Paul Kingma

65 statements · 4 topics

Peritoneal Dialysis Access · guest expert

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The all children's philosophy is that if you start your NG feeds in babies prior to their ability to take oral feeds because of respiratory trouble, that they will lose the. Developmental connection of oral feeding leads to a full belly, and so they don't feed them until they can feed by mouth.
quote · Congenital Diaphragmatic Hernia
The new protocol is we try to repair all ECMO kids within the 1st 12 to 24 hours of going on ECMO. And all the non-ECMO kids we repair somewhere between day 4 and 8, provided they are stable, which is the vast majority of the kids.
quote · Congenital Diaphragmatic Hernia
If parents want aggressive care, full respiratory support should be provided for at least the first 3 to 4 days, as many infants requiring high levels of support (including oscillator or pulmonary vasodilators) will begin to improve after this period.
clinical · Bladder Outlet Obstruction
Many infants who are pulmonary survivors have reduced reserve lung function, similar to reduced reserve renal function, and can rapidly transition from pulmonary survivor to non-survivor if injured.
clinical · Bladder Outlet Obstruction
If the baby is not showing signs of stabilizing and improving after the first 3 to 4 days, the reality that the infant is likely not a pulmonary survivor must be discussed with parents.
clinical · Oligohydramnios
If amniotic fluid levels are restored to normal through shunting or amnioinfusion, the likelihood of pulmonary survival increases to approximately 80%.
clinical · Oligohydramnios

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Paul's statements about Bladder Outlet Obstruction 9 statements

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Managing Advanced Chronic Kidney Disease: Cincinnati Fetal Center

Quotation yeah, but all that's important, but it doesn't matter if the patient is not a pulmonary survivor. Open
Statement If amniotic fluid levels are restored to normal through shunting or amnioinfusion, the likelihood of pulmonary survival increases to approximately 80%. Open
Statement If amniotic fluid levels are not returned to normal, the pulmonary outcome is poor. Open
Quotation just because you are a pulmonary survivor. That does not mean that you're normal from a respiratory standpoint. Open
Statement Many infants who are pulmonary survivors have reduced reserve lung function, similar to reduced reserve renal function, and can rapidly transition from pulmonary survivor to non-survivor if injured. Open
Statement Babies with renal problems who had normal amniotic fluid after replacement have developed chronic lung disease after delivery, demonstrating they are not normal from a respiratory standpoint. Open
Statement If parents want aggressive care, full respiratory support should be provided for at least the first 3 to 4 days, as many infants requiring high levels of support (including oscillator or pulmonary vasodilators) will begin to improve after this period. Open
Statement If the baby is not showing signs of stabilizing and improving after the first 3 to 4 days, the reality that the infant is likely not a pulmonary survivor must be discussed with parents. Open
Statement The question of pulmonary survival must be readdressed anytime there is an episode of lung injury, such as from sepsis. Open
Paul's statements about Congenital Diaphragmatic Hernia 29 statements

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Improving Outcomes for Congenital Diaphragmatic Hernia (CDH): Protocol Changes at Cincinnati Children's

Quotation Initially we focused on the delivery room and ECMO utilization and then ventilator management. We went through system by system EEN, cardiac, neuro to change each system. Open
Statement Initial protocol focus was on delivery room, ECMO utilization, and ventilator management, then progressed system by system through GI, cardiac, and neuro Open
Statement Previously, for non-ECMO patients, surgical repair was performed when echocardiography demonstrated improved pulmonary hypertension, ranging from a few days to as late as 56 days Open
Quotation If they were off ECMO, we would do the surgical repair when their echo demonstrated that their pulmonary hypertension was improved. And this could be anywhere from a few days to the most delayed repair I've ever had was 56 days. Open
Statement Under the new protocol, all ECMO patients are repaired within the first 12 to 24 hours of ECMO cannulation Open
Quotation The new protocol is we try to repair all ECMO kids within the 1st 12 to 24 hours of going on ECMO. And all the non-ECMO kids we repair somewhere between day 4 and 8, provided they are stable, which is the vast majority of the kids. Open
Statement All non-ECMO patients are repaired between day 4 and 8, provided they are stable, which applies to the vast majority Open
Quotation If you protect the lungs, all the rest will fall in line and improve. And never go above a peak pressure of 22. Open
Statement The clinical philosophy is that if you protect the lungs, all the rest will fall in line and improve Open
Statement The new protocol never exceeds a peak pressure of 22 cmH2O Open
Statement A standardized escalation and weaning protocol is followed approximately 100% of the time Open
Statement Every baby now gets started on hydrocortisone for blood pressure support Open
Statement There is a standardized protocol for which pressors are used Open
Statement Inhaled nitric oxide is only started if there is evidence of a need Open
Statement The All Children's philosophy is that starting NG feeds before oral feeding capability causes babies to lose the developmental connection between oral feeding and satiety Open
Quotation The all children's philosophy is that if you start your NG feeds in babies prior to their ability to take oral feeds because of respiratory trouble, that they will lose the. Developmental connection of oral feeding leads to a full belly, and so they don't feed them until they can feed by mouth. Open
Statement Babies are not fed enterally until they can feed by mouth; prior to that they receive TPN Open
Statement Every baby now gets started automatically on a continuous sedation drip Open
Quotation Even though we're starting at a higher level of sedation than what we did before and that we're starting automatically on a drip versus a PRN, our overall use of sedation has plummeted since we've started doing this. Open
Statement Overall use of sedation has plummeted since starting universal continuous drips despite starting at a higher baseline level Open
Statement After protocol implementation, the patient population appears to be skewed to the extremes with slightly more severe and slightly more mild cases Open
Quotation The most important thing, we have seen a bump up in survival from around that 70% mark to around 80% when we started implementing these changes. Open
Statement Survival increased from around 70% to around 80% after implementing protocol changes Open
Quotation In addition to the drop in sedation. Is a drop on time on mechanical ventilation from a median of 19 days to a median of 9 days, so almost a 50% decline in the time on ventilation. Open
Statement Median time on mechanical ventilation dropped from 19 days to 9 days, almost a 50% decline Open
Quotation Interestingly, even though we're saying Trying to get them on ECMO sooner if they need it. That philosophy hasn't really caused an increase in the number of ECMO babies. Open
Statement The philosophy of getting babies on ECMO sooner has not caused an increase in the number of ECMO babies Open
Statement There are many problems that CDH babies have beyond survival that need improvement Open
Quotation One important thing to realize is there's lots of problems that CDH babies have that we need to improve beyond survival. Open
Paul's statements about Oligohydramnios 9 statements

