Podcasts about Hemodynamics

Guest: Dr. Adrianne Rahde Bischoff Clinical Assistant Professor of Pediatrics-Neonatology Neonatal Hemodynamics Specialist University of Iowa, Stead Childrens Hospital   CEU objectives for this episode: Describe two differences between a TNE (Targeted Neonatal Echo) performed by NICU staff and a Cardiac Ultrasound performed by an Echo Tech Explain at least one way that hemodynamic measurements obtained during a TNE might change the clinical management of a baby in the NICU List two or more treatment options for a PDA This episode is eligible for CEUs. Visit https://handtohold.org/resources/podcasts/nicu-heroes/ to complete the questionnaire. It is the sole responsibility of the individual to verify if this credit is valid and eligible for use in your State and/or for your discipline for licensure or certification renewal.  

N Engl J Med 1996;334:1349-1355Background Before 1990, the prevailing idea held that the negative inotropy of beta-blockers would harm patients with impaired systolic function. Yet part of the progression of systolic heart failure involved over stimulation of the sympathetic nervous system. Norepinephrine can exert adverse effects on the circulation, both directly and indirectly. Smaller trials of beta-blockers in systolic heart failure found trends for benefit with beta-blockers, however, a mortality benefit had not yet been proven. The U.S. Carvedilol Heart Failure Study aimed to study mortality in patients with heart failure with a reduced ejection fraction.Cardiology Trial's Substack remains free of industry ads because of your support. Thank you. Please consider becoming a free or paid subscriber.Patients The study enrolled 1094 patients with chronic heart failure symptoms for at least 3 months, LVEF ≤ 0.35%, at least 2 months of treatment with diuretics and an angiotensin-converting enzyme (ACE) inhibitor (if tolerated). Treatment with digoxin, hydralazine, or nitrates was permitted but not required.Exclusion criteria were extensive and important to understand. These included any recent major cardiac events or surgery within the previous 3 months, uncorrected valvular disease, active myocarditis, sustained VT or higher degrees of AV block not controlled by pacing, systolic blood pressure of more than 160 or less than 85 mm Hg or diastolic blood pressure of more than 100 mm Hg, clinically significant kidney or liver disease or use of calcium-channel blockers, adrenergic agonists/antagonists, or class IC/III antiarrhythmic agents. Patients receiving β-adrenergic agonists or antagonists (presumably for another indication) were not enrolled.Baseline Characteristics The results of this and other beta-blocker trials in heart failure will be clear. One of the most important points for translating this evidence to patients will be the baseline characteristics. It is vital to understand who these patients were.The mean age was 58 years and approximately 76% were male. Most patients had mild to moderate heart failure, with 53% in NYHA Class II, 44% in Class III, and only 3% in Class IV. The etiology of heart failure was nearly evenly split between coronary artery disease (47%) and nonischemic cardiomyopathy (53%). Patients had significantly impaired cardiac function with a mean LVEF of 0.23. The mean six-minute walk distance ranged from 386 to 390 meters. Hemodynamic parameters were relatively stable, with mean systolic blood pressure of 116 mmHg, and mean heart rate of 83-84 beats per minute. Most patients were receiving standard heart failure therapy at baseline, including digitalis (90-91%), loop diuretics (95%), and ACE inhibitors (95%), while approximately one-third (32%) were on direct-acting vasodilators.Trial Procedures Patients were assessed for eligibility during a 3-week screening period during which exercise capacity was assessed with a 6-minute walk test. Notable was that these were outpatients able to complete a 6-minute walk test. Enrollment was stratified to one of four treatment protocols on the basis of the patients' performance on the exercise test: patients able to walk between 426 and 550 m when tested were assigned to the mild-heart-failure protocol; those able to walk between 150 and 425 m were assigned either to the moderate-heart-failure protocol or to a dose-ranging protocol, depending on the location of the study center; and those able to walk only less than 150 m were assigned to the severe-heart-failure protocol.After this base-line testing, all patients received 6.25mg of carvedilol twice daily for two weeks in an open-label run-in period. Those who tolerated this initial dose were then randomized to receive either placebo (n=398) or carvedilol (n=696) on a double-blind basis, in addition to their usual medications.The allocation ratio (carvedilol:placebo) was 2:1 in the mild and severe heart failure protocols and 1:1 in the moderate heart failure protocol. The dose was gradually increased to target levels of 25-50mg twice daily over 2-10 weeks, followed by maintenance therapy for an additional 6 months (12 months for mild heart failure).Endpoints At the time of trial planning, the original intent was safety. That is, to show that carvedilol did not increase mortality. The original intent was to enroll 1100 patients. As smaller trials on beta-blockers were published, the statistical plan included the possibility of beta-blocker benefit. The trialists therefore planned two sided statistical analysis.Cumulative survival curves were constructed as time-to-first-event plots by Kaplan–Meier survivorship methods and differences between the curves were tested for significance by the log-rank statistic with use of a Cox proportional-hazards regression model (which included the protocol as a covariate).Results Median follow-up was only 6.5 months due to early termination for benefit. The patients mean total daily dose of carvedilol was 45±27 mg. Overall mortality was 7.8% in the placebo group vs. 3.2% in carvedilol group. The relative risk reduction from carvedilol vs placebo was 65% (95% CI, 39-80%; p

Returning for a second study this month, the JHLT Digital Media Editors invite first author Charlotte Van Edom to discuss the paper, “Apixaban plasma levels in patients with HeartMate 3 support.” As a cardiologist in training and a PhD candidate at the University Hospitals Leuven in Belgium, Van Edom's work focuses on hemocompatibility and mechanical circulatory support, covering both short-term and long-term support. The episode explores: The evolution of the use and understanding of direct oral anticoagulants (DOACs) during LVAD support, including the increased focus on Factor Xa inhibitors Encouraging findings from the study and what clinical practices might need to change if introducing apixaban Additional studies exploring DOACs in LVAD patients For the latest studies from JHLT, visit www.jhltonline.org/current, or, if you're an ISHLT member, access your Journal membership at www.ishlt.org/jhlt. Treat or research pulmonary vascular diseases? Check out the first April episode for a study on sotatercept in PAH patients. Don't already get the Journal and want to read along? Join the International Society of Heart and Lung Transplantation at www.ishlt.org for a free subscription, or subscribe today at www.jhltonline.org.

Commentary by Dr. Jian'an Wang.

Philippe Rola, intensivist, master of the VEXUS scan, and founder of the Hospitalist and Resuscitationist conference, shares his recent model of four hemodynamic interfaces to describe the entire circulatory system. Register for the H&R conference (May 22-23 2025) here with the discount code provided in the show. (No, we're not sponsored, just a cool event.) … Continue reading "Lightning rounds 51: Hemodynamic interfaces with Philippe Rola"

Read the article here: https://journals.sagepub.com/doi/full/10.1177/30494826241300881

Read the article here: https://journals.sagepub.com/doi/full/10.1177/30494826241296669

Drs. Gerard Slobogean, Conor Kleweno, Jon Eastman, and Josh Parry discuss the highlights from this 2024 OTA Annual Meeting symposium. Live from the 2024 OTA Annual Meeting. For additional educational resources visit OTA.org

Abdullah Al-Abcha, MD, social media editor of JACC: Cardiovascular Interventions, and Thomas Pilgrim, MD, MSc, discuss a recently published manuscript reporting the incidence, predictors, and clinical outcomes hemodynamic valve deterioration after transcatheter aortic valve replacement.

