PARDS--Beyond the Basics Part 4 with Dr. Nadir Yehya: Adjunctive Strategies (prone positioning, steroids, paralysis, iNO etc)
Jan 23, 2023
auto_awesome
Dr. Nadir Yehya, an Assistant Professor of Anesthesiology and Critical Care and Pediatrics at the Perelman School of Medicine, discusses adjunctive strategies for treating ARDS, including corticosteroids, prone positioning, iNO, and surfactant. The podcast explores the benefits of these strategies in improving ventilation and oxygenation, and highlights the importance of weighing risks and potential benefits. Additionally, the use of nitric response, monitoring, and weaning protocol for ARDS patients is discussed, along with the use of surfactant and VV ECMO in ARDS management.
Prone positioning can improve oxygenation and lung function by redistributing ventilation and perfusion in acute respiratory distress syndrome (ARDS).
The use of corticosteroids as an adjunct strategy in ARDS management can improve lung injury, compliance, and gas exchange, but their impact on mortality and side effects are still debatable and should be considered on an individual basis.
Deep dives
Adjunct strategies for ARDS treatment
The podcast discusses the use of adjunct strategies for the treatment of acute respiratory distress syndrome (ARDS). These adjunct strategies include corticosteroids, prone positioning, nitric oxide, and surfactant. Each strategy has its own potential benefits and considerations. Corticosteroids have been shown to improve lung injury in adults, but their impact on outcomes is still debated. Prone positioning redistributes ventilation and perfusion, improving oxygenation and lung function. Nitric oxide can improve ventilation-perfusion matching, while surfactant replacement therapy is more commonly used in neonatal respiratory distress syndrome. Overall, the choice of adjunct strategies depends on the specific clinical context and the risk-benefit balance.
Neuromuscular blockade for accurate pressure measurements
The podcast highlights the use of neuromuscular blockade as an adjunct strategy for ARDS treatment. Neuromuscular blockade allows for more accurate ventilator pressure measurements and the assessment of lung stiffness. It also helps improve hypercarbia and hypoxemia caused by ventilator disynchrony or heterogeneous ventilation-perfusion distribution. However, the duration and potential risks of neuromuscular blockade, such as deconditioning, should be carefully considered and monitored. The speaker emphasizes the need for further research to better understand the impact and optimal use of neuromuscular blockade in ARDS management.
The effectiveness and mechanisms of prone positioning
The podcast discusses prone positioning as an adjunct strategy for ARDS treatment. Prone positioning is believed to have multiple beneficial effects on ventilation and lung behavior. It redistributes ventilation and perfusion, resulting in a more favorable distribution of air in the lungs. Prone positioning opens up more lung tissue and reduces the negative consequences of lung consolidation and edema. This position also promotes better oxygenation and helps the lung move toward a more fluid-like behavior. The speaker emphasizes the importance of understanding the underlying mechanisms of prone positioning and its potential role in reducing ventilator-associated lung injury.
The use of corticosteroids in ARDS
The podcast explores the use of corticosteroids as an adjunct strategy for ARDS management. Corticosteroids have been studied extensively and have shown improvements in lung injury, compliance, and gas exchange. However, their impact on mortality and the risk of side effects, such as neuromuscular weakness and rebound hyperinflammation, remain areas of debate. The timing and duration of corticosteroid therapy may also affect its efficacy. The speaker suggests that early initiation of corticosteroids, such as dexamethasone, may be more beneficial in ARDS cases. The risks and benefits of corticosteroids should be carefully considered on an individual basis.
Dr. Yehya is a graduate of the University of California at Berkeley and the University of California at Los Angeles School of Medicine. After completing pediatrics training at Children’s Hospital of Los Angeles, he completed his pediatric critical care fellowship at Children’s Hospital of Philadelphia (CHOP), and joined the faculty after graduation in 2011. He is currently an Assistant Professor of Anesthesiology and Critical Care and Pediatrics at the Perelman School of Medicine at the University of Pennsylvania and an attending physician in the pediatric intensive care unit at CHOP.
Dr. Yehya’s research interests encompass all aspects of pediatric respiratory failure, with a particular emphasis on pediatric acute respiratory syndrome (ARDS) and mechanical ventilation. ARDS consists of sudden, severe flooding of the lungs in response to an inflammatory insult causing difficulty breathing, frequently requiring mechanical ventilation. Sepsis is a leading cause of ARDS in children. His long-term goal is better characterization of ARDS in children and to test therapies designed to improve outcomes. His NIH-funded work is assessing the utility of specific plasma biomarkers in pediatric ARDS, with subsequent proteomic characterization and testing in pre-clinical models. Dr. Yehya has several active studies involving biomarkers, clinical epidemiology, and pathophysiological mechanisms in the field of pediatric ARDS, and is involved in several multicenter and multinational collaborations.
Objectives:
After listening to this episode, learners should be able to:
Understand the role of heated high-flow nasal cannula and non-invasive mechanical ventilation in the management of pediatric acute respiratory distress syndrome (PARDS).
Recognize the potential for patient self-inflicted lung injury in PARDS.
Recognize high-risk situations when non-invasive mechanical ventilation is relatively contraindicated in favor of intubation and mechanical ventilation.
Acknowledgement: Thank you to Dr. Nick Bartel for his help in creating learning objectives for this series.
How to support PedsCrit: Please complete our Listener Feedback Survey Please rate and review on Spotify and Apple Podcasts! Donations are appreciated @PedsCrit on Venmo , you can also support us by becoming a patron on Patreon. 100% of funds go to supporting the show.
Thank you for listening to this episode of PedsCrit. Please remember that all content during this episode is intended for educational and entertainment purposes only. It should not be used as medical advice. The views expressed during this episode by hosts and our guests are their own and do not reflect the official position of their institutions. If you have any comments, suggestions, or feedback-you can email us at pedscritpodcast@gmail.com. Check out http://www.pedscrit.comfor detailed show notes. And visit @critpeds on twitter and @pedscrit on instagram for real time show updates.
Get the Snipd podcast app
Unlock the knowledge in podcasts with the podcast player of the future.
AI-powered podcast player
Listen to all your favourite podcasts with AI-powered features
Discover highlights
Listen to the best highlights from the podcasts you love and dive into the full episode
Save any moment
Hear something you like? Tap your headphones to save it with AI-generated key takeaways
Share & Export
Send highlights to Twitter, WhatsApp or export them to Notion, Readwise & more
AI-powered podcast player
Listen to all your favourite podcasts with AI-powered features
Discover highlights
Listen to the best highlights from the podcasts you love and dive into the full episode