Ep 164: What parents need to know about the Pediatric ICU, with Dr Kyle Willsey

In this conversation, Dr. Kyle Willse, a pediatric intensivist, shares insights on the Pediatric Intensive Care Unit (PICU).  The discussion is meant to provide a basic understanding as to how the  PICU operates and to help parents be an advocate for their children.   A must listen for anybody who has a child or a loved one in the PICU.

Kyle Willse, DO, is board certified in Pediatrics and in Pediatric Critical Care.  For the past 5 years, he has worked at Cedars-Sinai hospital as an attending in the pediatric and congenital cardiac intensive care unit.  His comments in the podcast are his individual thoughts and opinions and do not represent Cedars Sinai.    

Dr Jessica Hochman is a board certified pediatrician, mom to three children, and she is very passionate about the health and well being of children. Most of her educational videos are targeted towards general pediatric topics and presented in an easy to understand manner.

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Transcript

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Hi everybody. I'm Dr Jessica Hochman, pediatrician and mom of three. On this podcast, I like to talk about various pediatric health topics, sharing my knowledge, not only as a doctor, but also as a parent. Ultimately, my hope is that when it comes to your children's health, you feel more confident, worry less, and enjoy your parenting experience as much as possible. Are you curious about your family's gut health? You may have heard of the microbiome, which plays a vital role in your digestion, immunity, overall, wellness and more. I want to tell you about a new company called tinyhealth. Tinyhealth makes it easy to learn about the gut health of all ages, even babies using a simple at home test. Their personalized reports provide tailored recommendations for nutrition and probiotics to help make informed decisions for your family's well being, whether you're addressing specific health concerns or exploring ways to optimize your wellness. Tiny health empowers you to take control of your health journey. As a special offer for my listeners, use promo code. Dr Jessica, that's D, R, J, E, S, S, I, C, A, for savings on your first test, visit tinyhealth.com today, it's quick, easy and packed with actionable insights. Hi everybody. Welcome back to the Ask Dr Jessica Podcast. Today, we're diving into a topic that no parent ever hopes to face, but one that's important to understand, the pediatric intensive care unit or the PICU. If your child ever ends up in the PICU, it can be overwhelming, confusing and emotionally taxing, to say the least. That's why I'm so grateful to be joined today by Dr Kyle Wilsey, a Board Certified pediatrician and pediatric critical care specialist at Cedars Sinai Hospital. In this episode, Dr Wilsey walks us through what parents can expect if their child is admitted to the PICU. He breaks down common and often confusing medical terms that you might hear. He explains how the PICU operates, and he offers insights to help parents feel a little more prepared. Should they ever find themselves in this situation. And now, before we get started, if you could take a moment and leave a five star review wherever it is you listen to podcasts, I would be incredibly grateful. So let's jump in and hear from Dr Kyle Wilsey. Dr Kyle Wilsey, thank you so much for being here today. I'm so happy to meet you, of course. Thank you for having me appreciate it. Thank you so much for coming here, because I know you are a busy man and the work that you do is incredibly important. So thank you so much for taking the time to come to my office. Of course, of course. So yeah, I'm what you call an intensivist. I work in the pediatric ICU. You'll commonly hear us call it the pick you. Wow. And how did you pick this path? Short, short end of the long bit. I always knew I wanted to be a pediatrician. Kids have always been my passion. And then I got into residency and was like, Oh, I really, really like severity. I like that critical illness. I love that acuity. I love that not knowing what's coming in the door, and I loved helping the families kind of transition through that. So just became my passion. I love it, and I love it. I wouldn't do anything different. I think it takes a really special person to gravitate towards working with really sick kids. So thank you for the work that you do. Of course, appreciate it. Yeah, thank you for you outpatient pediatricians there. I think your job is infinitely harder than mine, actually. Well, we'll have to, we'll have to debate this after the interview. So for multiple reasons, I'm excited to have you here, but a big reason is I find the PICU, the ICU, for children, to be a very daunting place. Understandably so for families. And I was hoping to talk to you, sort of to serve as a primer for families that have to face going to the ICU with their children so that they can get an idea of what to expect. Because, of course, I could never take all that worry from parents when they have a sick kid that they're dealing with, but I think if there's that baseline and understanding of what they might expect from the PICU, maybe