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Healthcare workload has emerged as an important metric associated with poor outcomes. To measure workload, studies have used bed occupancy as a surrogate. However, few studies have examined frontline clinician workload and outcomes. Host Elizabeth Mack, MD, MS, FCCM, is joined by Michael Fundora, MD, FAAP, to discuss if the hypothesized frontline clinician workload, measured by bed occupancy and staffing, is associated with poor outcomes and unnecessary testing (Fundora M.P., et al. Pedtr Crit Care Med. 2021 August; 22:683-691). Michael Fundora is a physician in the Division of Cardiology, Department of Pediatrics, Children’s Healthcare of Atlanta at Emory University School of Medicine in Atlanta, Georgia. This podcast is sponsored by Mölnlycke.
As a proof of concept, a recurrent neural network (RNN) model was developed using electronic medical record (EMR) data capable of continuously assessing a child’s risk of mortality throughout an ICU stay as a proxy measure of illness severity. Host Margaret M. Parker, MD, MCCM, is joined by Melissa D. Aczon, PhD, to discuss how the RNN model can process hundreds of input variables contained in a patient’s EMR and integrate them dynamically as measurements become available. The RNN’s high discrimination suggests its potential to provide an accurate, continuous, and real-time assessment of a child in the PICU. (Aczon M, et al. Ped Crit Care Med. 2021;22:519-529) Dr. Aczon is a principal data scientist at Children’s Hospital Los Angeles. Melissa D. Aczon, PhD is a Principal Data Scientist at Children’s Hospital Los Angeles.
Targets for treatment of raised intracranial pressure or decreased cerebral perfusion pressure in pediatric neurocritical care are not well defined. Host Margaret Parker, MD, MCCM, is joined by Alicia K. Au, MD, MS, to discuss the process of defining intracranial pressure and cerebral perfusion pressure thresholds associated with in-hospital mortality across a large single-center pediatric neurocritical care cohort (Au A, et al. Pediatr Crit Care Med. 2021 Feb;22:135-146). Dr. Au is assistant professor of critical care medicine and associate medical director of the pediatric intensive care unit at the University of Pittsburgh Medical Center in Pittsburgh, Pennsylvania.
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.