Podcasts about crit care med

The ICU Liberation Campaign from the Society of Critical Care Medicine (SCCM) has transformed critical care, but the COVID-19 pandemic and subsequent staffing challenges have posed major obstacles to maintaining progress. In this episode of the SCCM Podcast, host Ludwig H. Lin, MD, speaks with Juliana Barr, MD, FCCM, a key architect of the ICU Liberation Campaign. Dr. Barr was a lead author of the 2013 “Clinical Practice Guidelines for the Management of Pain, Agitation, and Delirium in Adult Patients in the Intensive Care Unit,” known as the PAD guidelines, an original cornerstone of the ICU Liberation Campaign (Barr J, et al. Crit Care Med. 2013;41:263-306). The guidelines' recent 2025 update also addressed immobility and sleep disruption (Lewis K, et al. Crit Care Med. 2025;53:e711-e727). Dr. Barr shares her personal journey from traditional ICU practices of heavy sedation and immobility to leading efforts that prioritize patient recovery, well-being, and post-ICU quality of life. She emphasizes how ICU Liberation reintroduced low-tech, high-impact interventions such as minimizing sedation, promoting early mobility, and engaging families—leading to better outcomes at lower costs. She cites the 2017 international survey by Morandi et al that demonstrated uneven but steady improvements in global ICU Liberation practices before the pandemic (Morandi A, et al. Crit Care Med. 2017;45:e1111-e1122). Dr. Barr details the need for reeducation, multidisciplinary team engagement, and reworking electronic health record (EHR) systems to better support ICU Liberation goals. Looking forward, Dr. Barr offers a "burning platform" approach, stressing that delaying ICU Liberation practices risks poorer patient outcomes. She advocates for cultural change, leadership engagement, real-time metrics visibility, and hospital-wide investment—including IT support to surface buried ICU Liberation Bundle data within EHRs. By reframing ICU Liberation as a "team sport" and making best practices part of daily ICU culture, Dr. Barr believes institutions can reestablish the bundle's momentum and reconnect healthcare teams to their core mission—helping patients return to meaningful lives after critical illness. This conversation offers energizing, practical strategies for ICU teams at every stage of ICU Liberation implementation or reinvigoration.

Welcome to another exciting episode of PICU Doc on Call! Today, we're diving deep into the world of pediatric critical care with our expert hosts, Dr. Rahul Damania, Dr. Pradip Kamat, and Dr. Monica Gray. Get ready to unravel the mysteries of the oxygen extraction ratio (O2ER) and its pivotal role in managing pediatric acute respiratory distress syndrome (ARDS) and multi-organ dysfunction.Picture this: a seven-year-old girl battling severe pneumonia that spirals into ARDS and septic shock. Our hosts walk you through this gripping case, shedding light on calculating O2ER and why central venous oxygen saturation (ScvO2) is a game-changer. They'll share their top strategies for optimizing oxygen delivery and cutting down on oxygen demand.But that's not all! This episode is all about the holistic approach to managing critically ill pediatric patients. Tune in to discover how these insights can lead to better outcomes for our youngest and most vulnerable patients. Don't miss out on this vital conversation!Show Highlights:Clinical significance of the oxygen extraction ratio (O2ER) in pediatric critical careImportance of understanding oxygen delivery and consumption in critically ill patientsCalculation and interpretation of O2ER and its relationship to central venous oxygen saturation (ScvO2)Physiological concepts related to oxygenation, including intrapulmonary shunting and ventilation-perfusion mismatchManagement strategies for increasing oxygen delivery and reducing oxygen demand in ARDS and septic shockInterventions such as blood transfusions, sedation, and optimization of cardiac outputImplications of lactic acidosis and anaerobic metabolism in the context of inadequate oxygen deliveryHolistic approach to patient management, focusing on both numerical values and overall metabolic needsWe welcome you to share your feedback, subscribe & place a review on our podcast! Please visit our website picudoconcall.org.References:Fuhrman B.P. & Zimmerman J.J. (Eds.). Pediatric Critical Care, 6th ed. Elsevier; 2021. (Key concepts of oxygen delivery, consumption, and extraction in shock states are discussed in Chapter 13) .Nichols D.G. (Ed.). Roger's Textbook of Pediatric Intensive Care, 5th ed. Wolters Kluwer; 2016. (Comprehensive review of oxygen transport and utilization in critically ill children, including ARDS and shock).Lucking S.E., Williams T.M., Chaten F.C., et al. Dependence of oxygen consumption on oxygen delivery in children with hyperdynamic septic shock and low oxygen extraction. Crit Care Med. 1990;18(12):1316–1319. doi:10.1097/00003246-199012000-00002.Ronco J.J., Fenwick J.C., Tweeddale M.G., et al. Pathologic dependence of oxygen consumption on oxygen delivery in acute respiratory failure. Chest. 1990;98(6):1463–1466. doi:10.1378/chest.98.6.1463 .Carcillo J.A., Davis A.L., Zaritsky A. Clinical practice parameters for hemodynamic support of pediatric and neonatal septic shock. Crit Care Med. 2002;30(6):1365–1378. (ACCM guidelines emphasizing ScvO₂ targets in shock) .Emeriaud G, López-Fernández YM, Iyer NP, et al; PALICC-2 Group; PALISI Network. Executive summary of the second international guidelines for the diagnosis and management of pediatric ARDS (PALICC-2). Pediatr Crit Care Med. 2023;24(2):143–168. doi:10.1097/PCC.0000000000003147.

In this episode, Dr. Sergion Zanotti discusses TEE in cardiac arrest and shock. Critical care clinicians commonly utilize transthoracic echocardiography in the ICU as part of their point-of-care-ultrasonography (POCUS) toolkit. However, there is a growing push to train intensivists in using transesophageal echocardiography (TEE) for cardiac arrest and peri-arrest situations in the ICU. Our guest is Dr. Sara Nikravan, a cardiothoracic anesthesia critical care physician with training in advanced perioperative echocardiography. Dr. Nikravan is an Associate Professor of Cardiothoracic Anesthesiology and Critical Care Medicine at the University of Washington Medical School and practices at the UW Medical Center. She is recognized as an expert and master educator in Critical Care, Perioperative echocardiography, and Point of Care Ultrasound. She has authored numerous peer-reviewed papers and is the guidelines co-chair of the Society of Critical Care Medicine Guidelines on Adult Critical Care Ultrasonography: Focused Update 2024, recently published in Critical Care Medicine.  Additional links: Society of Critical Care Medicine Guidelines on Adult Critical Care Ultrasonography: Focused Update 2024, Crit Care Med 2025: https://pubmed.ncbi.nlm.nih.gov/39982182/ Focused Transesophageal Echocardiography During Cardiac Arrest Resuscitation: JACC Review Topic of the Week. JACC 2020: https://pubmed.ncbi.nlm.nih.gov/32762909/ Landing page for the Resuscitative TEE Project website: https://www.resuscitativetee.com/ Books mentioned in this episode: The Prophet. By Kahlil Gibran: https://www.amazon.com/dp/998247037X?psc=1&smid=ATVPDKIKX0DER&ref_=chk_typ_imgToDp

Host Kyle Enfield, MD, FCCM, welcomes Adriano Targa, PhD, to discuss the article, “Sleep and Circadian Health of Critical Survivors: A 12-Month Follow-Up Study,” published open access in the August 2024 issue of Critical Care Medicine (Henríquez-Beltrán M, et al. Crit Care Med. 2024;52:1206-1217). They will discuss the prevalence of sleep disturbances and circadian rhythm fragmentation in critical survivors, the impact of factors such as invasive mechanical ventilation and hospitalization duration, and associations among sleep quality, mental health, and respiratory function one year post-discharge. Dr. Targa is a researcher at the Center for Biomedical Research Network - CIBER in Madrid, Spain. Find more expert-developed articles from Critical Care Medicine at ccmjournal.org.

In this episode of the SCCM Podcast, host Diane C. McLaughlin, DNP, AGACNP-BC, CCRN, FCCM, is joined by Heather Meissen, DNP, FCCM, to discuss the importance to nurses of publication and navigating the academic publishing process. They discuss how nurses at the bedside are uniquely positioned to identify trends and gaps in patient care that can be addressed through research and publication. This podcast aims to raise awareness for nurses and other critical care practitioners wanting to enter the research and publishing fields. This unique professional development topic is designed for healthcare workers at the beginning of their research and publishing journeys. Dr. Meissen stresses that publishing is vital for advancing nursing practice and improving patient care, urging clinicians to “just get started” on their research and writing journeys. She emphasizes the importance of finding a mentor to help refine research questions, structure projects, and navigate challenges. She provides practical advice on identifying a research topic, conducting a literature review, and selecting the appropriate journal for submission. The discussion also highlights imposter syndrome among new writers and how overcoming self-doubt is crucial to getting published. The conversation touches on the peer review process, including how to handle feedback constructively and spot predatory journals that seek publication fees without legitimate editorial oversight. Dr. Meissen also discusses the role of AI in writing and research, cautioning against its misuse while acknowledging its potential benefits. Finally, she encourages nurses to participate in the Society of Critical Care Medicine (SCCM) Reviewer Academy, which aims to train a community of trusted, skilled, and diverse peer reviewers to perform high-quality reviews for the SCCM journals (Alexander P, et al. Crit Care Med. 2023;51:1111-1123). Learn more about the SCCM Reviewer Academy at sccm.org/journals. Diane C. McLaughlin, DNP, AGACNP-BC, CCRN, FCCM, is a neurocritical care nurse practitioner at University of Florida Health Jacksonville. She is active within SCCM, serving on both the APP Resource and Ultrasound committees, and is a social media ambassador for SCCM. Heather Meissen, DNP, FCCM, is a nurse practitioner and associate clinical professor at Emory Healthcare in Atlanta, Georgia.

In this episode of the Saving Lives Podcast, we review a 2025 study from Critical Care Medicine comparing lactated Ringer's and normal saline for initial fluid resuscitation in sepsis-induced hypotension. The findings suggest that LR may improve survival and increase hospital-free days compared to NS, supporting current guidelines favoring balanced crystalloids. Tune in for a deep dive into the study's results and clinical implications!The Vasopressor & Inotrope HandbookI have written "The Vasopressor & Inotrope Handbook: A Practical Guide for Healthcare Professionals," a must-read for anyone caring for critically ill patients (check out the reviews)! You have several options to get a physical copy. Amazon: ⁠⁠⁠⁠⁠https://amzn.to/47qJZe1⁠⁠⁠⁠⁠ (Affiliate Link)My Store: ⁠⁠⁠⁠⁠https://eddyjoemd.myshopify.com/products/the-vasopressor-inotrope-handbook⁠⁠⁠⁠⁠ (Use "podcast" to save 10%)Citation: Gelbenegger G, Shapiro NI, Zeitlinger M, Jilma B, Douglas IS, Jorda A. Lactated Ringer's or Normal Saline for Initial Fluid Resuscitation in Sepsis-Induced Hypotension. Crit Care Med. 2025 Feb 19. doi: 10.1097/CCM.0000000000006601. Epub ahead of print. PMID: 39969246.

Send us a textDiese Woche beschäftigen sich mein Kollege Paul Zerweck und ich mit einer Arbeit über Komplikationen nach V-A-ECMO:Djavidi N, Boussouar S, Duceau B, et al. Vascular Complications After Venoarterial Extracorporeal Membrane Oxygenation Support: A CT Study. Crit Care Med. 2025;53(1):e96-e108. doi:10.1097/CCM.0000000000006476

Listener discretion is advised. References: Gutierrez, E. (2023). The Vasopressor & Inotrope Handbook: A Practical Guide for Healthcare Professionals. Hu W, Wang X, Su G. Infective endocarditis complicated by embolic events: Pathogenesis and predictors. Clin Cardiol. 2021 Mar;44(3):307-315. doi: 10.1002/clc.23554. Epub 2021 Feb 1. PMID: 33527443; PMCID: PMC7943911. Marik PE, Farkas JD. The Changing Paradigm of Sepsis: Early Diagnosis, Early Antibiotics, Early Pressors, and Early Adjuvant Treatment. Crit Care Med. 2018 Oct;46(10):1690-1692. doi: 10.1097/CCM.0000000000003310. PMID: 30216303.