it will help a little bit. So if you don't mind, I'm going to ask you some questions about the PICU, just so that, if any parents do have to think about going to the PICU, maybe they can use this episode to help them. Of course, yeah, let's do it. So first tell me, how does one end up in the PICU? So you know, happens along the same path. Every single time you your child gets an illness at home, and it usually, you know, the typical path is they start off get sick for a few days, and then they come into the ER or your pediatrician's office, and then you guys see me like, we need more resources. We need to send you to the ER. I would say probably 90% of our admissions come in that way. So that's typically how the kind of starting process of getting to the PICU is, and from there, your ER physic going to kind of make that assessment themselves first, and they may reach out for a consult to us, and they call out to, you know, several centers and see, hey, I have this kid. They're not looking really great. What do you think? Do you think this rewards an ICU? And then we have a conversation and kind of help them guide the management, diagnosis process of that. So that's typically how things start. We see a whole host of things, though, right? It's not just acute illness. This can be an acute injury. This can be trauma. This can be a new oncologic process, unfortunately. So we get any and all comers. So. We not to say that it's not just sick kids, but that just tells you that most of our kids, when they get sick, have presented in such an acute way that the ER sees them and says, ooh, this is even above where I feel comfortable, and they just need a little more intense resources to help them be cared for. So that's kind of how the process starts. Now my next question is, this is going to be a tough one, I think, to answer well, but I find that the PICU in itself, is a very intimidating place by nature. And I want to paint a picture for parents what the ICU looks like, and maybe some of the words that are spoken and said in the ICU. Because I think when anyone walks into an ICU, it can feel incredibly intimidating. Medical jargon is used all the time, and people don't know what is being said. They're already scared at baseline. Maybe, can you tell us what are some words and terms that you wish parents knew? And maybe can you explain what might they expect to see that they might not realize that it might benefit them if they know this ahead of time? Yeah, I'm guilty of this. And every intensivist, any pediatricians that may watch this as well, we're all pretty guilty of throwing out those acronyms. And I think we need to take a step back sometimes and realize that family members have zero idea what I'm saying. So because I think about it like I've once read that when a patient leaves their pediatrician, half of the time they have a visit with the pediatrician. At least one word is said by the doctor that a family doesn't understand, and it has to be higher in the PICU, and probably infinitely higher, because we just abbreviate everything. And we're talking about, you know, the high, highest level of diagnostics and therapeutics that we can offer. So we tend to have a lot of terms and scary procedures and things like that that can be really, really daunting. I think the biggest things that I can tell parents to take away, and things that we talk about frequently are respiratory things. If you look at the general population of ICUs and what gets admitted to an ICU and especially pediatrics, by far and wide, the biggest percentage of anybody that comes into the PICU is respiratory okay, it's coming to be respiratory season now. So we are going to see those influxes. So knowing the terms that we use for respiratory support, I bet you, is the best place to start for parents. So when you hear us talk about oxygen, right, that's the big thing, that we really provide a lot of support in the PQ is oxygen and the ability to support a child's breathing. So this can range from something called nasal cannula, which is just a cannon that goes in the nose and it provides a little oxygen, to something called High Flow nasal cannula. You may hear us talk about that a lot, and that provides, as it says in its name, much more higher flows. We can provide much higher concentrations of oxygen to support a child. This not only helps just provide more oxygen, but actually helps them passively and actively with some of their breathing, expiratory, inspiratory phases. The other things that become much more scary for patients and families, especially is using terms like intubation or endotracheal intubation. We call it an ET tube. You may hear us talk about that, right? I'm just curious, when you do these more invasive procedures on kids and parents want to watch, do you have a stance on whether or not they should stay or leave, or is it up to the parents? We typically ask families to step out. It is traumatic. It's traumatic. It's it's not a good experience. It's a tricky combo, though, right? Like your child's ill, your child's at the very sickest that they will ever be and may ever be, and the families rightfully so. As a parent myself, I want to be there for that my kid every single moment that I