5 *MYTHS* about HYPOTENSION in infants// + 5 BP PEARLS!!
ฝัง
- เผยแพร่เมื่อ 24 ก.ค. 2024
- Dopamine?! Steroids?! Fluid bolus?!// When to echo??!! Sooo much we all THINK we KNOW about neonatal BPs- and here we cover those myths! Are CUFF pressures accurate in babies? Is DOPAMINE the best drug? What about volume boluses? When should we get an ECHO of the heart?!! When should we consider STEROIDS?? In part II of these series we delve into all these questions!!
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Dr. Tala is double boarded in Neonatology and Pediatrics and has worked in busy level III and IV units for the past 16 years. She has won multiple teaching awards throughout her time as a neonatologist.
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References:
Giesinger RE, McNamara PJ. Hemodynamic instability in the critically ill neonate: An approach to cardiovascular support based on disease pathophysiology. Semin Perinatol. 2016 Apr;40(3):174-88. doi: 10.1053/j.semperi.2015.12.005. Epub 2016 Jan 14. PMID: 26778235.
Mullaly R, El-Khuffash AF. Haemodynamic assessment and management of hypotension in the preterm. Arch Dis Child Fetal Neonatal Ed. 2024 Feb 19;109(2):120-127. doi: 10.1136/archdischild-2022-324935. PMID: 37173119.
König, Kai, Dan M. Casalaz, Emily J. Burke, and Andrew Watkins. "Accuracy of non-invasive blood pressure monitoring in very preterm infants." Intensive care medicine 38 (2012): 670-676.
Rahde Bischoff A, Bhombal S, Altman CA, Fraga MV, Punn R, Rohatgi RK, Lopez L, McNamara PJ. Targeted Neonatal Echocardiography in Patients With Hemodynamic Instability. Pediatrics. 2022 Nov 1;150(Suppl 2):e2022056415I. doi: 10.1542/peds.2022-056415I. PMID: 36317979.
Dionne JM, Bremner SA, Baygani SK, Batton B, Ergenekon E, Bhatt-Mehta V, Dempsey E, Kluckow M, Pesco Koplowitz L, Apele-Freimane D, Iwami H, Klein A, Turner M, Rabe H; International Neonatal Consortium. Method of Blood Pressure Measurement in Neonates and Infants: A Systematic Review and Analysis. J Pediatr. 2020 Jun;221:23-31.e5. doi: 10.1016/j.jpeds.2020.02.072. PMID: 32446487.
St Peter D, Gandy C, Hoffman SB. Hypotension and Adverse Outcomes in Prematurity: Comparing Definitions. Neonatology. 2017;111(3):228-233. doi: 10.1159/000452616. Epub 2016 Nov 30. PMID: 27898415.
Fanaroff JM, Wilson-Costello DE, Newman NS, Montpetite MM, Fanaroff AA. Treated hypotension is associated with neonatal morbidity and hearing loss in extremely low birth weight infants. Pediatrics. 2006 Apr;117(4):1131-5. doi: 10.1542/peds.2005-1230. PMID: 16585307
Dempsey EM, Barrington KJ, Marlow N, O'Donnell CPF, Miletin J, Naulaers G, Cheung PY, Corcoran JD, El-Khuffash AF, Boylan GB, Livingstone V, Pons G, Macko J, Van Laere D, Wiedermannova H, Straňák Z; HIP consortium. Hypotension in Preterm Infants (HIP) randomised trial. Arch Dis Child Fetal Neonatal Ed. 2021 Jul;106(4):398-403. doi: 10.1136/archdischild-2020-320241. Epub 2021 Feb 24. PMID: 33627329; PMCID: PMC8237176.
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*Disclaimer*: This video is intended for educational purposes only and while
we strive to give the most accurate information, errors may occur. Subsequently,
this video should not be a replacement for medical advice.