Send us a textNeste episódio, trazemos um compilado de estudos recentes que abordam avanços e desafios no manejo hemodinâmico dos recém-nascidos, um tema essencial para neonatologistas e cardiologistas pediátricos. Nosso objetivo é fornecer informação acessível e atualizada para profissionais da área que falam a língua portuguesa. Vamos aos artigos selecionados:"Changes in Patent Ductus Arteriosus Management and Outcomes in Infants Born at 26 to 28 Weeks' Gestation", por Kaluarachchi DC et al. https://www.jpeds.com/article/S0022-3476(24)00559-6/abstract Este estudo analisa mudanças recentes na abordagem do tratamento do persistência do canal arterial (PCA) em prematuros de 26 a 28 semanas e seus impactos nos desfechos clínicos. "Hemodynamic assessment by neonatologist using echocardiography: Primary provider versus consultation model", por Shahab Noori et al. https://www.nature.com/articles/s41390-024-03248-7 Este artigo compara a avaliação hemodinâmica realizada diretamente pelo neonatologista com o modelo tradicional de consulta cardiológica. "Newborn Screening for Critical Congenital Heart Disease: A New Algorithm and Other Updated Recommendations", por Oster ME et al. https://publications.aap.org/pediatrics/article/155/1/e2024069667/200337/Newborn-Screening-for-Critical-Congenital-Heart A Academia Americana de Pediatria apresenta um novo algoritmo para a triagem de cardiopatias congênitas críticas em recém-nascidos. "Vasopressin as adjunctive therapy in pulmonary hypertension associated with refractory systemic hypotension in term newborns", por Santelices F et al. https://www.nature.com/articles/s41372-024-02015-0#citeas Este estudo investiga o uso da vasopressina como terapia adjuvante na hipertensão pulmonar associada à hipotensão sistêmica refratária em recém-nascidos a termo. Queremos saber sua opinião! Se este episódio foi útil para você, avalie nosso programa na sua plataforma de streaming favorita e compartilhe com colegas interessados na neonatologia. Sua participação nos ajuda a continuar trazendo conteúdo relevante e acessível para a comunidade.Prepare-se para um evento imperdível em Neonatologia! De 3 a 5 de abril, Gramado/RS recebe o IX Encontro Internacional de Neonatologia e o VII Simpósio Interdisciplinar de Atenção ao Prematuro. Inscreva-se agora: evento.fundmed.org.br/encontroneonatologia2025Até o próximo episódio! Não esqueça: você pode ter acesso aos artigos do nosso Journal Club no nosso site: https://www.the-incubator.org/podcast-1 Lembrando que o Podcast está no Instagram, @incubadora.podcast, onde a gente posta as figuras e tabelas de alguns artigos. Se estiver gostando do nosso Podcast, por favor dedique um pouquinho do seu tempo para deixar sua avaliação no seu aplicativo favorito e compartilhe com seus colegas. Isso é importante para a gente poder continuar produzindo os episódios. O nosso objetivo é democratizar a informação. Se quiser entrar em contato, nos mandar sugestões, comentários, críticas e elogios, manda um e-mail pra gente: incubadora@the-incubator.org

Send us a textHemodynamic assessment by neonatologist using echocardiography: Primary provider versus consultation model.Noori S, Ramanathan R, Lakshminrusimha S, Singh Y.Pediatr Res. 2024 May 22. doi: 10.1038/s41390-024-03248-7. Online ahead of print.PMID: 38778230As always, feel free to send us questions, comments, or suggestions to our email: nicupodcast@gmail.com. You can also contact the show through Instagram or Twitter, @nicupodcast. Or contact Ben and Daphna directly via their Twitter profiles: @drnicu and @doctordaphnamd. The papers discussed in today's episode are listed and timestamped on the webpage linked below. Enjoy!

TopMedTalk at The American Society of Anesthesiologists (ASA)'s annual general meeting; Anesthesiology 2024. We're bringing you a series of podcasts from the conference. Make sure you check our podcast feed and are subscribed to TopMedTalk, as we are currently releasing episodes more often than usual to accommodate high demand. This piece provides much needed focus on the topic of pediatrics and hemodynamics. Is it true to say that children are completely different to adults? What information do we need and what should the considerations around this topic really be? Presented by Desiree Chappell and Mike Grocott with their guests Dwight Bailey, Chief, Division of Pediatric Critical Care Medicine at Atrium Health, Levine Children's Hospital and Jonathan Tan, Vice Chair of Analytics and Clinical Effectiveness, Department of Anesthesiology Critical Care Medicine, Assistant Professor of Clinical Anesthesiology and Spatial Sciences, Children's Hospital Los Angeles, Keck School of Medicine of the University of Southern California, Spatial Sciences Institute of the University of Southern California

Send us a textBen and Daphna welcome back Dr. Srirupa Gopal, who returns to The Incubator podcast with exciting updates. Now an Assistant Professor of Neonatology at SSM Health Cardinal Glennon Children's Hospital, Dr. Gopal shares insights from her CHNC workshop on hemodynamic-based strategies in neonatal care and her perspective on evolving medication approaches. Additionally, Dr. Gopal introduces her new role within The Incubator team, leading a special series featuring neonatal fellows discussing their research projects. Tune in to learn how this initiative aims to foster international collaboration and bring neonatal research to a global audience.As always, feel free to send us questions, comments, or suggestions to our email: nicupodcast@gmail.com. You can also contact the show through Instagram or Twitter, @nicupodcast. Or contact Ben and Daphna directly via their Twitter profiles: @drnicu and @doctordaphnamd. The papers discussed in today's episode are listed and timestamped on the webpage linked below. Enjoy!

Answering emails and questions. Books: The Man Who Broke Capitalism by Gelles, The Ethnic Cleansing of Palestine by Pappe

Darshan H. Brahmbhatt, Podcast Editor of JACC: Advances discusses a recently published original research paper on a novel hemodynamic index characterizing mitral regurgitation undergoing transcatheter edge to edge repair

Send us a Text Message.In this episode of "The Incubator" at NeoHeart 2024, hosts Ben and Daphna interview Dr. Phil Levy from Boston Children's Hospital.Dr. Levy discusses his experience preparing for a year-in-review presentation on 18 months of neonatal hemodynamics research. He highlights the work of Dr. Reagan Geisinger and her trainees, emphasizing their contributions to various aspects of neonatal hemodynamics, including:Hemodynamic screening programs and their impact on outcomesPDA management strategies across different gestational agesThe use of inhaled nitric oxide in preterm infantsEstablishing normal values for cardiac function in premature babiesHemodynamic changes during therapeutic hypothermiaDr. Levy also mentions the updated 2024 guidelines for Targeted Neonatal Echocardiography and Point of Care Ultrasound, highlighting their comprehensive approach to teaching, education, and training.The conversation touches on recent trends in PDA management, including a decrease in surgical ligations and an increase in device closures. Dr. Levy discusses new guidelines on the timing of PDA interventions, emphasizing the importance of a multidisciplinary approach.Finally, Dr. Levy shares information about an upcoming addition to NRP training that will include modules on resuscitating babies with congenital heart disease, highlighting the growing collaboration between neonatology and cardiology. As always, feel free to send us questions, comments, or suggestions to our email: nicupodcast@gmail.com. You can also contact the show through Instagram or Twitter, @nicupodcast. Or contact Ben and Daphna directly via their Twitter profiles: @drnicu and @doctordaphnamd. The papers discussed in today's episode are listed and timestamped on the webpage linked below. Enjoy!

Send us a Text Message.In this episode of "The Incubator" at NeoHeart 2024, hosts Ben and Daphna interview Dr. Lauren Ruoss from Winnie Palmer Hospital and Dr. Catalina Bazacliu from the University of Florida.Dr. Ruoss discusses her role in bridging cardiac-focused care and targeted neonatal echo. She highlights her upcoming session on when cardiac POCUS (Point-of-Care Ultrasound) may aid in neonatal care, emphasizing the nuances and training required for cardiac POCUS compared to other applications like lung ultrasound. Dr. Ruoss also shares successes from her program, including improved physiological discussions and management of acute pulmonary hypertension in term infants.Dr. Bazacliu shares her motivation for attending NeoHeart, citing her goal to stay current with literature and eventually start a hemodynamic program at the University of Florida. The conversation emphasizes the welcoming nature of the conference for professionals at various stages in their hemodynamics journey.The hosts and guests discuss the collaborative nature of the neonatal hemodynamics community, highlighting resources like Gabriel Altit's curriculum and monthly case reviews. They stress the importance of ongoing learning and the need for more training programs in this field.The episode underscores the evolving nature of neonatal hemodynamics and the value of conferences like NeoHeart in fostering knowledge exchange and professional growth. As always, feel free to send us questions, comments, or suggestions to our email: nicupodcast@gmail.com. You can also contact the show through Instagram or Twitter, @nicupodcast. Or contact Ben and Daphna directly via their Twitter profiles: @drnicu and @doctordaphnamd. The papers discussed in today's episode are listed and timestamped on the webpage linked below. Enjoy!

