Akira Nishisaki is an attending intensivist at Children's Hospital of Philadelphia, with nearly two decades in pediatric airway management. Doug Atkinson, a pediatric cardiac anesthesiologist also from Boston Children's, joins him to discuss critical aspects of airway management in the pediatric ICU. They explore the alarming statistics of intubation failures and complications, advancements in techniques like video laryngoscopy, and the significance of effective teamwork. The conversation also emphasizes the role of training and checklists in improving patient safety during high-risk procedures.

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!

Discussion on the challenges and collaboration in managing pediatric patients with complex airway issues. Treatment options for severe airway stenosis and malformations. Assessment and workup process for complex airway patients. Challenges of maintaining non-sick lungs in sedated children. Benefits of using micro cuff tube and rigid endoscope in complex airway surgeries. Approaching airway complications and post-extubation care. Criteria for escalating non-invasive support in pediatric patients after extubation.

Airway Management remains the single highest risk time for our patients in pedsICU & pedsCICU. We've known about problems for long time, but finally gaining attention, new ways of thinking & new ways to use drugs & devices- there's a lot more gray then there used to be. We'll discuss resuscitation and airway management in child with cardiac disease or hemodynamic instability, introduce the concept of the resus spiral staircase and talk about how you can optimize your team, respiratory support and hemodynamics. We cover delayed sequence intubation and that not every patient needs a tube and not every patient needs a tube right now. With better drugs and devices like dexmedetomidine and non-invasive, we've actually opened up a big zone between no support and invasive ventilation. We'll discuss ECMO standby when, how, who, and then finally de-resuscitation and extubation or separation from support. This was a really big episode, so we've split it into two. The first half covered the resus spiral, team management, equipment & environment. In this second episode, we will go into respiratory and hemodynamic support, rescue strategies, including ECMO and finally extubation. Featuring regular hosts @drpetaalexander @BostonChildrens @karen_choong @MCH-childrens @drgregkelly @SCHNkids 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

What are the pediatric #ECMO scenarios that even experts struggle with? "Challenging Pediatric ECMO Scenarios" Special Collaboration w @PCICS @ECMOPedi and @PedsIntensiva 3 cases covering what our expert hosts and panelists all decided were three of the HARDEST scenarios to deal with: 1. VA ECMO for respiratory support; 2. L heart decompression on VA ECMO &; 3. "Inadequate" VV ECMO support Feat. international experts @drpetaalexander @deanna_md @ETEmrath @DrGregKelly @JFurlongDillard @ozmen001 and Dr Ariane Willems As usual, the audio content will be released as a tweet thread that you can find and comment on - here is the link Pedsintensiva.com      

In this episode, guest_name_1, a pediatric ICU specialist, discusses the risks of airway management in pediatric ICU, especially for children with cardiac disease or hemodynamic instability. They explore the concept of the resus spiral staircase and how to optimize team management, respiratory support, and hemodynamics. Topics covered include delayed sequence intubation, the use of better drugs and devices, ECMO standby, and de-resuscitation. The podcast also touches on controlling variability during intubation, staff turnover, challenges in the pediatric ICU unit, and the importance of successful intubation and post-intubation monitoring.

Culture and Practice Change are a vital element to implement ICU based rehabilitation in the pediatric ICU - because even when we know what to do it can be really hard to get our large and diverse teams on board and manage resource limitations, change fatigue and differing views. Here, experts from around the world discuss how they implemented change in their units - using everything from quality science to gossip and merchandise! Invited guests are Dr Brianna McKelvie from @CHEO, an intensivist with a masters degree in quality science, Dr Matteo DiNardo from Bambino Gesu, who has implemented QI projects in Italy and in low resource settings and Dr Mirjana Cvetkovic @mirjanaxxx @GreatOrmondStreet a cardiac intensivist and anesthetist who has driven change at GOS. Featuring regular hosts @drpetaalexander @BostonChildrens @karen_choong @MCH-childrens @drgregkelly @SCHNkids 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/culture-practice-change-in-picu-based-rehabilitation/

Long term & technology dependent aka "chronic critically ill" #pedsICU patients with Dr Rob Graham @BostonChildrens @karen_choong @drgregkelly @drpetaalexander Our #ICUrehab season focussed on preventing PICU morbidities & improving recovery. Our successes in #pedsICU mean that most kids survive & we increasingly see survivors with chronic complex conditions, either in ICU or frequently readmitted. They are still a relatively small population but use a huge proportion of our bed days and are a population with unique risks & needs. Dr Rob Graham established the home ventilation program at Boston Children's and has deep expertise on these patients. #ICUrehab #ICUSurvivorship 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/long-term-technology-dependent-aka-chronic-critically-ill-pedsicu-patients-feat-dr-rob-graham/  

There is a growing awareness of the broad range of problems that patients and their families can face after a stay in the #pedsICU which is now known as Post Intensive Care Syndrome - pediatrics Nurse researcher and clinician Joseph Manning developed the PICS-p framework and has deep experience in following up these patients and families after they leave the ICU Pediatrica Intensiva season 3 is guest edited by Professor Karen Choong from McMaster University in Hamilton, Canada and co hosted by Drs Greg Kelly (Sydney Children's Hospital Network), Peta Alexander (Boston Children's Hospital) and Mike Clifford (Royal Children's Hospital Melbourne) No time to listen or want to participate in the discusion? You can find a full Tweetorial of this episode on Twitter https://twitter.com/PedsIntensiva and our website here https://pedsintensiva.com/post-intensive-care-syndrome-in-pedsicu-pics-p-with-nurse-researcher-joseph-manning-mbe-rn/

Analgesia and/or Sedation is provided to almost all the patients in the #pedsICU but it is something that often lacks precision. In this episode we speak to intensivist Prof Jayashree Muralidharan, #pedsICU nurse Sharon Prior and pharmacist Jonathon Wong Pediatrica Intensiva season 3 is guest edited by Professor Karen Choong from McMaster University in Hamilton, Canada and co hosted by Drs Greg Kelly (Sydney Children's Hospital Network), Peta Alexander (Boston Children's Hospital) and Mike Clifford (Royal Children's Hospital Melbourne) No time to listen or want to participate in the discusion? You can find a full Tweetorial of this episode on Twitter https://twitter.com/PedsIntensiva and our website here https://pedsintensiva.com/analgesia-sedation-in-pedsicu-feat-jayashree-muralidharan/