Host Diane C. McLaughlin, DNP, AGACNP-BC, CCRN, FCCM, welcomes Matthew Kirschen, MD, PhD, FAAN, FNCS, to discuss what critical care professionals need to know about determining brain death/death by neurologic criteria (BD/DNC). In October 2023, a revised consensus practice guideline for the determination of brain death in both children and adults was published in Neurology (Greer DM, et al. Neurology. 2023;101;1112-1132). The guideline integrated guidance for adults and children to provide a comprehensive, practical way to evaluate patients with catastrophic brain injuries to determine whether they meet the criteria for brain death. The Society of Critical Care Medicine (SCCM) offers several additional resources to support critical care clinicians' understanding of the updated guidelines, including an article published in the March 2024 issue of Critical Care Medicine addressing what the critical care team needs to know about the guidelines (Kirschen MP, et al. Crit Care Med. 2024;52:376-386). Dr. Kirchen was the lead author of that article and shares key points in this podcast episode. Other resources include: Pediatric and Adult Brain Death/Death by Neurologic Criteria Consensus Practice Guidelines 2024 Critical Care Congress presentation Free AAN evaluation tool that walks clinicians through the process of brain death evaluation. Special article in Neurology: Clinical Practice that provides a detailed narrative about what has changed in the 2023 guidelines compared to prior guidelines. The article also includes tables outlining comparisons, bolding new recommendations, and italicizing age-specific guidance to easily identify the differences between determining brain death in children versus adults.

Send us a textIn dieser Folge geht es um den Einfluss von Kalzium auf das Membranpotenzial in er Hyperkaliämie, und ein besseres Verständnis des Themas "Membranstabilisierung": Piktel JS, Wan X, Kouk S, Laurita KR, Wilson LD. Beneficial Effect of Calcium Treatment for Hyperkalemia Is Not Due to "Membrane Stabilization". Crit Care Med. 2024;52(10):1499-1508. doi:10.1097/CCM.0000000000006376Im Studio mit dabei: Julie Zangarini, wissenschaftliche Mitarbeiterin der Klinik für Anästhesiologie am UKHD

In this episode, Dr. Sergio Zanotti discusses the application of behavioral economics to clinical practice, specifically choice framing in ICU goals-of-care Meetings. He is joined by Dr. Joanna Hart, a pulmonary critical care physician and assistant professor of medicine at the Perelman School of Medicine at the University of Pennsylvania in Philadelphia. She is also a core faculty member of the Palliative and Advanced Illness Research Center and is affiliated with the Center for Health Incentives and Behavioral Economics. Additional Resources: Clinician's Use of Choice Framing in ICU Family Meetings. Joanna L Hart et al. Crit Care Med 2024: https://pubmed.ncbi.nlm.nih.gov/38912880/ Using Default Options and Other Nudges to Improve Critical Care. Scott Halpern. Crit Care Med 2019: https://pmc.ncbi.nlm.nih.gov/articles/PMC5826616/ Books mentioned in this episode: Demon Copperhead. By Barbara Kingsolver: https://bit.ly/4hYCqQv Thinking Fast and Slow. By Daniel Kahneman: https://bit.ly/4i3eknK Nudge. By Richard H. Thaler, et al.: https://bit.ly/3YUqxlG

Send us a textIn dieser Folge dreht sich alles um die Frage rechts vs. links bei der ultraschallgestützten ZVK-Anlage in die V.subclavia: Shin KW, Park S, Jo WY, et al. Comparison of Catheter Malposition Between Left and Right Ultrasound-Guided Infraclavicular Subclavian Venous Catheterizations: A Randomized Controlled Trial. Crit Care Med. 2024;52(10):1557-1566. doi:10.1097/CCM.0000000000006368Im Studio mit dabei: Lena Gaissmaier, wiss. Mitarbeiterin der Klinik für Anästhesiologie am UKHD

In this episode, we review the recommendations from the 2024 SCCM/ASHP stress ulcer prophylaxis guidelines and highlight three of the more recent landmark critical care trials investigating the role of stress ulcer prophylaxis. Key Concepts After 25 years, the stress ulcer prophylaxis guidelines have been updated by SCCM and ASHP. These guidelines make 13 recommendations in a PICO format. Three large, landmark randomized controlled trials (SUP-ICU, PEPTIC, and REVISE) have significantly contributed to the body of literature regarding stress ulcer prophylaxis. The SCCM/ASHP guidelines recommend stress ulcer prophylaxis in patients with coagulopathy, shock, chronic liver disease, and possibly in neurocritical care patients. They do not specifically recommend prophylaxis in mechanically ventilated patients; this is a controversial recommendation. The SCCM/ASHP guidelines equally prefer proton pump inhibitor (PPI) and histamine-2 receptor antagonists (H2RA) drug therapies given either intravenously or orally. The prophylaxis regimen should be continued until the indication for prophylaxis has resolved or the patient leaves the ICU. References MacLaren R, Dionne JC, Granholm A, et al. Society of Critical Care Medicine and American Society of Health-System Pharmacists Guideline for the Prevention of Stress-Related Gastrointestinal Bleeding in Critically Ill Adults. Crit Care Med. 2024;52(8):e421-e430. doi:10.1097/CCM.0000000000006330 SUP-ICU study. Krag M, Marker S, Perner A, et al. Pantoprazole in Patients at Risk for Gastrointestinal Bleeding in the ICU. N Engl J Med. 2018;379(23):2199-2208. doi:10.1056/NEJMoa1714919 PEPTIC study. PEPTIC Investigators for the Australian and New Zealand Intensive Care Society Clinical Trials Group, Alberta Health Services Critical Care Strategic Clinical Network, and the Irish Critical Care Trials Group, Young PJ, Bagshaw SM, et al. Effect of Stress Ulcer Prophylaxis With Proton Pump Inhibitors vs Histamine-2 Receptor Blockers on In-Hospital Mortality Among ICU Patients Receiving Invasive Mechanical Ventilation: The PEPTIC Randomized Clinical Trial. JAMA. 2020;323(7):616-626. doi:10.1001/jama.2019.22190 REVISE study. Cook D, Deane A, Lauzier F, et al. Stress Ulcer Prophylaxis during Invasive Mechanical Ventilation. N Engl J Med. 2024;391(1):9-20. doi:10.1056/NEJMoa2404245

Host Samantha Gambles Farr, MSN, AG-ACNP, FNP-C, RNFA, is joined by Roman Melamed, MD, to discuss the comparative effectiveness of reduced-dose versus full-dose alteplase for acute pulmonary embolism, focusing on patient outcomes and complications. They will highlight study findings on significant improvements in hemodynamic and respiratory parameters in both groups, with a lower rate of hemorrhagic complications in the reduced-dose group (Melamed R, et al. Crit Care Med. 2024;52:729-742). Dr. Melamed is a critical care intensivist and director of the Pulmonary Embolism Program at Abbott Northwestern Hospital in Minneapolis, Minnesota, USA, and an adjunct associate professor at the University of Minnesota.

A patient with a large TBSA burn injury is transferred to a regional burn center. You are faced with some difficult clinical decisions as the resuscitation proves to be challenging. Join Drs. Tam Pham, Rob Cartotto, Julie Rizzo, Alex Morzycki and Jamie Oh as they discuss the clinical challenges in titrating and troubleshooting during acute burn resuscitation.  Hosts: ·  Dr. Tam Pham: UW Medicine Regional Burn Center ·  Dr. Robert Cartotto: University of Toronto, Ross Tilley Burn Centre  ·  Dr. Julie Rizzo: Brooke Army Medical Center  ·  Dr. Alex Morzycki: UW Medicine Regional Burn Center ·  Dr. Jamie Oh: UW Medicine Regional Burn Center Learning Objectives: ·  Understand the role of colloids as complement/rescue to standard crystalloid fluid titration.  ·  Identify the fluid threshold associated with development of abdominal compartment syndrome ·  Understand the role of continuous renal replacement therapy for patients with acute kidney injury during the resuscitation phase. ·  List specific patient populations who may experience a more difficult resuscitation. References: 1.     Ivy ME, Atweh NA, Palmer J, et al. Intra-abdominal hypertension and abdominal compartment syndrome in burn patients. J Trauma 2000 https://pubmed.ncbi.nlm.nih.gov/11003313/ 2.     Cartotto R, Johnson LS, Savetamal A, et al. American Burn Association Clinical Practice Guidelines on Burn Shock Resuscitation. J Burn Care Res 2023 https://pubmed.ncbi.nlm.nih.gov/38051821/ 3.     Greenhalgh DG, Cartotto R, Taylor SL, et al. Burn Resuscitation practices in North America: results of the Acute Burn ResUscitation Prospective Trial (ABRUPT). Ann Surg 2023 https://pubmed.ncbi.nlm.nih.gov/34417368/ 4.     Cartotto R, Callum J. A review of the use of human albumin in burn patients. J Burn Care Res 2012 https://pubmed.ncbi.nlm.nih.gov/23143614/ 5.     Cruz MV, Carney BC, Luker JN, et al. Plasma ameliorates endothelial dysfunction in burn injury. J Surg Res 2019 https://pubmed.ncbi.nlm.nih.gov/30502286/ 6.     Falhstrom K, Boyle C, Makic MBF. Implementation of a nurse-driven burn resuscitation protocol: a quality improvement project. Critical Care Nurses 2013 https://pubmed.ncbi.nlm.nih.gov/23377155/ 7.     Salinas J, Chung KK, Mann EA, et al. Computerized decision support system improves fluid resuscitation following severe burns: an original study. Crit Care Med 2011 https://pubmed.ncbi.nlm.nih.gov/21532472/ 8.     Kenney CL, Singh P, Rizzo J, et al. Impact of alcohol and methamphetamine use on burn resuscitation. J Burn Care Res 2023 https://pubmed.ncbi.nlm.nih.gov/37227949/ Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.   If you liked this episode, check out our recent episodes here: https://app.behindtheknife.org/listen

Host Elizabeth H. Mack, MD, MS, FCCM, is joined by Samuel Snider, MD, and Michael Fong, MD, to discuss a retrospective cohort study that examined factors such as cardiac arrest, brain neoplasms, and EEG patterns to determine their association with status epilepticus and isolated seizures in critically ill patients, aiming to improve monitoring and treatment strategies for high-risk patients (Snider SB, et al. Crit Care Med. 2023 Aug;51:1001-1011). Samuel Snider, MD, is a board-certified neurologist at Brigham and Women's Hospital and an instructor of neurology at Harvard Medical School in Boston, Massachusetts. Michael Fong, MD, is an assistant professor adjunct at the Yale School of Medicine in New Haven, Connecticut.

Host Kyle B. Enfield, MD, FCCM, is joined by Daisuke Kawakami, MD, to discuss the Critical Care Medicine article, “Evaluation of the Impact of ABCDEF Bundle Compliance Rates on Postintensive Care Syndrome: A Secondary Analysis Study.” (Kawakami D, et al. Crit Care Med. 2023 Dec;51:1685-1696). The study examines how compliance with the ICU Liberation Bundle (A-F) impacts post-intensive care syndrome and intensive care unit mortality rates Dr. Kawakami is a physician in the Department of Emergency and Critical Care Medicine at St. Marianna University School of Medicine in Kawasaki, Japan. Learn more about the ICU Liberation Bundle at sccm.org/iculiberation.