can. It's important to remember. You know, we don't lightly ask you to step away. We know that that is traumatic to see one, and that imparts little PTSD to the to the parents. But we also, when we do this, we're providing a heavy amount of sedation so the child doesn't experience pain, doesn't experience anxiety, and quite honestly, has a little bit of retrograde amnesia where they don't remember it, and sometimes, if they're sick enough, they may not remember anyway. So while we may ask you to step away, it's only because we need to keep the room calm. We need to keep the scenario calm for everybody, because we have a lot of communication that we do in these high risk procedures like that. So if we ever ask you to step away, it's not because we don't think you'll be able to handle it, necessarily. We just do it for maximal safety of your child. I think now what you're describing sounds totally understandable, because I'm trying to place myself in the position of the parents. And yes, I think it'd be really difficult to watch your child go through something. But I really I get comfort knowing that you spend time communicating with the families what they're going to what the child's going to go through, what medications they're going to receive, and what the procedure will be like. Are there any other procedures that you think parents would merit from knowing about ahead of time? Yeah, like the big one that comes to my mind. During COVID. There's a lot of talk about ECMO, and a lot of my friends were asking me, what is ECMO? I keep hearing this term ECMO is that, can you describe what that Sure. So ECMO, first and foremost, stands for extra corporeal, membranous oxygenation. That's a mouthful. So which is why we call it ECMO, essentially and conceptually. What I can describe it to parents as is a heart lung bypass machine. The goal of this procedure, in this machine is to act as your both heart and your lungs at its most severe the most severe cases. So these are patients that you know have such significant either a lung injury that they can't even be provided ventilating support with a breathing tube, which we have encountered very, very frequently. Or they need such significant cardiovascular or heart support that none of our medications even work anymore, and we have to give them an augmented support with this system called ECMO. Now, by the way, I feel I'm very appreciative that you're describing these terms, because I recognize that it's incredibly intimidating for parents to hear about these terms, but when I listen, yes, it's intimidating, but I'm also grateful to know that there's modern medicine, to know that there are such advances that can help kids. Should they really need it? Yeah, and it's not to be, you know, thought about lightly we I don't want to call it mundane, but it becomes regular practice for us in the ICU that it's such a we come in and we get desensitized, honestly, over the over time about how sick of a patient we take care of. And so it's always important that we all take a step back and recognize that it's somebody's kid in there, somebody's family member. It's somebody's, you know, significant other in an ICU setting that that really is going through it, and the families that go through it, we recognize that when we talk about this, you know, we had years of extra training to talk about the highest acuity interventions that we can offer human beings, quite honestly. So it's daunting enough for us to just have to absorb all the information that's coming at us when your child is at their very sickest. So also then having to translate that to something that's meaningful for you, for parents to like, absorb, and then you take the stress of, well, it's still my kid that's sick. So not only you have to go from taking that I have a really sick child and having to digest all these specialists, including the intensivists that are in the unit giving recommendations of how we're going to continue to support your child, but to recognize that that's hard information to translate, because we're trying to translate multiple sub specialties, dogmas into one care plan and then present it to you, who's already going through the most intense stress you've ever been through in your entire life. And I'm just thinking as you're talking, I'm on one hand, I'm glad that you're desensitized, because it's impossible to do what you do every day. If you felt everything right, I think you would obviously burnout, it would psychologically be incredibly stressful. But also, at the same time, I think what's tricky for parents is, I hear this all the time where they go to the ICU and they feel like doctors don't really understand where they're coming from. They don't understand why they're so nervous. They don't they feel very intimidated asking questions. So it's nice to hear that you it's nice that you still recognize that parents need that communication. Yeah, and I'll peel back the the curtain a little bit. You know, it's not something that you always get to hear. You know, in in difficult cases and in the even the most unfortunate cases where a child passes away, we have a lot of internal support within our our institutions to help us get through that, because we