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https://www.readbyqxmd.com/read/29434764/pediatric-acute-respiratory-distress-syndrome-current-views
#1
Jinfeng Liu, Wei Wang, Fengli Liu, Zhenguang Li
Acute respiratory distress syndrome (ARDS) mainly involves acute respiratory failure. In addition to this affected patients feel progressive arterial hypoxemia, dyspnea, and a marked increase in the work of breathing. The only clinical solution for the above pathological state is ventilation. Mechanical ventilation is necessary to support life in ARDs but it itself worsen lung injury and the term is known clinically as 'ventilation induced lung injury' (VILI). At the cellular level, respiratory epithelial cells are subjected to cyclic stretch, i...
February 2018: Experimental and Therapeutic Medicine
https://www.readbyqxmd.com/read/29320485/non-invasive-ventilation-and-surfactant-treatment-as-primary-mode-of-respiratory-support-in-surfactant-deficient-newborn-piglets
#2
Carmen Rey-Santano, Victoria E Mielgo, Miguel Angel Gomez-Solaetxe, Francesca Ricci, Federico Bianco, Fabrizio Salomone, Begoña Loureiro, Jon López de Heredia Y Goya
BACKGROUND: Nasal continuous positive airway pressure (NCPAP) and nasal intermittent positive pressure ventilation (NIPPV), forms of non-invasive ventilation (NIV) for respiratory support, are increasingly being chosen as the initial treatment for neonates with surfactant (SF) deficiency. Our objective was to compare NCPAP with NIPPV with or without SF administration as a primary mode of ventilation. METHODS: Twenty-four newborn piglets with SF-deficient lung injury produced by repetitive bronchoalveolar lavages were randomly assigned to NCPAP or NIPPV, with or without SF administration (InSurE method)...
January 10, 2018: Pediatric Research
https://www.readbyqxmd.com/read/29276865/high-frequency-oscillatory-ventilation-versus-conventional-mechanical-ventilation-in-pediatric-acute-respiratory-distress-syndrome-a-randomized-controlled-study
#3
Ahmed El-Nawawy, Azza Moustafa, Hassan Heshmat, Ahmed Abouahmed
El-Nawawy A, Moustafa A, Heshmat H, Abouahmed A. High frequency oscillatory ventilation versus conventional mechanical ventilation in pediatric acute respiratory distress syndrome: A randomized controlled study. Turk J Pediatr 2017; 59: 130-143. The aim of this prospective randomized study is to compare the outcomes of the early use of either high frequency oscillation (HFO) or conventional mechanical ventilation (CMV) in patients with pediatric acute respiratory distress syndrome (PARDS). We allocated two hundred PARDS patients over 5 years in 1:1 ratio to either mode...
2017: Turkish Journal of Pediatrics
https://www.readbyqxmd.com/read/28941533/pathophysiology-and-management-of-acute-respiratory-distress-syndrome-in-children
#4
REVIEW
Sabrina M Heidemann, Alison Nair, Yonca Bulut, Anil Sapru
Acute respiratory distress syndrome (ARDS) is a syndrome of noncardiogenic pulmonary edema and hypoxia that accompanies up to 30% of deaths in pediatric intensive care units. Pediatric ARDS (PARDS) is diagnosed by the presence of hypoxia, defined by oxygenation index or Pao2/Fio2 ratio cutoffs, and new chest infiltrate occurring within 7 days of a known insult. Hallmarks of ARDS include hypoxemia and decreased lung compliance, increased work of breathing, and impaired gas exchange. Mortality is often accompanied by multiple organ failure...