In this World Shared Practice Forum podcast, Drs. Sapna Kudchadkar and Kate Madden discuss early mobilization programs in pediatric intensive care units (PICUs). They highlight the importance of interdisciplinary collaboration, including the need for shared mental frameworks regarding sedation practices and delirium screening and management. Dr. Kudchadkar describes the potential risks of delirium, the benefits of keeping patients oriented and engaged, and highlights the need for sustainability of early mobilization. She also discusses the implementation and challenges of the PICU UP! program. LEARNING OBJECTIVES Following this discussion, learners will be able to: - Discuss the importance of early mobilization in PICU - Explain the risks of delirium, as well as appropriate screening and management - Identify the origins, goals, and benefits of the PICU Up! program AUTHORS Sapna Kudchadkar, MD, PhD, FCCM Professor, Anesthesiologist-in-Chief of Johns Hopkins Children's Center, Vice Chair for Pediatric Anesthesiology and Critical Care Medicine, Director of the John Hopkins PICU Up! Program Johns Hopkins University School of Medicine Kate Madden, MD Senior Associate, BCH Medical-Surgical ICU Boston Children's Hospital Assistant Professor of Anesthesiology Harvard Medical School DATE Initial publication date: May 24, 2024. ARTICLES REFERENCED 00:04:43 Wieczorek B, Ascenzi J, Kim Y, et al. PICU Up!: Impact of a Quality Improvement Intervention to Promote Early Mobilization in Critically Ill Children. Pediatr Crit Care Med. 2016;17(12):e559-e566. doi:10.1097/PCC.0000000000000983 (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5138131/) 00:06:32 Marra A, Ely EW, Pandharipande PP, Patel MB. The ABCDEF Bundle in Critical Care. Crit Care Clin. 2017;33(2):225-243. doi:10.1016/j.ccc.2016.12.005 (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5351776) 00:06:37 ICU liberation initiative (https://www.sccm.org/iculiberation) 00:33:24 Lin JC, Srivastava A, Malone S, et al. Caring for Critically Ill Children With the ICU Liberation Bundle (ABCDEF): Results of the Pediatric Collaborative. Pediatr Crit Care Med. 2023;24(8):636-651. doi:10.1097/PCC.0000000000003262 (https://pubmed.ncbi.nlm.nih.gov/37125798/) 00:34:32 Kudchadkar SR, Nelliot A, Awojoodu R, et al. Physical Rehabilitation in Critically Ill Children: A Multicenter Point Prevalence Study in the United States. Crit Care Med. 2020;48(5):634-644. doi:10.1097/CCM.0000000000004291 (https://pubmed.ncbi.nlm.nih.gov/32168030/) 00:39:40 X @SapnaKMD (https://x.com/sapnakmd) Please visit: http://www.openpediatrics.org OPENPediatrics™ is an interactive digital learning platform for healthcare clinicians sponsored by Boston Children's Hospital and in collaboration with the World Federation of Pediatric Intensive and Critical Care Societies. It is designed to promote the exchange of knowledge between healthcare providers around the world caring for critically ill children in all resource settings. The content includes internationally recognized experts teaching the full range of topics on the care of critically ill children. All content is peer-reviewed and open-access and thus at no expense to the user. For further information on how to enroll, please email: openpediatrics@childrens.harvard.edu Kudchadkar SR, O'Hara JE, Madden K. PICU Up!: Collaboration for Success by S. Kudchadkar | OPENPediatrics. 05/2024. OPENPediatrics. Online Podcast. https://soundcloud.com/openpediatrics/picu-up-collaboration-for-success-by-s-kudchadkar-openpediatrics

We've recently had several challenging, wide-complex tachycardia cases here at MCHD, so the podcast crew decided to bring forth some VT vs. SVT with aberrancy knowledge. Learn the V-Tach FACT, and you'll feel more comfortable with your next wide rhythm at a rate of 185. REFERENCES 1. https://litfl.com/vt-versus-svt-ecg-library/ 2. https://www.youtube.com/watch?v=UXh8PS9dtmo 3. Marill KA, Wolfram S, Desouza IS, Nishijima DK, Kay D, Setnik GS, Stair TO, Ellinor PT. Adenosine for wide-complex tachycardia: efficacy and safety. Crit Care Med. 2009 Sep;37(9):2512-8.

Host Marilyn N. Bulloch, PharmD, BCPS, FCCM, is joined by Joy Peterson, PharmD, BCPS, BCIDP, Neha Paranjape, MD, MPH, to discuss the article, "Outcomes and Adverse Effects of Baricitinib Versus Tocilizumab in the Management of Severe COVID-19," (Crit Care Med. March 2023 51(3):337-346) which delves into the comparative outcomes, mortality rates, and adverse effects of baricitinib and tocilizumab in severe COVID-19 cases. Dr. Peterson is a Clinical Pharmacy Specialist in infectious disease, and Dr. Paranjape is an Infectious Disease Specialist at Wellstar Health System in Marietta, Georgia.

https://www.cursotdc.com.br/antibiotico/lead/

Sim Moove recevait aujourd'hui Cécile Monteil, Médecin aux urgences pédiatriques de l'Hôpital Robert Debré (AP-HP), formatrice en simulation en santé depuis plusieurs années, Experte en E-Santé et conférencière. Elle participe activement à la formation de formateur à travers le pays via le programme de la plateforme Ilumens et est responsable d'un programme de formation in-situ aux urgences pédiatrique de son hôpital. Elle partage avec nous ses réussites, ses moments de simulation à impact et donne un maximum de conseils pour ce tous les passionnés de simulation. Nous avons parlé de quelques études qui montrent de manière translationnelle le bénéfice de la simulation en santé sur les apprenants: - *[Pezel T, Dreyfus J, Mouhat B, et al. Effectiveness of Simulation-Based Training on Transesophageal Echocardiography Learning: The SIMULATOR Randomized Clinical Trial. JAMA Cardiol. 2023;8(3):248–256. doi:10.1001/jamacardio.2022.5016](https://jamanetwork.com/journals/jamacardiology/article-abstract/2800011)* mais aussi sur les patients et les soignants: - *[El Khamali R et al. Effects of a Multimodal Program Including Simulation on Job Strain Among Nurses Working in Intensive Care Units: A Randomized Clinical Trial. JAMA. 2018](https://pubmed.ncbi.nlm.nih.gov/30357264/)* - *[Barsuk JH, McGaghie WC, Cohen ER, O'Leary KJ, Wayne DB. Simulation-based mastery learning reduces complications during central venous catheter insertion in a medical intensive care unit. Crit Care Med. 2009](https://pubmed.ncbi.nlm.nih.gov/19885989/)* Et enfin, quelques conseils lectures gentiment partagés par notre invitée: - Communication non violente, Marshall Rosenberg - Eviter les erreurs médicales grâce à la simulation, Olivier et Sylvie Angel Pour toute information complémentaire sur notre invitée du jour vous pouvez consulter son Site internet ou son profil Linkedin

This episode delves into the 2024 update on corticosteroid guidelines for critically ill patients with sepsis, ARDS, and community-acquired pneumonia. We break down the recommendations, evidence, and clinical implications of this crucial guidance for healthcare providers. The Vasopressor & Inotrope Handbook: ⁠⁠⁠⁠Amazon Affiliate Link⁠⁠⁠⁠ (I will earn an extra small commission) and ⁠⁠⁠⁠Signed/Personalized Copies⁠⁠⁠⁠. Citation: Chaudhuri D, Nei AM, Rochwerg B, Balk RA, Asehnoune K, Cadena RS, Carcillo JA, Correa R, Drover K, Esper AM, Gershengorn HB, Hammond NE, Jayaprakash N, Menon K, Nazer L, Pitre T, Qasim ZA, Russell JA, Santos AP, Sarwal A, Spencer-Segal J, Tilouche N, Annane D, Pastores SM. Executive Summary: Guidelines on Use of Corticosteroids in Critically Ill Patients With Sepsis, Acute Respiratory Distress Syndrome, and Community-Acquired Pneumonia Focused Update 2024. Crit Care Med. 2024 Jan 19. doi: 10.1097/CCM.0000000000006171. Epub ahead of print. PMID: 38240490. --- Support this podcast: https://podcasters.spotify.com/pod/show/eddyjoemd/support

Dr. Casey Clements spent two hours breaking down the history and influences in sepsis care over the past three decades and going through the best practices in today's emergency medicine. Do you know how Sepsis is defined currently? What is the difference between SEP - 1 and surviving sepsis campaign? What is the role of steroids or vitamin C? Can you resuscitate these patients with albumin? These and so many more questions will be answered in this two part series. So join Venk like vancomycin, and Alex (aka Zosyn) and Casey "not-cidal" Clements in these amazing episodes.   CONTACTS X - @AlwaysOnEM; @VenkBellamkonda YouTube - @AlwaysOnEM; @VenkBellamkonda Instagram – @AlwaysOnEM; @Venk_like_vancomycin; @ASFinch Email - AlwaysOnEM@gmail.com REFERENCES & LINKS SOFA Score: Vincent JL, MOreno R, Takala J, et al. The SOFA (Sepsis-related organ failure assessment) score to describe organ dysfunction / failure. On Behalf of the working group on Sepsis-Related Problems of the European Society of Intensive Care Medicine. Intensive Care Med. 1996 Jul;22(7):707-10 Vincent JL, de Mendonca A, Cantraine F, et al. Use of the SOFA score to assess the incidence of organ dysfunction / failure in intensive care units: results of a multicenter, prospective study. Working group on ‘sepsis-related problems' of the European Society of Intensive Care Medicine. Crit Care Med. 1998;26(11):1793-1800 Ferreira FL, Bota DP, Bross A, Merlot C, Vincent JL. Serial evaluation of the SOFA score to predict outcomes in critically ill patients. JAMA. 2001 Oct 10;286(14):1754-8 Cardenas-Turanzas M, Ensor J, Wakefield C, Zhang K, Wallace SK, Price KJ, Nates JL. Cross-validation of a sequential organ failure assessment score-based model to predict mortality in patients with cancer admitted to the intensive care unit. J Crit Care. 2012 Dec;27(6):673-80 qSOFA score Seymour CW, Liu VX, Iwashyna TJ, et al. Assessment of clinical criteria for sepsis: for the Third International Consensus Definitions for sepsis and septic shock (Sepsis-3). JAMA. 2016;315(8):762-774 Shankar-Hari M, Phillips GS, Levy ML, et al. Developing a new definition and assessing new clinical criteria for septic shock: For the Third International Consensus Definitions for Sepsis and SEptic Shock (Sepsis-3). JAMA. 2016;315(8):775-787 Freund Y, Lemachatti N, Krastinova E, et al. Prognostic accuracy of Sepsis-3 Criteria for in-hospital mortality among patients with suspected infection presenting to the emergency department. JAMA. 2017;317(3):301-308 Raith EP, Udy AA, Bailey M, et al. Prognostic accuracy of the SOFA score, SIRS criteria, and qSOFA score for in-hospital mortality among adults with suspected infection admitted to the intensive care unit. JAMA. 2017;317(3):290-300 Comparing Prognostic scores Henning DJ, Puskarich MA, Self WH, Howell MD, Donnino MW, Yealy DM, Jones AE, Shapiro NI. An Emergency Department validation of the SEP-3 Sepsis and Septic Shock definitions and comparison with 1992 consensus definitions. Ann Emerg Med. 2017 Oct;70(4):544-552 IDSA concern Rhee C, Chiotos K, Cosgrove SE, Heil EL, Kadri SS, Kalil AC, Gilbert DN, Masur H, Septimus EJ, Sweeney DA, Strich JR, Winslow DL, Klompas M. Infectious diseases society of america position paper: Recommended revisions to the National Severe Sepsis and Septic Shock early management bundle (SEP-1) Sepsis Quality Measure. Clin Infect Dis. 2021 Feb 16;72(4):541-552 About Barcelona Declaration Slade E, Tamber PS, Vincent JL. The Surviving Sepsis Campaign: raising awareness to reduce mortality. Crit Care. 2003;7:1-2 1- hour surviving sepsis bundle guidance Freund Y, Khoury A, Mockel M, et al. European Society of Emergency Medicine position paper on the 1-hour sepsis bundle of the Surviving Sepsis Campaign: expression of concern. Eur J Emerg Med. 2019 Aug;26(4):232-233 Early Goal Directed Therapy Rivers E, Nguyen B, Havstad S, et al. Early goal-directed therapy in the treatment of severe sepsis and septic shock. NEJM. 2001 Nov 8;345(19):1368-77 SEP - 1 Quality Measure National Quality Forum Measure submission and evaluation worksheet 5.0 for NQF #0500 Severe Sepsis and Septic Shock: Management Bundle, last updated Date: Oct 05, 2012. Website link Accessed 01-31-2024: https://www.qualityforum.org/Projects/i-m/Infectious_Disease_Endorsement_Maintenance_2012/0500.aspx  National Quality Forum: NQF Revises Sepsis Measure. Website link accessed 01-31-2024: https://www.qualityforum.org/NQF_Revises_Sepsis_Measure.aspx  Faust JS, Weingart SD. The Past, Present, and Future of the Centers for Medicare and Medicaid Services Quality Measure SEP-1 - the early management bundle for severe sepsis / septic shock. Emerg Med Clin N Am. 2017; 35:219-231 Affordable care act Patient Protection and Affordable Care Act, Public Law 148, U.S. Statutes at Large 124 (2010):119-1024. Website link accessed 01-31-2024: https://www.govinfo.gov/app/details/STATUTE-124/STATUTE-124-Pg119/summary.  Fluids for sepsis in concerning populations Pence M, Tran QK, Shesser R, Payette C, Pourmand A. Outcomes of CMS-mandated fluid administration among fluid-overloaded patients with sepsis: A systematic review and meta-analysis. Am J Emerg Med. 2022 May:55:157-166 Zadeh AV, Wong A, Crawford AC, Collado E, Larned JM. Guideline-based and restricted fluid resuscitation strategy in sepsis patients with heart failure: A systematic review and meta-analysis. Am J Emerg Med. 2023 Nov:73:34-39   WANT TO WORK AT MAYO? EM Physicians: https://jobs.mayoclinic.org/emergencymedicine EM NP PAs: https://jobs.mayoclinic.org/em-nppa-jobs   Nursing/Techs/PAC: https://jobs.mayoclinic.org/Nursing-Emergency-Medicine EMTs/Paramedics: https://jobs.mayoclinic.org/ambulanceservice All groups above combined into one link: https://jobs.mayoclinic.org/EM-Jobs  

