PedsCrit

Dr. Palen Mallory, a pediatric intensivist at Duke Children's Hospital, unpacks the essential nuances of Airway Pressure Release Ventilation (APRV) for ARDS. She discusses the importance of personalized ventilator settings and innovative strategies to boost oxygenation and ventilation. Advanced weaning techniques are explored, emphasizing the role of end-tidal CO2 monitoring. Mallory also highlights the need for standardized protocols in pediatric care and sheds light on future research directions, making for a compelling listen for healthcare professionals.

Palen Mallory, a pediatric intensivist at Duke University, dives into the fascinating world of Airway Pressure Release Ventilation (APRV) for pediatric ARDS. She discusses the physiological rationale behind APRV and its potential benefits for critically ill children. The conversation addresses the challenges clinicians face, including managing unintended extubation and monitoring complications. Mallory also emphasizes the importance of careful patient selection and institutional practices in optimizing care, shedding light on her ongoing research in this field.

In this engaging discussion, MJ Sacco, a pediatric intensivist, and Andrew Parsons, an internist and hospitalist, delve into the intricacies of clinical reasoning. They explore the importance of structured decision-making in pediatric care, highlighting cases that challenge trainees. The duo emphasizes the need for open dialogue and the Socratic method in medical training to identify knowledge gaps. They introduce the REACT tool for urgent scenarios and stress the significance of effective communication and autonomy in developing confident clinicians.

Dr. Omar Alibrahim, a pediatric intensivist at Duke University, shares insights on negative pressure ventilation for treating acute respiratory failure in children. He discusses the management of a case involving a seven-month-old battling RSV bronchiolitis and explains the importance of ventilation strategies like Continuous Negative Intrathoracic Pressure. The conversation also covers challenges with sensitivity triggers in ventilation systems and the critical factors to consider when providing respiratory care to young patients.

Dr. Omar Alibrahim, a pediatric intensivist at Duke University and expert in critical care, joins to discuss negative pressure ventilation (NPV) for bronchiolitis. He examines how NPV enhances lung function and cardiac output, particularly in children with unique cardiac conditions. The conversation also highlights the implementation challenges and benefits of this innovative technique in pediatric care. Dr. Alibrahim shares his experiences developing a clinical program for NPV, aiming to improve respiratory support while fostering teamwork in healthcare settings.

About our Guest: Kyle Rehder, MD, is a Professor of Pediatrics at Duke University and a pediatric intensivist at Duke Children's Hospital, where he serves as the Vice-Chair of Pediatric Education. He completed his medical school, residency, and chief residency at UNC-Chapel Hill, followed by his fellowship at Duke University. His research is focused on team development and evaluation of advanced respiratory support in the PICU.Learning Objective:Develop an expert-based approach to diagnosing and managing common presentations of patient-ventilator asynchrony in the PICU.References: Flynn, B. C., Miranda, H. G., Mittel, A. M., & Moitra, V. K. (2022). Stepwise Ventilator Waveform Assessment to Diagnose Pulmonary Pathophysiology. Anesthesiology, 137(1), 85–92. https://doi.org/10.1097/ALN.0000000000004220Patient-Ventilator Dyssynchrony • LITFL • CCC VentilationCitation:Rehder K, Hodges Z, Shanklin A. Patient-Ventilator Asynchrony. PedsCrit. Online Podcast. 04/2025. https://www.pedscrit.com/patient-ventilator-asynchrony-with-dr-kyle-rehder/ Questions, comments or feedback? Please send us a message at this link (leave email address if you would like us to relpy) Thanks! -Alice & ZacSupport the showHow to support PedsCrit:Please complete our Listener Feedback SurveyPlease 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.com for detailed show notes. And visit @critpeds on twitter and @pedscrit on instagram for real time show updates.

Join Dr. Brian Bridges, Division Chief of Pediatric Critical Care Medicine, and Dr. Abhinav Totapally, pediatric intensivist, as they delve into the complexities of VA ECMO for refractory septic shock in children. They discuss the pros and cons of central versus peripheral cannulation, sharing personal experiences and insights on patient selection. The talk explores advancements in ECMO, emphasizing the impact of early intervention on outcomes, monitoring techniques, and the need for multidisciplinary care to tackle this critical condition effectively.

Delve into the world of VA ECMO for children facing refractory septic shock. Hear expert insights on timely interventions and the complexities of patient management. Discover critical indicators for selecting candidates for ECMO and the importance of hemodynamic assessments. The discussion highlights the balance between flow rates and outcomes, along with approaches to optimize care. Personal stories enrich the exploration of mentorship and innovation in pediatric critical care, emphasizing collaboration for better patient outcomes.

Ilyse Genser, a pediatric neurologist and associate program director at Children's National Hospital, delves into the fascinating world of neuroimaging for critically ill children. She discusses the vital role of MRI with contrast in diagnosing conditions like encephalitis and the nuances of using FLAIR sequences for post-infectious disorders. Ilyse also tackles diagnosis challenges in pediatric mastoiditis, highlighting innovative imaging strategies, and wraps up with her favorite ice cream spots, blending medical insights with a dash of fun.

In this insightful discussion, Dr. Ilyse Genser, a pediatric neurologist and associate program director at Children's National Hospital, dives into the intricacies of neuroimaging for critically ill children. She shares essential insights on using head ultrasounds and CT scans, underlining the balance between diagnostic benefits and radiation concerns. Dr. Genser explains the urgent protocols for assessing pediatric strokes and highlights the importance of timely imaging. Her expert guidance equips pediatric intensivists with practical strategies for navigating complex cases.