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lung protective ventilation pediatric

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
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)...
October 3, 2016: Prehospital Emergency Care
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
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
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
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
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
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
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
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
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
M Beer, B Ammann
Pediatric lung diseases are a common clinical problem. Besides the clinical examination and laboratory tests, imaging studies are the mainstay in the diagnostics of pediatric lung diseases. Thorough consideration of radiation protection based on optimized equipment also includes the protection of relatives and medical staff. The high impact of radiation protection in children necessitates a different choice of imaging modalities compared to adults. Ultrasound and magnetic resonance imaging (MRI) as adjunct or complementary imaging methods are of greater value than computed tomography (CT)...
July 2015: Der Radiologe
Jeffrey M Feldman
Mechanical ventilation of the pediatric patient is challenging because small changes in delivered volume can be a significant fraction of the intended tidal volume. Anesthesia ventilators have traditionally been poorly suited to delivering small tidal volumes accurately, and pressure-controlled ventilation has become used commonly when caring for pediatric patients. Modern anesthesia ventilators are designed to deliver small volumes accurately to the patient's airway by compensating for the compliance of the breathing system and delivering tidal volume independent of fresh gas flow...
January 2015: Anesthesia and Analgesia
Lorena Fernandez-Restrepo, Minnette Son, Ruben Restrepo, Marcos Restrepo
Respiratory Support PostersSESSION TYPE: Original Investigation PosterPRESENTED ON: Wednesday, October 29, 2014 at 01:30 PM - 02:30 PMPURPOSE: Our aims were to evaluate the tidal volume selection in a group of mechanically ventilated pediatric patients and to determine if a low VTstrategy was used when patients receive high oxygen requirements.METHODS: This was a retrospective cohort study in a single Medical-Surgical PICU during a three-month period. We included patients younger than 18 years of age who required mechanical ventilation for more than 24 hours...
October 1, 2014: Chest
Valéria Cabral Neves, Adriana Koliski, Dinarte José Giraldi
Recent changes were introduced in acute hypoxemic respiratory failure children ventilation methods. There are evidences that less aggressive ventilation strategies can improve severe pulmonary injury survival. Experimental trials evidenced a relationship between inappropriate ventilatory measures and delayed acute pulmonary injury improvement, or even worsening. From this, a protective ventilatory measure arises in combination with alveolar recruitment maneuver. This association is believed in clinical practice to determine importantly reduced morbidity and mortality as well as reduced mechanic ventilation-induced injuries...
December 2009: Revista Brasileira de Terapia Intensiva
Thomas Blakeman, Tyler Britton, Dario Rodriquez, Richard Branson
BACKGROUND: Aeromedical transport of critically ill patients requires continued, accurate performance of equipment at altitude. Changes in barometric pressure can affect the performance of mechanical ventilators calibrated for operation at sea level. Deploying ventilators that can maintain a consistent tidal volume (VT) delivery at various altitudes is imperative for lung protection when transporting wounded war fighters to each echelon of care. METHODS: Three ventilators (Impact 731, Hamilton T1, and CareFusion Revel) were tested at pediatric (50 and 100 mL) and adult (250-750 mL) tidal VTs at 0 and 20 cm H₂O positive end expiratory pressure and at inspired oxygen of 0...
September 2014: Journal of Trauma and Acute Care Surgery
Anne-Françoise Rousseau, Pierre Damas, Ludovic Renwart, Théo Amand, Marie Erpicum, Philippe Morimont, Bernard Dubois, Paul B Massion
Acute respiratory distress syndrome management is currently based on lung protective ventilation. Such strategy may lead to hypercapnic acidosis. We report a case of refractory hypercapnia in a severe burn adult, treated with simplified veno-venous extracorporeal carbon dioxide removal technique. We integrated a pediatric oxygenator in a continuous veno-venous hemofiltration circuit. This technique, used during at least 96h, was feasible, sure and efficient with carbon dioxide removal rate up to 32%.
November 2014: Burns: Journal of the International Society for Burn Injuries
Jacqui Jauncey-Cooke, Chris E East, Fiona Bogossian
Lung recruitment is used as an adjunct to lung protective ventilation strategies. Lung recruitment is a brief, deliberate elevation of transpulmonary pressures beyond what is achieved during tidal ventilation levels. The aim of lung recruitment is to maximise the number of alveoli participating in gas exchange particularly in distal and dependant regions of the lung. This may improve oxygenation and end expiratory levels. Restoration of end expiratory levels and stabilisation of the alveoli may reduce the incidence of ventilator induced lung injury (VILI)...
March 2015: Paediatric Respiratory Reviews
Y Sutherasan, M Vargas, I Brunetti, P Pelosi
The mortality of postcardiac arrest patients has gradually reduced in years but it still is as high as 50%, despite advancements in the diagnostic and therapeutic approaches, i.e. revascularization and therapeutic moderate hypothermia. However, recent evidence suggests that other therapeutic interventions aimed to minimize progressive deterioration of the brain and other organs function might be helpful to reduce in-hospital mortality and improve neurologic outcome as well as quality of life after cardiac arrest...
January 2015: Minerva Anestesiologica
Courtney M Rowan, Mara E Nitu, Mark R Rigby
There is variability in critical care outcome of the HSCT recipient. One potential reason may be due to the inconsistent ventilation approaches. To quantitate this variability, we conducted a survey to assess self-reported use of ventilation and adjunctive strategies for the HSCT recipient. Electronic survey, open from June 2012 through January 201, distributed through the Pediatric Acute Lung Injury and Sepsis Investigators network electronic mailing list. Ninety-four individual responses were from 36 different institutions...
March 2014: Pediatric Transplantation
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