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Pediatric Respiratory support

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https://www.readbyqxmd.com/read/28720673/challenges-with-implementation-of-a-respiratory-therapist-driven-protocol-of-spontaneous-breathing-trials-in-the-pediatric-icu
#1
Conrad Krawiec, Dale Carl, Christy Stetter, Lan Kong, Gary D Ceneviva, Neal J Thomas
BACKGROUND: Timely ventilator liberation is crucial in the pediatric ICU. In many pediatric ICUs, the decision to initiate weaning is driven by the physician, which may lead to delays in ventilator liberation. The objectives of this quality improvement project were to develop and implement a respiratory therapist (RT)-led protocol for screening for spontaneous breathing trial (SBT) readiness, to test protocol feasibility, and to evaluate its impact on SBT timing. METHODS: A retrospective chart review was performed on all intubated patients in the pediatric ICU for 18 months prior to protocol institution...
July 18, 2017: Respiratory Care
https://www.readbyqxmd.com/read/28654569/maintaining-interrater-agreement-of-core-assessment-instruments-in-a-multisite-randomized-controlled-clinical-trial-the-randomized-evaluation-of-sedation-titration-for-respiratory-failure-restore-trial
#2
Ruth Lebet, Jennifer Hayakawa, Tracy B Chamblee, Joana A Tala, Nakul Singh, David Wypij, Martha A Q Curley
BACKGROUND: RESTORE (Randomized Evaluation of Sedation Titration for Respiratory Failure) was a cluster randomized clinical trial evaluating a sedation strategy in children 2 weeks to <18 years of age with acute respiratory failure supported on mechanical ventilation. A total of 31 U.S. pediatric intensive care units (PICUs) participated in the trial. Staff nurse rater agreement on measures used to assess a critical component of treatment fidelity was essential throughout the 4-year data collection period...
July 2017: Nursing Research
https://www.readbyqxmd.com/read/28653420/impact-of-endotracheal-tube-shortening-on-work-of-breathing-in-neonatal-and-pediatric-in-vitro-lung-models
#3
Rebecca Mohr, Jörg Thomas, Vincenzo Cannizzaro, Markus Weiss, Alexander R Schmidt
BACKGROUND: Work of breathing accounts for a significant proportion of total oxygen consumption in neonates and infants. Endotracheal tube inner diameter and length significantly affect airflow resistance and thus work of breathing. While endotracheal tube shortening reduces endotracheal tube resistance, the impact on work of breathing in mechanically ventilated neonates and infants remains unknown. AIM: The objective of this in vitro study was to quantify the effect of endotracheal tube shortening on work of breathing in simulated pediatric lung settings...
June 27, 2017: Paediatric Anaesthesia
https://www.readbyqxmd.com/read/28651525/sofia-%C3%A2-rsv-prospective-laboratory-evaluation-and-implementation-of-a-rapid-diagnostic-test-in-a-pediatric-emergency-ward
#4
Léa C Tran, Céline Tournus, Julia Dina, Rémy Morello, Jacques Brouard, Astrid Vabret
BACKGROUND: Respiratory syncytial virus (RSV) is responsible for severe respiratory infections and higher costs in medical care. The two aims of this work were to assess the performances of SOFIA(®)RSV tests in "real-life-laboratory" conditions (study 1) and implemented at point-of-care testing in a pediatric emergency department (ED, study 2), during two consecutive winter seasons. METHODS: In study 1, fresh nasopharyngeal swabs from patients of all ages were sampled in 1...
June 26, 2017: BMC Infectious Diseases
https://www.readbyqxmd.com/read/28641244/computerized-lung-sound-screening-for-pediatric-auscultation-in-noisy-field-environments
#5
Dimitra Emmanouilidou, Eric D McCollum, Daniel E Park, Mounya Elhilali
GOAL: Chest auscultations offer a non-invasive and low-cost tool for monitoring lung disease. However, they present many shortcomings including inter-listener variability, subjectivity, and vulnerability to noise and distortions. The current work proposes a computer-aided approach to process lung signals acquired in the field under adverse noisy conditions, by improving the signal quality and offering automated iden- tification of abnormal auscultations indicative of respiratory pathologies...
