In this special “PICU Doc On Call Shorts” episode, pediatric ICU physicians Dr. Monica Gray, Dr. Pradip Kamat, and Dr. Rahul Damania break down the concept of Mean Arterial Pressure (MAP). Using a case of a six-year-old in septic shock, they discuss how to calculate MAP, normal pediatric values, and the physiological determinants and clinical significance of MAP. The hosts highlight MAP’s role in guiding management of critically ill children, review autonomic and endothelial regulation, and reinforce learning with a board-style question. This episode emphasizes practical bedside application for pediatric interns and ICU providers.

Show Highlights:

1. Overview of Mean Arterial Pressure (MAP) and its clinical significance in pediatric critical care.
2. Introduction of a clinical case involving a 6-year-old child in septic shock.
3. Explanation of the formula for calculating MAP and its application to the clinical case.
4. Discussion of normal reference values for MAP in children and their clinical implications.
5. Physiological determinants of MAP, including cardiac output and systemic vascular resistance.
6. Role of the autonomic nervous system in regulating MAP through baroreceptor reflexes.
7. Importance of maintaining adequate MAP for organ perfusion, particularly in critically ill patients.
8. Clinical applications of MAP monitoring and management strategies in the PICU.
9. Summary of key takeaways regarding MAP calculation, physiological determinants, and clinical relevance.
10. Mention of related topics, such as invasive versus non-invasive blood pressure monitoring.

References:

1. DeMers D, Wachs D. Physiology, Mean Arterial Pressure. StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing.
2. Pediatric Blood Pressure Metrics and Hypotension Thresholds (details the task force data used to derive the 5th and 50th percentile MAP estimation formulas for children)
3. Berlin DA, Bakker J. Starling curves and central venous pressure. Crit Care. 2015 Feb 16;19(1):55.
4. Magder S. Volume and its relationship to cardiac output and venous return. Crit Care. 2016 Sep 10;20(1):271

In this episode of "PICU Doc on Call," Drs. Pradip Kamat and Rahul Damania dive into a pediatric ICU case involving a 4-year-old girl who presents with severe anemia and bleeding, ultimately diagnosed with von Willebrand disease (VWD). They chat about the causes and different types of VWD, walk through the key clinical features, and break down how to diagnose and manage this condition. Drs. Kamat and Damania highlight the important roles of desmopressin and factor concentrates in treatment. Throughout the episode, they stress the need to recognize VWD in kids who have mucosal bleeding and offer practical tips for intensivists on lab evaluation and treatment strategies for this common inherited bleeding disorder.

Show Nighlights:

1. Clinical case discussion of a 4-year-old girl with severe anemia and bleeding symptoms
2. Diagnosis of von Willebrand disease (VWD) and its significance in pediatric critical care
3. Etiology and pathogenesis of von Willebrand disease
4. Classification of von Willebrand disease into types (Type 1, Type 2 with subtypes, Type 3)
5. Clinical manifestations and symptoms associated with VWD
6. Diagnostic approach for identifying von Willebrand disease, including laboratory tests
7. Management strategies for VWD, including desmopressin and von Willebrand factor concentrates
8. Role of adjunctive therapies such as antifibrinolytics and hormonal treatments
9. Importance of multidisciplinary collaboration in managing complex bleeding disorders
10. Overview of the pathophysiology of von Willebrand factor and its role in hemostasis

References:

1. Fuhrman & Zimmerman - Textbook of Pediatric Critical Care Chapter ***.
2. Reference 1: Leebeek FW, Eikenboom JC. Von Willebrand's Disease. N Engl J Med. 2016 Nov 24;375(21):2067-2080.
3. Reference 2: Ng C, Motto DG, Di Paola J. Diagnostic approach to von Willebrand disease. Blood. 2015 Mar 26;125(13):2029-37.
4. Platton S, Baker P, Bowyer A, et al. Guideline for laboratory diagnosis and monitoring of von Willebrand disease: A joint guideline from the United Kingdom Haemophilia Centre Doctors' Organisation and the British Society for Hematology. Br J Haematol 2024 May;204(5):1714-1731.
5. Mohinani A, Patel S, Tan V, Kartika T, Olson S, DeLoughery TG, Shatzel J. Desmopressin as a hemostatic and blood-sparing agent in bleeding disorders. Eur J Haematol. 2023 May;110(5):470-479. doi: 10.1111/ejh.13930. Epub 2023 Feb 12. PMID: 36656570; PMCID: PMC10073345.

In this episode of "PICU Doc On Call," Drs. Pradip Kamat and Rahul Damania discuss the acute management of a 14-year-old boy with severe rectal bleeding and hypertension, ultimately diagnosed with inflammatory bowel disease (IBD). They review the approach to pediatric lower GI bleeding, diagnostic workup, and imaging, emphasizing early recognition and resuscitation. They outline IBD management, including steroids, biologics such as infliximab, and nutritional support, while highlighting the importance of screening for infections before immunosuppression. The episode provides practical insights for PICU physicians on handling acute GI emergencies in children.

Show Nighlights:

1. Clinical case of a 14-year-old male with hypertension and rectal bleeding.
2. Diagnosis of inflammatory bowel disease (IBD) following significant blood loss.
3. Approach to pediatric rectal bleeding and its implications.
4. Diagnostic workup including laboratory tests and imaging modalities.
5. Management strategies for IBD in acute pediatric care.
6. Importance of early recognition and resuscitation in cases of shock.
7. Physiological principles related to blood loss and shock in children.
8. Differential diagnoses for lower gastrointestinal bleeding in pediatrics.
9. Initial evaluation and stabilization protocols for pediatric patients.
10. Nutritional support and multidisciplinary care in managing IBD.

References:

1. Romano C, Oliva S, Martellossi S, et al. Pediatric gastrointestinal bleeding: Perspectives from the Italian Society of Pediatric Gastroenterology. World J Gastroenterol. 2017;23(8):1326-1337.
2. Pai AK, Fox VL. Gastrointestinal bleeding and management. Pediatr Clin North Am. 2017;64(3):543-561.
3. Padilla BE, Moses W. Lower gastrointestinal bleeding and intussusception. Surg Clin North Am. 2017;97(1):63-80.
4. Kaur M, Dalal RL, Shaffer S, Schwartz DA, Rubin DT. Inpatient management of inflammatory bowel disease-related complications. Clin Gastroenterol Hepatol. 2020;18(11):2417-2428.
5. Ashton JJ, Ennis S, Beattie RM. Early-onset paediatric inflammatory bowel disease. Lancet Child Adolesc Health. 2017;1(2):147-158.
6. Bouhuys M, Lexmond WS, van Rheenen PF. Pediatric inflammatory bowel disease. Pediatrics. 2022;150(6):e2022059341.
7. Rosen MJ, Dhawan A, Saeed SA. Inflammatory bowel disease in children and adolescents. JAMA Pediatr. 2015;169(11):1053-1060.
8. Conrad MA, Rosh JR. Pediatric Inflammatory Bowel Disease. Pediatr Clin North Am. 2017 Jun;64(3):577-591.