Show notes at pharmacyjoe.com/episode936. In this episode, I'll discuss why ketamine can sometimes cause post-induction hemodynamic instability when it is used for rapid sequence intubation. The post 936: Why does ketamine for RSI sometimes cause post-induction hemodynamic instability? appeared first on Pharmacy Joe.

This episode of the Society of Critical Care Medicine Podcast offers insights on hemodynamics monitoring in critically ill patients. Kyle Enfield, MD, FCCM, is joined by Courtney Bennett, DO, FCC, FASE, to discuss foundational concepts in hemodynamic monitoring and shock management, stressing the importance of understanding data quality and ongoing debates in critical care. SCCM offers a hemodynamic monitoring skills precourse as part of its Critical Care Congress programming. Courtney Bennett, DO, FCC, FASE, is an associate professor at Lee Valley Health Network in Allentown, Pennsylvania, USA.

While advanced monitoring technology can provide valuable information, the importance of clinical judgment and examination should not be minimized. Host Ludwig H. Lin, MD, is joined by Maurizio Cecconi, MD, to discuss the integration of clinical judgment with technology when assessing hemodynamic instability and shock. They emphasize the importance of fluid challenges tailored to individual patient characteristics, along with standardized approaches. Dr. Cecconi explores the role of big data and artificial intelligence (AI) in treatment refinement and advocates for global access to care. He highlights fluid responsiveness dynamics and the interaction between fluids and vasopressors, urging a cautious approach to fluid administration due to its drug-like effects. Dr. Cecconi is an anesthesiologist and intensive care specialist and chair of the Department of Anesthesia and Intensive Care at Humanitas Research Hospital and University in Milan, Italy. This podcast is sponsored by Baxter Healthcare.

This piece focuses upon the Hypotension Predictive Index (HPI) technology. We look at the validation process of HPI, addressing criticisms and clarifying its predictive ability for hemodynamic instability. How important is it to understand the underlying causes of instability rather than solely relying on blood pressure readings? What is the role of HPI in early detection and proactive management? The discussion also touches on the limitations of traditional mean arterial pressure (MAP) monitoring and the need for a holistic approach to hemodynamic assessment. Presented by Desiree Chappell, TopMedTalk's co-editor in Chief, speaking with Monty Mythen, Senior Vice President Medical Affairs, Edwards Lifesciences, Critical Care, Emeritus Professor of Anaesthesia and Critical Care, University College London, Thomas Sheeran, Senior Director Medical Affairs, Edwards Lifesciences, and Simon Davies, Consultant Anaesthetist at York Teaching Hospital NHS Foundation Trust. The paper 'Comparison of Differences in Cohort (Forward) and Case Control (Backward) Methodological Approaches for Validation of the Hypotension Prediction Index' is here: https://pubs.asahq.org/anesthesiology/article/doi/10.1097/ALN.0000000000004989/139987/Comparison-of-Differences-in-Cohort-Forward-and?searchresult=1 Here's the link to the Physiology Lab section of last year's ASA symposium on YouTube: https://youtu.be/yfl1VMMgIRs?si=YxGfOs-pdlIVVGt1 Here are publications relating HPI to hemodynamic instability at a microcirculation level: https://pubmed.ncbi.nlm.nih.gov/33755645/ https://pubmed.ncbi.nlm.nih.gov/36335548/

This piece is part of our coverage of The International Anesthesia Research Society (IARS) annual meeting. This wide ranging conversation tackles hemodynamics, intraoperative hypotension and its implications. We also discuss finance for medical practitioners and patient-centered research. Presented by Desiree Chappell, Vice President of Clinical Quality at NorthStar Anesthesia and TopMedTalk co-editor in Chief and Monty Mythen, TopMedTalk's founder and Senior Vice President Medical Affairs, Edwards Lifesciences with their guest Wael Saasouh, Anesthesiologist and Director of Research for NorthStar Anesthesia.

In this exclusive Live Podcast Event, we dive into pulmonary artery catheters (PACs), a critical tool in the management of critically ill patients. Often regarded as a cornerstone in the monitoring of hemodynamics, PACs provide invaluable insights into the heart's function and the pulmonary circulation's state. We will unpack the principles behind how they measure key physiological parameters such as pulmonary artery pressure, cardiac output, and mixed venous oxygen saturation. These metrics are vital for diagnosing and managing conditions like heart failure, shock, and pulmonary hypertension.Featuring leading Critical Care Expert Nicole Kupchik, MN, RN, CCNS, CCRN-CMC, PCCN, CEO - Nicole Kupchik Consulting, this episode brings you the latest research and technological advancements related to pulmonary artery catheters. Whether you're a CVICU nurse seeking to deepen your understanding of hemodynamic monitoring or simply curious about the science behind the use case of PACs, this episode offers comprehensive insights into the use of pulmonary artery catheters in critical care.Giveaway! You could WIN a copy of Nicole's Book “Critical Care Survival Guide” (a $100 value!) in our social media giveaway! Find us on Instagram @crnaschoolprepacademy. We're running the contest May 8th through 10th so don't miss out! Get a FREE Copy of the Slides Used in this Presentation! Click Here: https://mailchi.mp/kupchikconsulting/cspa-pulmonary-artery-catheter FREE! 8 Steps to Becoming a CRNA: https://www.cspaedu.com/3m9jgffpLearn How to Ace Your CCRN®, PCCN®, CMC® or CSC® Certification Exams with Nicole Kupchik: Click HereGet access to planning tools, interview preparation opportunities, valuable CRNA Faculty guidance, and mapped-out courses that have been proven to accelerate your CRNA success! Become a member of CRNA School Prep Academy: https://cspaedu.com/joinGet CRNA School insights sent straight to your inbox! Join the CSPA email list: https://www.cspaedu.com/podcast-emailJoin the Free Facebook Community here! https://www.facebook.com/groups/crnaschoolprepacademyfreeBook a mock interview, resume or personal statement critique, transcript review and more: www.teachrn.com

In this episode, hosts Terry and Garry tackle the pressing topic of hemodynamic instability in surgical patients, exploring its implications, challenges, and potential solutions. Drawing from data highlighting the alarming rate of preventable harm among perioperative patients, we'll underscore the urgency of addressing hemodynamic instability. We'll discuss the gaps in current recommendations, emphasizing the need for a sustained, coordinated plan involving all stakeholders to reduce patient risk.   Here's some of what we discuss in this episode: There's a gap in specific recommendations guiding clinicians on identifying risk, utilizing essential monitoring, and knowing those crucial thresholds for intervention. What do we already know and where do we go from here? The methods behind tackling perioperative hemodynamic instability. Technology that will define the future of perioperative care.   Visit us online and get show resources here: https://beyondthemaskpodcast.com/   Get the CE Certificate here: https://beyondthemaskpodcast.com/wp-content/uploads/2020/04/Beyond-the-Mask-CE-Cert-FILLABLE.pdf   Help us grow by leaving a review: https://podcasts.apple.com/us/podcast/beyond-the-mask-innovation-opportunities-for-crnas/id1440309246

