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"respiratory support"

Roshan Patel, Madelyn Kahana
A 3-year-old pediatric patient with previously diagnosed Pelizaeus-Merzbacher syndrome presented for outpatient dental restoration. Given the infrequency of this demyelinating disorder, an anesthetic plan was tailored to address the patient's hypotonia and aspiration risk, as well as minimize potential complications including seizures, hemodynamic instability, and postoperative respiratory support. Multimodal analgesia, along with an appropriate ventilation strategy and normothermia, allowed the patient to successfully undergo a general anesthetic and be safely discharged home the same day...
June 18, 2018: A&A practice
Rebeca de Oliveira Chappaz, Simone Dos Santos Barreto, Karin Zazo Ortiz
BACKGROUND: Pneumo-phono-articulatory coordination is often impaired in dysarthric patients. Because all speech is produced upon exhalation, adequate respiratory support and coordination are essential for communication. Nevertheless, studies investigating respiratory parameters for speech are scarce. The objectives of the present study were to analyze and compare the numbers of words and syllables (universal measurement) per exhalation among healthy and dysarthric speakers, in different speech tasks...
June 18, 2018: São Paulo Medical Journal, Revista Paulista de Medicina
So-Hyun Nam, Kyoung-Ah Kwon
BACKGROUND: Lymphatic malformations are histologically benign vascular structures that vary in anatomic lesion and size. Extensive head and neck lymphatic malformations may be life-threatening. In the present study, we described three difficult-to-treat infants with giant cervico-mediastinal lymphatic malformations accompanied by severe respiratory distress. CASE PRESENTATIONS: Case 1. A Korean girl born at a gestational age of 37 weeks and weighing 2920 g had a large cervical mass compressing the trachea...
June 15, 2018: Journal of Medical Case Reports
Laura Ellwein Fix, Joseph Khoury, Russell R Moores, Lauren Linkous, Matthew Brandes, Henry J Rozycki
Non-invasive ventilation is increasingly used for respiratory support in preterm infants, and is associated with a lower risk of chronic lung disease. However, this mode is often not successful in the extremely preterm infant in part due to their markedly increased chest wall compliance that does not provide enough structure against which the forces of inhalation can generate sufficient pressure. To address the continued challenge of studying treatments in this fragile population, we developed a nonlinear lumped-parameter respiratory system mechanics model of the extremely preterm infant that incorporates nonlinear lung and chest wall compliances and lung volume parameters tuned to this population...
2018: PloS One
Xing-Wang Zhu, Yuan Shi, Li-Ping Shi, Ling Liu, Jiang Xue, Rangasamy Ramanathan
BACKGROUND: Invasive mechanical ventilation (IMV) is associated with the development of adverse pulmonary and non-pulmonary outcomes in very premature infants. Various modes of non-invasive respiratory support are increasingly being used to decrease the incidence of bronchopulmonary dysplasia. The aim of this trial is to compare the effect of non-invasive high-frequency oscillatory ventilation (NHFOV) and nasal continuous positive airway pressure (NCPAP) in preterm infants with respiratory distress syndrome (RDS) as a primary non-invasive ventilation support mode...
June 14, 2018: Trials
Ruchi Amin, Marjorie J Arca
BACKGROUND: The use of neurally adjusted ventilator assist (NAVA) in congenital diaphragmatic hernia (CDH) patients has been historically deemed unwise, since the trigger for breaths is the electromyographic activity of the diaphragmatic muscle. We report on our NAVA experience in CDH patients. METHODS: We performed an IRB-approved retrospective review of newborns from 1/1/2012-1/1/2017 at a Level I Children's Surgery Center undergoing CDH repair. Data obtained included demographics, defect type and repair, respiratory support, and outcomes...
May 19, 2018: Journal of Pediatric Surgery
Prathik Bandiya, Sushma Nangia, Arvind Saili
Objective: The objective of this study was to evaluate the effect of surfactant lung lavage (SLL) on duration of respiratory support in neonates with meconium aspiration syndrome (MAS). Patients and methods: Sixty term infants with MAS who had moderate to severe respiratory distress (Downes score >4) were randomized toSLL (n = 31) or no lung lavage-NLL (n = 29). Neonates in intervention group underwent lung lavage with dilute surfactant and those in control group were managed as per unit protocol...