take it home with us. We try not to, and we go through coping strategies, and we talk about debriefing, and again, I'm pulling the curtain back on how we sort of do this in the most extreme circumstances. We do support each other pretty heavily. We have ways of coping. We have mechanisms built in to try to help support the intensivists, the nurses, the respiratory therapists, the specialists. Through that in the most severe cases, we try to build an intricate network of support within our ICUs across the country to stave off some of the burnout that we will all inevitably experience in our careers. I'm glad to hear that, because A is good for you. It's good for the doctors. It's nice to know that you guys are protected in that way and looked after in that way. And also for families. You can tell when you're with a doctor that's burnt out. I remember when I was in residency, I was at UCLA, and we had to spend a month every year of our training. There's three years of pediatric training. One month a year was in the PICU, and always that was my least favorite month of the year. And I'm sorry to say that, but it's okay. I had a hard time with it. The kids were so sick, the families were so, so tearful, so uncomfortable, and so it's pleasing to me to know that there's a support system in place for you guys. Yes, you know. But on the flip side to this too is, you know, it's important for us to get that support. But again, we're not central to this. It's always centralized to the children we care for. There's been a movement in the adult world that eventually, again, translated to the pediatric world on, you know, how do we integrate families into rounds. How do we integrate families into these decision making processes when it's so complex already, and we don't expect any family member to know 98% of the things we're talking about because it's impossible for them to know. So there's new strategies, new ways to integrate them into rounds, Family Centered Rounds and so and tell everybody what. What are rounds? For those that may not sure, rounds and typical rounding structure, rounds are when the primary team, which is usually the intensivist team, comes by, and that may be a nurse practitioner with a doctor or a couple doctors come by, and we talk about your child for the day, we talk about what the plan is. How are we proceeding? How are we what are the next steps? Do we need more diagnostic testing? Do we need another image? Do we need more labs? And then we you will very methodically see us around in the ICU, and we typically go by organ systems. So we take it and break it down by system, by system, in hopes that one it makes it a little less daunting, rather than just spitting an entire plan out at once, they can at least families can hear all right, here's what they're doing for my kid today when it comes to the ventilator, and we try to make it a little more palatable. Do you tell parents ahead of time what time rounds are going to be? If I were a parent, I'd be so worried to miss rounds? Yeah, we try to make it pretty standard. I don't want to speak for every unit out there, but you will find, typically, most rounds will start at like early morning, 8am 8:30am and that's not atypical for anywhere else, and that's only because we want to be able to have time to enact all these plans, engage specialists and watch how treatment goes throughout the day hours. Because when you're in an ICU, it's 24/7 so you know, we'll have rounds. Rounds includes everybody. We try to incorporate, literally everybody that we can so the physician, like I said before, an advanced practice nurse, like a nurse practitioner or physician assistant will be there the bedside. Nurse, obviously, kind of the key component to that a respiratory therapist. So if there's a ventilator or any sort of respiratory support needs, we have our RT. There. RT is another nice abbreviation for people respiratory therapist. It's impressive. You cut yourself. You've been doing it now. And then sub specialists too, if we're able to incorporate them into the rounding structure, and we present your child's data, everything about the child, overnight findings, vital signs, labs, new cultures, current medications, and then structure that afterwards about and we will talk about the plan what's most important, and again, like that new culture shift is incorporating families into that one. It makes things there's much more support to the families, like they can be part of the planning process or ask the questions right then and there, so they're not left in the lurch. But we do do every effort to include them in rounds. We also are understanding that it's 2024, as much as you want to be there with your child, what if you can't be present for rounds? We make every effort to either FaceTime you in or zoom you into the to the rounding structure as securely as we can, or we'll call and update you throughout the day and tell you, here's what we talked about in rounds. And we also encourage open loop communication. If you ever have to leave the ICU, you need to take a break, we always are open to have that open line of communication. They can call in. They can call directly to your bedside nurse and then get a hold of us indirectly, if