Today, Dr. Rahul Damania, Dr. Pradip Kamat, and Dr. Monica Gray, pediatric intensivists, sit down to chat about the diagnosis and management of acute myocarditis in children. They focus on a real-life case involving a one-month-old infant who presented with poor feeding, respiratory distress, and fever. Together, they break down the possible causes, key clinical signs, diagnostic approaches, and treatment options for pediatric myocarditis. Throughout the discussion, they highlight the importance of early recognition, a multidisciplinary team approach, and supportive care in improving outcomes for these critically ill infants. This episode is packed with practical insights and is designed to help pediatric intensivists tackle this challenging and potentially life-threatening condition. Tune in to hear more!

Show Highlights:

• Definition and etiology of acute myocarditis in pediatric patients
• Clinical case presentation of a one-month-old infant with acute myocarditis
• Symptoms and clinical manifestations of acute myocarditis in children
• Diagnostic approaches for identifying acute myocarditis, including echocardiography and laboratory tests
• Management strategies for acute myocarditis, including intensive care and medication
• Importance of recognizing atypical presentations in infants
• Prognosis and risk factors associated with acute myocarditis
• Role of multidisciplinary collaboration in managing acute myocarditis
• Impact of viral infections on the development and severity of myocarditis
• Outcomes and potential complications related to acute myocarditis in pediatric patients

References:

• Fuhrman & Zimmerman - Textbook of Pediatric Critical Care Chapter 108. Life-threatening viral diseases and their treatment. Vora S et al. Pages 1273-1278
• Rogers’ textbook of Pediatric Intensive Care. Chapter 74: cardiomyopathy, myocarditis, and mechanical circulatory support. Harmon WG et al. Pages 1247-1255
• Robinson J, Hartling L, Vandermeer B, Sebastianski M, Klassen TP. Intravenous immunoglobulin for presumed viral myocarditis in children and adults. Cochrane Database Syst Rev. 2020 Aug 19;8(8): CD004370. Doi: 10.1002/14651858.CD004370.pub4. PMID: 32835416

In this episode of "PICU Doc on Call," pediatric intensivists Dr. Rahul Damania, Dr. Pradip Kamat, and Dr. Monica Gray discuss a critical case involving a 16-year-old male who experienced severe carbon monoxide poisoning after being found unresponsive in a garage. They chat about the pathophysiology, clinical manifestations, diagnostic workup, and management of carbon monoxide toxicity. Furthermore, they cover the importance of early oxygen administration, recognizing potential delayed neurological sequelae, and keeping an eye out for cardiac complications. Tune in and hear more about a comprehensive approach to treatment and the significance of multidisciplinary support for achieving the best patient outcomes.

Show Highlights:

• Case presentation of a 16-year-old male with severe carbon monoxide poisoning
• Pathophysiology of carbon monoxide toxicity and its effects on hemoglobin
• Clinical manifestations and symptoms associated with carbon monoxide poisoning
• Diagnostic workup for suspected carbon monoxide exposure
• Management principles for treating carbon monoxide poisoning in pediatric patients
• Sources and scenarios leading to carbon monoxide poisoning
• Complications arising from carbon monoxide exposure including neurological injuries
• Importance of early oxygen administration and monitoring in treatment
• Discussion of hyperbaric oxygen therapy and its indications
• Key takeaways for clinicians regarding the management and follow-up of carbon monoxide poisoning cases

We welcome you to share your feedback, subscribe & place a review on our podcast! Please visit our website picudoconcall.org.

References:

• Tapking, C., et al. (2021). Burn and inhalation injury. In J. J. Zimmerman & A. T. Rotta (Eds.), Fuhrman and Zimmerman’s Pediatric Critical Care (6th ed., pp. 1347–1362). Elsevier.
• Nañagas KA, Penfound SJ, Kao LW. Carbon Monoxide Toxicity. Emerg Med Clin North Am. 2022 May;40(2):283-312. doi: 10.1016/j.emc.2022.01.005. Epub 2022 Apr 5. PMID: 35461624.
• Smollin C, Olson K. Carbon monoxide poisoning (acute). BMJ Clin Evid. 2010 Oct 12;2010:2103. PMID: 21418677; PMCID: PMC3217756.
• Palmeri R, Gupta V. Carboxyhemoglobin Toxicity. [Updated 2023 Apr 17]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan.

Welcome to another exciting episode of PICU Doc on Call! Today, we're diving deep into the world of pediatric critical care with our expert hosts, Dr. Rahul Damania, Dr. Pradip Kamat, and Dr. Monica Gray. Get ready to unravel the mysteries of the oxygen extraction ratio (O2ER) and its pivotal role in managing pediatric acute respiratory distress syndrome (ARDS) and multi-organ dysfunction.

Picture this: a seven-year-old girl battling severe pneumonia that spirals into ARDS and septic shock. Our hosts walk you through this gripping case, shedding light on calculating O2ER and why central venous oxygen saturation (ScvO2) is a game-changer. They'll share their top strategies for optimizing oxygen delivery and cutting down on oxygen demand.

But that's not all! This episode is all about the holistic approach to managing critically ill pediatric patients. Tune in to discover how these insights can lead to better outcomes for our youngest and most vulnerable patients. Don't miss out on this vital conversation!

Show Highlights:

• Clinical significance of the oxygen extraction ratio (O2ER) in pediatric critical care
• Importance of understanding oxygen delivery and consumption in critically ill patients
• Calculation and interpretation of O2ER and its relationship to central venous oxygen saturation (ScvO2)
• Physiological concepts related to oxygenation, including intrapulmonary shunting and ventilation-perfusion mismatch
• Management strategies for increasing oxygen delivery and reducing oxygen demand in ARDS and septic shock
• Interventions such as blood transfusions, sedation, and optimization of cardiac output
• Implications of lactic acidosis and anaerobic metabolism in the context of inadequate oxygen delivery
• Holistic approach to patient management, focusing on both numerical values and overall metabolic needs

We welcome you to share your feedback, subscribe & place a review on our podcast! Please visit our website picudoconcall.org.

References:

1. Fuhrman B.P. & Zimmerman J.J. (Eds.). Pediatric Critical Care, 6th ed. Elsevier; 2021. (Key concepts of oxygen delivery, consumption, and extraction in shock states are discussed in Chapter 13) .
2. Nichols D.G. (Ed.). Roger’s Textbook of Pediatric Intensive Care, 5th ed. Wolters Kluwer; 2016. (Comprehensive review of oxygen transport and utilization in critically ill children, including ARDS and shock).
3. Lucking S.E., Williams T.M., Chaten F.C., et al. Dependence of oxygen consumption on oxygen delivery in children with hyperdynamic septic shock and low oxygen extraction. Crit Care Med. 1990;18(12):1316–1319. doi:10.1097/00003246-199012000-00002.
4. Ronco J.J., Fenwick J.C., Tweeddale M.G., et al. Pathologic dependence of oxygen consumption on oxygen delivery in acute respiratory failure. Chest. 1990;98(6):1463–1466. doi:10.1378/chest.98.6.1463 .
5. Carcillo J.A., Davis A.L., Zaritsky A. Clinical practice parameters for hemodynamic support of pediatric and neonatal septic shock. Crit Care Med. 2002;30(6):1365–1378. (ACCM guidelines emphasizing ScvO₂ targets in shock) .
6. Emeriaud G, López-Fernández YM, Iyer NP, et al; PALICC-2 Group; PALISI Network. Executive summary of the second international guidelines for the diagnosis and management of pediatric ARDS (PALICC-2). Pediatr Crit Care Med. 2023;24(2):143–168. doi:10.1097/PCC.0000000000003147.