precision medicine all about the genomics (side note: what’s the difference between genomics and genetics?), or can we make our own practice more precise with the tools we have now?

What investigations can we use, and are they ready for roll out now? Is the future bright…. or is this an ongoing dream?

All this and lots more. Enjoy!

Much research is technical and esoteric. Some research is fundamental and answers questions we want to answer every day. Often the first is easy to do (just add a lab and equipment), but the second is really, really hard.

Mark Peters and team have just published the OxyPICU trial in the Lancet. It’s the world’s biggest ever individually randomised trial in PICU, and involved most of the PICUs in the UK to achieve almost 2000 randomisations.

The question posed is simple: is a goal of 88-92% oxygen saturations better than 94-98%?

We go through the methodology, the statistics (probabalistic index anyone? It’s really simple once it’s explained), the results, the implications, and the implementation.

This study has gone straight in to the Top Ten PICU Studies, and will be a cornerstone of practice for the foreseeable future. We have done the hard work for you, so listen and you’ll be able to quote the results, and even parts of the supplemental data.

PicPod went to the 2023 PediCritiCon conference in Pune, India. It was a superb conference full of content, learning, and Bollywood dancing…!

We sat down with Brenda Morrow, Professor of Paediatrics at the Red Cross Hospital in Cape Town, physiotherapist, and president of the World Federation of Paediatric Intensive and Critical Care. She gave the keynote lecture at the conference.

Brenda has unparalleled knowledge of the state of intensive care around her region. We discuss the incredible progress which has been made in Malawi, but also the context within intensive care operates. What is “critical care”? Where does it begin, and how is it defined? Could contraception be defined as critical care?

The challenges are vast but the solutions are coming. Brenda discusses the fellowship training programme and what impact this is having.

Finally we discuss the Cape Town Red Cross hospital, and some of the excellent work being done there past and present.

At the PCCS2023 conference Harish and I were delighted to be invited to be a part of the conference. We were interviewed on stage by Zoltan Gyorgyi and Peter Donnelly, who asked us about the birth of PicPod, the process, and some highlights and lowlights.

Unfortunately questions from the audience were not recorded, but thank you to everyone there, and honestly, we were humbled at your thanks. We don’t do this “for the likes”, (note this quote by Banksy), we do this because it’s interesting and fun, but stories of inspiration and learning through the PicPod mean a lot.

So PicPod75 is a little different, an interview with us. Back to normal next time!

At the PCCS2023 conference in Edinburgh, we were lucky enough to meet David Cooper from Cincinnati Children’s Hospital. He gave a great talk on high reliability teams, and afterwards we chatted to him about his programme.

We discuss hierarchies: when are hierarchies good, and when are they bad? Is democracy a good thing? What is a Democribus?

How did this team reduce cardiac arrests on their unit? How did they prepare for sudden deteriorations, by making the unexpected expected?

What is a flight plan, how do they work, and how does this team avoid group think?

A really, truly fascinating 50 minutes which will make every one of us think deeply about how we can improve our systems.

The link to the website discussed during this episode is Pediatric Cardiac Critical Care Consortium (PC⁴) (pc4quality.org)

One of the most entertaining talks at the 2023 Paediatric Critical Care Society Conference was by Roddy O’Kane, consultant neurosurgeon in Glasgow, on the management of ICP.

On the theme of the conference, he was very clear: proper management of ICP depends on excellent team work, and listening to all the members of the team.

He spoke also about the dangers of being in PICU: what damage does the deep sedation we use do? Is the primary goal to keep the patient flat, or to get out of PICU?

On decompressive craniectomies: what did Rescue ICP tell us, or did it just underline what we thought we knew already? If you’re going to do one, then how large should it be?

Link to the article discussed during the podcast: Managing raised intracranial pressure in paediatric brain injury – Paediatrics and Child Health (paediatricsandchildhealthjournal.co.uk)

At the 2023 PCCS conference in Edinburgh we chatted to Marie Spiers, Emergency Department consultant in Glasgow, about paediatric traumatic cardiac arrest.

How does traumatic cardiac arrest differ to medical cardiac arrest? Is the treatment different? What should we be focusing on?

What is the point in chest compressions, and when should they be the absolute priority, and when are they a side show? What can studies in pigs show us, and are they extrapolatable? And, crucially, is “unhose” a word? (it’s not, by the way. Apologies).