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pediatric endotracheal tube

Kaitlin M Best, Lisa A Asaro, Martha A Q Curley
OBJECTIVE: To compare current analgesia and sedation management practices between critically ill children with pre-existing cognitive impairment and critically ill neurotypical children, including possible indicators of therapeutic efficacy. STUDY DESIGN: This study used secondary analysis of prospective data from the RESTORE clinical trial, with 2449 children admitted to the pediatric intensive care unit and receiving mechanical ventilation for acute respiratory failure...
December 5, 2018: Journal of Pediatrics
Cheryl Lynne McBeth, Rosa Solis Montes, Amy Powne, Sopon Elizabeth North, JoAnne E Natale
BACKGROUND: Ventilator-associated pneumonia (VAP) increases morbidity, mortality, and health care costs. OBJECTIVE: To reduce the VAP rate in the pediatric/cardiac intensive care unit to fewer than 2 events per 1000 ventilator days within 2 years and to sustain a rate near 0 for the next 5 years. METHODS: An evidence-based VAP prevention bundle was developed and implemented by an interprofessional team using the Six Sigma Define, Measure, Analyze, Improve, Control methodology...
December 2018: Critical Care Nurse
Andrew G Miller, Kyle J Rehder, Ira M Cheifetz, Neil R MacIntyre
No abstract text is available yet for this article.
December 2018: Respiratory Care
Jan Hau Lee, Gabrielle Nuthall, Takanari Ikeyama, Osamu Saito, Yee Hui Mok, Michael Shepherd, Philipp Jung, Rakshay Shetty, Sujatha Thyagarajan, Sholeen Nett, Natalie Napolitano, Vinay Nadkarni, Akira Nishisaki
OBJECTIVES: It is unknown if variation in tracheal intubation practice and outcomes exist across PICUs in different geographical regions. We hypothesized there would be differences in the process of care and adverse outcomes for tracheal intubation across PICUs in six different geographical regions (New Zealand, Japan, Singapore, Germany, India, and North America). DESIGN: Prospective multicenter pediatric tracheal intubation database (National Emergency Airway Registry for Children) SETTING:: Six non-North American (International) and 36 North American PICUs...
November 7, 2018: Pediatric Critical Care Medicine
Charis Khoo, A H NurHafiizhoh, Angela Tan, Tracy Tan, Hwan Ing Hee
BACKGROUND: The Auditory brainstem implant (ABI) is a new surgical option for hearing impaired children. Intraoperative neurophysiology monitoring includes brainstem mapping of cranial nerve (CN) IX, X, XI, XII and their motor nuclei, and corticobulbar tract motor-evoked potential. These require laryngeal electrodes and intra-oral pins, posing a challenge to airway management especially in the pediatric airway, where specialized electromyogram (EMG) tracheal tubes are not available. Challenges include determining the optimum position on the endotracheal tube (ETT) in which to place laryngeal electrode, and the increase in external diameter of ETT contributed by the wrapping the electrode around the shaft of ETT; this may necessitate downsizing of the tracheal tube...
November 7, 2018: BMC Anesthesiology
Kevin M Overmann, Stephanie D Boyd, Yin Zhang, Benjamin T Kerrey
BACKGROUND: Apneic oxygenation is the delivery of oxygen to the nasopharynx during intubation. It may mitigate the risk of oxyhemoglobin desaturation but has not been well-studied in children. METHODS: We conducted a retrospective, observational study of patients undergoing rapid sequence intubation (RSI) in a pediatric emergency department. We compared patients who received apneic oxygenation, delivered via simple nasal cannula at age-specific flow rates, to patients who did not receive apneic oxygenation...
October 18, 2018: American Journal of Emergency Medicine
Alexander P Marston, David R White
The subglottis is a narrow region of the pediatric airway that is exquisitely susceptible to the development of airway stenosis. The incidence of acquired subglottic stenosis in the setting of prolonged intubation has significantly decreased because of improved endotracheal tube management protocols. Advances in otolaryngology interventions, such as balloon dilation and endoscopic cricoid split techniques, may allow the avoidance of tracheostomy in patients with mild to moderate subglottic stenosis. However, patients with severe subglottic stenosis are often tracheostomy dependent...
