The PicPod

Patients with status epilepticus are one of the most common reasons for admission to Paediatric Intensive Care. There are two important questions: when should we stop the seizure, and how?

We go through evidence of when harm increases with a seizure. Can we define a threshold of when we need to stop the seizure? Does it matter?

Two landmark studies have recently been published, the ECLIPSE trial and the CONSEPT trial, both of which compared phenytoin with levetiracetam. What do the results of these studies mean, and what can we learn from them? Should we change practice? Which drug should we use…. or should we use both?

Welcome to PicPod 23. This episode we talk about new technology on PICU.

Does Point of Care Ultrasound (POCUS) work? Is it worthwhile? Does it help our assessment of the patient? Should we throw away our stethoscopes? Including an interview with Michael Griksaitis, POCUS aficionado, and co-founder of the UK POCUS CACTUS (Children’s Acute Ultrasound) course (conflict of interest statement: Patrick is also).

Electrical Impedance Tomography has been around for a while, but has never really caught on. We use is a lot, and have just published examples of our experience (https://www.nature.com/articles/s41598-019-41774-1). What can EIT add to our patient care? Is it worth it?

Finally, does telemedicine work, and is it ready for use in non-experimental ways? Can it really replace hands on assessment, or is it just a distraction?

Can intensivists really ever have too many toys?

Hope you enjoy it, until next time.

In PicPod 21 we looked at survival for oncology patients on Paediatric Intensive Care. In PicPod 22 we consider what is different about these patients, and what complications they can have. Almost all organ systems can be affected: but how, in what way, and how do we treat them?

And ultimately, does it matter? Or do we go back to the start, as always, and treat a sick child as a sick child. Is that fact that these complications are due to an oncological condition important or not?

Oncology patients in intensive care. Bad news: high mortality high morbidity, it’s hardly worth admitting them. Right?

NO! WRONG! Historical data shows extremely high mortality, but modern papers and evidence shows low mortality, around the levels seen in non-oncological patients with similar levels of organ dysfunction.

What are the numbers? What are the risk factors? Should these patients get CRRT? Are they ECMO candidates? And when should palliative teams be activated?

So much more about TBI. Following on from last week’s part 1, here is more on the same theme.

There’s too much to mention, and Picpod is off on holiday for a week. Details and references will be posted next week.

There is so much on paediatric traumatic brain injuries that we have had to split this topic in to two podcasts.

For the first part, we talk about the guidelines (and how they should be displayed). Decompressive craniectomies: should we? Cooling (briefly). The epidemiology of paediatric brain injury: firearms, cycling helmets, and boys vs girls. Haemoglobin thresholds in TBI: what should it be? Is hyperoxia helpful (and, actually, what is hyperoxia? DO2 equation anyone?)

Lots more coming very soon! And references will be posted soon.

Welcome to 2019! This was meant to be a Christmas Special, but we all have lives and it’s been kind of busy on the PICU. So it’s welcome to 2019.

The Christmas BMJ is a British medical tradition. In the spirit of the IgNobel prize, this edition is full of articles which are scientifically robust, statistically valid, and utterly ridiculous.

In this episode we review a variety of papers from this edition and consider their messages, validity, and humour. When do myocardial infarctions happen on Christmas Eve? Do Doctors really play golf? The first ever randomised controlled trial of jumping out of an aeroplane with or without a parachute. Ingesting lego heads. And if you don’t use your brain, will you lose it?

Reference list is as follows:

Myocardial Infarctions

Golf habits

Parachute randomised trial

Lego head ingestion

Use it or lose it

PicPod 17 is a pro/con debate on the use of inhaled nitric oxide for paediatric ARDS. Harish argues that Nitric Oxide has no place in PICU, and Patrick argues that we should use it in targeted cases.

What are the pathophysiological mechanisms with ARDS? Is it the same for children and for adults? How might nitric oxide be beneficial theoretically?

What is the evidence base behind nitric oxide? Is there any high quality evidence in children? What studies are there, and what are their weaknesses and strengths? 

Propensity matched studies: can we trust them? And, finally, why reading the online appendices on a paper is really important. 

Picpod 16 is all about renal. The kidney is one of the second equal most important organs in the body, with such an important role.

What is AKI, and who is at risk? What is CRRT good for, and what does it not work for? When should we start it? Who is it appropriate for?

Lots of thoughts, papers, and discussions. And some Guns N Roses too.

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Enjoy!

Bronchiolitis is THE standard illness for paediatric intensivists. Dozens of patients every season, all the same age, size, and type

But are they the same? What is bronchiolitis? How should we treat it? Does High Flow Nasal Cannulae treatment work: and what is it actually? What about fluids, ventilation modes, and antibiotics? And what about the respiratory dynamics: PEEP, compliance, resistance, and time constants?

As always, there may not be clear answers, but there’s plenty to think about in PicPod 15. The more we think we know, sometimes the more we get to think about!