June 19, 2017: IEEE Transactions on Bio-medical Engineering
https://www.readbyqxmd.com/read/28619306/management-of-viral-oral-ulcers-in-children-using-chinese-herbal-medicine-a-report-of-two-cases
#6
Yi-Chiao Lee, Ting-Hao Wang, Shih-Yu Chen, Hsiang-Ling Lin, Ming-Yen Tsai
OBJECTIVE: Viral oral ulcers are common presentations in pediatric clinics. Although self-limiting, painful ulcerative lesions and inflamed mucosa can decrease oral intake and lead to dehydration. Despite the widespread use of Chinese herbal medicine (CHM) for pediatric upper respiratory disease in Taiwan, there is little evidence for its effectiveness as an antipyretic or in aiding ulcer healing for children with viral oral ulcers. We report two cases of children who presented with viral oral ulcers to illustrate the potential efficacy of CHM treatment in recovery from herpangina (HA) and herpetic gingivostomatitis (HGS)...
June 2017: Complementary Therapies in Medicine
https://www.readbyqxmd.com/read/28614197/sedation-management-in-children-supported-on-extracorporeal-membrane-oxygenation-for-acute-respiratory-failure
#7
James B Schneider, Todd Sweberg, Lisa A Asaro, Aileen Kirby, David Wypij, Ravi R Thiagarajan, Martha A Q Curley
OBJECTIVES: To describe sedation management in children supported on extracorporeal membrane oxygenation for acute respiratory failure. DESIGN: Secondary analysis of prospectively collected data from a multicenter randomized trial of sedation (Randomized Evaluation of Sedation Titration for Respiratory Failure). SETTING: Twenty-one U.S. PICUs. PATIENTS: One thousand two hundred fifty-five children, 2 weeks to 17 years old, with moderate/severe pediatric acute respiratory distress syndrome...
June 13, 2017: Critical Care Medicine
https://www.readbyqxmd.com/read/28603625/physiological-impact-of-high-flow-nasal-cannula-therapy-on-postextubation-acute-respiratory-failure-after-pediatric-cardiac-surgery-a-prospective-observational-study
#8
Naohiro Shioji, Tatsuo Iwasaki, Tomoyuki Kanazawa, Kazuyoshi Shimizu, Tomohiko Suemori, Kentaro Sugimoto, Yasutoshi Kuroe, Hiroshi Morimatsu
BACKGROUND: Reintubation after pediatric cardiac surgery is associated with a high rate of mortality. Therefore, adequate respiratory support for postextubation acute respiratory failure (ARF) is important. However, little is known about the physiological impact of high-flow nasal cannula (HFNC) therapy on ARF after pediatric cardiac surgery. Our working hypothesis was that HFNC therapy for postextubation ARF after pediatric cardiac surgery improves hemodynamic and respiratory parameters...
2017: Journal of Intensive Care
https://www.readbyqxmd.com/read/28602381/variability-of-care-in-infants-with-severe-bronchiolitis-less-invasive-respiratory-management-leads-to-similar-outcomes
#9
Sandrine Essouri, Florent Baudin, Laurent Chevret, Mélanie Vincent, Guillaume Emeriaud, Philippe Jouvet
OBJECTIVE: To compare the management of children with severe bronchiolitis requiring intensive care (based on duration of ventilatory support and duration of pediatric intensive care unit [PICU] stay) in 2 countries with differing pediatric transport and PICU organizations. STUDY DESIGN: This was a prospective observational care study in 2 PICUs of tertiary care university hospitals, 1 in France and 1 in Canada. All children with bronchiolitis who required admission to the PICU between November 1, 2013, and March 31, 2014, were included...
June 8, 2017: Journal of Pediatrics
https://www.readbyqxmd.com/read/28598946/dexmedetomidine-for-sedation-during-noninvasive-ventilation-in-pediatric-patients
#10
Rasika Venkatraman, James L Hungerford, Mark W Hall, Melissa Moore-Clingenpeel, Joseph D Tobias
OBJECTIVES: To describe the use of dexmedetomidine for sedation in a large cohort of nonintubated children with acute respiratory insufficiency receiving noninvasive ventilatory support. DESIGN: Single-center, retrospective, observational cohort study. SETTING: A large quaternary-care PICU. PATIENTS: The study cohort included 202 children receiving noninvasive ventilatory and a dexmedetomidine infusion within 48 hours of PICU admission over a 6-month period...