December 2018: Clinics in Perinatology
Dianne F McKinley, Sharon B Kinney, Beverley Copnell, Frank Shann
BACKGROUND: Saline instillation is still used to assist in removal of secretions from endotracheal tubes in some pediatric intensive care units. OBJECTIVE: To compare the effect of using either no saline, quarter-normal (0.225%) saline, or normal (0.9%) saline during endotracheal suctioning of children receiving ventilatory support in a pediatric intensive care unit. METHOD: An unblinded, randomized trial with 3 treatment groups was conducted with 427 children who received ventilatory support for at least 12 hours...
November 2018: American Journal of Critical Care: An Official Publication, American Association of Critical-Care Nurses
David Greaney, John Russell, Ian Dawkins, Martina Healy
INTRODUCTION: The safety of cuffed endotracheal tubes in the neonatal and critically ill pediatric population continues to be questioned due to the theoretical risk of acquired subglottic stenosis. The incidence of acquired subglottic stenosis in the high-risk mixed surgical and medical critically ill pediatric cohort using high-volume, low-pressure cuffed endotracheal tube policy has not yet been described. The aim of our study was to describe and evaluate the use and complication rate of cuffed ETT's in our unit over a 5-year period...
October 29, 2018: Paediatric Anaesthesia
Rahul Pillai, Suresh Kumaran, L Jeyaseelan, Sajan P George, Raj Sahajanandan
Introduction: The search for an accurate and predictable method to estimate the endotracheal tube (ETT) size in pediatric population had led to derivation of many formulae. Of this, age-based formulae are the most commonly used. Studies have shown that minimal transverse diameter of subglottic airway (MTDSA) measurements using a high-frequency probe improves the success rate of predicting the airway diameter to about 90%. We did a prospective observational study using MTDSA as the criteria to select the size of ETT in children with congenital heart disease...
October 2018: Annals of Cardiac Anaesthesia
Chang-Hoon Koo, Sun Young Lee, Seung Hyun Chung, Jung-Hee Ryu
The purpose of this study was to compare the incidence of airway complications between extubation under deep anesthesia (deep extubation) and extubation when fully awake (awake extubation) in pediatric patients after general anesthesia. A systematic review was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta Analyses (PRISMA) statement standards. The review protocol was registered with the International Prospective Register of Systematic Reviews (registration number: CRD 42018090172)...
October 14, 2018: Journal of Clinical Medicine
Heather A Ballard, Olga S Leavitt, Anthony C Chin, Rashmi Kabre, Debra E Weese-Mayer, John Hajduk, Narasimhan Jagannathan
BACKGROUND: Congenital Central Hypoventilation Syndrome and Rapid-Onset Obesity with Hypothalamic dysfunction, Hypoventilation, and Autonomic Dysregulation are rare neurocristopathies characterized by autonomic dysregulation including bradyarrhythmias, abnormal temperature control, and most significantly, abnormal control of breathing leading to tracheostomy and ventilator dependence as life support. Surgical advancements have made phrenic nerve-diaphragm pacemakers available, to eliminate the tether to a mechanical ventilator for 12-15 hours each day...
November 2018: Paediatric Anaesthesia
Liang Chen, Jun Zhang, Guoshi Pan, Xia Li, Tianwu Shi, Wensheng He
Background: Cuffed and uncuffed endotracheal tubes are commonly used for pediatric patients in surgery and emergency situations. It is still controversial which approach should be adopted. The purpose of the study was to compare the application of cuffed and uncuffed endotracheal tubes in pediatric patients. Methods: We searched PubMed, Web of Science and Cochrane Library for clinical trials, which compared the two applications in children. The study characteristics and clinical data were summarized by two independent reviewers...
2018: Open Medicine (Warsaw, Poland)
Nathaniel H Greene, Edmund H Jooste, Dylan P Thibault, Amelia S Wallace, Alice Wang, David F Vener, Roland A Matsouaka, Marshall L Jacobs, Jeffrey P Jacobs, Kevin D Hill, Warwick A Ames
BACKGROUND: In adults undergoing cardiopulmonary bypass surgery, oral intubation is typically preferred over nasal intubation due to reduced risk of sinusitis and infection. In children, nasal intubation is more common and sometimes preferred due to perceived benefits of less postoperative sedation and a lower risk for accidental extubation. This study sought to describe the practice of nasal intubation in the pediatric population undergoing cardiopulmonary bypass surgery and assess the risks/benefits of a nasal route against an oral one...
