ECMO: The ultimate end point of Paediatric Intensive Care. We discussed all things ECMO with Chris Harvey, who leads the UK’s only mobile ECMO service. He will cannulate a patient in the referring hospital, and transport back to his ECMO centre in Leicester. What are the survival rates from ECMO? What are the survival rates of patients not accepted, either because they are too sick, or too well? What about E-CPR: which patients are eligible, and how common are they? What are the thresholds for ECMO referral? How has the type of patients referred changed over time? What are the limits of ECMO a
The PIVOTAL trial is the world’s first PIC specific Platform trial. It comes hot on the heels of some brilliant UK PIC research, like OxyPICU (PicPod77), and GASTRIC (not published yet, but will definitely have a PicPod soon!). It’s a platform which aims to reduce the life cycle of PIC research from about 10 years from idea to publication, down towards one half, or one third. All UK PICUs have signed up to this. We discuss the ethics, methodology, and statistics (spoiler alert: PicPod65 will help). We go through the aims, and hoped for end points. We discuss each of the three starting arms, (r
We were able to have a short conversation with Dr Mohammed Abed, director of the only functioning PICU in Gaza, at the Al Nasser hospital in Khan Younis. His dignity, pride, and incredible efforts in the face of a humanitarian catastrophe was incredibly humbling. He describes three cohorts of patients: a large amount of trauma, especially shrapnel injuries from bombs, patients admitted, and dying, of malnutrition, and recently a surge of flaccid paralysis patients, whose aetiology is unclear (but may be due to enterovirus D68 due to poor sanitation). He is working without a blood gas machine,
PicPod 88 is all about Pertussis in Paediatric Critical Care. Malignant Pertussis is, for intensivists, one of the most terrible conditions to treat, with a dearth of evidence, and but plenty of evidence of death. For PicPod 88 we have spoken to James Cherry from UCLA. James Cherry is a medical institution. At 94 years old he is still going strong with an encyclopaedic knowledge of Paediatric Infectious Diseases, and is author of the seminal Feigin and Cherry’s Textbook of Pediatric Infectious Diseases. First we hear of the history of pertussis vaccine, and the debate and controversy of “vacci
We spoke to Juan Valle Ortiz from Newcastle, Consultant in Paediatric Intensive Care. He is involved in the PaNGEa project (www. pangeacambridge.co.uk), and is an ESPNIC ventilation instructor. He’s also a singer! What is non invasive ventilation? Does it work? What are the thresholds for starting NIV? S/F ratios: are they useful in clinical practice? How do we know that NIV has been effective? How long do we have to assess benefit before mortality starts to rise? What are the reasons for NIV failure? When can we deliver “extreme” NIV? Should we use NIV in sepsis or multi organ failure? What a
Major traumatic brain injury is a huge issue for Paediatric Intensive Care. We have machines for almost every organ: but the brain is on its own. Shruti Agrawal, consultant in paediatric intensive care in Addenbrookes Hospital, Cambridge, is first author on the Starship study, recently published in the Lancet eClinical medicine. We discussed this study with her. 135 children with severe traumatic brain injury were studied with over 17,000 hours of data analysed. PRx: what is it, what does it mean, how do we derive it, and what implications does it have? What is the optimal cerebral perfusion p
“Saving lives” is what we do. But at what cost? Are we threatening the survival of the world by our PIC practices? What’s the point of healthcare, if we are destroying the world’s future for those same children? We talked to Heather Baid, an ICU nurse and lead for sustainability special interest group at the University of Brighton and Imogen Stringer, Head of Sustainability at Great Ormond St Hospital. How much waste do we create on PIC? How much of this is necessary, and how much is actually excessive? How do we balance the demands of, for instance, infection control vs the use of plastic glo
Nudge nudge…. a favourite of politicians and social commentators, but how can nudge technology help us in ventilation weaning? Lisa McIlmurray has been working on a pilot study of nudge technology attached to a ventilator. How does this help to move patients on? What are the algorithms used in this technology? Are there unintended consequences? What is the user acceptability? How was the tool developed, and how was it improved to be worthwhile? Alarms are annoyances which can distract from the patient, and therefore are often switched off. How is this different to an alarm, and how do we harne
Change is hard….isn’t it? We spoke to Rebecca Lawton, a professor of Psychology from the University of Leeds, who is an expert in patient safety; behaviour change; improvement science; workforce engagement and wellbeing. Why is change so difficult? Who is it most difficult for? And how do we convince individuals, and teams, to make changes? How do hierarchies interact with team changes? The psychology of change is challenging, but we cannot progress with our practice without this. Is it harder to adopt a practice, or to remove them? And why does this matter? And what do prehistoric cave dwelle
First, do no harm… How much of the things we do every day are worthwhile? We all do so many interventions, but are they actually worthwhile? Some may be ineffective, some inefficient, and some may be harmful. But which is which? How do we find out whether we should, or shouldn’t do something? What is an acceptable miss rate? What are the implications of getting this trending towards zero? Who will have our backs if something goes wrong, and how defensive should we be? Benficience, and non malifience. Not two sides of the same coin: they are two ends of a seesaw.
