Pediatrica intensiva: Art & Science of Pediatric Critical Care

In the second episode of our Fontan at 50 short season with @PCICS, Dr. Peter Laussen (Boston Children's Hospital) joins Greg and Deanna Tzanetos for the long view on how the Fontan evolved and where it's heading next.
Peter traces the procedural arc — atriopulmonary, lateral tunnel, fenestration, extracardiac conduit — and the physiology behind each shift: PAs in continuity, early staging of the pulmonary connection, setting the circulation up for passive flow. He covers the ICU preparation that still holds today, and why pushing the Fontan to younger ages stalled on an immature pulmonary vascular bed.
The conversation then turns forward. MRI-derived flow vectors and tailored anastomoses as the new standard. The adult Fontan problem, and why community EDs get into trouble applying a two-ventricle lens. "My Heart," a patient-carried app in development at Boston to help close that gap. And the most exciting shift of the last decade — staged myocardial growth for borderline left hearts, aiming at a two-ventricle endpoint instead of Fontan.
Peter closes with a challenge to the field: PCICS at the centre of a learning ecosystem that captures not just our actions, but our decisions.
Produced in collaboration with @PCICS.

The first in a 4 part collaboration with PCICS (the Pediatric Cardiac Intensive Care Society) honoring 50 plus years of the Fontan-Kreutzer Operation and asking "How did we get here, and where are we going?" This episode features Dr. Tom Glenn  from Texas Children's Hospital.  Dr Glenn has an extraordinarily valuable perspective as both a pediatric cardiologist at a world leading centre and someone living with a Fontan circulation. He offers amazing insights on the shifting focus from survival to quality of survival and then on to thriving and resilience and how we can rethink our attitudes and systems in ways that aid the natural resilience of our patients and families. Hint, it's not about the echo...
Hosted by Dr. Greg Kelly (Sydney Children's Hospital Westmead, Australia) and Dr. Deanna Todd Tzanetos (Norton Children's Hospital/U of Louisville)

Airway management remains the single highest risk time for our patients in pediatric ICU.  Different studies of pediatric airway management report first pass success as low as 50%. Rates of severe desaturation as high as 20%, and significant rates of cardiac arrest ranging from two to 15% in the 30 minute peri intubation window alone. A difficult airway might be anticipated or unanticipated and is not just difficult endotracheal intubation, but also difficulties with mask ventilation. supraglottic airway devices, difficult rescue techniques including front of neck access and physiologically difficult airways, which we covered in previous episodes. 
The good news is that the attention our community has been paying to these issues has reduced the rates of endo tracheal intubation (ETI) associated adverse events significantly, but there's still a long way to go. We are joined by Akira Nishisaki from NEAR 4 Kids & CHOP which has been one of the main drivers of improvements in this space for almost 20 years and who has an incredible knowledge of the literature and Doug Atkinson a pediatric anesthesiologist and cardiac intensivist from Boston Children's Hospital.
As always, we focus on how our expert panel do things in practice at their institutions whilst being aware of the evidence.

This season is  about airway management or airways that scare me and this episode, we discuss the respiratory unstable patient or the patient who's a "physiologically difficult airway" because they have bad lungs. We were incredibly lucky to have the amazing Robi Khemani from CHLA, a world expert on respiratory disorders in #pedsICU, join us and be able to share his thoughts.
It's not just about putting the tube in, it's about that whole high risk period of peri intubation. And with better drugs and devices we've opened a big space between low flow oxygen and invasive ventilation which makes decision making trickier.
Here we focus on that difficult decision making and the patients that really scare us. If you haven't heard it yet, our previous episode on team, environment, and equipment is very relevant here.
Featuring special guest Robinder Khemani from Children's Hospital LA and regular hosts @drpetaalexander @BostonChildrens @drgregkelly @SCHNkids and @Karen_Choong @MCH_childrens
No 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

Children with complex airway surgery are airways that truly scare us. Though a small number of patients in pedsICU, they can stay a long time and are at risk of death and morbidity from their underlying conditions, co-existing conditions, their treatment and ICU acquired problems. Managing these patients requires a high level of understanding, communication and teamwork between ENT/ORL, ICU, anesthesia, cardiothoracic surgery and numerous other teams.
We're going to cover the working up and investigation of patients transfers. The kind of conditions that are treated ranging from severe stenoses to severe malacias.  What the surgeons actually do what they want us to know and how it can best work together between ICU and surgical team.  We're also going to cover how we maintain these patients in the ICU, how we progress them, forwards, how we investigate problems and how we get the next debated and keep them safe.
Featuring special guests ORL surgeon and innovator David Zopf and Ryan Barbaro from University of Michigan and regular hosts @drpetaalexander @BostonChildrens  @drgregkelly @SCHNkids and Mike Clifford @RCH
No 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