The PicPod

Lots of us look after major trauma patients: but I can almost guarantee that no one has looked after trauma to the scale of Shehan Hettiaratchy. He gave a fascinating talk at the 2019 PICS/PCICS conference based around his experiences of major combat trauma in Afghanistan.

The survival rate for ISS 45 patients increased from 30% to 95%. How did they keep these patients alive? Extraordinary outcomes: but at what cost? What is the morbidity?

What are the ten most important principles in a combat trauma emergency department?

And what does the future hold? Freeze dried plasma? Ischaemic preconditioning? And how do we turn down the “supply” arm of the perfusion balance?

Reference list for this podcast:

Battlefield Resuscitation of the Future, Martin et al, Front Line Surgery

Ruchi Sinha is a consultant in PICU in St Mary’s, London, where she works in conjunction with the infectious diseases team to plan the UK’s response to High Consequence Infectious Diseases.

These are the scary ones: Ebola, Hantavirus, Lassa Fever, the novel coronaviruses, etc. These are the diseases which have a high mortality and a rapid spread. The news is full of the novel coronavirus in China, and its rapid spread throughout the world.

How is the UK set up for these? Can we cope? How should a paediatric intensive care deal with such a patient? Should they be offered full intensive care? If we do, is it physically possible? What are the risks to the health care staff? And what happens if it all truly hits the fan?

Scary diseases, scary thoughts. But we all need to have thought of them before it happens.

Peter Rimensberger is an intensivist in Geneva, well known for his work on ventilation. PicPod interviewed him during the PICS/PCICS conference in London in November.

NAVA (Neurally Adjusted Ventilatory Assist) mode uses an oesophageal probe to sense diaphragmatic electrical impulse, and adds ventilatory power to assist depending on how much the patient is working.

Sounds sensible: but does it work? What is the evidence base? Is it something which should be used in all, most, some, or no patients? Which patients should we target this to?

And with conventional ventilation modes, should we be using pressure or volume set modes?

Paul Kemp is a molecular biologist from Imperial College, London, who researches the genomics of muscle wasting in critical illness. Some surprising numbers here: how fast is our normal muscle turnover? What is the rate of critical illness myopathy, and does it matter?

Can we predict who gets myopathy, and if we can, what do we do about it? Are there future applications where we can predict how patients will react? And if mitochondira react in the muscles, are they also reacting in other tissues? Should we be stopping the process or not?

A great mix of basic science and clinical outcomes.

Welcome to the first of our podcasts using interviews recorded during the 2019 PICS/PCICS conference in London in November.

Anthony Bennett was one of the opening speakers. Almost ten years ago, aged 16, he became seriously unwell and underwent three weeks of ECMO, and had twelve cardiac arrests.

Since then he has become THE most inspirational speaker. He has used this experience to grow himself and others.

Listen to this superb interview with a great man, and consider what we do and the impact it has.

Links for Ant:

https://anthonyinspires.com/about-us@iamantbennett

The Tracheostomy: is it a short cut to discharge, or of significant benefit to the patients? What are the risks, and what are the benefits?

When should a tracheostomy be done? Are there benefits in the short and long term to going early or late? What is the evidence, and what is the quality of the evidence?

What factors influence the decision to go for the tracheostomy?

And what’s going on in Los Angeles? Is there a Tracheostomy war?

Sepsis is everywhere. We hear lots of news stories about sepsis patients, and the solution seems easy. Follow the guidelines, identify sepsis, and treat it early.

As always it’s not so simple. How is sepsis defined? How is it identified? And which patients need urgent treating?

Are the current sepsis guidelines fit for purpose? What are their sensitivities and specificities? Which guidelines are guidelines, and which are protocols? Should there be clinician judgement applied? What is the evidence behind these guidelines?

Food for thought for all who treat children with, and without sepsis.

PicPod 27 is about death. We try so hard to stop our patients from dying, and yet we cannot stop all of them.

How have death rates changed over the past 30 years? Have the patients dying changed? Has the mode of death changed? Is this because of better treatment, or is society changing?

How do parents cope, and what do they tell us they need when they are bereaved? How should we act, and what should we say?

Loads of content, lots of things to think about.

We are better at making children survive. But are we better at making them survive well? What are the trends in survival and outcome quality over time? There is obvious benefit to children needing PIC, but does PIC do harm to patients? How can we minimise this? What kind of patient does best, and which do worst?

How do we assess quality of life in children and do parents, or health care providers, know best?

Much to think about!

This episode is a three way discussion including Mark Russell, currently a senior fellow in Adelaide. In a Dickensian manner, we have a PIC consultant past, present, and future.

What is it like? How does it feel? When you turn up to a resuscitation, and your badge says PIC consultant, what is it like? What is the toll on your life, and how do we keep ourselves going?

Some of the sound quality is a little suboptimal, please forgive us.