This is the next episode of our Push Dose Pearls miniseries with ED Clinical Pharmacist, Chris Adams. In this ongoing series we'll dig into some of the questions we all have about medications we commonly see and use in the ED. This episode focuses on RSI (rapid sequence intubation) meds - stuff every ED doc needs to know! What has changed and what are the latest recommendations? We'll answer these questions and more!  Did this episode change your practice? Let us know on social media @empulsepodcast or at ucdavisem.com Hosts: Dr. Sarah Medeiros, Associate Professor of Emergency Medicine at UC Davis Dr. Julia Magaña, Associate Professor of Pediatric Emergency Medicine at UC Davis Guests: Christopher Adams, PharmD, Emergency Department Senior Clinical Pharmacist and Assistant Professor at UC Davis Resources: Acquisto NM, Mosier JM, Bittner EA, Patanwala AE, Hirsch KG, Hargwood P, Oropello JM, Bodkin RP, Groth CM, Kaucher KA, Slampak-Cindric AA, Manno EM, Mayer SA, Peterson LN, Fulmer J, Galton C, Bleck TP, Chase K, Heffner AC, Gunnerson KJ, Boling B, Murray MJ. Society of Critical Care Medicine Clinical Practice Guidelines for Rapid Sequence Intubation in the Critically Ill Adult Patient. Crit Care Med. 2023 Oct 1;51(10):1411-1430. doi: 10.1097/CCM.0000000000006000. Epub 2023 Sep 14. PMID: 37707379. Engstrom K, Brown CS, Mattson AE, Lyons N, Rech MA. Pharmacotherapy optimization for rapid sequence intubation in the emergency department. Am J Emerg Med. 2023 Aug;70:19-29. doi: 10.1016/j.ajem.2023.05.004. Epub 2023 May 10. PMID: 37196592. Bennett BL, Scherzer D, Gold D, Buckingham D, McClain A, Hill E, Andoh A, Christman J, Shonk A, Spencer SP. Optimizing Rapid Sequence Intubation for Medical and Trauma Patients in the Pediatric Emergency Department. Pediatr Qual Saf. 2020 Sep 25;5(5):e353. doi: 10.1097/pq9.0000000000000353. PMID: 33062904; PMCID: PMC7523837.. *** Thank you to the UC Davis Department of Emergency Medicine for supporting this podcast and to Orlando Magaña at OM Productions for audio production services.

Show Notes:EMS History is full of interventions we've rapidly adopted, often at great expense and withdisruption of existing processes, that later turned out to, how should I say this..... not work.Want examples? MAST and high-volume crystalloids in trauma. Mechanical compressiondevices, high-dose epinephrine, indiscriminate calcium administration in cardiac arrest. Do Ieven need to mention backboards?The next bright shiny thing promising to revolutionize cardiac arrest resuscitation is Head-UpCPR. It's certainly expensive and disruptive, but does it improve outcomes? What is theevidence?Dr. Jarvis has thoughts. He goes deep on this topic, using a recent paper on Head-Up CPR todiscuss how he evaluates new interventions for adoption. Oh, and he has thoughts on science ingeneral.Citations:1. Moore JC, Pepe PE, Scheppke KA, Lick C, Duval S, Holley J, Salverda B, Jacobs M, Nystrom P,Quinn R, et al.: Head and thorax elevation during cardiopulmonary resuscitation usingcirculatory adjuncts is associated with improved survival. Resuscitation. 2022;October;179:9–17.2. Swaminathan A: Heads Up! There is No Association with Improved Outcomes for Head UpCPR: Why We Must Read Past the Abstract.RebelEM. Available at https://rebelem.com/heads-up-there-is-no-association-with-improved-outcomes-for-head-up-cpr-why-we-must-read-past-the-abstract/.3. Mohan M, Swaminathan AK: Heads Up! Data Dredging Coming Through: Heads UpCardiopulmonary Resuscitation Does Not Improve Outcomes. Annals of Emergency Medicine.2023;February;81(2):244–5.3. Jarvis J: Not so fast: More evidence needed in head-up CPR.ems1.com. Available athttps://www.ems1.com/ems-products/cpr-resuscitaCon/arCcles/not-so-fast-more-evidence-needed-in-head-up-cpr-ZK2O7yt5eb8jryYm/. Accessed December 9, 2023.4. Moore JC: Faster Cme to automated elevation of the head and thorax duringcardiopulmonary resuscitation increases the probability of return of spontaneous circulation.ResuscitaCon. 2022;Jan(170):62–9.5. Pepe PE, Scheppke KA, Antevy PM, Crowe RP, Millstone D, Coyle C, Prusansky C, Garay S, EllisR, Fowler RL, et al.: Confirming the Clinical Safety and Feasibility of a Bundled Methodology toImprove Cardiopulmonary Resuscitation Involving a Head-Up/Torso-Up Chest CompressionTechnique. Crit Care Med. 2019;March;47(3):449–55.6. Metro Fire Chiefs: First-In Responders Providing Neuroprotective (“Heads-Up”) CPR as theStandard of Care for Emergency Medical Services Systems.NFPA. Available at https://www.nfpa.org/-/media/Files/Membership/member-secCons/Metro-Chiefs/Urban-Fire-Forum/2023/UFF23_NPCPR-PosiCon-Statement.ashx. Accessed November 4, 2023.

Guillaume Fossat, qui est kinésithérapeute dans le service de MIR à Orléans, nous parle du rôle du kinésithérapeute dans la prise en charge ventilatoire du patient de réanimation. Aucun conflit n'est déclaré. Sommaire La kinésithérapie respiratoire a-t-elle un impact sur le sevrage ventilatoire ? Comment fait-on du désencombrement bronchique en réanimation et quelles en sont les indications ? Peut-on imaginer que des non-kinésithérapeutes réalisent des techniques de désencombrement bronchiqueRéférences Références Wang YT, Lang JK, Haines KJ, Skinner EH, Haines TP. Physical Rehabilitation in the ICU: A Systematic Review and Meta-Analysis. Crit Care Med. 2022 Mar 1;50(3):375-388. doi: 10.1097/CCM.0000000000005285. PMID: 34406169. Lippi L, de Sire A, D'Abrosca F, Polla B, Marotta N, Castello LM, Ammendolia A, Molinari C, Invernizzi M. Efficacy of Physiotherapy Interventions on Weaning in Mechanically Ventilated Critically Ill Patients: A Systematic Review and Meta-Analysis. Front Med (Lausanne). 2022 May 9;9:889218. doi: 10.3389/fmed.2022.889218. PMID: 35615094; PMCID: PMC9124783.

Le Dr Michael Levy, qui est Maître de conférence des Universités à l'hôpital Robert Debré à Paris, nous parle du choc septique chez l'enfant et ou le nouveau-né en réanimation. Aucun conflit n'est déclaré. Sommaire Quelles sont les particularités de la définition et du diagnostic du choc septique chez l'enfant et ou le nouveau-né par rapport à l'adulte? Quels sont les éléments principaux de la stratégie thérapeutique et les thérapies adjuvantes du choc septique chez l'enfant et ou le nouveau-né ? Quel est le pronostic du choc septique chez les enfants et ou le nouveau-né ? Références Weiss SL, Peters MJ, Alhazzani W, Agus MSD, Flori HR, Inwald DP, Nadel S, Schlapbach LJ, Tasker RC, Argent AC, Brierley J, Carcillo J, Carrol ED, Carroll CL, Cheifetz IM, Choong K, Cies JJ, Cruz AT, De Luca D, Deep A, Faust SN, De Oliveira CF, Hall MW, Ishimine P, Javouhey E, Joosten KFM, Joshi P, Karam O, Kneyber MCJ, Lemson J, MacLaren G, Mehta NM, Møller MH, Newth CJL, Nguyen TC, Nishisaki A, Nunnally ME, Parker MM, Paul RM, Randolph AG, Ranjit S, Romer LH, Scott HF, Tume LN, Verger JT, Williams EA, Wolf J, Wong HR, Zimmerman JJ, Kissoon N, Tissieres P. Surviving Sepsis Campaign International Guidelines for the Management of Septic Shock and Sepsis-Associated Organ Dysfunction in Children. Pediatr Crit Care Med. 2020 Feb;21(2):e52-e106. doi: 10.1097/PCC.0000000000002198. PMID: 32032273. Davis AL, Carcillo JA, Aneja RK, Deymann AJ, Lin JC, Nguyen TC, Okhuysen-Cawley RS, Relvas MS, Rozenfeld RA, Skippen PW, Stojadinovic BJ, Williams EA, Yeh TS, Balamuth F, Brierley J, de Caen AR, Cheifetz IM, Choong K, Conway E Jr, Cornell T, Doctor A, Dugas MA, Feldman JD, Fitzgerald JC, Flori HR, Fortenberry JD, Graciano AL, Greenwald BM, Hall MW, Han YY, Hernan LJ, Irazuzta JE, Iselin E, van der Jagt EW, Jeffries HE, Kache S, Katyal C, Kissoon N, Kon AA, Kutko MC, MacLaren G, Maul T, Mehta R, Odetola F, Parbuoni K, Paul R, Peters MJ, Ranjit S, Reuter-Rice KE, Schnitzler EJ, Scott HF, Torres A Jr, Weingarten-Arams J, Weiss SL, Zimmerman JJ, Zuckerberg AL. American College of Critical Care Medicine Clinical Practice Parameters for Hemodynamic Support of Pediatric and Neonatal Septic Shock. Crit Care Med. 2017 Jun;45(6):1061-1093. doi: 10.1097/CCM.0000000000002425. Erratum in: Crit Care Med. 2017 Sep;45(9):e993. Van de Voorde P, Turner NM, Djakow J, de Lucas N, Martinez-Mejias A, Biarent D, Bingham R, Brissaud O, Hoffmann F, Johannesdottir GB, Lauritsen T, Maconochie I. European Resuscitation Council Guidelines 2021: Paediatric Life Support. Resuscitation. 2021 Apr;161:327-387. doi: 10.1016/j.resuscitation.2021.02.015. Epub 2021 Mar 24. PMID: 33773830.

In this World Shared Practice Forum podcast, Dr. Akira Nishisaki discusses the history of the NEAR4KIDS project and gives an in-depth description of his team's recent paper on the implementation of video laryngoscope-assisted coaching and the reduction of adverse tracheal intubation-associated events in the PICU. LEARNING OBJECTIVES Upon listening to this presentation, learners will be able to: - Explain the NEAR4KIDS project, including the background and goals for this multi-center prospective registry for advanced pediatric airway management - Describe the implementation process for video laryngoscopy-assisted coaching in the PICU - Compare NEAR4KIDS findings to adult and neonatal data - Review additional active and upcoming NEAR4KIDS projects AUTHORS Akira Nishisaki, MD, MSCE Attending Physician, Critical Care Medicine Co-Medical Director, Center for Simulation, Advanced Education, and Innovation Children's Hospital of Philadelphia Associate Professor of Anesthesiology, Critical Care, and Pediatrics University of Pennsylvania Perelman School of Medicine Traci Wolbrink MD, MPH Senior Associate in Critical Care Medicine Boston Children's Hospital Associate Professor of Anaesthesia Harvard Medical School DATES Initial publication: September 20, 2023. CITATION Nishisaki A, O'Hara JE, Wolbrink TA. Video Laryngoscopy to Improve Intubation Success in Pediatrics. 9/2023. OPENPediatrics. Online Podcast. Links: https://youtu.be/P0KQZVpKKuY. https://soundcloud.com/openpediatrics/video-laryngoscopy-to-improve-intubation-success-in-pediatrics-by-dr-akira-nishisaki. ARTICLES REFERENCED •Giuliano J Jr, Krishna A, Napolitano N, et al. Implementation of Video Laryngoscope-Assisted Coaching Reduces Adverse Tracheal Intubation-Associated Events in the PICU. Crit Care Med. 2023;51(7):936-947. doi:10.1097/CCM.0000000000005847 ADDITIONAL RESOURCES •NEAR4Kids: https://www.research.chop.edu/near4kids •NEAR4NEOS: https://www.research.chop.edu/near4neos •NEAR4PEM: https://www.research.chop.edu/near4pem Please visit: http://www.openpediatrics.org OPENPediatrics™ is an interactive digital learning platform for healthcare clinicians sponsored by Boston Children's Hospital and in collaboration with the World Federation of Pediatric Intensive and Critical Care Societies. It is designed to promote the exchange of knowledge between healthcare providers around the world caring for critically ill children in all resource settings. The content includes internationally recognized experts teaching the full range of topics on the care of critically ill children. All content is peer-reviewed and open-access and thus at no expense to the user. For further information on how to enroll, please email: openpediatrics@childrens.harvard.edu