they need to as well, and they have other questions. I'm just picturing if you're a family listening to rounds, and they're very detailed, which is reassuring to know that there's a really good plan in place, that you're really thinking everything through. So that part sounds really good to me. But what does a family do that has questions after Is it okay for them to ask questions? And who would they ask questions to? I'm just thinking they probably don't want to bother you, but they also understandably won't understand everything that was said. Who's the right person for them to go to for questions? Sure, there's a couple avenues you can take. Obviously, if you want to ask us directly, we will find time to sit down and talk with you. We want to connect with you, because you might have not only vital pieces of a story that we need to hear, but we want to connect with you like that's what we got into medicine for. So I will say, if you have questions, first and foremost, talk to your bedside nurse. They're going to be your best champions, honestly, and they might be able to answer some of the basics and. The bedside nurse is the nurse that's there with you throughout their shift. Throughout their shift. Just a little quick comment on nursing, they tend to have 12 hour runs, so they'll have a morning nurse and a night nurse. We do our best when a patient is admitted to keep you with the same nurses. Obviously, that's not always an easy task. It's not always guaranteed. Nurses have vacations. They switch off, but we try to keep you with the same staff. So if you make an assessment or you get to know a patient, we can have that camaraderie. We have that same shared mental model. So I would say, if you have those questions as a parent, start with your nurse first, and if they can't answer it, or you really have a specific question for a doctor, your first person would probably be the intensivist. Okay, we can answer 95% of the questions that are thrown at us, typically if you have further questions, and sometimes there are those families have very specific questions about something that even we can address, we would then defer and have our specialists come in and talk to you. Can I can picture both hats as a physician myself and also as a mother. I know you're so busy, you know in the ICU, you are so busy, you've got a lot on your plate. You have a lot of stress. But then also you have to make time for the families that have questions that probably from your perspective, you probably get similar questions over and over again, and you have to really stay patient and have the same reassurance that you would all the time with all the families. So it's, I can see it being a very tricky space. It takes a special person to work in the ICU. We, uh, we definitely have to learn how to to negotiate, to to communicate. And really, I mean, the goal of any ICU, when you come down to communication, should be open lines, open loop communication, just being able to communicate your feelings, your thoughts, your questions, your concerns, in a freely, open and safe space. Because it's so daunting. Again, it's daunting for the intensivist who trains in this. We do this day in and day out. So it's sometimes can be really challenging, and we, we will do our best. I think one of the important things that we should also bring into the calculus of any kid that comes into a hospital, quite frankly, not just the ICU, but any hospital has access to a lot more resources than you think. We talk about the general people that take care of them at the bedside, nursing physicians and respiratory therapists and specialists. They have other special people, like physical therapists, occupational therapists that come in, keep them mobilized, keep them engaged. These are really, really important to the recovery process in any ICU. Actually, they're pretty integral part of the team. One of the most important resources that I ever get to bring a consultant into is actually Child Life. Child Life Specialists. Child Life can be a great advocate for the child themselves who may be trying to communicate I need something, but the three year old may not be able to tell you what they need. They can act as that kind of advocacy for the patient and the families too. We use them a lot. That's nice to know. And can a family actually request a child absolutely and again, similar to nursing. You may have a couple of child life specialists there at any given time. We try to keep it with the same child life specialist, because they really form that pivotal key bond and can actually help break through in a lot of stressful situations. There was an episode I actually recorded in the past with Kelsey Mora. You can anyone can search that in the past, but I did an interview with Child Life Specialist, and it was really helpful to know what they do and how they advocate for kids. Very nice to know that they exist in the hospital. And along those same lines, Child Life can help you get access to other things. I said as well. Les talked about things but are actually really important pet therapy. We can actually get pet therapy to come in, and they can bring a dog service dog into the PICU. We had that happen several times. Sometimes