October 2017: Pediatric Clinics of North America
https://www.readbyqxmd.com/read/28930815/variability-in-usual-care-mechanical-ventilation-for-pediatric-acute-respiratory-distress-syndrome-time-for-a-decision-support-protocol
#5
Christopher J L Newth, Katherine A Sward, Robinder G Khemani, Kent Page, Kathleen L Meert, Joseph A Carcillo, Thomas P Shanley, Frank W Moler, Murray M Pollack, Heidi J Dalton, David L Wessel, John T Berger, Robert A Berg, Rick E Harrison, Richard Holubkov, Allan Doctor, J Michael Dean, Tammara L Jenkins, Carol E Nicholson
OBJECTIVES: Although pediatric intensivists philosophically embrace lung protective ventilation for acute lung injury and acute respiratory distress syndrome, we hypothesized that ventilator management varies. We assessed ventilator management by evaluating changes to ventilator settings in response to blood gases, pulse oximetry, or end-tidal CO2. We also assessed the potential impact that a pediatric mechanical ventilation protocol adapted from National Heart Lung and Blood Institute acute respiratory distress syndrome network protocols could have on reducing variability by comparing actual changes in ventilator settings to those recommended by the protocol...
November 2017: Pediatric Critical Care Medicine
https://www.readbyqxmd.com/read/28665929/effect-of-frequency-on-pressure-cost-of-ventilation-and-gas-exchange-in-newborns-receiving-high-frequency-oscillatory-ventilation
#6
Emanuela Zannin, Raffaele L Dellaca', Giulia Dognini, Lara Marconi, Martina Perego, Jane J Pillow, Paolo E Tagliabue, Maria Luisa Ventura
BackgroundWe hypothesized that ventilating at the resonant frequency of the respiratory system optimizes gas exchange while limiting the mechanical stress to the lung in newborns receiving high-frequency oscillatory ventilation (HFOV). We characterized the frequency dependence of oscillatory mechanics, gas exchange, and pressure transmission during HFOV.MethodsWe studied 13 newborn infants with a median (interquartile range) gestational age of 29.3 (26.4-30.4) weeks and body weight of 1.00 (0.84-1.43) kg. Different frequencies (5, 8, 10, 12, and 15 Hz) were tested, keeping carbon dioxide diffusion coefficient (DCO 2 ) constant...
December 2017: Pediatric Research
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
#7
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/28535820/predicted-body-weight-relationships-for-protective-ventilation-unisex-proposals-from-pre-term-through-to-adult
#8
Dion C Martin, Glenn N Richards
BACKGROUND: The lung-protective ventilation bundle has been shown to reduce mortality in adult acute respiratory distress syndrome (ARDS). This concept has expanded to other areas of acute adult ventilation and is recommended for pediatric ventilation. A component of lung-protective ventilation relies on a prediction of lean body weight from height. The predicted body weight (PBW) relationship employed in the ARDS Network trial is considered valid only for adults, with a dedicated formula required for each sex...
May 23, 2017: BMC Pulmonary Medicine
https://www.readbyqxmd.com/read/28497033/intrapulmonary-percussive-ventilation-as-an-airway-clearance-technique-during-venoarterial-extracorporeal-life-support-in-an-infant-with-pertussis
#9
Conrad Krawiec, Ken Ballinger, E Scott Halstead
Initiation of extracorporeal life support (ECLS) is often followed by complete opacification of pulmonary parenchyma and volume loss. The optimal mechanical ventilator management and lung recruitment strategy of a pediatric patient requiring extracorporeal membrane oxygenation is not known. We present a case of a 4-week old infant who developed a severe pertussis infection requiring ECLS. The severity of his illness and pertussis infection-associated intraluminal bronchiole obstruction made medical management challenging...
2017: Frontiers in Pediatrics
https://www.readbyqxmd.com/read/28212162/volume-and-pressure-delivery-during-pediatric-high-frequency-oscillatory-ventilation
#10
Ronald Wong, Timothy Deakers, Justin Hotz, Robinder G Khemani, Patrick A Ross, Christopher J Newth
OBJECTIVE: Identify variables independently associated with delivered tidal volume (VT) and measured mean airway pressure during high-frequency oscillatory ventilation across the range of pediatric endotracheal tube sizes. DESIGN: In vitro study. SETTING: Research laboratory. INTERVENTIONS: An in vitro bench model of the intubated pediatric respiratory system during high-frequency oscillatory ventilation was used to obtain delivered VT and mean airway pressure (in the distal lung) for various endotracheal tube sizes...