Trial of the Week: Unpeeling the Banana Bag Special Guests: Aaron Cook, PharmD, FCCP, FNCS, FKSHP, BCCCP, BCPS Alex Flannery, PharmD, PhD, FCCM, BCCCP, BCPS Listen to Aaron and Alex go into the history of this famous article, discuss how this paper, and how they still feel the impact years after publication. Flannery AH, Adkins DA, Cook AM. Unpeeling the Evidence for the Banana Bag: Evidence-Based Recommendations for the Management of Alcohol-Associated Vitamin and Electrolyte Deficiencies in the ICU. Crit Care Med. 2016 Aug;44(8):1545-52. https://pubmed.ncbi.nlm.nih.gov/27002274/ PharmacyToDose.Com  @PharmacyToDose  PharmacyToDose@Gmail.com Learn more about your ad choices. Visit megaphone.fm/adchoices

In this episode, we will discuss prone position ventilation in adult respiratory distress syndrome (ARDS). Despite clinical trials demonstrating a benefit on mortality, the adoption of prone position ventilation has been challenging. We will discuss the impact the COVID-19 pandemic had on the use of prone position ventilation and lessons learned that can help increase the proper use of this treatment modality moving forward. Our guest is Dr. Chad Hochberg, a member of the Division of Pulmonary and Critical Care Medicine, Department of Medicine, at John Hopkins University Medical School in Baltimore, Maryland. Additional Resources Factors Influencing the Implementation of Prone Positioning during the COVID-19 Pandemic. Hochberg C, et al. Ann Am Thorac Soc, 2023; https://pubmed.ncbi.nlm.nih.gov/35947776/ Declining Use of Prone Positioning After High Initial Uptake in COVID-19 Adult Respiratory Distress Syndrome. Hochberg C, et al. Crit Care Med 2023: https://pubmed.ncbi.nlm.nih.gov/37294144/ ESICM Guidelines on ARDS 2023. Intensive Care Medicine 2023: https://link.springer.com/article/10.1007/s00134-023-07050-7 ATS/ESICM/SCCM Clinical Practice Guideline: Mechanical Ventilation in Adult Patients with Acute Respiratory Distress Syndrome: https://www.atsjournals.org/doi/10.1164/rccm.201703-0548S Prone Position for Acute Respiratory Distress Syndrome: A Systematic Review and Meta-Analysis. Munshi L, et al. Ann Am Thorac Soc 2017: https://pubmed.ncbi.nlm.nih.gov/29068269/ Prone Positioning in Severe Acute Respiratory Distress Syndrome. Guerin C. Et al. PROSEVA Trial. New Eng J Med 2013: https://www.nejm.org/doi/full/10.1056/nejmoa1214103 Books Mentioned in this Episodes The Omnivore's Dilemma: A Natural History of Four Meals, By Michael Pollan: https://bit.ly/42FpndS

From the earliest days of critical care medicine, the importance of measuring cardiac output and hemodynamic monitoring were recognized in understanding the physiology of critically ill patients, especially those in shock. However, methods for measuring cardiac output were cumbersome or not widely available. Ashish K. Khanna, MD, FCCP, FCCM, is joined by Margaret M. Parker, MD, MCCM, to discuss the evolution of the pulmonary artery catheter in critically ill patients, as discussed in "The Story of the Pulmonary Artery Catheter: Five Decades in Critical Care Medicine," published in the February issue of Critical Care Medicine (Parker M et al. Crit Care Med. 2023;51:159-163). Dr. Parker is professor emeritus of pediatrics at Stony Brook University School of Medicine in Stony Brook, New York, USA.

In this podcast, Dr. Jon Cole - an emergency medicine physician with Hennepin Healthcare and medical director with Minnesota Poison Control Center and Samantha Lee, PharmD - managing director with Minnesota Poison Control Center discuss the poison control system - past and present; along with a disscusion around toxicology - the big, the bad, and the ugly. Enjoy the podcast. Objectives:Upon completion of this podcast, participants should be able to: Describe the purpose of the Minnesota Poison Control Center, and how it works. Name the most common call types coming into MN Poison Control Center. Summarize the management of toxicological exposures for APAP, bupropion and calcium channel blockers. CME credit is only offered to Ridgeview Providers & Allied Health staff for this podcast activity. After listening to the podcast, complete and submit the online evaluation form.  Upon successful completion of the evaluation, you will be e-mailed a certificate of completion within approximately 2 weeks. You may contact the accredited provider with questions regarding this program at Education@ridgeviewmedical.org. Click the link below, to complete the activity's evaluation. CME Evaluation (**If you are listening to the podcasts through iTunes on your laptop or desktop, it is not possible to link directly with the CME Evaluation for unclear reasons. We are trying to remedy this. You can, however, link to the survey through the Podcasts app on your Apple and other smart devices, as well as through Spotify, Stitcher and other podcast directory apps and on your computer browser at these websites. We apologize for the inconvenience.)  DISCLOSURE ANNOUNCEMENT  The information provided through this and all Ridgeview podcasts as well as any and all accompanying files, images, videos and documents is/are for CME/CE and other institutional learning and communication purposes only and is/are not meant to substitute for the independent medical judgment of a physician, healthcare provider or other healthcare personnel relative to diagnostic and treatment options of a specific patient's medical condition; and are property/rights of Ridgeview Medical Center & Clinics.  Any re-reproduction of any of the materials presented would be infringement of copyright laws.  It is Ridgeview's intent that any potential conflict should be identified openly so that the listeners may form their own judgments about the presentation with the full disclosure of the facts. It is not assumed any potential conflicts will have an adverse impact on these presentations. It remains for the audience to determine whether the speaker's outside interest may reflect a possible bias, either the exposition or the conclusions presented. Ridgeview's CME planning committee members and presenter(s) have disclosed they have no significant financial relationship with a pharmaceutical company and have disclosed that no conflict of interest exists with the presentation/educational event. Thank-you for listening to the podcast. SHOW NOTES:  *See the attachment for additional information.  HISTORY of MN POISON CONTROL CENTER TOXICOLOGYCalcium Channel Blockers - Diltiazem, Verapamil, Amlodipine - Causes bad distributive shock - Pulmonary edema is an issue - Norepinephrine infusion is recommended in setting of shock with high dose insulin simultaneously - "Red, white and blue" therapy for refractory Ca++ blocker overdose - Activated charcoal - not for all patients, give if patient not at risk of aspiration for potentially lethal ingestions Bupropion - Chemical structure similar to amphetamine and bath salts - Sympathomimetic effects (tachycardia, agitation, seizures, ultimately cardiogenic shock) - Treatment with benzodiazepines - usually high dose - may need intubation - Norepinephrine for cardiogenic shock - ECMO may be needed Sodium Nitrite - Salt used to cure meats - Internet suicide phenomenon - Effect: Life threatening methemoglobinemia (chocolate colored blood, pallor, low O2 sats) - Very rapid onset of symptoms - Methylene Blue use N-acetylcysteine (NAC) for acetaminophen poisoning - Transitioning from 3 bag Prescott regimen to a 2 bag regimen - Rumack-Matthew nomogram is the same Article Resources:Cole JB, Lee SC, Prekker ME, Kunzler NM, Considine KA, Driver BE, Puskarich MA, Olives TD. Vasodilation in patients with calcium channel blocker poisoning treated with high-dose insulin: a comparison of amlodipine versus non-dihydropyridines. Clin Toxicol (Phila). 2022 Nov;60(11):1205-1213. doi: 10.1080/15563650.2022.2131565. Epub 2022 Oct 25. PMID: 36282196.   Cole JB, Olives TD, Ulici A, Litell JM, Bangh SA, Arens AM, Puskarich MA, Prekker ME. Extracorporeal Membrane Oxygenation for Poisonings Reported to U.S. Poison Centers from 2000 to 2018: An Analysis of the National Poison Data System. Crit Care Med. 2020 Aug;48(8):1111-1119. doi: 10.1097/CCM.0000000000004401. PMID: 32697480. Coralic Z, Kapur J, Olson KR, Chamberlain JM, Overbeek D, Silbergleit R. Treatment of Toxin-Related Status Epilepticus With Levetiracetam, Fosphenytoin, or Valproate in Patients Enrolled in the Established Status Epilepticus Treatment Trial. Ann Emerg Med. 2022 Sep;80(3):194-202. doi: 10.1016/j.annemergmed.2022.04.020. Epub 2022 Jun 17. PMID: 35718575. Kline JA, Tomaszewski CA, Schroeder JD, Raymond RM. Insulin is a superior antidote for cardiovascular toxicity induced by verapamil in the anesthetized canine. J Pharmacol Exp Ther. 1993 Nov;267(2):744-50. PMID: 8246150.   Thanks to Dr. Jon Cole and Samantha Lee, PharmD for their knowledge and contribution to this podcast. Please check out the additional show notes for more information/resources.

MedLink Neurology Podcast is delighted to feature selected episodes from BrainWaves, courtesy of James E Siegler MD, its originator and host. BrainWaves is an academic audio podcast whose mission is to educate medical providers through clinical cases and topical reviews in neurology, medicine, and the humanities, and episodes originally aired from 2016 to 2021.Originally released: December 17, 2020I shouldn't have to tell you that traumatic brain injury is a major cause of morbidity and mortality. I shouldn't have to. But I will. And it is. In severe cases of head injury, there can be delayed and irreversible deterioration in the nervous system for which there is no treatment, and the prognosis is grim. This week on the program, Dr. Monisha Kumar (University of Pennsylvania) discusses the worst of the worst of these scenarios, what to look out for, and expert recommendations on what to do when it happens.Produced by James E Siegler and Monisha Kumar. Music courtesy of Rui, Swelling, Unheard Music Concepts, Jahzzar, Ian Southerland, and TRG Banks. The opening theme was composed by Jimothy Dalton. Sound effects by Mike Koenig and Daniel Simion. Unless otherwise mentioned in the podcast, no competing financial interests exist in the content of this episode. BrainWaves' podcasts and online content are intended for medical education only and should not be used for clinical decision-making. Be sure to follow us on Twitter @brainwavesaudio for the latest updates to the podcast.REFERENCESAdams JH, Graham DI, Murray LS, Scott G. Diffuse axonal injury due to nonmissile head injury in humans: an analysis of 45 cases. Ann Neurol 1982;12(6):557-63. PMID 7159059Arfanakis K, Haughton VM, Carew JD, Rogers BP, Dempsey RJ, Meyerand ME. Diffusion tensor MR imaging in diffuse axonal injury. AJNR Am J Neuroradiol 2002;23(5):794-802. PMID 12006280DeKosky ST, Ikonomovic MD, Gandy S. Traumatic brain injury--football, warfare, and long-term effects. N Engl J Med 2010;363(14):1293-6. PMID 20879875Gentry LR. Imaging of closed head injury. Radiology 1994;191(1):1-17. PMID 8134551Haghbayan H, Boutin A, Laflamme M, et al. The prognostic value of MRI in moderate and severe traumatic brain injury: a systematic review and meta-analysis. Crit Care Med 2017;45(12):e1280-8. PMID 29028764Izzy S, Mazwi NL, Martinez S, et al. Revisiting grade 3 diffuse axonal injury: not all brainstem microbleeds are prognostically equal. Neurocrit Care 2017;27(2):199-207. PMID 28477152Johnson VE, Stewart W, Smith DH. Widespread τ and amyloid-β pathology many years after a single traumatic brain injury in humans. Brain Pathol 2012;22(2):142-9. PMID 21714827Meythaler JM, Peduzzi JD, Eleftheriou E, Novack TA. Current concepts: diffuse axonal injury-associated traumatic brain injury. Arch Phys Med Rehabil 2001;82(10):1461-71. PMID 11588754Povlishock JT, Becker DP, Cheng CL, Vaughan GW. Axonal change in minor head injury. J Neuropathol Exp Neurol 1983;42(3):225-42. PMID 6188807Scheid R, Preul C, Gruber O, Wiggins C, von Cramon DY. Diffuse axonal injury associated with chronic traumatic brain injury: evidence from T2*-weighted gradient-echo imaging at 3 T. AJNR Am J Neuroradiol 2003;24(6):1049-56. PMID 12812926Schrag M, Greer DM. Clinical associations of cerebral microbleeds on magnetic resonance neu