Our ‘as live' coverage of the Society for Obstetric Anesthesia and Perinatology (SOAP) conference continues. This piece focuses upon advancements in medical technology, particularly in monitoring and managing hemodynamic parameters during childbirth and surgeries like C-sections. What are the latest advancements? How should we now understand hemodynamics? What new findings have we made in this area and how should we best go about tailoring our interventions? Presented by Desiree Chappell, TopMedTalk co-editor in Chief and Monty Mythen, TopMedTalk's founder, with their guest Andrew Geller, Medical Director Cedars-Sinai. More about SOAP here: https://www.soap.org/

Commentary by Dr. Candice Silversides

Commentary by Dr. Valentin Fuster

This session, presented by the renowned V. Carlyle, RN, BSN-CCRN, is a deep dive into the complexities of hemodynamic waveform analysis. Understanding these waveforms is crucial in critical care and perioperative settings, as it aids in accurate patient assessment and management. Key learning points: Fundamentals of hemodynamic waveform generation and interpretation. Techniques to analyze different waveforms and what they signify about cardiac function. Application of waveform analysis in diagnosing and managing patient conditions. Educational Objectives: Enhance knowledge of hemodynamic monitoring principles. Develop skills in interpreting complex waveforms. Understand the clinical applications and implications of waveform analysis in patient care. Who Should Attend: This session is highly beneficial for perfusionists, cardiac nurses, cardiovascular technologists, and other medical professionals involved in cardiac care and surgery. It offers an opportunity to understand a critical aspect of patient monitoring that directly impacts treatment decisions and outcomes. Benefits of Attending: Deepen your understanding of hemodynamic principles. Learn from an experienced healthcare professional with extensive knowledge in cardiac care. Gain valuable insights into advanced diagnostic techniques. Opportunity to earn continuing education units (CEUs) for professional development. Registration and More Information: For registration details and further information about this session and other offerings in the PerfWeb 97 series, please visit our website. Enhance your professional skills and join a network of experts dedicated to improving cardiac care.

Join us for an insightful and educational day at PerfWeb 97 on Thursday, February 22, 2024, as we delve into critical aspects of perfusion practice. This webinar, approved for 2.4 CEUs by the American Board of Cardiovascular Perfusion (ABCP), offers a comprehensive exploration of two vital topics: Treating Hemodynamic Disturbances and Weaning from Cardiopulmonary Bypass (CPB). 1500-1600: Treating Hemodynamic Disturbances - V. Carlyle, RN, BSN-CCRN The first session, led by esteemed faculty member V. Carlyle, RN, BSN-CCRN, focuses on treating hemodynamic disturbances. This segment will provide an in-depth understanding of the dynamics of blood flow, pressure, and resistance in the cardiovascular system. Participants will learn about the latest techniques and strategies for managing hemodynamic instabilities, including pharmacologic and mechanical interventions. Key learning points: Understanding the physiology and pathophysiology of hemodynamic disturbances. Identifying common causes and their impact on patient outcomes. Exploring contemporary management strategies, including drug therapy and innovative devices. 1600-1700: The Pressure is on Weaning from CPB - T. DiSalvio, CCP The second hour features T. DiSalvio, CCP, an expert in the field, discussing the critical process of weaning from cardiopulmonary bypass. This session will offer a detailed examination of the protocols, techniques, and challenges encountered during the weaning phase. Participants will gain valuable insights into optimizing patient stability and ensuring a successful transition from CPB. Key learning points: Overview of CPB weaning protocols and criteria for readiness. Techniques for balancing hemodynamics during the weaning process. Addressing common complications and strategies for their resolution. Who Should Attend: This webinar is ideal for perfusionists, cardiac nurses, cardiovascular technologists, and other healthcare professionals involved in cardiac surgery and patient care. Whether you are seeking to deepen your expertise or update your skills, this webinar provides a valuable opportunity for professional development.

“AI Predictive Monitoring to prevent Hemodynamic Instability and Deterioration in Perioperative and Acute Care Patients” was a talk given at the Evidence Based Perioperative Medicine (EBPOM) World Congress. For more on their conferences check out www.ebpom.org Presented by Feras Hatib, Vice President of the R&D Algorithms and Signal Processing organization for Critical Care and Vascular at Edwards Lifesciences in Irvine California. This piece works as a standalone talk but it is part 3 of a 4 part series. Part one is here: https://topmedtalk.libsyn.com/ai-in-perioperative-care-part-1-ebpom-london-2023 Part two is here: https://topmedtalk.libsyn.com/artificial-intelligence-in-perioperative-care-part-2-ebpom-2023 And, still to come, a fascinating panel discussion. Make sure you like and subscribe to TopMedTalk so you hear it first.

