Pediatric Critical Care Medicine Podcasts

SCCM Pod-442 Continuous Prediction of Mortality in the PICU: A Recurrent Neural Network Model in a Single-Center Dataset

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. 

Published: 9/2/2021

SCCM Pod-435 Intracranial and Cerebral Perfusion Pressure Thresholds Associated with In-Hospital Mortality Across Pediatric Neurocritical Care

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.

Published: 4/28/2021

SCCM Pod-431 Hypertonic Saline in Children with Raised Intracranial Pressure

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.

Published: 1/22/2021

SCCM Pod-425 Outcomes in Cystic Fibrosis PICU Admissions
Cystic fibrosis patient care has advanced greatly in recent years and the mortality rate has improved. Host Margaret M. Parker, MD, MCCM, talks with Michael A. Smith, MD, about PICU mortality and the factors associated with death among critically ill children with cystic fibrosis (Smith M, et al. Pediatr Crit Care Med. 2020 Oct;21:e879-887). Dr. Smith is in a pediatric critical care medicine fellow in the department of pediatric critical care medicine at the University of California, San Francisco in San Francisco, California, USA. Published: 10/15/2020

SCCM Pod-412 COVID-19 in Critically Ill Children
Gain valuable insight on the clinical management of COVID-19 and its relevance to the pediatric critical care provider (Ong J, et al. Pediatr Crit Care Med. 2020 Apr 7; Epub ahead of print) with host Elizabeth H. Mack, MD, MS, FCCM, and Jacqueline Ong, MB BChir, MMed (Paeds), MRCPCH.

Preparedness activities that every pediatric ICU should perform are also explored. Dr. Ong is head of the paediatric ICU at National University Hospital in Singapore. Published: 4/29/2020

SCCM Pod-411 Clinician Moral Distress
Margaret M. Parker, MD, MCCM, and Christopher S. Parshuram, MBChB, PhD, discuss clinician moral distress in Canadian pediatric and neonatal intensive care units (Dryden-Palmer,K, et al. Pediatri Crit Care Med. 2020;21(4): 314-323). They dive into a discussion on depersonalization, potentially mitigating factors, and more.

Dr. Parshuram is a pediatric critical care medicine physician at The Hospital for Sick Children and professor of pediatrics at the University of Toronto in Toronto, Ontario, Canada. Published: 4/8/2020

SCCM Pod-406 Surviving Sepsis Campaign Children's Guidelines
Margaret M. Parker, MD, MCCM, and Scott L. Weiss, MD, FCCM, discuss the release of "Surviving Sepsis Campaign International Guidelines for the Management of Septic Shock and Sepsis-Associated Organ Dysfunction in Children," published in the February 2020 issue of Pediatric Critical Care Medicine (Weiss S, et al. Pediatr Crit Care Med. 2020;21(2);e52-e106).

Dr. Weiss outlines the differences between the new pediatric Surviving Sepsis Campaign (SSC) guidelines and the 2017 “American College of Critical Care Medicine Clinical Practice Parameters for Hemodynamic Support of Pediatric and Neonatal Septic Shock” (Davis AL, et al. Crit Care Med. 2017;45:1061-1093), as well as key differences from the “Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016” (Rhodes A, et al. Crit Care Med. 2017;45:486-552).

The challenges in implementing the pediatric guidelines in resource-limited areas and key recommendations for resuscitation of children with sepsis and septic shock are also covered.

Dr. Weiss has served as the SCCM-appointed co-vice-chair of the SSC Guidelines Task Force. He is an attending physician at the Children’s Hospital of Philadelphia. Published: 2/7/2020

SCCM Pod-404 Population-Based Epidemiology and Outcomes of Acute Kidney Injury in Critically Ill Children
Margaret M. Parker, MD, MCCM, speaks with Rashid Alobaidi, MD, on his article titled “Population-Based Epidemiology and Outcomes of Acute Kidney Injury in Critically Ill Children,” published in the January 2020 issue of Pediatric Critical Care Medicine (Alobaidi R, et al. Pediatr Crit Care Med. 2020 Jan;21(1);82-91).

Dr. Alobaidi discusses the study and importance of enhanced surveillance for acute kidney injury (AKI) in critically ill children and the implementation of monitoring for AKI.

Dr. Alobaidi is assistant professor of pediatrics at the University of Alberta Stollery Children’s Hospital in Edmonton, Alberta, Canada. This podcast is sponsored by Baxter Healthcare Corporation. Published: 1/15/2020

SCCM Pod-399 Risk for Mortality in Critically Ill Children Needing Renal Replacement Therapy
Margaret M. Parker, MD, MCCM, speaks with Danny Hames, MD, on his article titled "Risk Factors for Mortality in Critically Ill Children Requiring Renal Replacement Therapy," published in the November 2019 issue of Pediatric Critical Care Medicine (Hames D, et al. Pediatr Crit Care Med. 2019;20;1069-1077).

Dr. Hames speaks about some of the challenges of monitoring patients with acute kidney injury, the implications of the study for pediatric intensivists, the importance of being mindful of renal function and fluid balance for ventilated patients, and areas that need further investigation.

Dr. Hames is an attending physician in the Division of Cardiovascular Critical Care in the Department of Cardiology at Boston Children’s Hospital and an instructor in the Department of Pediatrics at Harvard Medical School in Boston, Massachusetts, USA. Published: 11/13/2019

SCCM Pod-393 Updated Pediatric Admission, Discharge, and Triage and Levels of Care Guidance
Margaret M. Parker, MD, MCCM, and Lorry R. Frankel, MD, FCCM, discuss the updated pediatric critical care admission, discharge, and triage criteria and levels of care guidance published in the September issue of Pediatric Critical Care Medicine (Frankel L, et al. Pediatr Crit Care Med. 2019;20:847-887).

They review the methodology behind the development of this joint Society of Critical Care Medicine and American Academy of Pediatrics updated guidance, the areas of agreement, and what we may see in future updates.

Dr. Frankel is chair of the Department of Pediatrics at California Pacific Medical Center and emeritus professor of pediatrics at Stanford University School of Medicine in Stanford, California, USA. Published: 9/4/2019