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Pediatric noninvasive ventilation

Giovanna Chidini, Daniele De Luca, Giorgio Conti, Paolo Pelosi, Stefano Nava, Edoardo Calderini
OBJECTIVE: Neurally adjusted ventilatory assist has been shown to improve patient-ventilator interaction in children with acute respiratory failure. Objective of this study was to compare the effect of noninvasive neurally adjusted ventilatory assist versus noninvasive flow-triggered pressure support on patient-ventilator interaction in children with acute respiratory failure, when delivered as a first-line respiratory support. DESIGN: Prospective randomized crossover physiologic study...
September 30, 2016: Pediatric Critical Care Medicine
Anna Marie Nathan, Hui Yan Loo, Jessie Anne de Bruyne, Kah Peng Eg, Sze Ying Kee, Surendran Thavagnanam, Marilyn Bouniu, Jiat Earn Wong, Chin Seng Gan, Lucy Chai See Lum
INTRODUCTION: Home ventilation (HV) for children is growing rapidly worldwide. The aim was to describe (1) the sociodemographic characteristics of children on HV and (2) the indications for, means and outcome of initiating HV in children from a developing country. METHODOLOGY: This retrospective study included patients sent home on noninvasive or invasive ventilation, over 13 years, by the pediatric respiratory unit in a single center. Children who declined treatment were excluded...
October 6, 2016: Pediatric Pulmonology
Gyambo Sithey, Li Ming Wen, Patrick Kelly, Mu Li
STUDY OBJECTIVES: Our aim was to identify clinical predictors associated with changes in settings for pediatric invasive and noninvasive positive airway pressure therapy, which could help inform the allocation of limited polysomnogram (PSG) resources. METHODS: A retrospective review was conducted in children who underwent one or more PSGs for technology titration. Children were included if they were using continuous positive airway pressure (CPAP) therapy, bilevel positive airway pressure (BPAP) therapy, or invasive positive pressure ventilation (IPPV) the night of the PSG...
September 29, 2016: Journal of Clinical Sleep Medicine: JCSM: Official Publication of the American Academy of Sleep Medicine
Smeeta Sardesai, Manoj Biniwale, Fiona Wertheimer, Arlene Garingo, Rangasamy Ramanathan
Respiratory distress syndrome (RDS) due to surfactant deficiency is the most common cause of respiratory failure in preterm infants. Tremendous progress has been made since the original description that surfactant deficiency is the major cause of RDS. Surfactant therapy has been extensively studied in preterm infants and has been shown to significantly decrease air leaks and neonatal and infant mortality. Synthetic and animal-derived surfactants from bovine as well as porcine origin have been evaluated in randomized controlled trials...
October 5, 2016: Pediatric Research
G Fatima Shirly Anitha, Lakshmi Velmurugan, Shanthi Sangareddi, Krishnamurthy Nedunchelian, Vinoth Selvaraj
BACKGROUND AND AIMS: Noninvasive ventilation (NIV) is an emerging popular concept, which includes bi-level positive airway pressure or continuous positive airway pressure (CPAP). In settings with scarce resources for NIV machines, CPAP can be provided through various indigenous means and one such mode is flow inflating device - Jackson-Rees circuit (JR)/Bain circuit. The study analyses the epidemiology, various clinical indications, predictors of CPAP failure, and stresses the usefulness of flow inflating device as an indigenous way of providing CPAP...
August 2016: Indian Journal of Critical Care Medicine
Miguel Angel Palomero-Rodríguez, Héctor Chozas de Arteaga, Yolanda Laporta Báez, Jesús de Vicente Sánchez, Pascual Sanabria Carretero, Pilar Sánchez Conde, Antonio Pérez Ferrer
BACKGROUND: Over the last years, we have used a flow-inflating bag circuit with a nasotracheal or nasopharyngeal tube as an interface to deliver effective CPAP support in infants ("Mapleson D CPAP system"). The primary goal of this study was to assess the usefulness of the "Mapleson D CPAP system" for weaning of mechanical ventilation (MV) in infants who received MV over 24 h. MATERIALS AND METHODS: All infants who received MV for more than 24 h in the last year were enrolled in the study...
September 2016: Lung India: Official Organ of Indian Chest Society
Reena Khantwal Joshi, Neeraj Aggarwal, Mridul Agarwal, Veronique Dinand, Raja Joshi
OBJECTIVE: To delineate risk factors for failure of extubation in the operating room among pediatric cardiac surgery patients. DESIGN: Prospective, observational study. SETTING: Single center, tertiary care, teaching hospital. PARTICIPANTS: The study comprised 448 congenital cardiac surgery patients who were enrolled for intended extubation in the pediatric cardiac operating room over 5 years. INTERVENTIONS: The airways of enrolled patients were extubated in the operating room if predetermined suitability criteria were met...