Commentary by Dr. Valentin Fuster

OutlineChapter 14- Hypovolemic States- Etiology - True volume depletion occurs when fluid is lost from from the extracellular fluid at a rate exceeding intake - Can come the GI tract - Lungs - Urine - Sequestration in the body in a “third space” that is not in equilibrium with the extracellular fluid. - When losses occur two responses ameliorate them - Our intake of Na and fluid is way above basal needs - This is not the case with anorexia or vomiting - The kidney responds by minimizing further urinary losses - This adaptive response is why diuretics do not cause progressive volume depletion - Initial volume loss stimulates RAAS, and possibly other compensatory mechanisms, resulting increased proximal and collecting tubule Na reabsorption. - This balances the diuretic effect resulting in a new steady state in 1-2weeks - New steady state means Na in = Na out - GI Losses - Stomach, pancreas, GB, and intestines secretes 3-6 liters a day. - Almost all is reabsorbed with only loss of 100-200 ml in stool a day - Volume depletion can result from surgical drainage or failure of reabsorption - Acid base disturbances with GI losses - Stomach losses cause metabolic alkalosis - Intestinal, pancreatic and biliary secretions are alkalotic so losing them causes metabolic acidosis - Fistulas, laxative abuse, diarrhea, ostomies, tube drainage - High content of potassium so associated with hypokalemia - [This is a mistake for stomach losses] - Bleeding from the GI tract can also cause volume depletion - No electrolyte disorders from this unless lactic acidosis - Renal losses - 130-180 liters filtered every day - 98-99% reabsorbed - Urine output of 1-2 liters - A small 1-2% decrease in reabsorption can lead to 2-4 liter increase in Na and Water excretion - 4 liters of urine output is the goal of therapeutic diuresis which means a reduction of fluid reabsorption of only 2% - Diuretics - Osmotic diuretics - Severe hyperglycemia can contribute to a fluid deficit of 8-10 Iiters - CKD with GFR < 25 are poor Na conservers - Obligate sodium losses of 10 to 40 mEq/day - Normal people can reduce obligate Na losses down to 5 mEq/day - Usually not a problem because most people eat way more than 10-40 mEq of Na a day. - Salt wasting nephropathies - Water losses of 2 liters a day - 100 mEq of Na a day - Tubular and interstitial diseases - Medullary cystic kidney - Mechanism - Increased urea can be an osmotic diuretic - Damage to tubular epithelium can make it aldo resistant - Inability to shut off natriuretic hormone (ANP?) - The decreased nephro number means they need to be able to decrease sodium reabsorption per nephron. This may not be able to be shut down acutely. - Experiment, salt wasters can stay in balance if sodium intake is slowly decreased. (Think weeks) - Talks about post obstruction diuresis - Says it is usually appropriate rather than inappropriate physiology. - Usually catch up solute and water clearance after releasing obstruction - Recommends 50-75/hr of half normal saline - Talks briefly about DI - Skin and respiratory losses - 700-1000 ml of water lost daily by evaporation, insensible losses (not sweat) - Can rise to 1-2 liters per hour in dry hot climate - 30-50 mEq/L Na - Thirst is primary compensation for this - Sweat sodium losses can result in hypovolemia - Burns and exudative skin losses changes the nature of fluid losses resulting in fluid losses more similar to plasma with a variable amount of protein - Bronchorrhea - Sequestration into a third space - Volume Deficiency produced by the loss of interstitial and intravascular fluid into a third space that is not in equilibrium with the extracellular fluid. - Hip fracture 1500-2000 into tissues adjacent to fxr - Intestinal obstruction, severe pancreatitis, crush injury, bleeding, peritonitis, obstruction of a major venous system - Difference between 3rd space and cirrhosis ascities - Rate of accumulation, if the rate is slow enough there is time for renal sodium and water compensation to maintain balance. - So cirrhotics get edema from salt retension and do not act as hypovolemia - Hemodynamic response to volume depletion - Initial volume deficit reduced venous return to heart - Detected by cardiopulmonary receptors in atria and pulmonary veins leading to sympathetic vasoconstriction in skin and skeletal muscle. - More marked depletion will result in decreased cardiac output and decrease in BP - This drop in BP is now detected by carotid and aortic arch baroreceptors resulting in splanchnic and renal circulation vasoconstriction - This maintains cardiac and cerebral circulation - Returns BP toward normal - Increase in BP due to increased venous return - Increased cardiac contractility and heart rate - Increased vascular resistance - Sympathetic tone - Renin leading to Ang2 - These can compensate for 500 ml of blood loss (10%) - Unless there is autonomic dysfunction - With 16-25% loss this will not compensate for BP when patient upright - Postural dizziness - Symptoms - Three sets of symptoms can occur in hypovolemic patients - Those related to the manner in which the fluid loss occurs - Vomiting - Diarrhea - Polyuria - Those due to volume depletion - Those due to the electrode and acid base disorders that can accompany volume depletion - The symptoms of volume depletion are primarily related to the decrease in tissue perfusion - Early symptoms - Lassitude - Fatiguability - Thirst - Muscle cramps - Postural dizziness - As it gets more severe - Abdominal pain - Chest pain - Lethargy - Confusion - Symptomatic hypovolemia is most common with isosmotic Na and water depletion - In contrast pure water loss, causes hypernatremia, which results in movement of water from the intracellular compartment to the extracellular compartment, so that 2/3s of volume loss comes from the intracellular compartment, which minimizes the decrease in perfusion - Electrolyte disorders and symptoms - Muscle weakness from hypokalemia - Polyuria/poly dips is from hyperglycemia and hypokalemia - Lethargy, confusion, Seizures, coma from hyponatremia, hypernatremia, hyperglycemia - Extreme salt craving is unique to adrenal insufficiency - Eating salt off hands ref 18 - Evaluation of the hypovolemic patient - Know that if the losses are insensible then the sodium should rise - Volume depletion refers to extracellular volume depletion of any cause, while dehydration refers to the presence of hypernatremia due to pure water loss. Such patients are also hypovolemic. - Physical exam is insensitive and nonspecific - Finding most sensitive and specific finding for bleeding is postural changes in blood pressure - I don't find this very specific at all! - Recommends laboratory confirmation regardless of physical exam - Skin and mucous membranes - Should return too shape quickly - Elastic property is called Turgur - Not reliable is patients older than 55 to 60 - Dry axilla - Dry mucus membranes - Dark skin in Addison's disease Frim increased ACTH - Arterial BP - As volume goes down so does arterial BP - Marked fluid loss leads to quiet korotkoff signs - Interpret BP in terms of the patients “normal BP” - Venous pressure - Best done by looking at the JVP - Right atrial and left atrial pressure - LV EDP is RAP + 5 mmHg - Be careful if valvular disease, right heart failure, cor pulmonare, - Figure 14-2 - Shock - 30% blood loss - Lab Data - Urine Na concentration - Should be less than 25 mmol/L, can go as low as 1 mmol/L - Metabolic alkalosis can throw this off - Look to the urine chloride - Figure 14-3 - Renal artery stenosis can throw this off - FENa - Mentions that it doesn't work so well at high GFR - Urine osmolality - Indicates ADH - Volume depletion often associated with urine osm > 450 - Impaired by - Renal disease - Osmotic diuretic - Diuretics - DI - Mentions that severe volume depletion and hypokalemia impairs urea retension in renal medulla - Points out that isotonic urine does not rule out hypovolemia - Mentions specific gravity - BUN and Cr concentration - Normal ratio is 10:1 - Volume depletion this goes to 20:1 - Serum Na - Talks about diarrhea - Difference between secretory diarrhea which is isotonic and just causes hypovolemia - And osmotic which results in a lower electrolyte content and development of hypernatremia - Talks about hyperglycemia - Also can cause the sodium to rise from the low electrolyte content of the urine - But the pseudohyponatraemia can protect against this - Plasma potassium - Treatment - Both oral and IV treatment can be used for volume replacement - The goal of therapy are to restore normovolemia - And to correct associated acid-base and electrolyte disorders - Oral Therapy - Usually can be accomplished with increased water and dietary sodium - May use salt tablets - Glucose often added to resuscitation fluids - Provides calories - Promotes intestinal Na reabsorption since there is coupled Na and Glucose similar to that seen in the proximal tubule - Rice based solutions provide more calories and amino acids which also promote sodium reabsorption - 80g/L of glucose with rice vs 20 g/L with glucose alone - IV therapy - Dextrose solutions - Physiologically equivalent to water - For correcting hypernatremia - For covering insensible losses - Watch for hyperglycemia - Footnote warns against giving sterile water - Saline solutions - Most hypovolemic patients have a water and a sodium deficit - Isotonic saline has a Na concentration of 154, similar to that of plasma see page 000 - Half-isotonic saline is equivalent to 550 ml of isotonic saline and 500 of free water. Is that a typo? - 3% is a liter of hypertonic saline and 359 extra mEq of Na - Dextrose in saline solutions - Give a small amount of calories, otherwise useless - Alkalinizing solutions - 7.5% NaHCO3 in 50 ml ampules 44 mEq of Na and 44 mEq of HCO3 - Treat metabolic acidosis or hyperkalemia - Why 44 mEq and not 50? - Do not give with calcium will form insoluble CaCO3 - Polyionic solutions - Ringers contains physiologic K and Ca - Lactated Ringers adds 28 mEq of lactate - Spreads myth of LR in lactic acidosis - Potassium chloride - Available as 2 mEq/mL - Do not give as a bolus as it can cause fatal hyperkalemia - Plasma volume expanders - Albumin, polygelastins, hetastarch are restricted to vascular space - 25% albumin can pull fluid into the vascular space - 25% albumin is an albumin concentration of 25 g/dL compare to physiologic 4 g/dL - Says it pulls in several times its own volume - 5% albumin is like giving plasma - Blood - Which fluid? - Look at osmolality, give hypotonic fluids to people with high osmolality - Must include all electrolytes - Example of adding 77 mEw of K to 0.45 NS and making it isotonic - DI can be replaced with dextrose solutions, pure water deficit - Case 14-3 - Diarrhea with metabolic acidosis - He chooses 0.25 NS with 44 mEq of NaCl and 44 NaHCO3 - Talks about blood and trauma - Some studies advocate delaying saline until penetrating trauma is corrected APR about to. Keep BP low to prevent bleeding. Worry about diluting coagulation factors - Only do this if the OR is quickly available - Volume deficit - Provides formula for water deficit and sodium deficit - Do not work for isotonic losses - Provides a table to adjust fluid loss based on changes in Hgb or HCTZ - Says difficult to estimate it from lab findings and calculations - Follow serial exams - Serial urine Na - Rate of replacement - Goal is not to give fluid but to induce a positive balance - Suggests 50-100 ml/hr over what is coming out of the body - Urine - Insensibles 30-50 - Diarrhea - Tubes - Hypovolemic shock - Due to bleeding - Sequesting in third space - Why shock? - Progressive volume depletion leads to - Increased sympathetic NS - Increased Ang 2 - Initially this maintains BP, cerebral and coronary circulation - But this can decrease splanchnic, renal and mucocutaneous perfusion - This leads to lactic acicosis - This can result in intracellular contents moving into circulation or translocation of gut bacteria - Early therapy to prevent irreversible shock - In dogs need to treat with in 2 hours - In humans may need more than 4 hours - Irreversible shock associated with pooling of blood in capillaries - Vasomotor paralysis - Hyperpolarization of vascular smooth muscle as depletion of ATP allows K to flowing out from K channels opening. Ca flows out too leading to vasodilation - Glyburide is an K-ATP channel inhibitor (?) caused increased vasoconstriction and BP - Pluggin of capillaries by neutrophils - Cerebral ischemia - Increased NO generation - Which Fluids? - Think of what is lost and replace that. - Bleeding think blood - Raise the hct but not above 35 - Acellular blood substitutes, looked bad at the time of this writing - Di aspirin cross linked hemoglobin had increased 2 and 28 day mortality vs saline - Colloids sound great but they fail in RCTs - SAFE - FEAST - Points out that saline replaces the interstitial losses why do we think those losses are unimportant - Pulmonary circulation issue - Pulmonary circulation is more leaky so oncotic pressure less effective there - Talks about the lungs be naturally protected from pulmonary edema - Rate of fluid - 1-2 liters in first hour - Suggests CVP or capillary wedge pressure during resuscitation - No refs in the rate of fluid administration section - Lactic acidosis - Points out that HCO can impair lactate utilization - Also states that arterial pH does not point out what is happening at the tissue level. Suggests mixed-venous sample.ReferencesJCI - Phenotypic and pharmacogenetic evaluation of patients with thiazide-induced hyponatremia and a nice review of this topic: Altered Prostaglandin Signaling as a Cause of Thiazide-Induced HyponatremiaThe electrolyte concentration of human gastric secretion. https://physoc.onlinelibrary.wiley.com/doi/10.1113/expphysiol.1960.sp001428A classic by Danovitch and Bricker: Reversibility of the “Salt-Losing” Tendency of Chronic Renal Failure | NEJMOsmotic Diuresis Due to Retained Urea after Release of Obstructive Uropathy | NEJMIs This Patient Hypovolemic? | Cardiology | JAMAAnd by the same author, a textbook: Steven McGee. 5th edition. Evidence-Based Physical Diagnosis Elsevier Philadelphia 2022. ISBN-13: 978-0323754835The clinical course and pathophysiological investigation of adolescent gestational diabetes insipidus: a case report | BMC Endocrine DisordersSensitivity and specificity of clinical signs for assessment of dehydration in endurance athletes | British Journal of Sports MedicineDiagnostic performance of serum blood urea nitrogen to creatinine ratio for distinguishing prerenal from intrinsic acute kidney injury in the emergency department | BMC NephrologyThe meaning of the blood urea nitrogen/creatinine ratio in acute kidney injury - PMCLanguage guiding therapy: the case for dehydration vs volume depletion https://www.acpjournals.org/doi/10.7326/0003-4819-127-9-199711010-00020?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%20%200pubmedValidation of a noninvasive monitor to continuously trend individual responses to hypovolemiaReferences for Anna's voice of God on Third Spacing : Shires Paper from 1964 (The ‘third space' – fact or fiction? )References for melanie's VOG:1. Appraising the Preclinical Evidence of the Role of the Renin-Angiotensin-Aldosterone System in Antenatal Programming of Maternal and Offspring Cardiovascular Health Across the Life Course: Moving the Field Forward: A Scientific Statement From the American Heart Association2. excellent review of RAAS in pregnancy: The enigma of continual plasma volume expansion in pregnancy: critical role of the renin-angiotensin-aldosterone systemhttps://journals-physiology-org.ezp-prod1.hul.harvard.edu/doi/full/10.1152/ajprenal.00129.20163. 10.1172/JCI107462- classic study in JCI of AngII responsiveness during pregnancy4. William's Obstetrics 26th edition!5. Feto-maternal osmotic balance at term. A prospective observational study