April 2017: Pediatric Critical Care Medicine
https://www.readbyqxmd.com/read/27690714/can-ems-providers-provide-appropriate-tidal-volumes-in-a-simulated-adult-sized-patient-with-a-pediatric-sized-bag-valve-mask
#11
Jeffrey Siegler, Melissa Kroll, Susan Wojcik, Hawnwan Philip Moy
INTRODUCTION: In the prehospital setting, Emergency Medical Services (EMS) professionals rely on providing positive pressure ventilation with a bag-valve-mask (BVM). Multiple emergency medicine and critical care studies have shown that lung-protective ventilation protocols reduce morbidity and mortality. Our primary objective was to determine if a group of EMS professionals could provide ventilations with a smaller BVM that would be sufficient to ventilate patients. Secondary objectives included 1) if the pediatric bag provided volumes similar to lung-protective ventilation in the hospital setting and 2) compare volumes provided to the patient depending on the type of airway (mask, King tube, and intubation)...
January 2017: Prehospital Emergency Care
https://www.readbyqxmd.com/read/27630456/prevalence-and-risk-factors-of-pneumothorax-among-patients-admitted-to-a-pediatric-intensive-care-unit
#12
Ahmed Ahmed El-Nawawy, Amina Sedky Al-Halawany, Manal Abdelmalik Antonios, Reem Gamal Newegy
OBJECTIVE: Pneumothorax should be considered a medical emergency and requires a high index of suspicion and prompt recognition and intervention. AIMS: The objective of the study was to evaluate cases developing pneumothorax following admission to a Pediatric Intensive Care Unit (PICU) over a 5-year period. SETTINGS AND DESIGN: Case notes of all PICU patients (n = 1298) were reviewed, revealing that 135 cases (10.4%) developed pneumothorax, and these were compared with those patients who did not...
August 2016: Indian Journal of Critical Care Medicine
https://www.readbyqxmd.com/read/27513687/poor-adherence-to-lung-protective-mechanical-ventilation-in-pediatric-acute-respiratory-distress-syndrome
#13
Shan L Ward, Carson M Quinn, Stacey L Valentine, Anil Sapru, Martha A Q Curley, Douglas F Willson, Kathleen D Liu, Michael A Matthay, Heidi R Flori
OBJECTIVES: To determine the frequency of low-tidal volume ventilation in pediatric acute respiratory distress syndrome and assess if any demographic or clinical factors improve low-tidal volume ventilation adherence. DESIGN: Descriptive post hoc analysis of four multicenter pediatric acute respiratory distress syndrome studies. SETTING: Twenty-six academic PICU. PATIENTS: Three hundred fifteen pediatric acute respiratory distress syndrome patients...
October 2016: Pediatric Critical Care Medicine
https://www.readbyqxmd.com/read/27381701/year-in-review-2015-pediatric-ards
#14
REVIEW
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
https://www.readbyqxmd.com/read/27303142/chest-trauma-a-case-for-single-lung-ventilation
#15
Nagaraj Pandharikar, Anil Sachdev, Neeraj Gupta, Suresh Gupta, Dhiren Gupta
Chest trauma is one of the important causes of mortality and morbidity in pediatric trauma patients. The complexity, magnitude, and type of lung injury make it extremely challenging to provide optimal oxygenation and ventilation while protecting the lung from further injury due to mechanical ventilation. Independent lung ventilation is used sporadically in these patients who do not respond to these conventional ventilatory strategies using double-lumen endotracheal tubes, bronchial blocker balloons, etc. However, this equipment may not be easily available in developing countries, especially for pediatric patients...