I greatly appreciate your efforts and insanely wishing working with you Dr Tala .. always great and looks fresh even after a oncall night 😊
Oh thank you so much!!!! So happy you liked the video- thank you for your generous mention!!!
Another excellent “pearl (s)” by Dr. Tala. Well done!
THANK YOU so much- love your comments :)
Very well done . thank you for the hard work you put on these videos
THANK YOU! Also thank you for appreciating how much work each video is!! Only 20 minutes and yet somehow takes hours! We do love doing it though! Thanks again for being here :)
Brilliant as usual,thnx alot dr Tala ❤
Thank you so much for your lovely comments- we love that you are so supportive :)
Wonderful breakdown of Dopamine actions! Thank you!!
Thanks so much for taking the time to write and for subscribing!! So glad you liked it- thank YOU!
Bravo. three thumbs up , as usual.
Thank you so much as usual for your lovely comments!
I am a trainee neonatal nurse practitioner from the Uk.Your videos really helping me .Thank you so much.Would like to see videos on x-rays
Hello!!! Thanks so much for your lovely comment- always impressed when anyone supplementing their education in this way. We’ve actually filmed a few videos on X-rays- maybe check out on home page? We’re going to put out a line placement/ ETT one soon too :)
Watching from egypt
Amazing and very simple explanation .thnx dr tala
Hello! So glad you found it helpful- thanks for taking the time to write to us doc- shukran!
Excellent explanation. If you get chance can you teach us about basic understanding of ECHO. Thank you
I'm definitely not an expert on echos- i'm trying to improve but you would be better served by a cardiologist or someone with extensive experience of evaluating the pictures (not just the numbers the cardiologists give us). For now- check out th-cam.com/video/3_zE31TLLXA/w-d-xo.htmlsi=wtKWTlWLzs-_hezH
It's a fantatic resource!
Great work Dr
Thanks so much for being here :)
Watching from UAE
Amazing
Thank you
Lots family there! Thank you so much for letting us know!! Thank you xx
Excellent ,Excellent dr.Tala
Thank you so much again- your approval means a lot :)
Watching from Pune (India) lots of ❤ to Dr Tala..
Thank you for letting us know where you're watching from! Thank you for being here :)
Thank you Dr Tala!
Thank you for watching!!
Hello can you do videos on what a NICU nurses role is in a delivery and necessary clinical skills as a NICU nurse like would a NICU nurse intubate or would that be the doctors or RT role or would the NICU nurse have to place an IV or does the ARNP do it ? Etc..
Thank you I love your videos they are so informative.
Hello! I love the idea of that video- thank you so much- I'll convince some friends to do it (Arianna never wants to go on camera!). Thanks so much for being here and for your encouraging words XX
Perfect 🥰
Thank you so much- really appreciate your support!
Thank you❤
Next NVS..... 😊
Ok/ im sorry- it’s taken me ages to answer cos im not sure what NVS stands for? Do you mind letting me know!!!!
@@TalaTalksNICU neuro vital signs ❤
Should we be treating the diastolic pressure with a vasopressor in infants with PDA who have "adequate" MAPS but wide pulse pressures to prevent NEC?
OOFFF - PDAs are tough. The problem is- if you give a vasopressor with a PDA- then the blood leaving the left side of the heart- will 'see' the higher pressures in the body and then the lower pressure system in the lungs- and even MORE blood may be shunted to the lungs and away from the body. Ideally if we have such low BPs and we're not getting sufficient blood flow to the kidneys/ gut etc- then often the answer is to close the PDA.
I find it hilarious that most centers want a cuff pressure, even if on central blood pressure readings. Why would this plastic cuff tell you more than a state of the art transducer?
I know!!!! Esp when there’s a solid UAC in place! I’ve had this conversation a few times with people! With any PAL or for a UAC in a tiny baby in for longer than we’d want- I guess you never know when it will start “flattening” so it’s nice to have some correlation- I guess??? But still- do we need q3 cuff pressures?! Not sure what the answer is!!