When and why do we deviate from the septic shock algorithm? Why do cardiologists and neonatologists have various practices regarding vasoactives? What are the limits in monitoring and targeting endpoints in managing shock in neonates? Join us to for an enriching discussion with guests Denise Suttner, MD (Rady Children's/ UC San Diego), Amir Ashrafi, MD (Children's Hosp Orange County/UC Irvine) and Nim Goldshtrom, MD, MS (Morgan Stanley Children's Hospital/Columbia Univ Medical Ct). Host/Editor/Producer: Saidie Rodriguez, MD (CHOA/Emory). The recording of the session from the 8th World Congress of Pediatric Cardiology and Cardiac Surgery that we discuss in this episode can be found here.

This important piece covers the recent Anestheia Patient Safety Foundation (APSF) conference on perioperative hemodynamic instability, and the recent recommendations that they have just launched. The Anestheia Patient Safety Foundation is here: https://www.apsf.org/ Presented by Desiree Chappell and Mike Grocott with their guests, Daniel Cole MD, APSF President, Louise Y. Sun MD, SM, FRCPC , FAHA Professor of Anesthesiology at Stanford University, Michael Scott MB, ChB, FRCP, FRCA, FFICM Professor of Anesthesiology at the University of Pennsylvania. -- Originally streamed live as part of our coverage of Anesthesiology 2023; the annual meeting of the American Society of Anesthesiologists (ASA), the largest and most important gathering of anesthesiologists in the world. We're your free front row seat. For more on the ASA go here: https://www.asahq.org/ Check out our YouTube page for a record of the live stream video of this podcast: https://www.youtube.com/@topmedtalk7687/streams

Priya Bhaskar, M.D. is an Associate Professor of Pediatrics at UT Southwestern and an attending in the Cardiac ICU at Children's Medical Center Dallas. She completed her pediatric residency at Inova Children's Hospital in Virginia and critical care fellowship at UTSW prior to completing a 1 year CICU fellowship at Laurie Children's in Chicago. Prior to her current position here at UTSW she was a cardiac intensivist at Arkansas Children's Hospital. Her professional interests include extracorporeal support and education. She serves on the ECMO team as a core staff physician, and she has co-authored a review on this topic that we will use to guide our conversation. Learning Objectives:By the end of this podcast, listeners should be able to discuss:The general indications for VA-ECMO in pediatrics.The anatomic and physiologic rationale supporting various VA-ECMO cannulation strategies.Physiologic targets to ensure adequate oxygen delivery for patients on VA-ECMO.Hemodynamic complications of VA-ECMO such as left atrial hypertension and harlequin syndrome and general strategies in their management. Liberation strategies for VA-ECMO either to decannulation or conversion to ventricular assist device.How to support PedsCrit:Please rate and review on Spotify and Apple Podcasts!Donations are appreciated @PedsCrit on Venmo , you can also support us by becoming a patron on Patreon. 100% of funds go to supporting the show.Thank you for listening to this episode of PedsCrit. Please remember that all content during this episode is intended for educational and entertainment purposes only. It should not be used as medical advice. The views expressed during this episode by hosts and our guests are their own and do not reflect the official position of their institutions. If you have any comments, suggestions, or feedback-you can email us at pedscritpodcast@gmail.com. Check out http://www.pedscrit.com for detailed show notes. And visit @critpeds on twitter and @pedscrit on instagram for real time show updates.References:Bhaskar, P., Davila, S., Hoskote, A., & Thiagarajan, R. (2021). Use of ECMO for Cardiogenic Shock in Pediatric Population. Journal of clinical medicine, 10(8), 1573. https://doi.org/10.3390/jcm10081573Brown G, Moynihan KM, Deatrick KB, Hoskote A, Sandhu HS, Aganga D, Deshpande SR, Menon AP, Rozen T, Raman L, Alexander PMA. Extracorporeal Life Support Organization (ELSO): Guidelines for Pediatric Cardiac Failure. ASAIO J. 2021 May 1;67(5):463-475. doi: 10.1097/MAT.0000000000001431. Erratum in: ASAIO J. 2022 Jul 1;68(7):e129. PMID: 33788796.Xie A, Forrest P, Loforte A. Left ventricular decompression in veno-arterial extracorporeal membrane oxygenation. Ann Cardiothorac Surg. 2019 Jan;8(1):9-18. doi: 10.21037/acs.2018.11.07. PMID: 30854308; PMCID: PMC6379183. https://www.elso.org/ecmo-resources/elso-ecmo-guidelines.aspx https://www.congenitalheartacademy.com/home Support the show

