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Pratik Pandharipande, MD, FCCM, is an assistant professor of anesthesiology at Vanderbilt University Medical Center in Nashville, Tennessee. Pandharipande discusses the definition and scope of delirium and how to identify and manage the condition in children.
Timothy D. Girard, MD, MSCI, discusses his article published in the July 2010 Critical Care Medicine, titled “Delirium as a Predictor of Long-Term Cognitive Impairment in Survivors of Critical Illness.” His study tests the idea that duration of delirium in the ICU is an independent predictor of long-term cognitive impairment after critical illness. Girard is an assistant professor of medicine at Vanderbilt University School of Medicine in Nashville, Tennessee.
Michael Diringer, MD, FCCM, discusses his article published in Critical Care Medicine about the management of acute aneurysmal subarachnoid hemorrhage. Diringer is professor of neurology, neurosurgery, anesthesiology and occupational therapy at Washington University School of Medicine in St. Louis, Missouri. He is also section chief of neurological critical care. Diringer discusses the anticipation, prevention, and management of secondary complications related to aneurysmal subarachnoid hemorrhage.
Wesley Ely, MD, FCCM, discusses new developments in delirium management, focusing on his presentation at the 36th Critical Care Congress. Dr. Ely is a professor in the department of medicine at the Vanderbilt University School of Medicine and an outcomes researcher with the Vanderbilt Center for Health Services Research. His presentation was summarized in the Congress Review, which offers education credit.
Stephan Mayer, MD, FCCM, discusses cooling the neurological patient. Dr. Mayer is director of the neurological intensive care unit at Columbia University Medicine Center and he is an associate professor in neurology and neurosurgery Columbia University College of Physicians and Surgeons. He presented during the 36th Critical Care Congress on this topic.
Girard et al (N Engl J Med. 2018;379:2506-2516) and Page et al (Lancet Respir Med. 2013;1:515-523) evaluated the treatment of acute delirium with antipsychotics.
Review neurologic manifestations of COVID-19 and other severe respiratory viral contagions (Robinson C, et al. Crit Care Explor. 2020;2:e0107) with host Ludwig H. Lin, MD, and author Christopher P. Robinson, DO, MS. In their discussion, they touch on identifying primary and secondary neurological manifestations associated with COVID-19, the main mechanisms of neurological injury, diagnostics, and possible treatments.
Dr. Robinson is assistant professor of neurology and neurosurgery at the University of Florida in Gainesville, Florida, USA.
Margaret M. Parker, MD, MCCM, speaks with Rakesh Lodha, MD, on his article titled Polyneuropathy in Critically Ill Mechanically Ventilated Children: Experience from Tertiary Care Hospital in North India, published the September issue of Pediatric Critical Care Medicine (Shubham S, et al. Pediatr Crit Care Med. 2019;20:826-831).
The authors review the methodology, primary findings, and limitations of the study, as well as implications to the clinician at the bedside and pressing research issues.
Dr. Lodha is a professor at All India Institute of Medical Sciences in New Delhi, India. This podcast is sponsored by Sound Critical Care.
Margaret M. Parker, MD, MCCM, and Patrick M. Kochanek, MD, MCCM, discuss the updated pediatric severe traumatic brain injury guidelines (Kochanek P, et al. Pediatr Crit Care Med. 2019;20:S1-S82).
They review what is new in the third edition of the guidelines and what further research can be done.
Dr. Kochanek is director of the Safar Center for Resuscitation Research at the University of Pittsburgh Medical Center in Pittsburgh, Pennsylvania, USA.
This podcast is sponsored by Philips and Masimo.
Margaret Parker, MD, MCCM, speaks with Chani Traube, MD, about the article, “Delirium in Critically Ill Children: An International Point Prevalence Study,” published in the April 2017 issue of Critical Care Medicine. Dr. Traube discusses the complexity of diagnosing pediatric delirium in pediatric intensive care unit (PICU) patients. Study findings showed that one out of every four children in the PICU was delirious, with hypoactive delirium being most common. Dr. Traube is an Associate Professor of Pediatrics at Weill Cornell Medical College in New York where she works as a PICU attending and clinical researcher. Crit Care Med. 2017; 45(4):584-590. Released: 8/29/17
Margaret Parker, MD, MCCM, speaks with Ericka L. Fink, MD, MS, about the PANGEA study (Prevalence of Acute Critical Neurological Disease in Children: A Global Epidemiological Assessment), published in the April 2017 issue of Pediatric Critical Care Medicine. Sixteen percent of children in pediatric intensive care units (ICUs) have acute neurological conditions with brain damage due to cardiac arrest, traumatic brain injury, or other causes. The study's findings underscore the need for “transformational ideas” to improve outcomes for this large group of critically ill children at high risk of adverse clinical outcomes. Dr. Fink is an Associate Professor of Pediatrics at the University of Pittsburgh and works in the Division of Pediatric Critical Care Medicine at Children’s Hospital of Pittsburgh in Pittsburgh, Pennsylvania. Pediatr Crit Care Med. 2017; 18(4):330-342.