June 16, 2016: Journal of Cardiothoracic and Vascular Anesthesia
Florian Stehling, Katharina Alfen, Christian Dohna-Schwake, Uwe Mellies
Background In pediatric neuromuscular disorders (NMD), respiratory muscle weakness parallels respiratory failure. The objectives of this study are (1) to evaluate respiratory muscle capacity in neuromuscular children and (2) to assess the relationship between vital capacity, respiratory muscle performance, and alveolar ventilation during sleep and wakefulness. Methods Inspiratory vital capacity (IVC), peak inspiratory pressure (PIP), mouth occlusion pressure (P0.1), and noninvasive tension-time index of the respiratory muscles (TTImus) were studied in 80 NMD subjects (12...
August 23, 2016: Neuropediatrics
Amanda M Perak, Alexander R Opotowsky, Brian K Walsh, Jesse J Esch, James A DiNardo, Barry D Kussman, Diego Porras, Jonathan Rhodes
OBJECTIVE: To assess the feasibility and accuracy of inert gas rebreathing (IGR) pulmonary blood flow (Qp) estimation in mechanically ventilated pediatric patients, potentially providing real-time noninvasive estimates of cardiac output. STUDY DESIGN: In mechanically ventilated patients in the pediatric catheterization laboratory, we compared IGR Qp with Qp estimates based upon the Fick equation using measured oxygen consumption (VO2) (FickTrue); for context, we compared FickTrue with a standard clinical short-cut, replacing measured with assumed VO2 in the Fick equation (FickLaFarge, FickLundell, FickSeckeler)...
October 2016: Journal of Pediatrics
Florent Baudin, Sebastien Gagnon, Benjamin Crulli, François Proulx, Philippe Jouvet, Guillaume Emeriaud
BACKGROUND: High-flow nasal cannula (HFNC) therapy is increasingly used in pediatric ICUs as an intermediate level of support between conventional oxygen delivery and noninvasive ventilation (NIV). The safety of HFNC has seldom been studied, and some cases of barotrauma have been reported. This retrospective study aims to describe HFNC use in a tertiary care pediatric ICU, with a focus on the complications associated with this therapy. METHODS: Between January 2013 and January 2014, all children <18 y old treated with HFNC in the pediatric ICU were included...
October 2016: Respiratory Care
Ira M Cheifetz
Led by the work of the Pediatric Acute Lung Injury Consensus Conference, much was published on the topic of pediatric ARDS in 2015. Although the availability of definitive data to the pediatric practitioner for the management of infants and children with pediatric ARDS continues to lag behind that for the adult clinician, 2015 augmented the available medical literature with more information than had been seen for years. This article will review key pediatric ARDS publications with a focus on the Pediatric Acute Lung Injury Consensus Conference consensus definition, sedation management, use of high-frequency oscillatory ventilation, diagnosis of delirium, noninvasive respiratory support, lung-protective ventilation, and adjunct management therapies...
July 2016: Respiratory Care
Yusuke Okubo, Kotaro Nochioka, Hiroshi Hataya, Hiroshi Sakakibara, Toshiro Terakawa, Marcia Testa
BACKGROUND: Obesity and asthma are common health problems in the United States. OBJECTIVE: The objective of this study was to evaluate the clinical and economic burdens of obesity on hospitalized children with acute asthma exacerbation in 2012. METHODS: Hospital discharge records of patients aged 2 to 18 years with a diagnosis of asthma were obtained from the 2012 Kids' Inpatient Database, wherein the data were compiled by the Agency for Healthcare Research and Quality...
June 30, 2016: Journal of Allergy and Clinical Immunology in Practice
Jeffrey D Edwards, Amy J Houtrow, Adam R Lucas, Rachel L Miller, Thomas G Keens, Howard B Panitch, R Adams Dudley
OBJECTIVES: To characterize patients who received tracheostomies for airway compromise or were initiated on long-term ventilation for chronic respiratory failure in PICUs and to examine variation in the incidence of initiation, patient characteristics, and modalities across sites. DESIGN: Retrospective cross-sectional analysis. SETTINGS: Seventy-three North American PICUs that participated in the Virtual Pediatric Systems, LLC. PATIENTS: PICU patients admitted between 2009 and 2011...
August 2016: Pediatric Critical Care Medicine
(no author information available yet)
No abstract text is available yet for this article.