Desiree Chappell and Monty Mythen in conversation with Seenu Reddy, Cardiothoracic Surgeon at HCA‘s TriStar Cardiovascular Surgery in Nashville, National Physician Director, HCA Healthcare's CV Service line. We start with discussion about the ERAS Cardiac society, more about them here: https://www.erascardiac.org/ The paper discussed in this piece (10 minutes in) “Advanced artificial intelligence–guided hemodynamic management within cardiac enhanced recovery after surgery pathways: A multi-institution review” is available here: https://doi.org/10.1016/j.xjon.2023.06.023 TopMedTalk is the broadcasting arm of Evidence Based Perioperative Medicine (EBPOM). For more information on EBPOM Ireland go here: https://ebpom.org/ As mentioned in the piece we've enjoyed conversations with Seenu Reddy previously: https://topmedtalk.libsyn.com/the-eras-cardiac-society-conference-day-2-topmedtalk-0 https://topmedtalk.libsyn.com/eras-cardiac-2019-seenu-reddy And we mention a forthcoming “mini-doc” on the subject of Drinking Eating and Mobilising which will include part of our essential interview with Henrik Kehlet, that you can hear here: https://topmedtalk.libsyn.com/asa-henrik-kehlet-recovery-is-all-about-inflammation

Commentary by Dr. Valentin Fuster

In this World Shared Practice Forum podcast, Drs. Suchitra Ranjit and Luregn Schlapbach, discuss a framework to provide individualized hemodynamic support for pediatric patients with septic shock, especially those in lower and middle-income countries. The authors discuss considerations described in their expert group's recent article, including how to administer and assess the response of various therapies such as fluids, inotropes, and pressors. LEARNING OBJECTIVES By the end of this podcast, learners will be able to: - Describe the challenges to the early recognition of septic shock in children through a global lens - Introduce the concepts of flow, pressure, and filling in the context of septic shock and their clinical application - Discuss the individualized approach to fluid use in the treatment of septic shock in pediatric patients - Review the literature surrounding the use of fluids in pediatrics and adults AUTHORS Suchitra Ranjit, MD Chief, Pediatric Intensive Care Unit Apollo Children's Hospital, Chennai, India Luregn Schlapbach, Prof, MD, PhD, FCICM Head, Department of Intensive Care and Neonatology University Children`s Hospital Zurich, Switzerland DATES: Initial publication: August 22, 2023 CITATION: Ranjit S, Schlapbach LJ, O'Hara JE, Wolbrink TA. Individualized Hemodynamic Support for Pediatric Patients with Septic Shock. 08/2023. OPENPediatrics. Online Podcast. YT: https://youtu.be/AK6Uz_hZ_SY SC: https://soundcloud.com/openpediatrics/individualized-hemodynamic-support-for-pediatric-patients-with-septic-shock. ARTICLED REFERENCED: - Ranjit S, Kissoon N, Argent A, et al. Haemodynamic support for paediatric septic shock: a global perspective. Lancet Child Adolesc Health. 2023;7(8):588-598. doi:10.1016/S2352-4642(23)00103-7 - Fleischmann-Struzek C, Goldfarb DM, Schlattmann P, Schlapbach LJ, Reinhart K, Kissoon N. The global burden of paediatric and neonatal sepsis: a systematic review. Lancet Respir Med. 2018;6(3):223-230. doi:10.1016/S2213-2600(18)30063-8 (1:15) - Maitland K, Kiguli S, Opoka RO, et al. Mortality after fluid bolus in African children with severe infection. N Engl J Med. 2011;364(26):2483-2495. doi:10.1056/NEJMoa1101549 (4:58) - Gu W, Deng X, Lee M, et al. Rapid pathogen detection by metagenomic next-generation sequencing of infected body fluids. Nat Med. 2021;27(1):115-124. doi:10.1038/s41591-020-1105-z (14:02) - Meyhoff TS, Hjortrup PB, Wetterslev J, et al. Restriction of Intravenous Fluid in ICU Patients with Septic Shock. N Engl J Med. 2022;386(26):2459-2470. doi:10.1056/NEJMoa2202707 (24:50) - National Heart, Lung, and Blood Institute Prevention and Early Treatment of Acute Lung Injury Clinical Trials Network, Shapiro NI, Douglas IS, et al. Early Restrictive or Liberal Fluid Management for Sepsis-Induced Hypotension. N Engl J Med. 2023;388(6):499-510. doi:10.1056/NEJMoa2212663 (24:52) 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

Find out more about Afif at: www.the-incubator.org/139/____________________________________________________________________As always, feel free to send us questions, comments or suggestions to our email: nicupodcast@gmail.com. You can also contact the show through instagram or twitter, @nicupodcast. Or contact Ben and Daphna directly via their twitter profiles: @drnicu and @doctordaphnamd. enjoy!This podcast is proudly sponsored by Chiesi.

Hey everyone! Just a quick update for y'all! My first book has been published on Amazon! "From Novice to Nurse: Empowering Reflections" My new 11-page Hemodynamic Crash Course is now available HERE along with all my other cheat sheets for the Balloon Pump, Impella, and more! We have got some great episodes in the works so get subscribed so you are notified when they are released. Talk to y'all soon!

Commentary by Dr. Valentin Fuster

As always, feel free to send us questions, comments, or suggestions to our email: nicupodcast@gmail.com. You can also contact the show through Instagram or Twitter, @nicupodcast. Or contact Ben and Daphna directly via their Twitter profiles: @drnicu and @doctordaphnamd. The papers discussed in today's episode are listed and timestamped on the webpage linked below.Enjoy!_____________________________________________________________________________________Show notes and articles can be found on our website: http://www.the-incubator.org/133/

Airway management remains the single highest risk time for our patients in pediatric ICU. We've known about these problems for a long time, but they're finally gaining the attention they deserve with registry projects and multicenter studies, new ways of thinking that move away from old dogmas and new ways to use our drugs and devices. One of the groups with the highest rates of peri intubation cardiac arrest is the child with cardiac disease or hemodynamic instability. Recent studies show extraordinary rates of peri intubation cardiac arrest as high as four to 15% in the 30 minute peri-intubation window. We'll discuss resuscitation and airway management in child with cardiac disease or hemodynamic instability, introduce the concept of the resus spiral staircase and talk about how you can optimize your team, respiratory support and hemodynamics. We cover delayed sequence intubation and that not every patient needs a tube and not every patient needs a tube right now. With better drugs and devices like dexmedetomidine and non-invasive, we've actually opened up a big zone between no support and invasive ventilation. We'll discuss ECMO standby when, how, who, and then finally de-resuscitation and extubation or separation from support. This is a really big episode, so we've split it into two. This first half covers the resus spiral, team management and monitoring. And in the second episode, we will go into respiratory and hemodynamic support, rescue strategies, including ECMO and finally extubation. Featuring regular hosts @drpetaalexander @BostonChildrens @karen_choong @MCH-childrens @drgregkelly @SCHNkidsNo time to listen or want to participate in the discusion? You can find a full Tweetorial of this episode on Twitter @pedsintensiva and our website here https://pedsintensiva.com

Our coverage of Euroanesthesia 2023 continues; The European Society of Anaesthesiology and Intensive Care (ESAIC) is the leading European Organisation for Anaesthesia, Intensive Care, Pain and Perioperative Medicine. TopMedTalk is proud to bring you 'as live' coverage of their annual conference. For more information on the work ESIAC do check out their website here https://euroanaesthesia.org/ This piece covers a conversation about hemodynamics and fluid management as Desiree Chappell, Monty Mythen and Andy Cumpstey speak with their guest Marlies Ostermann, Consultant in Critical Care and Nephrology at Guy's and St Thomas' NHS Foundation Trust.