MedLink Neurology Podcast is delighted to feature selected episodes from BrainWaves, courtesy of James E Siegler MD, its originator and host. BrainWaves is an academic audio podcast whose mission is to educate medical providers through clinical cases and topical reviews in neurology, medicine, and the humanities, and episodes originally aired from 2016 to 2021.Originally released: April 25, 2019 For patients who survive cardiopulmonary arrest but do not wake up, neurologists are called to the bedside to prognosticate. And the question of “How much will this patient recover?” is not unlike “What is the benefit of aggressive therapy to await possible recovery?” In that way, you might consider neurologists to be the actuaries of hospital medicine. In this week's program, we review the clinical and diagnostic data that neurologists incorporate into their model for outcome prediction following anoxic brain injury. Produced by James E Siegler. Music courtesy of Swelling, Soft and Furious, Rafael Archangel, Lovira, and Dark Room. Sound effects by Mike Koenig and Daniel Simion. BrainWaves' podcasts and online content are intended for medical education only and should not be used for clinical decision-making. Be sure to follow us on Twitter @brainwavesaudio for the latest updates to the podcast. REFERENCES Booth CM, Boone RH, Tomlinson G, Detsky AS. Is this patient dead, vegetative, or severely neurologically impaired? Assessing outcome for comatose survivors of cardiac arrest. JAMA 2004;291(7):870-9. PMID 390099PMID: 14970067 Callaway CW, Donnino MW, Fink EL, et al. Part 8: Post-Cardiac Arrest Care: 2015 American Heart Association Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation 2015;132(18 Suppl 2):S465-82. Erratum in: Circulation 2017;136(10 ):e197. PMID 390099PMID: 26472996 Jorgensen EO, Holm S. The natural course of neurological recovery following cardiopulmonary resuscitation. Resuscitation 1998;36(2):111-22. PMID 9571727 Nielsen N, Wetterslev J, Cronberg T, et al. Targeted temperature management at 33°C versus 36°C after cardiac arrest. N Engl J Med 2013;369(23):2197-206. PMID 24237006 Sandroni C, D'Arrigo S. Neurologic prognostication: neurologic examination and current guidelines. Semin Neurol 2017;37(1):40-7. PMID 28147417 Sandroni C, Cariou A, Cavallaro F, et al. Prognostication in comatose survivors of cardiac arrest: an advisory statement from the European Resuscitation Council and the European Society of Intensive Care Medicine. Resuscitation 2014;85(12):1779-89. PMID 25438253 Seder DB. Management of comatose survivors of cardiac arrest. Continuum (Minneap Minn) 2018;24(6):1732-52. PMID 30516603 Seder DB, Sunde K, Rubertsson S, et al. Neurologic outcomes and postresuscitation care of patients with myoclonus following cardiac arrest. Crit Care Med 2015;43(5):965-72. PMID 25654176 Young GB. Clinical practice. Neurologic prognosis after cardiac arrest. N Engl J Med 2009;361(6):605-11. PMID 19657124We believe that the principles expressed or implied in the podcast remain valid, but certain details may be superseded by evolving knowledge since the episode's original release date.

Bloodstream infections (BSIs) acquired in the ICU are potentially preventable. Kyle B. Enfield, MD, FSHEA, FCCM, is joined by Sameer S. Kadri-Rodriguez, MD, MS, to discuss the article, Epidemiology of ICU-Onset Bloodstream Infection: Prevalence, Pathogens, and Risk Factors Among 150,948 ICU Patients at 85 U.S. Hospitals, (Gouel-Cheron A, et al. Crit Care Med. 2022;50:1725-1736). Dr. Kadri-Rodriguez is a critical care and infectious diseases physician at the National Institutes of Health Clinical Center in Bethesda, Maryland. This podcast is sponsored by Sound Physicians.

Contributor: Travis Barlock, MD Educational Pearls: Catheter related blood infections were thought to be caused by skin flora seeding the catheter. Thus, significant effort is applied to sterility and skin preparation.   However, studies have shown that bacteria growing on the tip of the catheter is not consistent with growth on cultures of skin.   Staphylococcus epidermidis is commonly found on cultures of catheter sites. It has also been found in the gut flora of >50% of ICU patients. Rates of catheter related blood infections have been decreased through oral decontamination and early feeding.  These findings suggest enteral bacterial translation as a major source of blood stream infection. References O'Grady NP, Alexander M, Burns LA, et al. Guidelines for the prevention of intravascular catheter-related infections. Clin Infect Dis. 2011;52(9):e162-e193. doi:10.1093/cid/cir257 von Eiff C, Becker K, Machka K, Stammer H, Peters G. Nasal carriage as a source of Staphylococcus aureus bacteremia. Study Group. N Engl J Med. 2001;344(1):11-16. doi:10.1056/NEJM200101043440102 ALTEMEIER WA, HUMMEL RP, HILL EO. Staphylococcal enterocolitis following antibiotic therapy. Ann Surg. 1963;157(6):847-858. doi:10.1097/00000658-196306000-00003 Marshall JC, Christou NV, Horn R, Meakins JL. The microbiology of multiple organ failure. The proximal gastrointestinal tract as an occult reservoir of pathogens. Arch Surg. 1988;123(3):309-315. doi:10.1001/archsurg.1988.01400270043006 Mrozek N, Lautrette A, Aumeran C, et al. Bloodstream infection after positive catheter cultures: what are the risks in the intensive care unit when catheters are routinely cultured on removal?. Crit Care Med. 2011;39(6):1301-1305. doi:10.1097/CCM.0b013e3182120190 Atela I, Coll P, Rello J, et al. Serial surveillance cultures of skin and catheter hub specimens from critically ill patients with central venous catheters: molecular epidemiology of infection and implications for clinical management and research. J Clin Microbiol. 1997;35(7):1784-1790. doi:10.1128/jcm.35.7.1784-1790.1997 Tani T, Hanasawa K, Endo Y, et al. Bacterial translocation as a cause of septic shock in humans: a report of two cases. Surg Today. 1997;27(5):447-449. doi:10.1007/BF02385710   Summarized by Kirsten Hughes, MS4 | Edited by John Spartz, MS4 & Erik Verzemnieks, MD In an effort to promote diversity, equity, and inclusion in Emergency Medicine, The Emergency Medical Minute is proud to present our 2nd annual Diversity and Inclusion Award. We support increasing the representation of underrepresented groups in medicine and extend this award to individuals applying to emergency medicine residencies during the 2022-2023 cycle. For information on award eligibility and the application process, visit https://emergencymedicalminute.com/edi-award/ Donate to EMM today!

What an academic feast organized by the SEMI-WB on the weekend of 16-17th July 2022 for the academic residents of emergency medicine. I start of the episode by talking about the EZECON. Also the 24th Annual Conference of SEMI is happening in Kerala from 23-27th November. Do register for it. In this episode I give an insight towards dealing with acid base disorders using the modified stewart's approach. Following are the references you can go through to understand more and change your practice - 1. https://emcrit.org/wp-content/uploads/acid_base_sheet_2-2011.pdf 2. Story DA. Stewart Acid-Base: A Simplified Bedside Approach. Anesth Analg. 2016 Aug;123(2):511-5. doi: 10.1213/ANE.0000000000001261. PMID: 27140683. 3. Jones NL. A quantitative physicochemical approach to acid-base physiology. Clin Biochem. 1990 Jun;23(3):189-95. doi: 10.1016/0009-9120(90)90588-l. PMID: 2115411. 4. Mallat J, Michel D, Salaun P, Thevenin D, Tronchon L. Defining metabolic acidosis in patients with septic shock using Stewart approach. Am J Emerg Med. 2012 Mar;30(3):391-8. doi: 10.1016/j.ajem.2010.11.039. Epub 2011 Jan 28. PMID: 21277142. 5. Morgan TJ. The Stewart approach--one clinician's perspective. Clin Biochem Rev. 2009 May;30(2):41-54. PMID: 19565024; PMCID: PMC2702213. 6.Kaplan LJ, Kellum JA. Initial pH, base deficit, lactate, anion gap, strong ion difference, and strong ion gap predict outcome from major vascular injury. Crit Care Med. 2004 May;32(5):1120-4. doi: 10.1097/01.ccm.0000125517.28517.74. PMID: 15190960. 7. Malatesha G, Singh NK, Bharija A, Rehani B, Goel A. Comparison of arterial and venous pH, bicarbonate, PCO2 and PO2 in initial emergency department assessment. Emerg Med J. 2007 Aug;24(8):569-71. doi: 10.1136/emj.2007.046979. PMID: 17652681; PMCID: PMC2660085. 8. Kelly AM, McAlpine R, Kyle E. Venous pH can safely replace arterial pH in the initial evaluation of patients in the emergency department. Emerg Med J. 2001 Sep;18(5):340-2. doi: 10.1136/emj.18.5.340. PMID: 11559602; PMCID: PMC1725689. 9. Byrne AL, Bennett M, Chatterji R, Symons R, Pace NL, Thomas PS. Peripheral venous and arterial blood gas analysis in adults: are they comparable? A systematic review and meta-analysis. Respirology. 2014 Feb;19(2):168-175. doi: 10.1111/resp.12225. Epub 2014 Jan 3. PMID: 24383789.

The utilization of point-of-care ultrasound and other non-invasive cardiac output monitoring technologies varies because of knowledge, resource availability and cultural practices. In this  Clinical Challenge in Surgery episode from the Surgical Critical Care team at Behind the Knife, we provide a brief history of the use of cardiac-output monitoring in the ICU, introduce a few clinical scenarios in the context of point of care ultra-sound and other less-invasive cardiac-output monitoring technologies. Learning Objectives:  In this episode, we review the historical uses of central venous pressure monitoring, pulmonary-artery catheters and the more frequently utilized point-of-care-ultrasound (or POCUS) in managing complex ICU patients. We review the outcomes behind these technologies, describe the views and utility of POCUS, and introduce less-invasive or completely non-invasive ways to measure cardiac-output monitoring.  Hosts: Brittany Bankhead, MD, MS (@BBankheadMD) is an Assistant Professor of Surgery at Texas Tech University Health Sciences Center. Ryan Dumas, MD, FACS (@PMH_Trauma_RPD) is an Assistant Professor of Surgery at the University of Southwestern Medical Center and Parkland Memorial Hospital. Caroline Park, MD, MPH, FACS (@CPark_MD) is an Assistant Professor of Surgery at the University of Southwestern Medical Center and Parkland Memorial Hospital. Links to Papers Referenced in this Episode: National Heart, Lung, and Blood Institute Acute Respiratory Distress Syndrome (ARDS) Clinical Trials Network, Wheeler AP, Bernard GR, Thompson BT, Schoenfeld D, Wiedemann HP, deBoisblanc B, Connors AF Jr, Hite RD, Harabin AL. Pulmonary-artery versus central venous catheter to guide treatment of acute lung injury. N Engl J Med. 2006 May 25;354(21):2213-24. doi: 10.1056/NEJMoa061895. Epub 2006 May 21. PMID: 16714768. Yildizdas D, Aslan N. Ultrasonographic inferior vena cava collapsibility and distensibility indices for detecting the volume status of critically ill pediatric patients. J Ultrason. 2020 Nov;20(82):e205-e209. doi: 10.15557/JoU.2020.0034. Epub 2020 Sep 28. PMID: 33365158; PMCID: PMC7705480. Kircher BJ, Himelman RB, Schiller NB. Noninvasive estimation of right atrial pressure from the inspiratory collapse of the inferior vena cava. Am J Cardiol. 1990 Aug 15;66(4):493-6. doi: 10.1016/0002-9149(90)90711-9. PMID: 2386120. Marik PE, Cavallazzi R. Does the central venous pressure predict fluid responsiveness? An updated meta-analysis and a plea for some common sense. Crit Care Med. 2013 Jul;41(7):1774-81. doi: 10.1097/CCM.0b013e31828a25fd. PMID: 23774337. Acknowledgements:  We would like to acknowledge Dr. Hassan Mashbari and the Department of Surgical Critical Care and Anesthesia at the Massachusetts General Hospital and Dr. Christopher Choi and the Department of Anesthesiology at the University of Texas Southwestern for their ultra-sound video contributions. Please visit behindtheknife.org to access other high-yield surgical education podcasts, videos and more.  

