Stories about: critical care

Sounding out intracranial pressure with a hearing test

Heidary ear ICP measurement croppedBrain tumors, traumatic head injury and a number of brain and nervous system conditions can cause pressure to build up inside the skull. As intracranial pressure (ICP) rises, it can compress the brain and result in swelling of the optic nerves, damaging brain tissue and causing irreversible vision loss.

That’s what nearly happened to a 13-year-old boy who had three weeks of uncontrolled headaches and sudden double vision. His neuro-ophthalmologist at Boston Children’s Hospital, Gena Heidary, MD, PhD, found reduced vision in the right eye, along with poor peripheral vision, an enlarged blind spot and swelling of both optic nerves.

As Heidary suspected, he had idiopathic intracranial hypertension, a condition that can raise ICP both in children and adults. Heidary performed an operation around the optic nerve to relieve the pressure, and vision in the boy’s right eye gradually improved, though not completely. Heidary has had to monitor his ICP ever since to protect his visual system from further irreversible damage.

Unfortunately, such monitoring currently is pretty invasive.

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Intelligent ICU monitoring for patients in status epilepticus: BurSIn

The BurSIn system, in development, interprets EEG data along several key parameters and accurately identifies burst and suppression patterns.
The BurSIn system, in development, interprets EEG data along several key parameters and accurately identifies burst and suppression patterns.

Status epilepticus, a life-threatening form of persistent seizure activity in the brain, is challenging to treat. It requires hospitalization in an intensive care unit, constant monitoring and meticulous medication adjustment. An automated, intelligent monitoring system developed by clinicians and engineers at Boston Children’s Hospital could transform ICU care for this neurological emergency.

Typically, children in status epilepticus are first given powerful, short-acting seizure medications. If their seizures continue, they may need to be placed in a medically induced coma, using long-acting sedatives or general anesthetics. “The goal,” explains biomedical engineer Christos Papadelis, PhD, “is to supply enough sedating medication to suppress brain activity and protect the brain from damage, while at the same time avoiding over-sedation.”

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Injectable oxygen getting closer to clinical reality

John Kheir, MD, first envisioned an injectable form of oxygen eight years ago, the night one of his patients, a nine-month-old girl, died after catastrophic lung failure. Kheir, a cardiac intensive care specialist at Boston Children’s Hospital, spoke last night to WBZ-TV’s Mallika Marshall, MD, about his efforts to try to buy precious time for children whose lungs stop working:

Want to know more? Read Kheir’s own words about his hopes and challenges for intravenous oxygen in a post he penned for Vector.

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DNR orders and end-of-life decisions for children: The elephant in the room

End of life decisions: The elephant in the roomAmy Sanderson, MD, is a critical care physician at Boston Children’s Hospital whose research interests include developing and studying interventions to improve the quality of communication among clinicians, parents and children with life-threatening illnesses.

Do-Not-Resuscitate (DNR) orders are supposed to tell clinicians what not to do should a patient stop breathing or his heart stop beating (cardiopulmonary arrest). But our research in children with life-threatening illness reveals that DNR orders often are used in variable, unintended ways that, while well-intentioned, are problematic.

We surveyed physicians and nurses practicing in oncology, the intensive care unit (ICU) and the cardiac ICU—settings where end-of–life decisions typically take place. Of our 266 respondents, 67 percent agreed that a DNR order should guide medical decisions only during a cardiopulmonary arrest. Yet, in reality, their responses indicate that DNR orders influence care much more broadly.

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“Could we have given her intravenous oxygen?” Breathing an idea to life

This syringe, containing particles of oxygen gas mixed with liquid, can potentially save the lives of patients unable to breathe — like the infant Kheir was unable to save early in his career.

John Kheir, MD, a physician in the Cardiac Intensive Care Unit at Boston Children’s Hospital, led a team that created tiny particles filled with oxygen gas, which, when mixed with liquid, could be injected directly into the blood. In an emergency, IV oxygen delivery could potentially buy clinicians time to start life-saving therapies. Kheir will recount his journey this evening at TEDMED, during the 5:30-7:30 p.m. session “Welcoming Death Into Life.” To preview his talk, we’re reprising his popular post from last year.

It was an ordinary Saturday night in the ICU at Boston Children’s, in the fall of 2006. One of my patients was a 9-month-old girl who was admitted with pneumonia, and was having trouble breathing. I had gone in to check on her just a few minutes before; although she was not feeling well, she reached out and touched my hand as I examined her. I assured her mother she was in the best possible place for her care.