September 5, 2018: Anesthesia and Analgesia
Edward D Ferenczy, Michael J Stoner, Sandra P Spencer, Samantha W Gee, Daniel J Scherzer, Joseph D Tobias
OBJECTIVE: The objective of this study was to evaluate endotracheal tube cuff pressure after emergency intubation and identify variables associated with an elevated cuff pressure. METHODS: This was a prospective cohort study of intubated patients in the emergency department of Nationwide Children's Hospital. The primary study outcome, cuff pressure, was measured via manometer. Clinical details related to the intubation were collected and analyzed as secondary outcomes...
October 2018: International Journal of Pediatric Otorhinolaryngology
Kazuhiro Uda, Chitose Koyama-Wakai, Kensuke Shoji, Noriyasu Iwase, Daisuke Motooka, Shota Nakamura, Isao Miyairi
BACKGROUND: WU polyomavirus (WUPyV) is a relatively new virus associated with respiratory infections. However, its role is unclear in children with severe respiratory failure. OBJECTIVES: We aimed to evaluate the characteristics of severe respiratory failure associated with WUPyV infection in children. STUDY DESIGN: We retrospectively reviewed cases of respiratory tract infection at a tertiary children's hospital in Japan and performed real-time polymerase chain reaction (PCR) for WUPyV using residual extracted nucleic acid samples taken from respiratory tract samples of pediatric patients primarily with respiratory failure...
August 9, 2018: Journal of Clinical Virology: the Official Publication of the Pan American Society for Clinical Virology
Milton Halyson Benevides de Freitas, Luciana Cavalcanti Lima, Tania Cursino de Menezes Couceiro, Maria Célia Ferreira da Costa, Márcio Handerson Benevides de Freitas
BACKGROUND AND OBJECTIVES: Conjoined twins are monozygotic twins physically joined at some part of the body. This is a rare phenomenon, estimated between 1:50,000 to 1:200,000 births. The objective of this report is to present the anesthetic management and the perioperative challenges for a separation surgery. CASE REPORT: Thoraco-omphalopagus twins were diagnosed by ultrasound and were followed by the fetal medicine team of the service. After 11hours of cesarean, the pediatric surgical team chose to separate the twins...
August 7, 2018: Revista Brasileira de Anestesiologia
Megan M Gray, Rachel A Umoren, Spencer Harris, Thomas P Strandjord, Taylor Sawyer
OBJECTIVE: To examine the use and perceived safety of stylets for neonatal intubation in a cohort of providers in the United States. STUDY DESIGN: A cross-sectional survey was sent to members of the American Academy of Pediatrics Section on Neonatal-Perinatal Medicine. RESULT: A total of 640 responses were received. 57% reported using a stylet 'every time' or 'almost every time' they intubated. The preferred stylet bend was a smooth bend of <30 degrees...
October 2018: Journal of Perinatology: Official Journal of the California Perinatal Association
Teresa A Volsko, Yuriy Petrov, Neil L McNinch, Donald S Prough, Clark R Anderson, Michael T Bigham
BACKGROUND: Confirmation of endotracheal tube (ETT) tip position and timely identification and correction of malposition is an essential component of care for endotracheally intubated and mechanically ventilated children. We evaluated the ability of a prototype optoacoustic medical device to determine ETT tip position. We hypothesized that the precision of optoacoustic assessment of ETT tip position would be comparable to chest radiography. METHODS: We recruited children aged newborn to 16 y who were admitted to the pediatric ICU requiring tracheal intubation and undergoing a chest radiograph for clinical purposes...
July 31, 2018: Respiratory Care
Paulo Sergio Lucas da Silva, Nádia Lais Lobrigate, Marcelo Cunio Machado Fonseca
OBJECTIVES: Postextubation dysphagia is common and associated with worse outcomes in the PICU. Although there has been an increased participation of speech-language pathologists in its treatment, there is limited evidence to support speech-language pathologists as core PICU team member. We aimed to assess the impact of speech-language pathologists interventions on the treatment of postextubation dysphagia. DESIGN: A quasi-experimental prospective study. In the historical group (controls), patients received a standard care management for dysphagia whereas the intervention group was routinely treated by speech-language pathologists...
October 2018: Pediatric Critical Care Medicine
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