it's even more therapeutic for us as the physicians that we can combine. We have a personally, we have a dog in our family, and we've been using our dog as pet therapy, especially when our kids are in a grumpy mood. We find that if we just put the dog in their room with them, it does wonders. So I love pet therapy is huge. Less available services, but are really, really pivotal to is music therapy. Sometimes we can bring in music musicians that can come in and help kind of soothe patients and do a lot of that supportive care when they really need it too, fantastic. So these are just all the little nuances that you can always ask if you're a parent, like, Hey, do you have this sort of thing? You have access to this. And again, these services may not be available every single day. They tend to have scheduled services for these sorts of things, but if you let somebody know, we can definitely get you engaged with those sorts of things if you think it'll be valuable for your kid. So now. I have a general question to bring up. Now this might be a hard question to answer, but this is about parents being advocates for their kids, and while they're being an advocate, how do they not come across annoying? For better use of the word annoying to the PICU doctors or to the staff in the PICU. So an example is, there's routine in the PICU that I know you need to have this routine in order to function well. So for example, checking vitals every four hours or doing blood draws in the morning, I know is very standard for many kids. And I've seen parents where they say, Hey, you know my kid, I know will get better if they sleep. And checking the vitals every four hours is difficult for them to sleep, and when they when they ask these requests, is it okay if we don't check vitals overnight so my child can sleep? How can parents ask those questions without coming across irritating, like, how can they advocate for their kids in a way that's on the team of their kids, but also understanding that the doctors have to do their job? Yeah, that's a great question. We run into this, you know, relatively frequently, first and foremost. And as I said before, just communicate. Just let us know. I a lot of these parental requests aren't unreasonable, and unless we become guilty of this, you know, ICU medicine is has some automation to it. We want to trend. That's the big thing in ICU medicine is trending. I want to see how the blood pressure trends. I want to see how your hemoglobin, your red blood cells, trend over time. So we may have a cadence. We might recommend checking labs every six to eight hours, or something more frequent than that, and it can be disturbing. We want also four children to sleep and try to resume normalcy when they can. So I would say, first and foremost, just communicate, because a lot of the time, the request of the parents should be substantiated, and we should take that into the calculus. But on the flip side, if, if you hear from your ICU specialist, you know, I I respect what you said, but I really need this lab because it's going to help me make a key decision point in the middle of the night. So having that open communication and just asking and if, and if you don't understand, ask why. It's okay to ask why. Because, again, we may be checking a very specific lab, like an inflammatory marker or something like that, because we're watching for infection. And timing might be important, it may not be important, so it's okay. Sometimes it gives us that introspection as physicians. So I would say, most importantly, just communicate. It sounds like for the parent, you should always ask. Maybe think about how you ask, yeah, ask in a respectful way, and be okay if you don't get the answer that you want. And I agree with your perspective, communication is key, and it's probably so hard because everybody's so stressed out in the ICU, you will, you will find that most of us are not unflinching, like no, we're going to do it this way, and it has to be done this way. These are reasonable requests. Now, unless you're at the highest level of acuity, we might have to just say, unfortunately, we have to do these things right now, just for stability and stabilization and trending. But you're right most of the time, we can acquiesce to most of these requests, I think that's really helpful to hear, because, as we talked about before, the ICU is a very intimidating place, and doctors can be intimidating and hospital staff can be intimidating. So it's nice, I think, for parents listening to know that if you have questions, don't be afraid to ask that these doctors are there for you. They're there to help your child, ultimately, and if you have a concern, if you are nervous about something, if any question crosses your mind, the doctors want to hear from you. They want to know what you're what you're concerned about. And I forgot to mention this before too. And this kind of plays into right rounds. We don't just do a day round also. We actually do night rounds as well. So in this another level of communication, right? We want to see that the day plan hasn't changed when we do night rounds or something has changed, and we need to make modifications. Now we know that making a one time plan