Assine o Guia, ganhe tempo e atualize-se sem esforço. www.tadeclinicagem.com.br/guia Confira o Resumo Visual do episódio no Youtube: https://youtu.be/5yQWSwxBcYg Kauê e Joca convidam José Marcos para uma conversa sobre Morte Encefálica. Conversamos um pouco sobre o fluxo do protocolo de Morte Encefálica no Brasil, desde sua abertura até o diagnóstico final, incluindo as particularidades do exame físico, teste da apneia e exames complementares. Principais medicamentos depressores do sistema nervoso central e intervalo de tempo da suspensão do uso até o início da determinação da morte encefálica - https://www.scielo.br/j/rbti/a/R7rGGHpRV6fmBZYDzHpfrPS/?lang=pt# (Quadro 2). Referências: 1. Resolução Nº 2.173, de 23 de novembro de 2017 - https://saude.rs.gov.br/upload/arquivos/carga20171205/19140504-resolucao-do-conselho-federal-de-medicina-2173-2017.pdf 2. Goudreau JL, Wijdicks EF, Emery SF. Complications during apnea testing in the determination of brain death: predisposing factors. Neurology 2000; 55:1045. 3. Russell JA, Epstein LG, Greer DM, et al. Brain death, the determination of brain death, and member guidance for brain death accommodation requests: AAN position statement. Neurology 2019. 4. Wahlster S, Wijdicks EF, Patel PV, et al. Brain death declaration: Practices and perceptions worldwide. Neurology 2015; 84:1870. 5. Machado C. Are brain death findings reversible? Pediatr Neurol 2010; 42:305. 6. Lévesque S, Lessard MR, Nicole PC, et al. Efficacy of a T-piece system and a continuous positive airway pressure system for apnea testing in the diagnosis of brain death. Crit Care Med 2006; 34:2213. 7. Sharpe MD, Young GB, Harris C. The apnea test for brain death determination: an alternative approach. Neurocrit Care 2004; 1:363. 8. Flowers WM Jr, Patel BR. Persistence of cerebral blood flow after brain death. South Med J 2000; 93:364. 9. Thompson BB, Wendell LC, Potter NS, et al. The use of transcranial Doppler ultrasound in confirming brain death in the setting of skull defects and extraventricular drains. Neurocrit Care 2014; 21:534. 10. Wijdicks EF, Varelas PN, Gronseth GS, et al. Evidence-based guideline update: determining brain death in adults: report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology 2010; 74:1911. 11. Westphal, Glauco Adrieno, et al. Diretrizes para avaliação e validação do potencial doador de órgãos em morte encefálica. Rev. bras. ter. intensiva 2016; 28(3); 220-255.

Catecholamine is used in patients with septic shock to augment hemodynamics and achieve goal mean arterial pressure. Ludwig H. Lin, MD, is joined by Gretchen L. Sacha BCCCP, PharmD, to discuss this retrospective observational study to evaluate the associations of catecholamine dose, lactate concentration, and timing from shock onset at vasopressin initiation with in-hospital mortality. (Sacha G, et al. Crit Care Med. 2022;50:614-623). Dr. Sacha is a critical care clinical specialist at Cleveland Clinic in Cleveland, Ohio. This podcast is sponsored by Sound Physicians.

Contributor: Nick Hatch, MD Educational Pearls: “Smiling Death” describes the prehospital phenomenon of a person who is happy to be extricated from an extended period of crush injury, but dies suddenly soon after the rescue.   Smiling Death is caused by Crush Syndrome. Crush Syndrome begins when large areas of tissue are damaged by compression and subsequent impeded blood flow. Resultant cell death is followed by release of myoglobin and efflux of electrolytes including potassium. Upon removal of the crushing force, high levels of potassium enter circulation and cause cardiac arrhythmias leading to sudden death.  Prevention measures include aggressive hydration using normal saline before extrication. An acceptable starting rate is 1L per hour, but providers should take patient status into consideration and titrate appropriately.  Standard techniques for controlling hyperkalemia by intracellular shifting may be less effective. Early dialysis may be useful.  References Gonzalez D. Crush syndrome. Crit Care Med. 2005;33(1 Suppl):S34-S41. doi:10.1097/01.ccm.0000151065.13564.6f Better OS. Rescue and salvage of casualties suffering from the crush syndrome after mass disasters. Mil Med. 1999;164(5):366-369. Summarized by Kirsten Hughes, MS4 | Edited by John Spartz MS4 & Erik Verzemnieks, MD The Emergency Medical Minute is excited to announce that we are now offering AMA PRA Category 1 credits™ via online course modules. To access these and for more information, visit our website at https://emergencymedicalminute.org/cme-courses/ and create an account.  Donate to EMM today!

Contributor: Aaron Lessen, MD Educational Pearls: Tidal volume is the amount of breath a patient receives in a single ventilation  Traditional tidal volume (TV) setting was 10 ml/kg but studies showed lower TV had less incidence of respiratory distress, ARDS, and overall better outcomes  ED ventilation settings may get carried on for hours or days when a patient is admitted, making this an important part of patient care Recent large systematic review shows that low TV setting in the ED leads to decreased incidence of ARDS, shorter ICU and hospital length of stay, shorter duration of mechanical ventilation, and decreased mortality  Consider an ED low tidal volume ventilation setting at around 6 ml/kg of predicted body weight References De Monnin K, Terian E, Yaegar LH, et al. Low Tidal Volume Ventilation for Emergency Department Patients: A Systematic Review and Meta-Analysis on Practice Patterns and Clinical Impact [published online ahead of print, 2022 Feb 7]. Crit Care Med. 2022;10.1097/CCM.0000000000005459. doi:10.1097/CCM.0000000000005459 Summarized by Kirsten Hughes, MS4 | Edited by John Spartz MS4 & Erik Verzemnieks, MD   The Emergency Medical Minute is excited to announce that we are now offering AMA PRA Category 1 credits™ via online course modules. To access these and for more information, visit our website at https://emergencymedicalminute.org/cme-courses/ and create an account.  Donate to EMM today!

Drs. Kate DeSear (@IDPharmD_Kate) and Frank Tverdek (@FTverdek) join Dr. Julie Ann Justo (@julie_justo) to discuss the practice of empiric escalation in this episode of our gram-negative resistance series. Listen in for encouragement on following your intuition and tips on how, when, and why to practice this other side of antimicrobial stewardship. Learn more about the Society of Infectious Diseases Pharmacists: https://sidp.org/About Twitter: @SIDPharm (https://twitter.com/SIDPharm) Instagram: @SIDPharm (https://www.instagram.com/sidpharm/) Facebook: https://www.facebook.com/sidprx LinkedIn: https://www.linkedin.com/company/sidp/ References Clinical and Laboratory Standards Institute. Access Our Free Resources: M100 and M60. Accessed at https://clsi.org/standards/products/free-resources/access-our-free-resources/ Gallagher JC, et al. Open Forum Infect Dis. 2018 Oct 31;5(11):ofy280. doi: 10.1093/ofid/ofy280. PMID: 30488041. Castan B, et al. Infect Dis Now. 2021 Sep;51(6):532-539. doi: 10.1016/j.idnow.2021.05.003. Epub 2021 May 17. PMID: 34015539. Cultrera R, et al. Antibiotics (Basel). 2020 Sep 24;9(10):640. doi: 10.3390/antibiotics9100640. PMID: 32987821. Strich JR, et al. Clin Infect Dis. 2021 Feb 16;72(4):611-621. doi: 10.1093/cid/ciaa061. PMID: 32107536. Montravers P, Bassetti M. Curr Opin Infect Dis. 2018 Dec;31(6):587-593. doi: 10.1097/QCO.0000000000000490. PMID: 30299359. Strich JR, Heil EL, Masur H. J Infect Dis. 2020 Jul 21;222(Suppl 2):S119-S131. doi: 10.1093/infdis/jiaa221. PMID: 32691833. Kumar A, et al. Crit Care Med. 2006 Jun;34(6):1589-96. doi: 10.1097/01.CCM.0000217961.75225.E9. PMID: 16625125. Hibbard ML, et al. Surg Infect (Larchmt). 2010 Oct;11(5):427-32. doi: 10.1089/sur.2009.046. PMID: 20818984. Rosa RG, Goldani LZ, dos Santos RP. BMC Infect Dis. 2014 May 23;14:286. doi: 10.1186/1471-2334-14-286. PMID: 24884397. Benanti GE, et al. Antimicrob Agents Chemother. 2019 Jan 29;63(2):e01813-18. doi: 10.1128/AAC.01813-18. PMID: 30509935.

Dr. Ben Weaver and Dr. Elisa Walsh (@elisacwalsh) from Massachusetts General Hospital join the show to discuss the literature around the infectious risk of arterial catheters and the role of barrier precautions. This is the first episode produced from a new podcast elective that's available to MGH anesthesia residents. Special thanks to Dr. Saddawi-Konefka for supporting the initiative. Thanks for listening! If you enjoy our content, leave a 5-star review on Apple Podcasts and consider helping us offset the costs of production by donating through our Patreon at https://bit.ly/3n0sklh. — Follow us on Instagram @DepthofAnesthesia and on Twitter @DepthAnesthesia for podcast and literature updates. Email us at depthofanesthesia@gmail.com with episode ideas or if you'd like to join our team. Music by Stephen Campbell, MD. — References Cohen DM, Carino GP, Heffernan DS, et al. Arterial catheter use in the ICU: A national survey of antiseptic technique and perceived infectious risk. Crit Care Med. 2015;43(11):2346-2353. doi:10.1097/CCM.0000000000001250 Koh DBC, Gowardman JR, Rickard CM. Prospective study of peripheral arterial catheter infection and comparison with concurrently sited central venous catheters (Critical Care Medicine (2008) 36, (397-402)). Crit Care Med. 2008;36(4):1394. doi:10.1097/CCM.0b013e31816e6d16 Lucet JC, Bouadma L, Zahar JR, et al. Infectious risk associated with arterial catheters compared with central venous catheters. Crit Care Med. 2010;38(4):1030-1035. doi:10.1097/CCM.0b013e3181d4502e O'Horo JC, Maki DG, Krupp AE, Safdar N. Arterial catheters as a source of bloodstream infection: A systematic review and meta-analysis. Crit Care Med. 2014;42(6):1334-1339. doi:10.1097/CCM.0000000000000166 Raad II, Hohn DC, Gilbreath BJ, et al. Prevention of Central Venous Catheter-Related Infections by Using Maximal Sterile Barrier Precautions during Insertion Srr PREVENTION OF CENTRAL VENOUS CATHETER-RELATED INFECTIONS BY USING MAXIMAL STERILE BARRIER. 1994;15(4). Rijnders BJA, Van Wijngaerden E, Wilmer A, Peetermans WE. Use of full sterile barrier precautions during insertion of arterial catheters: A randomized trial. Clin Infect Dis. 2003;36(6):743-748. doi:10.1086/367936 Rijnders BJA, Wijngaerden E Van, Peetermans WE. Catheter-Tip Colonization as a Surrogate End Point in Clinical Studies on Catheter-Related Bloodstream Infection : How Strong Is the Evidence ? 2002;35:1053-1058.

In this podcast, host Kyle B. Enfield, MD, FSHEA, FCCM, is joined by Samuel K. McGowan, MD, to discuss a systematic review that found significant differences in care and outcomes, including mortality rates, among intensive care unit (ICU) patients of different races (McGowan S, et al. Crit Care Med. 2022 Jan;50:1-20). Dr. McGowan is a first-year fellow in pulmonary and critical care at University of California in San Francisco, California, USA. This podcast is sponsored by Sound Physicians.