In this week's episode, host Mike Moore talks with Andrew Malcolmson and Ashwin Belle, CEO and co-founder, and Chief Analytics Officer of Fifth Eye respectively. Fifth Eye has developed an AI-powered software as a medical device platform called AHI that measures heart rate variability to detect and predict hemodynamic instability. Today, Mike, Andrew, and Ashwin discuss the science behind the AHI platform, its potential applications, and the regulatory process involved in bringing it to market. They also discuss the benefits of AHI in providing early insight into a patient's condition, allowing for more proactive interventions and potentially avoiding costly adverse events. The conversation also covers the economic benefits of AHI, including cost avoidance, better resource allocation, and avoiding unreimbursed hospital-acquired events. Notable Quotes “Having a cloud-based solution where we can get the information processing to give you results in real-time, but we also have the ability to push it back down so you can see it and, you know, react to it on whatever screen you're already looking at, whether it's your, you know, central research station or in the ICU just in the EMR, if that's the place you want it or if you want it at the patient's bedside, that's achievable as well.” – Andrew (27:56) “I think from the team's strengths perspective, we really pride ourselves on the combination of signal processing and machine learning, where most technologies tend to do a lot and they explain a lot about the machine learning because they're using flight data that comes in from each of the structured systems they do using dynamic data by using data that comes in continuously at a high speed.” – Ashwin (34:38) In This Episode (02:08) Comparison of the AHI platform to pulse oximetry (05:39) Potential applications of the AHI platform  (07:59) The science and breakthrough behind the AHI platform (09:29) The experimental dataset captured by the Department of Defense to simulate hypovolemia (14:36) How Fifth Eye's platform enhances patient monitoring, aiding clinical decision-making protocols. (16:26) Real-time detection and prediction (20:05) Economic value of AHI to hospitals  (22:35) Differences from other early detection systems (24:30) How Fifth Eye's AI-powered software complements existing early detection  systems (25:15) Fifth Eye's solution for processing live streaming data challenges. (29:39) Feedback from early adopters (34:02) Fifth Eye product roadmap (36:36) Biggest opportunities and challenges for AHI moving forward (39:48) Fifth Eye's corporate culture and its importance in the current work environment Our Guests Ashwin Belle is a highly experienced professional with over a decade of leadership in healthcare research and development. His expertise spans ideation, R&D, design, productization, clinical trials, licensing, FDA regulation, go-to-market strategy, and commercialization, all aimed at improving patient care and saving lives. With over 20 years in MedTech, Andrew Malcolmson boasts extensive expertise in both Medical Equipment and Medical Software. His background spans R&D, Sales & Marketing, and Strategic Business Development in Medical Device companies both large and small, and he has been leading the application of data science to solve today's clinical challenges since starting one of the first Remote Monitoring & Clinical Decision Support software platforms at Covidien (Now Medtronic) in 2011. Resources & Links Mike Moore https://www.linkedin.com/in/michaeljeffreymoore/ https://www.linkedin.com/company/thebleedingedgeofdigitalhealth/ The Bleeding Edge of Digital Health Apple Podcasts Google Amazon Spotify YouTube Andrew Malcolmson   https://www.linkedin.com/in/andrew-malcolmson-7415972/ Ashwin Belle https://www.linkedin.com/in/ashwinbelle/ Fifth Eye https://fiftheye.com/

Commentary by Dr. Valentin Fuster

It's another session of CardioNerds Rounds! In these rounds, Dr. Karan Desai (Formerly FIT at University of Maryland Medical Center and currently faculty at Johns Hopkins School of Medicine) joins Dr. Dan Burkhoff (Director of Heart Failure, Hemodynamics and MCS Research at the Cardiovascular Research Foundation) to discuss mechanical circulatory support options through the lens of pressure-volume loops! Dr. Burkhoff is the author of Harvi, an interactive simulation-based application for teaching and researching many aspects of ventricular hemodynamics. Don't miss this wonderfully nerdy episode with a world-renowned expert in hemodynamics and MCS! Audio editing by CardioNerds Academy Intern, student doctor Chelsea Amo Tweneboah. This episode is supported with unrestricted funding from Zoll LifeVest. A special thank you to Mitzy Applegate and Ivan Chevere for their production skills that help make CardioNerds Rounds such an amazing success. All CardioNerds content is planned, produced, and reviewed solely by CardioNerds. Case details are altered to protect patient health information. CardioNerds Rounds is co-chaired by Dr. Karan Desai and Dr. Natalie Stokes.  Challenging Cases - Atrial Fibrillation with Dr. Hugh Calkins CardioNerds Rounds PageCardioNerds Episode PageCardioNerds AcademyCardionerds Healy Honor Roll CardioNerds Journal ClubSubscribe to The Heartbeat Newsletter!Check out CardioNerds SWAG!Become a CardioNerds Patron! Show notes - Hemodynamics and Mechanical Circulatory Support Case Synopsis: Case SynopsisWe focused on one case during these rounds. A man in his mid-50s presented to his local community hospital with 3 days of chest pain, nausea, and vomiting. He appeared ill in the emergency room with HR in the 150s, BP 90/70s and ECG demonstrating inferior ST elevations. He was taken emergently to the catheterization lab and received overlapping stents to his right coronary artery. Over the next 24 hours, he developed a new harsh systolic murmur heard throughout his precordium and progressed to cardiogenic shock. Echocardiogram demonstrated a large basal inferoseptum ventricular septal rupture. From this point, we discussed the hemodynamics of VSR and MCS options. Case Takeaways Dr. Burkhoff took us through the hemodynamics of VSR with pressure-volume loops to better understand the pathology and impact of various MCS options. Of note, there are no MCS devices specifically approved to treat acute ventricular septal rupture. In regards to the acute hemodynamic effects of a VSR (an abrupt left to right shunt), there are several aspects to note. First, the effective LV afterload is reduced; however, there is less “forward flow” as well and as a consequence, decreased left-sided cardiac output (“Qs”) and blood pressure. At the same time, flow through the pulmonary artery increases (the “Qp”). Additionally, due to the abrupt shunt flow, there is increased RV “loading” with increasing central venous pressure and pulmonary artery pressure. The hemodynamic priorities in treating patients with cardiogenic shock and VSR are to normalize blood pressure, cardiac output, and oxygen delivery, while attempting to minimize shunt flow to allow healing. However, medications and MCS are unlikely to completely normalize hemodynamics. For instance, if the patient was placed on peripheral VA ECMO, while total CO and BP may increase, flow across the VSR could also increase at high ECMO flows (e.g., by introducing more LV afterload). In patients with persistent cardiogenic shock and VSR, short-term MCS to divert flow away from the shunt can be an effective strategy. LV-to-aorta or LA-to-arterial MCS may provide the best single-device hemodynamic profiles by decreasing shunt flow, reducing pulmonary capillary wedge pressure, and improving blood pressure. Surgical and percutaneous VSD repair are the definitive treatment options. If able to stabilize patients and pursue delayed repair,

The cardiac OR can be a daunting place for any medical student or resident who finds themself on a cardiac surgery rotation. Have no fear, this Cardiac Surgery Crash Course is a short series focused on high-yield topics to help introduce students and residents to cardiac surgery prior to or during a cardiac surgery rotation. In this episode join Dr. Aaron Williams and our education fellow Dr. Jessica Millar as they break down ICU monitoring and hemodynamics of post-op cardiac surgery patients.  If you have any suggestions or requests for this series, please feel free to reach out to us by email:  Jessica Millar: millarje@med.umich.edu Inotrope/Pressor Reference Card:  https://i0.wp.com/emcrit.org/wp-content/uploads/2020/02/pressortable.jpg?resize=1536%2C1345&ssl=1 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://behindtheknife.org/listen/