once a day isn't always the right thing for every kid. Medicine and illness is dynamic. Dynamic. It changes. So we will tend to round at night. And that's another opportunity, and a really important opportunity, as you said before, like, Hey, I think it's important my child sleeps right now. Do we really need to do that blood draw at 4am just ask, that's the great time to ask too, because we can be like, No, it's not important to get it at 4am I don't need a time for that. Are there any pet peeves that you have of families when they come to the ICU? A tricky question. I'm just, you know, I'm just curious, like, Are there anything, are there any things that families do that tend to bother you, or can be pet peeves, like, I'm just picturing if they bring in their own homeopathic medicine, or if they have their own idea. Is about things, or if they've Googled something, and they tell you, I Googled this, just this is the right path forward. This is, I think, inpatient medicine at large, for pediatrics. First and foremost, if your child can't eat, please don't eat in front of them. It is torture. It's torture. So if you bring in Chick fil A, or in and out, and they can't eat for whatever reason. They got a surgery procedure, it's not safe for them to eat, and they see that, especially young kids, they don't know that's good advice. It's just going to be a battle for you, a battle for your child, and it's just going to create more anxiety. So if you have to eat, step away from the unit and do it, because it's just going to make your kiddo more anxious? Two, I encourage parents to be advocates and carefully research the conditions that their kids come in with. It is hard to interpret the deluge of knowledge that you can look at on Google, and if you're using that as your sole reference and finding very obscure articles or resources, it can be challenging when you bring that to the bedside, but if you want to bring it up, ask us again. You know, we're not we're not infallible. People make mistakes. Medicine makes mistakes, but we are very, very versatile and no and knowledgeable. We we have an additional three years of training on top of pediatric residency to to address a lot of this. Some of us have even more training after that. So we are specialists in in and of our own right. But you know, that's not to suffice it to say that we're not open to to new things that parents find, but don't go, you know, looking in a rabbit hole, because sometimes you're going to find treatment, things that may not be appropriate, may not be safe. And I would just say, communicate with us and ask us first, like, hey, we found this article. We heard about this treatment. What do you think about it's good to know. It's helpful. Yeah, it's tricky. It's tricky. In the information age, there's just so much out there, information and disinformation alike. And you can be honest. What about families where they have doctors in the family? Is that a Yeah, it can be tricky. What we commonly run into is my cousin's a neurologist. Well, they're an adult neurologist. And as much as some people will espouse to everybody else, and we hear this a lot. Adult medicine is not pediatric medicine. It is not the same. It is not one to one, but we will again always. We don't want to just poo poo, everything that you know someone brings to the table and their expertise, but that becomes a delicate situation, and we would encourage you to defer to some of our specialists that are more pediatric trained. I know I said this earlier, but I really mean it is, you have to be such a special person to be a doctor or a to be in medical staff or a doctor in the ICU, because there's such different skills that you need. You have to be able to handle stress and work, you know, work under pressure, but then you also have to be so patient when you have a child under your care, are you always thinking about, what are the steps to get them home? Absolutely. You know, we always try to give a road map. How long does this average do we think this your kid may need to stay in the ICU? So that's always the goal. And then move you to the next step, which is usually, you usually don't get just straight discharge from the ICU. The next step is usually to go down to the pediatric ward where they can continue the care what's a little less intense, and that is typically the cadence. So we tend to have a descriptive road map in our heads, like if your kid comes in with, let's say, something called bronchiolitis, and they may need some high flow. And just using this as a scenario, high flow, nasal cannula and oxygen. Now we know what high flow is. Now we know you've heard the term, Right exactly. So you're on high flow, we expect kids tend to need to stay, especially neonates or infants, tends to need to stay in the ICU for two to three days, depending on the severity, and if you're just that average run of the mill bronchiolitis patient, we can get you out of the ICU two to three days. That doesn't mean you get to go home, though. You still have to get off the remainder of the oxygen. You still have to get back to eating normally. You still have to be back to drinking and hydrating normally. So just because you leave the ICU doesn't mean