June 6, 2018: Journal of Tropical Pediatrics
Shi-Wen He, Yue-E Xiong, Li-Hui Zhu, Bo Lv, Xi-Rong Gao, Hua Xiong, Huan Wang, Hua-Rong Shi, Jos M Latour
BACKGROUND: Most Neonatal Intensive Care Units (NICUs) in China have restricted visiting policies for parents. This also implicates that parents are not involved in the care of their infant. Family Integrated Care (FIC), empowering parents in direct care delivery and decisions, is becoming the standard in NICUs in many countries and can improve quality-of-life and health outcomes of preterm infants. The aim of this study was to evaluate the impact of a FIC intervention on the clinical outcomes of preterm infants with Bronchopulmonary Dysplasia (BPD)...
June 5, 2018: Italian Journal of Pediatrics
Mark J Peters, Gareth A L Jones, Daisy Wiley, Jerome Wulff, Padmanabhan Ramnarayan, Samiran Ray, David Inwald, Michael Grocott, Michael Griksaitis, John Pappachan, Lauran O'Neill, Simon Eaton, Paul R Mouncey, David A Harrison, Kathryn M Rowan
BACKGROUND: Oxygen saturation monitoring for children receiving respiratory support is standard worldwide. No randomised clinical trials have compared peripheral oxygen saturation (SpO2 ) targets for critically ill children. The harm of interventions to raise SpO2 to > 94% may exceed their benefits. METHODS: We undertook an open, parallel-group randomised trial of children > 38 weeks completed gestation and < 16 years of age receiving invasive or non-invasive respiratory support and supplemental oxygen who were admitted urgently to one of three paediatric intensive care units...
June 4, 2018: Intensive Care Medicine
Padmanabhan Ramnarayan, Paula Lister, Troy Dominguez, Parviz Habibi, Naomi Edmonds, Ruth R Canter, Jerome Wulff, David A Harrison, Paul M Mouncey, Mark J Peters
BACKGROUND: Although high-flow nasal cannula therapy (HFNC) has become a popular mode of non-invasive respiratory support (NRS) in critically ill children, there are no randomised controlled trials (RCTs) comparing it with continuous positive airway pressure (CPAP). We performed a pilot RCT to explore the feasibility, and inform the design and conduct, of a future large pragmatic RCT comparing HFNC and CPAP in paediatric critical care. METHODS: In this multi-centre pilot RCT, eligible patients were recruited to either Group A (step-up NRS) or Group B (step-down NRS)...
June 4, 2018: Critical Care: the Official Journal of the Critical Care Forum
Mihir R Atreya, John M Lorenz, Vivek Narendran
BACKGROUND: Bubble continuous positive airway pressure (bCPAP) is a simple, safe, and cost-effective strategy to provide respiratory support to newborns with respiratory distress syndrome in resource-limited settings. PURPOSE: To understand whether implementation of bCPAP, relative to other modes of respiratory support in the care of newborns with respiratory distress syndrome, increases positive attitudes about its potential for consistent and widespread use among providers in neonatal intensive care units (NICUs) of lower middle-income countries...
May 31, 2018: Advances in Neonatal Care: Official Journal of the National Association of Neonatal Nurses
Juan Valencia-Ramos, Alicia Mirás, Amacia Cilla, Carlos Ochoa, Juan Arnaez
BACKGROUND: High-flow nasal cannula (HFNC) is increasingly used to provide respiratory support in infants with bronchiolitis. The delivery of aerosol therapy through a jet nebulizer is widely indicated despite its controversial efficacy and poor tolerability. METHODS: This randomized cross-over study aimed to evaluate the comfort and satisfaction of the delivery of aerosol therapy using a nebulization system integrated into HFNC compared with the standard practice of using a jet nebulizer with a face mask...
May 29, 2018: Respiratory Care
Aldo García-Covarrubias, Luis García-Covarrubias, Dulce A Alcántara-López, Héctor Hinojosa-Heredia, Paola Prieto-Olivares, Arturo Reding-Bernal
Antecedents: In the field of organ donation and procurement, a possible donor is a patient with severe neurological damage and appropriate medical criteria for donation, and a potential donor is a patient suspected of being brain dead. Objective: The aim of this study is to identify specific factors that cause the loss of possible multiorgan donors in an intensive care unit (ICU). Methods: A review of cross-sectional charts of possible liver and kidney donors was done with patients admitted to the ICU with full respiratory support and Glasgow score < 8...
2018: Cirugia y Cirujanos
Xiaoming Shi, Mary J Edwards, Jordan Guice, Richard Strilka, Brandon Propper
BACKGROUND: The pediatric patient's response to hemorrhage as a function of young age is not well understood. As a result, there is no consensus on optimal resuscitation strategies for hemorrhagic shock in pediatric patients, or on the identification of clinical triggers to prompt implementation. The study objective was to develop a model of pediatric hemorrhage using young pigs to simulate school-aged children, and determine clinical and laboratory indicators for significant hemorrhage...