June 8, 2017: Pediatric Critical Care Medicine
https://www.readbyqxmd.com/read/28588119/high-flow-nasal-cannula-utilization-in-pediatric-critical-care
#11
Kristen D Coletti, Dayanand N Bagdure, Linda K Walker, Kenneth E Remy, Jason W Custer
BACKGROUND: High-flow nasal cannula (HFNC) is increasingly utilized in pediatrics, delivering humidified air and oxygen for respiratory conditions causing hypoxia and distress. In the neonatal ICU, it has been associated with better tolerance, lower complications, and lower cost. Few data exist regarding indications for use and the epidemiology of disease/pathology that warrants HFNC in the pediatric ICU. METHODS: This study is a retrospective cohort study of patients admitted to a tertiary children's hospital pediatric ICU and placed on HFNC from October 1, 2011 to October 31, 2013...
June 6, 2017: Respiratory Care
https://www.readbyqxmd.com/read/28584437/severe-pediatric-acute-respiratory-distress-syndrome-due-to-scrub-typhus-successful-ventilation-with-airway-pressure-release-ventilation-mode-after-becoming-refractory-to-protective-ventilation
#12
Sudha Chandelia, Sarika Jain
Scrub typhus can affect lungs from mild illness like pneumonitis to a severe illness like acute respiratory distress syndrome (ARDS). Such patients may be very challenging to treat when their hypoxemia becomes severe and refractory to treatment. Main treatment is supportive in terms of mechanical ventilation. In adult ARDS, low tidal volume (TV) ventilation has been recommended, but there is no consensus on most effective ventilation mode in children. We present a case of a 12-year-old girl who developed severe ARDS (PO2/FiO2 ratio - 58), refractory to low TV ventilation...
May 2017: Indian Journal of Critical Care Medicine
https://www.readbyqxmd.com/read/28557863/pediatric-extracorporeal-life-support-organization-registry-international-report-2016
#13
Ryan P Barbaro, Matthew L Paden, Yigit S Guner, Lakshmi Raman, Lindsay M Ryerson, Peta Alexander, Viviane G Nasr, Melania M Bembea, Peter T Rycus, Ravi R Thiagarajan
The purpose of this report is to describe the international growth, outcomes, complications, and technology used in pediatric extracorporeal life support (ECLS) from 2009 to 2015 as reported by participating centers in the Extracorporeal Life Support Organization (ELSO). To date, there are 59,969 children who have received ECLS in the ELSO Registry; among those, 21,907 received ECLS since 2009 with an overall survival to hospital discharge rate of 61%. In 2009, 2,409 ECLS cases were performed at 157 centers...
May 23, 2017: ASAIO Journal: a Peer-reviewed Journal of the American Society for Artificial Internal Organs
https://www.readbyqxmd.com/read/28551379/review-of-1-000-consecutive-extracorporeal-membrane-oxygenation-runs-as-a-quality-initiative
#14
Harold N Lovvorn, Daphne C Hardison, Heidi Chen, Ashly C Westrick, Melissa E Danko, Brian C Bridges, William F Walsh, John B Pietsch
BACKGROUND: Extracorporeal membrane oxygenation is a resource-intensive mode of life-support potentially applicable when conventional therapies fail. Given the initial success of extracorporeal membrane oxygenation to support neonates and infants in the 1980s, indications have expanded to include adolescents, adults, and selected moribund patients during cardiopulmonary resuscitation. This single-institution analysis was conducted to evaluate programmatic growth, outcomes, and risk for death despite extracorporeal membrane oxygenation across all ages and diseases...
May 24, 2017: Surgery
https://www.readbyqxmd.com/read/28546375/extracorporeal-membrane-oxygenation-for-severe-pediatric-respiratory-failure
#15
John C Lin
Extracorporeal membrane oxygenation (ECMO) was developed initially in the 1960s to support refractory respiratory failure in addition to the cardiac support inherent in a venoarterial bypass circuit. Early successes occurred predominantly in the neonatal population with subsequent randomized controlled trials and comprehensive reviews concluding therapeutic efficacy for ECMO in neonatal respiratory failure. In contrast, the evidence supporting ECMO for respiratory failure in children is less definitive. However, although pediatric randomized controlled trials have not been completed, sufficient evidence in support of ECMO as a beneficial therapy for pediatric respiratory failure exists...
