The Fifth King’s John Price Paediatric Respiratory Conference kicked off this year with ten whole-day, hands-on pre-conference masterclasses, covering fundamentals, innovations and practical aspects of a diverse range of paediatric respiratory problems.
Psychosocial Workshop in Paediatric Respiratory Care
This workshop aimed to inform delegates of the psychosocial constellations of problems surrounding children with chronic respiratory disease, focusing particularly on difficult asthma and its psychosocial associations. Delivered by healthcare professionals from the Royal Brompton, KCH and Great Ormond Street, it also covered strategies to prevent procedural anxiety from developing, and managing it when it does occur. The masterclass highlighted the social factors that can contribute to difficult to manage asthma, and how these factors can be identified and effectively managed to improve outcomes. Useful discussion to come from the masterclass included practical approaches and innovations that can support the resilience and coping of families with children with chronic respiratory disorders, as well as supporting clinicians in their own resilience.
Paediatric/Young Adult Asthma Training
This masterclass, focusing sharply on how paediatricians and allied healthcare professions can prevent unnecessary asthma deaths, covered the timeline of child presenting with symptoms of asthma – such as wheeze – through diagnosis, enabling effective adherence to medication and other management, through to monitoring and individualising asthma care. With interactive case discussions and a closing quiz, this workshop presented the most recent research insights into risk factors for asthma deaths, as well as practical approaches to improving adherence and approaching the child with severe or refractory asthma. By combining an evidence based approach with practical pearls from clinicians experienced in asthma care, this masterclass provided participants with the tools they need to have confidence in being an Asthma Champion in their faculty.
The Paediatric Sleep masterclass, presented by senior sleep doctors and specialist sleep physiologists, provided a crash course in the range of sleep investigations available in the UK, when they should be used, and the interpretation of the resulting studies. With practical interludes demonstrating the set up of monitoring equipment on a volunteer, this masterclass combined in-depth lectures and discussion with hands-on sessions culminating in sleep investigation interpretation quizzes to consolidate the learning of the day.
Thoracic Ultrasound and Guided Drain Insertion
This highly practical masterclass focused on equipping delegates with the theoretical and practical skills needed to be confident in the use of thoracic ultrasound for viewing pleural, pulmonary, diaphragmatic, thymic and laryngeal pathology, and using ultrasound guided techniques for managing some of these pathologies. Delegates had the opportunity to rotate around three practical sessions, including diagnostic ultrasound; practice of ultrasound-guided needle placement for pleural drain insertion; and practice of intercostal anaesthetic blocks for pleural intervention. These practical techniques were underpinned by lectures on the physics of ultrasound and normal anatomy on ultrasound to provide delegates with a clear underpinning of the theory behind the techniques.
Paediatric Dysfunctional Breathing: Diagnosis to Discharge
Designed to ‘provide better understanding of dysfunctional breathing in children from diagnosis to discharge,’ this masterclass covered the investigation, diagnosis and management of dysfunctional breathing, beginning with the warning that ‘not all dyspnoea is asthma.’ Practical rotations in the afternoon covered the techniques used by and impact of physiotherapists and speech and language therapists involvement in the care of children with dysfunctional breathing, allowing medical colleagues an insight into the tools used by different members of the MDT. Interactive cases allowed for application of the theories and skills learnt to real life case discussions.
Interpreting Oximetry in Children: Controversies and Consensus – New Dimensions to Explore
This session explored the wide scope of use of oximetry in paediatric respiratory patients, from its use in neonates admitted to the NICU to use in older children referred for obstructive sleep apnoea. With a particular focus on the evidence base for the various uses of oximetry, the masterclass allowed delegates to get to grips with interpreting oximetry traces whilst being mindful of the clinical context. A parent’s perspective was also discussed as the workshop welcomed the parents of a paediatric patient who required oxygen at home to share their experiences of the home oxygen service. Practical sessions provided tips on setting up oximeters and getting the most out of interpretation software.
Measuring Spirometry in Children
Tackling the nuances of interpreting spirometry traces in paediatric patients, the masterclass, led by paediatric respiratory physiologists, recapped some basic respiratory physiology before allowing delegates a hands on session in setting up spirometry equipment. The basics covered, the remainder of the workshop focused on the use and interpretation of spirograms, including detecting errors, when to use bronchodilators, and recognition of obstructive and restrictive patterns of spirometry. The session rounded off with group discussion and interpretation of cases, embedding the learning of the day into clinical scenarios.
With an increasing shift in use of non-invasive ventilation over intubation in the context of acutely unwell children, this masterclass equipped delegates with the theoretical and practical knowledge to recognise when NIV is an appropriate choice; use NIV safely and effectively; and manage some of the challenges of NIV. Multiple small group skill stations gave every delegate the chance to practice common scenarios in which NIV should be used, in both children and infants, with full simulation of selection of equipment, settings and appropriate monitoring.
Stabilisation of the Acutely Unwell Child
In this much sought after session delegates were taken through the management of the critically unwell child, from rapid assessment to a structured approach to management to referral on to high dependency or intensive care units. With a focus on acute respiratory presentations such as bronchiolitis, acute asthma, pneumonia and empyema, discussion sessions included airway management and use of nebulised hypertonic saline. A masterclass that drew upon the expertise of emergency, paediatric and anaesthetic colleagues, the highlight was the high fidelity simulation of a case of an acutely unwell child that closed the day.
Chronic Lung Disease of Prematurity – Challenges Today and Tomorrow
Welcoming respiratory and neonatal specialists alike, this masterclass aimed to cover the prevention and management of bronchopulmonary dysplasia, with a focus on comparing the evidence for various prevention and management strategies. Further sessions explored the long term sequelae of bronchopulmonary dysplasia, including the latest updates in the neurodevelopmental outcomes and additional nutritional needs of children with bronchopulmonary dysplasia. Final words added a different perspective – that of the ethical challenges of having difficult conversations with parents, and how to effectively manage their expectations.
Thanks must go to all of our masterclass leaders, who generously gave their time, experience and insights to lead these interesting and thoughtfully delivered practical sessions.
For the highlights of the day, including of the Opening Ceremony, see our Day 1 Highlights Blog. If you weren’t able to be at the conference this year, insights can be found on our Twitter feed @LondonPaedResp or by searching this year’s conference hashtag ‘#paedresp2019’.