June 2016: Annals of Intensive Care
Khalid Alansari, Fatihi Hassan Toaimah, Hany Khalafalla, Lamiaa Awny El Tatawy, Bruce L Davidson, Wessam Ahmed
OBJECTIVE: To evaluate the efficacy and safety of caffeine citrate in the treatment of apnea in bronchiolitis. STUDY DESIGN: Eligible infants aged ≤4 months presenting to the main pediatric emergency service with apnea associated bronchiolitis were stratified by gestational age (<34 weeks or longer) and randomized to receive a single dose of intravenous 25 mg/kg caffeine citrate or saline placebo. The primary efficacy outcome was a 24-hour apnea-free period beginning after completion of the blinded study drug infusion...
October 2016: Journal of Pediatrics
L Nava-Guerra, W H Tran, P Chalacheva, S Loloyan, B Joshi, T G Keens, K S Nayak, S L Davidson Ward, M C K Khoo
Obstructive sleep apnea (OSA) involves the interplay of several different factors such as an unfavorable upper airway anatomy, deficiencies in pharyngeal muscle responsiveness, a low arousal threshold, and ventilatory control instability. Although the stability of ventilatory control has been extensively studied in adults, little is known about its characteristics in the pediatric population. In this study, we developed a novel experimental setup that allowed us to perturb the respiratory system during natural non-rapid eye movement (NREM) sleep conditions by manipulating the inspiratory pressure, provided by a bilevel pressure ventilator, to induce sighs after upper airway stabilization...
July 1, 2016: Journal of Applied Physiology
A Amaddeo, J Moreau, A Frapin, S Khirani, O Felix, M Fernandez-Bolanos, A Ramirez, B Fauroux
INTRODUCTION: Long term noninvasive continuous positive airway pressure (CPAP) and noninvasive ventilation (NIV) are increasingly used in children but limited information is available on the criteria and conditions leading to the initiation of these treatments. The aim of the study is to describe the objective overnight respiratory parameters and clinical situations that led to the initiation of CPAP/NIV in a pediatric NIV unit. MATERIAL AND METHODS: Retrospective analysis of the data of all the children discharged on home CPAP/NIV over a 1 year period...
September 2016: Pediatric Pulmonology
Emilie Courtois, Patricia Cimerman, Valérie Dubuche, Marie-France Goiset, Claire Orfèvre, Audrey Lagarde, Betty Sgaggero, Céline Guiot, Mélanie Goussot, Etienne Huraux, Marie-Christine Nanquette, Céline Butel, Anne-Marie Ferreira, Sylvie Lacoste, Sandrine Séjourné, Valérie Jolly, Gladys Lajoie, Valérie Maillard, Romain Guedj, Hélène Chappuy, Ricardo Carbajal
BACKGROUND: Newborns in intensive care units (ICUs) undergo numerous painful procedures including venipunctures. Skin-breaking procedures have been associated with adverse neurodevelopment long-term effects in very preterm neonates. The venipuncture frequency and its real bedside pain management treatment are not well known in this setting. OBJECTIVES: To describe venipuncture frequency, its pain intensity, and the analgesic approach in ICU newborns; to determine the factors associated with the lack of preprocedural analgesia and with a high pain score during venipuncture...
May 2016: International Journal of Nursing Studies
Peter Szmuk, Jeffrey W Steiner, Patrick N Olomu, Roxana P Ploski, Daniel I Sessler, Tiberiu Ezri
BACKGROUND: Pulse oximetry provides no indication of downward trends in PaO2 until saturation begins to decrease. The Oxygen Reserve Index (ORI) is a novel pulse oximeter-based nondimensional index that ranges from 1 to 0 as PaO2 decreases from about 200 to 80 mmHg and is measured by optically detecting changes in SvO2 after SaO2 saturates to the maximum. The authors tested the hypothesis that the ORI provides a clinically important warning of impending desaturation in pediatric patients during induction of anesthesia...
April 2016: Anesthesiology
Ilaria Milesi, David G Tingay, Emanuela Zannin, Federico Bianco, Paolo Tagliabue, Fabio Mosca, Anna Lavizzari, Maria Luisa Ventura, C Elroy Zonneveld, Elizabeth J Perkins, Don Black, Magdy Sourial, Raffaele L Dellacá
BACKGROUND: Aerosolization of exogenous surfactant remains a challenge. This study is aimed to evaluate the efficacy of atomized poractant alfa (Curosurf) administered with a novel atomizer in preterm lambs with respiratory distress syndrome. METHODS: Twenty anaesthetized lambs, 127 ± 1 d gestational age, (mean ± SD) were instrumented before birth and randomized to receive either (i) positive pressure ventilation without surfactant (Control group), (ii) 200 mg/kg of bolus instilled surfactant (Bolus group) at 10 min of life or (iii) 200 mg/kg of atomized surfactant (Atomizer group) over 60 min from 10 min of life...
July 2016: Pediatric Research
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