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Managing Advanced Chronic Kidney Disease: Cincinnati Fetal Center

Quotation yeah, but all that's important, but it doesn't matter if the patient is not a pulmonary survivor. Open
Statement If amniotic fluid levels are restored to normal through shunting or amnioinfusion, the likelihood of pulmonary survival increases to approximately 80%. Open
Statement If amniotic fluid levels are not returned to normal, the pulmonary outcome is poor. Open
Quotation just because you are a pulmonary survivor. That does not mean that you're normal from a respiratory standpoint. Open
Statement Many infants who are pulmonary survivors have reduced reserve lung function, similar to reduced reserve renal function, and can rapidly transition from pulmonary survivor to non-survivor if injured. Open
Statement Babies with renal problems who had normal amniotic fluid after replacement have developed chronic lung disease after delivery, demonstrating they are not normal from a respiratory standpoint. Open
Statement If parents want aggressive care, full respiratory support should be provided for at least the first 3 to 4 days, as many infants requiring high levels of support (including oscillator or pulmonary vasodilators) will begin to improve after this period. Open
Statement If the baby is not showing signs of stabilizing and improving after the first 3 to 4 days, the reality that the infant is likely not a pulmonary survivor must be discussed with parents. Open
Statement The question of pulmonary survival must be readdressed anytime there is an episode of lung injury, such as from sepsis. Open
Paul's statements about Peritoneal Dialysis Access 18 statements

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Managing Advanced Chronic Kidney Disease: Cincinnati Fetal Center

Quotation yeah, but all that's important, but it doesn't matter if the patient is not a pulmonary survivor. Open
Quotation yeah, but all that's important, but it doesn't matter if the patient is not a pulmonary survivor. Open
Statement If amniotic fluid levels are restored to normal through shunting or amnioinfusion, the likelihood of pulmonary survival increases to approximately 80%. Open
Statement If amniotic fluid levels are restored to normal through shunting or amnioinfusion, the likelihood of pulmonary survival increases to approximately 80%. Open
Statement If amniotic fluid levels are not returned to normal, the pulmonary outcome is poor. Open
Statement If amniotic fluid levels are not returned to normal, the pulmonary outcome is poor. Open
Quotation just because you are a pulmonary survivor. That does not mean that you're normal from a respiratory standpoint. Open
Quotation just because you are a pulmonary survivor. That does not mean that you're normal from a respiratory standpoint. Open
Statement Many infants who are pulmonary survivors have reduced reserve lung function, similar to reduced reserve renal function, and can rapidly transition from pulmonary survivor to non-survivor if injured. Open
Statement Many infants who are pulmonary survivors have reduced reserve lung function, similar to reduced reserve renal function, and can rapidly transition from pulmonary survivor to non-survivor if injured. Open
Statement Babies with renal problems who had normal amniotic fluid after replacement have developed chronic lung disease after delivery, demonstrating they are not normal from a respiratory standpoint. Open
Statement Babies with renal problems who had normal amniotic fluid after replacement have developed chronic lung disease after delivery, demonstrating they are not normal from a respiratory standpoint. Open
Statement If parents want aggressive care, full respiratory support should be provided for at least the first 3 to 4 days, as many infants requiring high levels of support (including oscillator or pulmonary vasodilators) will begin to improve after this period. Open
Statement If parents want aggressive care, full respiratory support should be provided for at least the first 3 to 4 days, as many infants requiring high levels of support (including oscillator or pulmonary vasodilators) will begin to improve after this period. Open
Statement If the baby is not showing signs of stabilizing and improving after the first 3 to 4 days, the reality that the infant is likely not a pulmonary survivor must be discussed with parents. Open
Statement If the baby is not showing signs of stabilizing and improving after the first 3 to 4 days, the reality that the infant is likely not a pulmonary survivor must be discussed with parents. Open
Statement The question of pulmonary survival must be readdressed anytime there is an episode of lung injury, such as from sepsis. Open
Statement The question of pulmonary survival must be readdressed anytime there is an episode of lung injury, such as from sepsis. Open