Five minutes later, the code bell alarmed. Our team rushed into her room to the most horrific sight I have ever seen.

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Raising an early warning in the ICU: T3

How can ICU clinicians manage the data from all these monitors?

With the Internet’s meteoric rise in the last 20 years—to the point of being available 24/7 in your pocket—technology pundits, psychologists and sociologists have been sounding ever louder warnings about information overload: the constant onslaught of communication, information and media coming at us all the time, and in ever greater volume.

Now imagine you’re a doctor or nurse in an intensive care unit (ICU). For you, information overload isn’t just a daily reality—it’s a necessary one. To make the right decisions at the right time for each patient, you must keep tabs on numerous bedside monitors—in the ICUs at Boston Children’s Hospital, that’s 10 or more for each child.

Melvin C. Almodovar, MD, medical director of Boston Children’s Cardiac Intensive Care Unit (CICU), and his colleagues wanted a better way to assess the patient’s physiologic state and catch crises before they happen.

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Got vitamin D? Study finds low levels in critically ill children

The sun helps us get some of the vitamin D we need, but not enough of it. A new study finds that critically ill kids are more than twice as likely as kids generally to be vitamin D deficient. (nichole ★/Flickr)

When a child is admitted to a hospital’s intensive care unit (ICU), probably one of the last things on anyone’s mind is, “Are they getting enough vitamin D?”

But this question could be a very important one, according to Kate Madden, MD, and Adrienne Randolph, MD, critical care medicine specialists at Boston Children’s Hospital. In a study of children admitted to Boston Children’s ICU, they found that those with very low vitamin D levels—below what the American Association of Pediatrics (AAP) considers deficient—tended to have more severe illness.

So what’s so important about vitamin D? Turns out, a lot more than most people think.

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New app streamlines and improves emergency care

It may seem like just a smartphone application, but BEAPPER, a real-time alert and communication platform, has been making waves in the Emergency Department (ED) at Boston Children’s Hospital, which sees an average of 150 patients per day.

The app sends Twitter-like alerts when beds become available, when orders have been placed and when lab results are back, reducing waiting time for families. Physicians working together can view each others’ profiles, and can quickly check on their patients’ status without having to sit down at a computer and log in.

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Strategies for pediatric telehealth: Lessons from TeleConnect

Boston Children's David Casavant, MD, in a mock TeleConnect drill with South Shore Hospital.

Naomi Fried, PhD, is Boston Children’s Hospital’s chief innovation officer. Shawn Farrell, MBA, Telehealth Program Manager at Boston Children’s Hospital, contributed to this post.

Imagine yourself in an emergency department taking care of a very sick child. Should he be transferred to a higher-level care setting? Can he safely go by ambulance, rather than helicopter? As a doctor, you would like to consult virtually with colleagues and experts at remote locations.

Then imagine yourself in a large room in the heart of Silicon Valley, just a stone’s throw from Cupertino and Apple headquarters. In that room are 5,000 of the biggest thinkers in health care and technology, exploring the next major paradigm shift in care delivery: telehealth. You realize that health care is on the brink of a telehealth explosion.

The energy was palpable as I took the stage at the recent American Telemedicine Association (ATA) conference. I was there to share our experiences launching the TeleConnect program at Boston Children’s Hospital,

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Breathing an idea to life: Injectable oxygen microparticles

This syringe, containing particles of oxygen gas mixed with liquid, can potentially save the lives of patients unable to breathe -- like the infant Kheir was unable to save early in his career.

John Kheir, MD, is a staff physician and researcher in the Cardiac Intensive Care Unit at Boston Children’s Hospital. As reported this week in Science Translational Medicine, he led a team that created a method for IV oxygen delivery — tiny particles filled with oxygen gas, mixed with liquid and injected directly into the blood. In an emergency, the injections could potentially buy clinicians time to start life-saving therapies. The technology was reported by The Atlantic, Popular Science, Scientific American, Technology Review and other outlets.

It was an ordinary Saturday night in the ICU at Boston Children’s, in the fall of 2006.  One of my patients was a 9-month-old girl who was admitted with pneumonia, and was having trouble breathing. I had gone in to check on her just a few minutes before; although she was not feeling well, she reached out and touched my hand as I examined her. I assured her mother she was in the best possible place for her care.

Five minutes later, the code bell alarmed. Our team rushed into her room to the most horrific sight I have ever seen.

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