April 2016: Indian Journal of Critical Care Medicine
https://www.readbyqxmd.com/read/27058971/electrical-impedance-tomography-as-possible-guidance-for-individual-positioning-of-patients-with-multiple-lung-injury
#16
Sylvia Lehmann, Steffen Leonhardt, Chuong Ngo, Lukas Bergmann, Simone Schrading, Konrad Heimann, Norbert Wagner, Klaus Tenbrock
INTRODUCTION: Electrical Impedance Tomography (EIT) is a tomographic, radiation-free technique based on the injection of a harmless alternating current. OBJECTIVE: As electrical impedance strictly correlates with the variation of air content, EIT delivers highly dynamic information about global and regional ventilation. We want to demonstrate the potential of EIT individualizing ventilation by positioning. METHODS: Gravity-dependent EIT findings were analyzed retrospectively in a critically ill mechanically ventilated pediatric patient with cystic fibrosis and coincident lung diseases...
April 5, 2016: Clinical Respiratory Journal
https://www.readbyqxmd.com/read/27058500/posterior-convex-release-and-interbody-fusion-for-thoracic-scoliosis-technical-note
#17
MULTICENTER STUDY
Jean-Marc Mac-Thiong, Jahangir Asghar, Stefan Parent, Harry L Shufflebarger, Amer Samdani, Hubert Labelle
Anterior release and fusion is sometimes required in pediatric patients with thoracic scoliosis. Typically, a formal anterior approach is performed through open thoracotomy or video-assisted thoracoscopic surgery. The authors recently developed a technique for anterior release and fusion in thoracic scoliosis referred to as "posterior convex release and interbody fusion" (PCRIF). This technique is performed via the posterior-only approach typically used for posterior instrumentation and fusion and thus avoids a formal anterior approach...
September 2016: Journal of Neurosurgery. Spine
https://www.readbyqxmd.com/read/26643101/intraoperative-mechanical-ventilation-for-the-pediatric-patient
#18
REVIEW
Martin C J Kneyber
Invasive mechanical ventilation is required when children undergo general anesthesia for any procedure. It is remarkable that one of the most practiced interventions such as pediatric mechanical ventilation is hardly supported by any scientific evidence but rather based on personal experience and data from adults, especially as ventilation itself is increasingly recognized as a harmful intervention that causes ventilator-induced lung injury. The use of low tidal volume and higher levels of positive end-expiratory pressure became an integral part of lung-protective ventilation following the outcomes of clinical trials in critically ill adults...
September 2015: Best Practice & Research. Clinical Anaesthesiology
https://www.readbyqxmd.com/read/26618559/airway-cd8-t-cells-are-associated-with-lung-injury-during-infant-viral-respiratory-tract-infection
#19
Thomas J Connors, Thyyar M Ravindranath, Kara L Bickham, Claire L Gordon, Feifan Zhang, Bruce Levin, John S Baird, Donna L Farber
Infants and young children are disproportionately susceptible to severe complications from respiratory viruses, although the underlying mechanisms remain unknown. Recent studies show that the T cell response in the lung is important for protective responses to respiratory infections, although details on the infant/pediatric respiratory immune response remain sparse. The objectives of the present study were to characterize the local versus systemic immune response in infants and young children with respiratory failure from viral respiratory tract infections and its association to disease severity...
June 2016: American Journal of Respiratory Cell and Molecular Biology
https://www.readbyqxmd.com/read/26226341/comparison-of-tidal-volumes-at-the-endotracheal-tube-and-at-the-ventilator
#20
COMPARATIVE STUDY
Paul Kim, Adler Salazar, Patrick A Ross, Christopher J L Newth, Robinder G Khemani
OBJECTIVE: Lung protective ventilation for children with acute respiratory distress syndrome requires accurate assessment of tidal volume. Although modern ventilators compensate for ventilator tubing compliance, tidal volume measured at the ventilator may not be accurate, particularly in small children. Although ventilator-specific proximal flow sensors that measure tidal volume at the endotracheal tube have been developed, there is little information regarding their accuracy. We sought to test the accuracy of ventilator measured tidal volume with and without proximal flow sensors against a calibrated pneumotachometer in children...
November 2015: Pediatric Critical Care Medicine
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