May 28, 2018: Pediatric Surgery International
Paula Heikkilä, Paula Sokuri, Minna Mecklin, Kirsi Nuolivirta, Terhi Tapiainen, Outi Peltoniemi, Marjo Renko, Matti Korppi
AIM: Using a high-flow nasal cannula (HFNC) for infant bronchiolitis is increasingly common, but insufficiently studied. In this retrospective study, we examined the outcomes of HFNC and compared infants who did and did not respond to this oxygen delivery method. METHODS: This 2012-2015 study of six Finnish hospitals focused on 88 infants under 12 months who received HFNC: 53 on paediatric wards and 35 in paediatric intensive care units (PICUs). We reviewed patient files for underlying factors, clinical parameters and HFNC treatment...
May 26, 2018: Acta Paediatrica
Madeleine C Murphy, Christian Heiring, Nicoletta Doglioni, Daniele Trevisanuto, Mats Blennow, Kajsa Bohlin, Gianluca Lista, Ilaria Stucchi, Colm P F O'Donnell
Importance: Treatment options for a symptomatic pneumothorax in newborns include needle aspiration (NA) and chest drain (CD) insertion. There is little consensus as to the preferred treatment, reflecting a lack of evidence from clinical trials. Objective: To investigate whether treating pneumothoraces diagnosed on chest radiography (CR) in newborns receiving respiratory support with NA results in fewer infants having CDs inserted within 6 hours of diagnosis. Design, Setting, and Participants: This randomized clinical trial was conducted from October 7, 2013, to December 21, 2016...
May 14, 2018: JAMA Pediatrics
Sophia Teoh, Elizabeth Clyde, Theodore Dassios, Anne Greenough
The use of humidified high-flow nasal cannulae (HHFNC) as an alternative mode of non-invasive ventilation (NIV) in neonates has become widespread. A survey of UK neonatal units showed the proportion using HHFNC had increased from 56% in 2012 to 87% in 2015 (1). A recently reported Cochrane Review (2) comparing the use of HHFNC against other NIV modes of ventilation immediately after birth or following extubation showed no significant difference in the rates of bronchopulmonary dysplasia (BPD) or death and no significant difference in the rates of treatment failure/reintubation...
May 24, 2018: Acta Paediatrica
Heyman Luckraz, Na'ngono Manga, Eshan L Senanayake, Mahmoud Abdelaziz, Shameer Gopal, Susan C Charman, Ramesh Giri, Raymond Oppong, Lazaros Andronis
Background: Ventilator-associated pneumonia is associated with significant morbidity, mortality and healthcare costs. Most of the cost data that are available relate to general intensive care patients in privately remunerated institutions. This study assessed the cost of managing ventilator-associated pneumonia in a cardiac intensive care unit in the National Health Service in the United Kingdom. Methods: Propensity-matched study of prospectively collected data from the cardiac surgical database between April 2011 and December 2014 in all patients undergoing cardiac surgery (n = 3416)...
May 2018: Journal of the Intensive Care Society
Sarah McAndrew, Krishna Acharya, T Hang Nghiem-Rao, Steven Leuthner, Reese Clark, Joanne Lagatta
OBJECTIVE: To describe how trisomy 21 affects neonatal intensive care management and outcomes of full-term infants without congenital anomalies. STUDY DESIGN: Retrospective cohort of full-term infants without anomalies with and without trisomy 21 admitted to Pediatrix NICUs from 2005 to 2012. We compared diagnoses, management, length of stay, and discharge outcomes. RESULTS: In all, 4623 infants with trisomy 21 and 606 770 infants without trisomy 21 were identified...
May 25, 2018: Journal of Perinatology: Official Journal of the California Perinatal Association
Michelle Bosley Henderson, Jeff E Schunk, Jeffrey L Henderson, Gitte Y Larsen, Jacob Wilkes, Susan L Bratton
OBJECTIVES: To describe asthma management, investigate practice variation, and describe asthma-associated charges and resource use during asthma management in the PICU. METHODS: Children ages 2 to 18 years treated for status asthmaticus in the PICU from 2008 to 2011 are included in this study. This is a retrospective, single-center, cohort study. Data were collected by using the Intermountain Healthcare Enterprise Data Warehouse. RESULTS: There were 262 patients included and grouped by maximal respiratory support intervention...
May 24, 2018: Hospital Pediatrics
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