Todd Fraser, MD, speaks with Arjen Slooter, MD, PhD, about the article, “Long-Term Mental Health Problems After Delirium in the ICU,” published in Critical Care Medicine. Dr. Slooter is Professor of Intensive Care Neuropsychiatry at Utrecht University’s Rudolf Magnus Brain Center. He also serves as a consultant neurologist-intensivist in the Department of Intensive Care Medicine at University Medical Center Utrecht in the Netherlands. In this article, Dr. Slooter and coauthors examine whether delirium during ICU stay is associated with long-term mental health problems defined as symptoms of anxiety, depression, and posttraumatic stress disorder. Crit Care Med. 2016; 44(10):1808-1813.
Margaret Parker, MD, MCCM, speaks with Steven L. Shein, MD, about the article, “Effectiveness of Pharmacological Therapies for Intracranial Hypertension in Children With Severe Traumatic Brain Injury—Results From an Automated Data Collection System Time-Synched to Drug Administration,” published in the March 2016 issue of Pediatric Critical Care Medicine. Dr. Shein is an Assistant Professor of Pediatric Critical Care Medicine at Rainbow Babies & Children’s Hospital in Cleveland, Ohio. In this article, Dr. Shein and coauthors discuss effects of medications commonly used to treat intracranial hypertension in children with traumatic brain injury.
Margaret Parker, MD, MCCM, speaks with Chani Traube, MD, about the article, “Pediatric Delirium and Associated Risk Factors: A Single-Center Prospective Observational Study,” published in the May 2015 issue of Pediatric Critical Care Medicine. Dr. Traube is an Associate Professor of Pediatrics in the Department of Pediatric Critical Care at Weill Cornell Medical College, New York Presbyterian Hospital, in New York. In this article, Dr. Traube and coauthors describe the prevalence and associated risk factors of delirium in critically ill children.
Margaret Parker, MD, MCCM, speaks with Nicole O’Brien, MD, about the article, “The Epidemiology of Vasospasm in Children with Moderate-to-Severe Traumatic Brain Injury,” published in the March 2015 issue of Critical Care Medicine. Dr. O’Brien is an Associate Professor of Clinical Medicine in the Department of Critical Care at Nationwide Children’s Hospital in Columbus, Ohio. In this article, Dr. O’Brien and coauthors examine the prevalence of vasospasm in children suffering traumatic brain injury.
Michael Weinstein, MD, FACS, FCCP, speaks with Christopher W. Seymour, MD, MSc, lead author on an article published in the October Critical Care Medicine, “Diurnal Sedative Changes During Intensive Care: Impact on Liberation from Mechanical Ventilation and Delirium.” Seymour is an assistant professor of critical care and emergency medicine at the University of Pittsburgh School of Medicine in Pittsburgh, Pennsylvania. He also is a core faculty member in the Clinical Research, Investigation, and Systems Modeling of Acute Illness (CRISMA) Center in the Department of Critical Care, where he contributes to the Program on Critical Care Health Policy. Additionally, he was the Society’s 2012 Vision Grant recipient.
Margaret Parker, MD, FCCM, associated podcast editor, speaks with Patrick M. Kochanek, MD, MCCM, about the revised guidelines for acute medical management of severe traumatic brain injury in infants, children, and adolescents, published as a supplement to the January 2012 Pediatric Critical Care Medicine. Kochanek is a professor and vice chair in the Department of Critical Care Medicine at the University of Pittsburgh School of Medicine in Pittsburgh, Pennsylvania, USA. He is also the editor-in-chief of Pediatric Critical Care Medicine.
Jennifer A. Frontera, MD, discusses national trends in the prevalence, cost and discharge disposition of patients after subdural hematoma. After reviewing patient data from 1998 to 2007 she published her analysis of the impact of this under-studied disease in Critical Care Medicine. Frontera is an assistant professor in neurosurgery and neurology at Mount Sinai School of Medicine, and she is the director of the neuroscience ICU at Mount Sinai Hospital in New York.
Mannitol is a commonly used osmotherapy agent in raised intracranial pressure (ICP) but the side effects are significant. An alternative therapy, hypertonic saline, has shown varied results. Host Margaret M. Parker, MD, MCCM, is joined by Arun Bansal, MD, to review a study that compared the effect of hypertonic saline versus mannitol on raised ICP in pediatric acute central nervous system infections (Rameshkumar R, et al. Pediatr Crit Care Med. 2020 Dec;21:1071-1080). Dr. Bansal is a professor in the department of pediatrics at the Advanced Pediatrics Centre, Postgraduate Institute of Medical Education and Research in Chandigarh, India.
Jeffrey Guy, MD, MSc, MMHC, speaks with Juliana Barr, MD, FCCM, lead author on the Society of Critical Care Medicine's American College of Critical Care Medicine, “Clinical Practice Guidelines for the Management of Pain, Agitation, and Delirium in Adult Patients in the Intensive Care Unit,” published in the January Critical Care Medicine. The guidelines provide a roadmap for developing integrated, evidence-based, and patient-centered protocols for preventing and treating pain, agitation and delirium (PAD) in critically ill patients. Bundles included in the guideline link management strategies with other intensive care unit (ICU) interventions, such as spontaneous awakening trials and early mobility protocols. Barr is an Associate ICU Medical Director at the Veterans Affairs Palo Alto Health Care System in Palo Alto, California, and Associate Professor in Anesthesia at Stanford University.