What topics should be covered in a pediatric critical care lecture for anesthesia residents?

Essential Topics for Pediatric Critical Care Lectures for Anesthesia Residents

A comprehensive pediatric critical care lecture for anesthesia residents should focus on cardiopulmonary physiology, airway management, pharmacology, and management of common complications to optimize morbidity, mortality, and quality of life outcomes.

Cardiopulmonary Physiology

• Determinants of oxygen delivery, cardiac output, and vascular resistance in pediatric patients 1
• Physiology of patients with congenital heart defects, including:
  • Single ventricle physiology and management 1
  • Ductal-dependent lesions and their management 1
  • Fixed restriction of pulmonary blood flow 1
  • Transposition of great arteries 1
• Cardiopulmonary interactions, particularly how mechanical ventilation affects cardiac output in children 1

Airway Management

• Pediatric-specific airway anatomy and physiology differences from adults 2, 3
• Algorithms for unexpected difficult intubation in pediatric patients 1
• Proper use of supraglottic airway devices as rescue techniques 1
• Video laryngoscopy techniques and indications in pediatric patients 3
• Management of the difficult pediatric airway, including:
  • Proper positioning techniques 1
  • Use of appropriate airway adjuncts 4
  • Rescue techniques when primary approach fails 1

Cardiovascular Pharmacology

• Inotropic agents: mechanisms, dosing, and clinical applications 1
• Vasodilators and antihypertensive medications in pediatric patients 1
• Antiarrhythmic drugs commonly used in pediatric critical care 1
• Pulmonary vasodilators including inhaled nitric oxide and prostacyclin 1
• Prostaglandin E1 for ductal-dependent lesions 1
• Neuromuscular blocking agents: pediatric considerations 1
• Analgesics and sedatives: dosing and monitoring in critically ill children 1

Mechanical Ventilation

• Commonly used modes of mechanical ventilation in pediatric cardiac patients 1
• Ventilation strategies for specific cardiac lesions 1
• Prevention and management of ventilator-associated complications 1
• Weaning protocols specific to pediatric cardiac patients 1

Critical Care Management

• Recognition and management of common postoperative complications:
  • Catheter-related sepsis 1
  • Pathological thrombosis 1
  • Surgically-induced heart block 1
• Cardiopulmonary resuscitation protocols specific to pediatric patients 1
• Extracorporeal membrane oxygenation (ECMO) and other cardiac support systems 1
• End-of-life and palliative care considerations 1

Diagnostic Modalities

• Echocardiography: indications and interpretation in the ICU setting 1
• Invasive pressure measurements and their interpretation 1
• Arterial blood gas analysis in pediatric cardiac patients 1
• Advanced imaging techniques and their applications 1

Common Critical Incidents

• Recognition and management of respiratory events (most common critical incidents at 55% of all reported events) 5
• Tracheal tube-related complications and their management 5
• Management of laryngospasm in pediatric patients 5
• Prevention and management of cardiac arrest in pediatric anesthesia 5

Quality Improvement and Safety

• Critical incident reporting and analysis 5
• Human factors in pediatric critical care errors 5
• Implementation of safety protocols and checklists 6
• Use of analytics and data-driven approaches to improve outcomes 6

Practical Training Recommendations

• Simulation-based training for rare but critical events 3
• Hands-on experience with pediatric airway equipment 4
• Team-based training for crisis resource management 2
• For anesthesia residents, a minimum of two months' full-time experience in pediatric cardiac ICU is recommended if they will be providing primary care 1