June 2017: Respiratory Care
https://www.readbyqxmd.com/read/28546373/noninvasive-respiratory-support-in-infants-and-children
#16
Katherine L Fedor
CPAP and noninvasive ventilation (NIV) offer an alternative to intubation and mechanical ventilation in the treatment of acute and chronic respiratory disorders commonly encountered in infants and children. There are many distinct challenges associated with the application, management, and safety of CPAP and NIV in the pediatric population. This review attempts to identify indications, contraindications, management strategies, and safety measures associated with the application of CPAP or NIV delivery in children...
June 2017: Respiratory Care
https://www.readbyqxmd.com/read/28540285/allergen-avoidance-in-allergic-asthma
#17
REVIEW
Francesca Cipriani, Elisabetta Calamelli, Giampaolo Ricci
Allergic asthma is the most frequent disease among the chronic respiratory disorders in pediatric age with an important social impact. In the last years, many efforts have been made to identify effective preventive approaches to get a better control of symptoms and to obtain the best future outcomes for the patients. In patients with allergic asthma triggered by the exposure to indoor allergens, the avoidance is the first intervention to prevent the appearance or the worsening of bronchial symptoms. This review article summarized the most recent evidence from literature about the efficacy of specific control interventions for the most important allergens...
2017: Frontiers in Pediatrics
https://www.readbyqxmd.com/read/28538606/assessing-severity-in-pediatric-pneumonia-predictors-of-the-need-for-major-medical-interventions
#18
Are Stuwitz Berg, Christopher Stephen Inchley, Hans Olav Fjaerli, Truls Michael Leegaard, Britt Nakstad
OBJECTIVE: The aim of this study was to determine potential predictors of the need for major medical interventions in the context of assessing severity in pediatric pneumonia. METHODS: This was a prospective, cohort study of previously healthy children and adolescents younger than 18 years presenting to the pediatric emergency room with clinically suspected pneumonia and examining both the full cohort and those with radiologically confirmed pneumonia. The presence of hypoxemia (peripheral oxygen saturation ≤92%), age-specific tachypnea, high temperature (≥38...
May 23, 2017: Pediatric Emergency Care
https://www.readbyqxmd.com/read/28531789/do-picu-patients-meet-technical-criteria-for-performing-indirect-calorimetry
#19
Megan R Beggs, Gonzalo Garcia Guerra, Bodil M K Larsen
BACKGROUND & AIMS: Indirect calorimetry (IC) is considered gold standard for assessing energy needs of critically ill children as predictive equations and clinical status indicators are often unreliable. Accurate assessment of energy requirements in this vulnerable population is essential given the high risk of over or underfeeding and the consequences thereof. The proportion of patients and patient days in pediatric intensive care (PICU) for which energy expenditure (EE) can be measured using IC is currently unknown...
October 2016: Clinical Nutrition ESPEN
https://www.readbyqxmd.com/read/28487415/randomized-comparison-of-helmet-cpap-versus-high-flow-nasal-cannula-oxygen-in-pediatric-respiratory-distress
#20
Giovanna Vitaliti, Maria Concetta Vitaliti, Maria Carla Finocchiaro, Vita Antonella Di Stefano, Piero Pavone, Nassim Matin, Nazgol Motamed-Gorji, Riccardo Lubrano, Raffaele Falsaperla
BACKGROUND: The current study aimed to compare the efficacy and safety of 2 noninvasive respiratory support methods, which included helmet CPAP and high-flow nasal cannula (HFNC) in children with respiratory distress admitted to a pediatric intermediate care unit. METHODS: This study was a prospective observational study conducted on children with respiratory distress (age 1-24 months) who were admitted to our acute and emergency operative unit. All included subjects were randomly treated with helmet CPAP or HFNC in a 1:1 fashion until their clinical picture, oxygen saturation, and arterial blood gas (ABG) parameters resolved...
May 9, 2017: Respiratory Care
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