The PicPod

Big Data. Artificial Intelligence. Machine Learning. All very 2022, all very trendy. But how can this help our practice in Paediatric Intensive Care?

Heather Duncan, consultant intensivist in Birmingham, has been working for many years with AI and Machine Learning, including input from the MacLaren F1 team. What is Big Data? Is it useful at the bedside? What is AI, and what types of machine learning are there?

Can human intuition be bettered by a computer, or are we kidding ourselves that we can do better? What are the results of initial trials in this area? How does it feel to be beaten by a computer? How should the computers be talking to the humans? And is medicine more or less complicated than the best game in the world, Go?

Published concurrently with the 2022 PCCS conference in Leicester, UK.

Coming this September: a proper face to face conference IS BACK! The 2022 Paediatric Critical Care Society Conference, held in Leicester on the 14-16th September 2022, will be packed full of mind-expanding workshops, cross cutting plenary topics, and focussed sessions on a breadth of PCC issues for all members of our team.

Listen to Eldilla Rizal, chair of the organising committee, summarising the educational (and social) programme for this superb conference. More details at www.picsmeeting.com, and through the free PICCHub app (android here and iOS here).

PicPod is creating five podcasts with conference speakers, which will be released during their respective talks, and will be chairing a 100% slide free session, for future release as podcasts.

For international listeners: there is a streamed option, and registration option for LMIC countries.

Hope to see you there!

Severe TBI is a difficult, frustrating condition to treat. The secondary injury process occurs despite our best efforts: and our monitoring tools are incredibly blunt. Physiological parameters change when it’s too late: ICP is a localised and at times unreliable measure. CPP is two steps away from cerebral blood flow.

So what can we monitor, and how does it help us? Which technology is useful? Which indices and calculations are useful? There are multiple monitoring indices available: which are clinically going to change management?

And once we have the numbers, what do we do then? Lots of answers here from one of the UK’s leading brain injury researchers.

For the June Paediatric Critical Care Society Hot Topics Webinar series, we have interviewed one of the the speakers Barney Scholefield from Birmingham, an expert in the field of Post Cardiac Arrest care.

First of all: what is cardiac arrest? How do we define it, and how do we classify it? What are the outcomes of in and out of hospital cardiac arrest, and how robust is our knowledge in this?

What allows us to prognosticate for these patients? Are there any tests or indices which can help?

What about cooling? Surely in the post THAPCA world this question has been answered…. or has it? Is there scope for more studies: and why? Which patients might yet benefit from cooling? And does rapid, targetted cooling help?

Much more as well: we could have talked for hours. Luckily for you we didn’t!

We were invited to chair a session at the 2022 Paediatric Critical Care Society Study Group meeting at St Mary’s Hospital in London. This is a national meeting of research interested PIC clinicians.

Two excellent speakers contributed. Chris Gale is a neonatologist who has led the WHEAT trial, in to feeding neonates around blood transfusions. This uses opt-out consent: there is no signed informed consent for this trial. Lots of ethics to chew over: how do the rights and needs of the population and the individual balance, and is this a logical end point of deferred consent?

Tony Gordon is the UK lead for the REMAP-CAP trial, one of the two blockbuster platform trials which were able to scale up during Covid. How was this done, how was it maintained, and what can we learn in paediatrics?

A great discussion, lots to think about, and maybe a look in to the future?

Paediatric Acute Respiratory Distress Syndrome (PARDS) is one of the very difficult situations which paediatric intensivists fear. As part of the UK Paediatric Critical Care Society Hot Topics series, this PicPod episode interviews Heidi Flori, Clinical Associate Professor at the University of Michigan, and PALICC member, who was a speaker at the PCCS webinar on PARDS on the 17th March 2022.

What is PARDS? Is the definition intellectually valid, or is it merely descriptive? Is PARDS actually one illness? What is the pathophysiology behind PARDS and what are the implications of this?

Heidi explains the differing phenotypes of PARDS: but does this mean that there are strategies available to treat? What is the overlap between PARDS and everyone’s favourite viral pneumonitis du jour, COVID? Might Tociluzimab be a therapy?

What is the correct tidal volume to ventilate these patients, and why was there low agreement on this in the PALICC document? And finally, what are the ultimate rescue therapies for the very severe PARDS patients?

More linked resources on the PCCS Hot Topics Webinars at:

Recording of the talks for members, and information on free live streams for all for future webinars, at www.pccsociety,uk

Collections of papers used by the speakers, and referenced in the talks, at www.picujournalwatch.com, and @PICJournalWatch

More information on the webinar, and linked clinical cases, through the PCCS twitter feed @PICSociety (soon to be @PCCSociety)

All linked through the free PICCHub app, on Android here and on iOS here

And of course news on new podcasts @PicPod_podcast

We are pleased to announce that in the coming weeks the UK Paediatric Critical Care Society (https://pccsociety.uk/, @PICSociety, soon to be @PCCSociety) is going to be joining up its educational resources run by its members.

In this short podcast we explain the strategy.

First we have Akash Deep, chair of the PCCS Science and Education Committee, telling us about the programme of free webinars, accessible to all (but recordings only accessible to members).

Then Costas Kanaris, of @DrKanaris Friday Case of the Week fame, explaining how he will be linking in.

Also: Hari Krishnan, Mr PICUJournalWatch (www.picujournalwatch.com/, @PICJournalWatch) will be collating a papers and references page specific to the webinar, linking in all the references used by our speakers.

We at PicPod (@PicPod_Podcast) will be interviewing at least one speaker per webinar, and timing release of the podcast to the timing of the webinar.

And everything will be available easily linked through the PICCHub app, free on Android and iOS

Happy learning!

Some conditions are rare. Some conditions are difficult to understand. Some conditions are difficult to treat. ADEM is all 3.

A sometimes devastating condition affecting completely normal children, ADEM is an upsetting and challenging condition. Treatment this aggressively is important.

Mainstays of treatment are steroids, IVIG, and plasma exchange. But: which of these works? How much evidence is there for any/all of these? Are there other treatments worth looking at? Or is time be best medicine?

PicPod 55 was all about Lactate: this one’s about the opposite (in some ways): Oxygen. Mark Peters is a professor of Paediatric Intensive Care at Great Ormond St Hospital in London. He is leading the Oxy-PICU trial, looking at whether a targeted saturation of 88-92% is different to 94-98% in ventilated children.

Why should they be different? What are the risks of giving more oxygen? Are there local or endothelial effects? Or is there an increased length of stay, increased ventilation, and more ventilatory trauma? Is there a lower limit to how low we can go, or are we just constrained by history?

Is there an oxygen saturation number which is unequivocally bad (yes there is)? What are the next steps in oxygen saturation research?

Lactate, the intensivist’s friend and the athlete’s enemy. As intensivists we always ask about the lactate as it’s a great indicator of problems afoot.

But where does it come from? What does it signify? Is lactate itself actually bad? Does it cause damage? Does CRRT reduce lactate (hint: yes, but no).

And for prognostication, what lactate numbers should we be (most) worried about. Starting lactate, 6h, 24h, AUC, or reduction?

A mixture of basic science, experience, papers, and numbers. Intensivist heaven. Enjoy!