you're ready to go home. Is there anything that we haven't talked about so far that you wish parents knew? Having my own kids now and being on the other side of the looking glass, the ICU is a scary place, and we get every. Thing, everything, the sickest of the sick, and every aspect and every organ system you can imagine. One of the things and trends that I'm even guilty of as a parent is putting our kids in a bubble. I do this myself, just having seen the sickest of the sick. I think it's really, really important to remember that their kids, they need to get out into the world and experience things. It's up to us as parents pediatricians to give them the tools to thrive and survive, and that's a tricky balance, right? I want my kids to be able to go out and explore a swimming pool and have fun at a swimming pool. But is there safety involved with that? Is there a gate? Do they have supervision? Is it a no cell phone environment? These are all really important things that we can give parents tools to do, but it's also needs to be in the back of our mind that we got to let them be kids at some point too. We can do that safely, and it's hard. It's a hard balance. As a dad myself, it's a hard balance because I see the worst of the worst. I always want to be behind my son, who's walking on a step, and if he falls backwards and hits his head, I was like, oh, man, he's gonna go the ICU. He's not gonna have to go to the ICU. Yeah, I imagine it must be hard for you, as an ICU doctor, not to take the worry for your child to another level, because that's what you see, right? So it's primed in your head to think, think about the worst case scenarios. I what I'm hearing from you as we're talking what I'm thinking about, and I think this is actually true for so many life experiences, is we're all better off if we put ourselves in the other person's shoes as best as we can. So if patients put them themselves in the shoes of the medical staff, thinking about, Oh, well, they're they're not being short with me on purpose. They have other things going on. They're in a high stress work environment, great. And I think if also doctors put themselves as best they can in the shoes of the parents, I think that will help them stay patient, stay understanding, stay sympathetic as best they can. I think that would help take the edge off the stress for everybody. If there's one resounding point I think I've made this entire time we've been talking, is that communication, that level of communication, it's so important in an ICU and one last parting thought. And this is again, not a fun topic to talk about, but when you come to an ICU, I hope that you know all the listeners and everybody here that your kids never you a have to be in my ICU. I always tell my families when I send them home, it's like, I hope I never see you again in Costco. And I probably won't you see me in Costco. Let's let's chat, but I hope I never see you again. But there are those instances where we have tragedy. I think one of the things that is important for physicians, families, parents, to see is we are human. This is a difficult field, and if we want to do this for 30 years, we have to be able to take time, even if it's 20 seconds, to step away and have a moment to think about what's happening in our lives. So the one thing I do ask parents sometimes is have a little we try to give you all the empathy in the world, but have a little empathy on the ICU side, because it is a difficult place to be in when you do this three or four times a year where you may have a child pass away, is not a natural thing, so we do take some time. I didn't want to think about it, but I know that that's a reality of being a picky doctor. So I can leave you on the one positive note, though severe, you look at adult ICU medicine and you know, the mortality in most adult ICUs is 10 to 25% so it means only 75 to 80% of people walk out of the adult ICU. I mean, it's still a lot of people, but that means there's a good percentage that don't pediatric ICU medicine. The latest figures, that's 97% of children that walk out of an ICU, that's an impressive number. That just tells you the resilience of kids, the resilience of the care that they receive. So always take it with a grain of salt. Yes, you're if your child is ever unfortunately sick enough to land in the ICU, just know that the care that they're going to get is exemplary, and that most children, by far and wide, recover. That's a great final message. Thank you so much. Thank you so much. Kyle, thanks for being here, and thank you for all the work that you do. And thank you to everybody that works in an ICU. I give you so much respect, and hopefully most people listening will not benefit from listening to this episode. This episode, but I really appreciate your your advice and your knowledge, and thank you for being here, of course, anytime. Thank you for listening. And I hope you enjoyed this week's episode of Ask Dr Jessica. Also, if you could take a moment and leave a five star review, wherever it is you listen to podcasts, I would greatly appreciate it. You. It really makes a difference to help this podcast grow. You can also follow me on Instagram at ask Dr Jessica. See you next Monday. You.