Pediatrica intensiva: Art & Science of Pediatric Critical Care

Airways That Scare Me - Respiratory Instability w Robi Khemani

Jul 11, 2024

In this engaging talk, Robi Khemani, a leading expert on pediatric respiratory disorders from Children's Hospital LA, dives into the challenges of managing respiratory unstable patients. He delves into the complexities of peri-intubation risks and highlights the roles of newer drugs and devices that complicate decision-making. The discussion emphasizes the importance of teamwork in high-pressure situations, innovative non-invasive ventilation strategies, and the ongoing need for vigilance in monitoring patient conditions. A must-listen for anyone in pediatric critical care!

55:14

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Robi Khemani

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Quick takeaways

Airway management extends beyond intubation; focusing on patient stability and continuous heart function during the peri-intubation period is crucial.

Identifying high-risk patients, such as those with ARDS, relies on evaluating their oxygen saturation and respiratory effort before intubation.

The integration of advanced non-invasive ventilation techniques requires careful decision-making to avoid harm from delaying necessary intubation for deteriorating patients.

Deep dives

Peri-Intubation Risks and Strategies

Airway management involves not just the act of intubation but also managing patient stability throughout the peri-intubation period. Ensuring continuous heart function during intubation is crucial, as stopping a heartbeat for the procedure is not considered successful. New evidence suggests that strategies like pre-recruitment, apneic oxygenation, and apneic ventilation can improve outcomes for patients with compromised lungs. This paradigm shift requires healthcare professionals to adapt their approaches to ensure better oxygenation and stability before and during intubation.

Intro

2min

Navigating Pediatric Respiratory Instability

18min

Navigating Decisions in Respiratory Management

2min

The Importance of Teamwork in Respiratory Care

2min

Mastering ICU Intubation: Preparation and Techniques

20min

Assessing Blood Gases in Bronchiolitis Care

2min

Monitoring Ventilated Patients

9min

This season is about airway management or airways that scare me and this episode, we discuss the respiratory unstable patient or the patient who's a "physiologically difficult airway" because they have bad lungs. We were incredibly lucky to have the amazing Robi Khemani from CHLA, a world expert on respiratory disorders in #pedsICU, join us and be able to share his thoughts.

It's not just about putting the tube in, it's about that whole high risk period of peri intubation. And with better drugs and devices we've opened a big space between low flow oxygen and invasive ventilation which makes decision making trickier.

Here we focus on that difficult decision making and the patients that really scare us. If you haven't heard it yet, our previous episode on team, environment, and equipment is very relevant here.

Featuring special guest Robinder Khemani from Children's Hospital LA and regular hosts @drpetaalexander @BostonChildrens @drgregkelly @SCHNkids and @Karen_Choong @MCH_childrens

No time to listen or want to participate in the discusion? You can find a full Tweetorial of this episode on Twitter @pedsintensiva and our website here https://pedsintensiva.com

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Pediatrica intensiva: Art & Science of Pediatric Critical Care

Airways That Scare Me - Respiratory Instability w Robi Khemani

Episode guests