En este nuevo episodio me inspiro de la increíble entrevista del gran Antonio Pérez y la increible Susana Simó en el "Café Club del Conocimiento" y os hablo de la Dopamina según la evidencia. ¿Aumenta la mortalidad? ¿Es buena en pacientes en shock? Vamos a intentar poner luz al uso tan extendido de la Dopa e intentemos con este episodio retirarla poco a poco de los ampularios. Espero que os guste y sea de utilidad. Bibliografía: - Susana Simó. Café club del conocimiento. Shock. Disponible en: https://www.youtube.com/watch?v=U7khSoWgk0s - James A. Russell, Anthony C. Gordon, Mark D. Williams, John H. Boyd, Keith R. Walley, Niranjan Kissoon. Vasopressor Therapy in the Intensive Care Unit. Semin Respir Crit Care Med 2021; 42(01): 059-077 - De Backer D, Biston P, Devriendt J. et al; Investigadores de SOAP II. Comparación de dopamina y norepinefrina en el tratamiento del shock. N Engl J Med 2010; 362 (09) 779-789 - Allwood MJ, Ginsburg J. Efectos vasculares periféricos y de otro tipo de las infusiones de dopamina en el hombre. Clin Sci 1964; 27: 271-281 - Bennett ED, Tighe D, Wegg W. Abolición, por bloqueo de dopamina, de la respuesta natriurética producida por la presión positiva de la parte inferior del cuerpo. Clin Sci (Lond) 1982; 63 (04) 361-366 - Juste RN, Panikkar K, Soni N. Los efectos de las infusiones de dosis bajas de dopamina sobre los parámetros hemodinámicos y renales en pacientes con shock séptico que requieren tratamiento con noradrenalina. Intensive Care Med 1998; 24 (06) 564-568 - Holmes CL, Walley KR. Mala medicina: dosis bajas de dopamina en la UCI. Pecho 2003; 123 (04) 1266-1275 - D'Orio V, el Allaf D, Juchmès J, Marcelle R. El uso de dosis bajas de dopamina en medicina intensiva. Arch Int Physiol Biochim 1984; 92 (04) S11-S20 - Olsen NV, Hansen JM, Ladefoged SD, Fogh-Andersen N, Leyssac PP. Reabsorción tubular renal de sodio y agua durante la infusión de dosis bajas de dopamina en el hombre normal. Clin Sci (Lond) 1990; 78 (05) 503-507 - Yard B, Beck G, Schnuelle P. et al. Prevención de lesiones por preservación del frío de las células endoteliales cultivadas por catecolaminas y compuestos relacionados. Am J Trasplante 2004; 4 (01) 22-30 - Schnuelle P, Gottmann U, Hoeger S. et al. Efectos del pretratamiento del donante con dopamina sobre la función del injerto después del trasplante renal: un ensayo controlado aleatorio. JAMA 2009; 302 (10) 1067-1075 - Kotloff RM, Blosser S, Fulda GJ. et al; Society of Critical Care Medicine/American College of Chest Physicians/Association of Organ Procurement Organizations Donor Management Task Force. Gestión del posible donante de órganos en la UCI: Declaración de consenso de la Sociedad de Medicina de Cuidados Críticos/American College of Chest Physicians/Association of Organ Procurement Organizations. Crit Care Med 2015; 43 (06) 1291-1325 - Juste RN, Moran L, Hooper J, Soni N. Aclaramiento de dopamina en pacientes críticamente enfermos. Intensive Care Med 1998; 24 (11) 1217-1220

Acute Kidney Injury (AKI) with Dr. Archana Dhar and Dr. Molly McGetrick About our guests:Dr. Dhar is a is an associate Professor of Pediatrics and practicing pediatric intensivist at Children's Medical Center and UT Southwestern in Dallas.Dr. McGetrick recently completed her pediatric critical care fellowship training at UT Southwestern and is a current pediatric cardiovascular ICU fellow at Texas Children's. How to support PedsCrit?Please share, like, rate and review on Apple Podcasts or Spotify!Donations appreciated @PedsCrit on Venmo --100% of all funds will go to supporting the show to keep this project going.Learning Objectives: After listening to this series of episodes, learners should be able to:Define AKI.Discuss incident and epidemiology of AKI in the pediatric critical care setting.Know how to diagnose AKI according to the KDIGO guidelines.Recall the role of biomarkers and renal angina index in risk stratification and early identification of AKI.Discuss a clinical approach to managing a patient with acute kidney injury.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 updatesThanks again for listening! References/Further Reading: Sethi SK, Bunchman T, Chakraborty R, Raina R. Pediatric acute kidney injury: new advances in the last decade. Kidney Res Clin Pract. 2021 Mar;40(1):40-51. doi: 10.23876/j.krcp.20.074. Epub 2021 Mar 3. PMID: 33663033; PMCID: PMC8041642.Alobaidi R, Anton N, Burkholder S, Garros D, Garcia Guerra G, Ulrich EH, Bagshaw SM. Association Between Acute Kidney Injury Duration and Outcomes in Critically Ill Children. Pediatr Crit Care Med. 2021 Feb 26. doi: 10.1097/PCC.0000000000002679. Epub ahead of print. PMID: 33729733.Kaddourah A, Basu RK, Bagshaw SM, Goldstein SL; AWARE Investigators. Epidemiology of Acute Kidney Injury in Critically Ill Children and Young Adults. N Engl J Med. 2017;376(1):11-20. doi:10.1056/NEJMoa1611391 Hessey E, Melhem N, Alobaidi R, Ulrich E, Morgan C, Bagshaw SM, Sinha MD. Acute Kidney Injury in Critically Ill Children Is Not all Acute: Lessons Over the Last 5 Years. Front Pediatr. 2021 Mar 15;9:648587. doi: 10.3389/fped.2021.648587. PMID: 33791260; PMCID: PMC8005629.Basu RK, Kaddourah A, Terrell T, et al. Assessment of Worldwide Acute Kidney Injury, Renal Angina and Epidemiology in critically ill children (AWARE): study protocol for a prospective observational study. BMC Nephrol. 2015;16:24.Schneider J, Khemani R, Grushkin C, Bart R. Serum creatinine as stratified in the RIFLE score for acute kidney injury is associated with mortality and length of stay for children in the pediatric intensive care unit. Crit Care Med. 2010;38:933–9. doi: 10.1097/CCM.0b013e3181cd12e1.Villarreal EG, Rausa J, Chapel AC, Loomba RS, Flores S. Effects of Fenoldopam in the Pediatric Population: Fluid Status, Serum Biomarkers, and Hemodynamics: A Systematic Review and Meta-Analysis. J Pediatr Intensive Care. 2021 Jun;10(2):118-125. doi: 10.1055/s-0040-1714704. Epub 2020 Aug 10. PMID: 33884212; PMCID: PMC8052110.Support the show

Acute Kidney Injury (AKI) with Dr. Archana Dhar and Dr. Molly McGetrick About our guests:Dr. Dhar is a is an associate Professor of Pediatrics and practicing pediatric intensivist at Children's Medical Center and UT Southwestern in Dallas.Dr. McGetrick recently completed her pediatric critical care fellowship training at UT Southwestern and is a current pediatric cardiovascular ICU fellow at Texas Children's. How to support PedsCrit?Please share, like, rate and review on Apple Podcasts or Spotify!Donations appreciated @PedsCrit on Venmo --100% of all funds will go to supporting the show to keep this project going.Learning Objectives: After listening to this series of episodes, learners should be able to:Define AKI.Discuss incident and epidemiology of AKI in the pediatric critical care setting.Know how to diagnose AKI according to the KDIGO guidelines.Recall the role of biomarkers and renal angina index in risk stratification and early identification of AKI.Discuss a clinical approach to managing a patient with acute kidney injury.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 updatesThanks again for listening! References/Further Reading: Sethi SK, Bunchman T, Chakraborty R, Raina R. Pediatric acute kidney injury: new advances in the last decade. Kidney Res Clin Pract. 2021 Mar;40(1):40-51. doi: 10.23876/j.krcp.20.074. Epub 2021 Mar 3. PMID: 33663033; PMCID: PMC8041642.Alobaidi R, Anton N, Burkholder S, Garros D, Garcia Guerra G, Ulrich EH, Bagshaw SM. Association Between Acute Kidney Injury Duration and Outcomes in Critically Ill Children. Pediatr Crit Care Med. 2021 Feb 26. doi: 10.1097/PCC.0000000000002679. Epub ahead of print. PMID: 33729733.Kaddourah A, Basu RK, Bagshaw SM, Goldstein SL; AWARE Investigators. Epidemiology of Acute Kidney Injury in Critically Ill Children and Young Adults. N Engl J Med. 2017;376(1):11-20. doi:10.1056/NEJMoa1611391 Hessey E, Melhem N, Alobaidi R, Ulrich E, Morgan C, Bagshaw SM, Sinha MD. Acute Kidney Injury in Critically Ill Children Is Not all Acute: Lessons Over the Last 5 Years. Front Pediatr. 2021 Mar 15;9:648587. doi: 10.3389/fped.2021.648587. PMID: 33791260; PMCID: PMC8005629.Basu RK, Kaddourah A, Terrell T, et al. Assessment of Worldwide Acute Kidney Injury, Renal Angina and Epidemiology in critically ill children (AWARE): study protocol for a prospective observational study. BMC Nephrol. 2015;16:24.Schneider J, Khemani R, Grushkin C, Bart R. Serum creatinine as stratified in the RIFLE score for acute kidney injury is associated with mortality and length of stay for children in the pediatric intensive care unit. Crit Care Med. 2010;38:933–9. doi: 10.1097/CCM.0b013e3181cd12e1.Villarreal EG, Rausa J, Chapel AC, Loomba RS, Flores S. Effects of Fenoldopam in the Pediatric Population: Fluid Status, Serum Biomarkers, and Hemodynamics: A Systematic Review and Meta-Analysis. J Pediatr Intensive Care. 2021 Jun;10(2):118-125. doi: 10.1055/s-0040-1714704. Epub 2020 Aug 10. PMID: 33884212; PMCID: PMC8052110.Support the show

Acute Kidney Injury (AKI) with Dr. Archana Dhar and Dr. Molly McGetrick About our guests:Dr. Dhar is a is an associate Professor of Pediatrics and practicing pediatric intensivist at Children's Medical Center and UT Southwestern in Dallas.Dr. McGetrick recently completed her pediatric critical care fellowship training at UT Southwestern and is a current pediatric cardiovascular ICU fellow at Texas Children's. How to support PedsCrit?Please share, like, rate and review on Apple Podcasts or Spotify!Donations appreciated @PedsCrit on Venmo --100% of all funds will go to supporting the show to keep this project going.Learning Objectives: After listening to this series of episodes, learners should be able to:Define AKI.Discuss incident and epidemiology of AKI in the pediatric critical care setting.Know how to diagnose AKI according to the KDIGO guidelines.Recall the role of biomarkers and renal angina index in risk stratification and early identification of AKI.Discuss a clinical approach to managing a patient with acute kidney injury.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 updatesThanks again for listening! References/Further Reading: Sethi SK, Bunchman T, Chakraborty R, Raina R. Pediatric acute kidney injury: new advances in the last decade. Kidney Res Clin Pract. 2021 Mar;40(1):40-51. doi: 10.23876/j.krcp.20.074. Epub 2021 Mar 3. PMID: 33663033; PMCID: PMC8041642.Alobaidi R, Anton N, Burkholder S, Garros D, Garcia Guerra G, Ulrich EH, Bagshaw SM. Association Between Acute Kidney Injury Duration and Outcomes in Critically Ill Children. Pediatr Crit Care Med. 2021 Feb 26. doi: 10.1097/PCC.0000000000002679. Epub ahead of print. PMID: 33729733.Kaddourah A, Basu RK, Bagshaw SM, Goldstein SL; AWARE Investigators. Epidemiology of Acute Kidney Injury in Critically Ill Children and Young Adults. N Engl J Med. 2017;376(1):11-20. doi:10.1056/NEJMoa1611391 Hessey E, Melhem N, Alobaidi R, Ulrich E, Morgan C, Bagshaw SM, Sinha MD. Acute Kidney Injury in Critically Ill Children Is Not all Acute: Lessons Over the Last 5 Years. Front Pediatr. 2021 Mar 15;9:648587. doi: 10.3389/fped.2021.648587. PMID: 33791260; PMCID: PMC8005629.Basu RK, Kaddourah A, Terrell T, et al. Assessment of Worldwide Acute Kidney Injury, Renal Angina and Epidemiology in critically ill children (AWARE): study protocol for a prospective observational study. BMC Nephrol. 2015;16:24.Schneider J, Khemani R, Grushkin C, Bart R. Serum creatinine as stratified in the RIFLE score for acute kidney injury is associated with mortality and length of stay for children in the pediatric intensive care unit. Crit Care Med. 2010;38:933–9. doi: 10.1097/CCM.0b013e3181cd12e1.Villarreal EG, Rausa J, Chapel AC, Loomba RS, Flores S. Effects of Fenoldopam in the Pediatric Population: Fluid Status, Serum Biomarkers, and Hemodynamics: A Systematic Review and Meta-Analysis. J Pediatr Intensive Care. 2021 Jun;10(2):118-125. doi: 10.1055/s-0040-1714704. Epub 2020 Aug 10. PMID: 33884212; PMCID: PMC8052110.