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Chua KY, Paranchothy M, Ng SF, Lee CC. Short-term Non-invasive Ventilation for Children with Palliative Care Needs. Indian J Palliat Care 2024; 30:182-186. [PMID: 38846132 PMCID: PMC11152513 DOI: 10.25259/ijpc_304_2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 02/28/2024] [Indexed: 06/09/2024] Open
Abstract
Objectives Non-invasive ventilation (NIV), namely continuous positive airway pressure (CPAP) and bi-level positive airway pressure (BiPAP), delivers mechanical ventilation without endotracheal intubation. Short-term NIV (planned for <21 days during initiation) can be used for the management of acute respiratory distress (ARD) among paediatric palliative patients with "Do Not Resuscitate or Intubate" (DNI) as the ceiling of care. This study aimed to describe the usage of short-term NIV among paediatric palliative patients in a woman and child hospital with a paediatric palliative subspecialty. Materials and Methods A retrospective and observational study was conducted on all paediatric palliative patients who received short-term NIV in Tunku Azizah Hospital Kuala Lumpur, Malaysia, from March 2020 to May 2022. Results During the study period, short-term NIV was offered on 23 occasions for 20 different children. Indications for short-term NIV include 16 (69.6%) occasions of potentially reversible ARD (NIV Category 1) and 7 (30.4%) occasions of comfort care at the end of life (NIV Category 2). The main cause of ARD was pneumonia (90.3%) due to either aspiration or infection. The modality of NIV used was BiPAP only (14 occasions, 60.9%), CPAP only (three occasions, 13%) and both BiPAP and CPAP (six occasions, 26.1%). The median duration of NIV usage was four days (minimum one day and maximum 15 days). NIV was initiated as an escalation from nasal prong, Ventimask or high-flow mask oxygen on 22 occasions and as weaning down post-extubation on one occasion. For the 22 occasions of escalating therapy, there was significant improvement at six hours compared to pre-NIV in the median heart rate (136 to 121, P=0.002), respiratory rate (40 to 31, P=0.002) and oxygen saturation (96% to 99%, P=0.025). All 17 documented parental impressions of the child's condition post six hours of NIV were that the child had improved. Adverse events during short-term NIV include five episodes (21.7%) of stomach distension, four episodes (17.4%) of skin sores on the face and one episode (4.3%) of excessive drooling. Three patients passed away while on NIV in the hospital. For the other 20 (87%) occasions, patients were able to wean off NIV. Post-weaning off NIV, three patients passed away during the same admission. On 17 occasions, patients were discharged home after weaning off NIV. Conclusion Usage of short-term NIV in paediatric palliative care, where children have an advanced directive in place indicating DNI, as seen in our study, can be a valuable modality of management for distressing symptoms, in addition to the pharmacological management of breathlessness. This is shown through our study to be of benefit in potentially reversible ARD as well as comfort care at the end of life. Further rigorous studies will need to be conducted for a clearer understanding of short-term NIV that would enable the formulation of guidelines to improve the quality of life and death in children.
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Affiliation(s)
- Ker Yang Chua
- Department of Paediatrics, Hospital Tunku Azizah, Ministry of Health, Malaysia
| | - Malini Paranchothy
- Department of Paediatrics, Hospital Tunku Azizah, Ministry of Health, Malaysia
| | - Su Fang Ng
- Department of Paediatrics, Hospital Likas, Ministry of Health, Malaysia
| | - Chee Chan Lee
- Department of Paediatrics, Hospital Tunku Azizah, Ministry of Health, Malaysia
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2
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Ghirardo S, Ullmann N, Zago A, Ghezzi M, Minute M, Madini B, D'Auria E, Basile C, Castelletti F, Chironi F, Capodiferro A, Andrenacci B, Risso FM, Aversa S, Dotta L, Coretti A, Vittucci AC, Badolato R, Amaddeo A, Barbi E, Cutrera R. Increased bronchiolitis burden and severity after the pandemic: a national multicentric study. Ital J Pediatr 2024; 50:25. [PMID: 38350986 PMCID: PMC10865582 DOI: 10.1186/s13052-024-01602-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 01/28/2024] [Indexed: 02/15/2024] Open
Abstract
BACKGROUND The coronavirus 2019 (COVID-19) related containment measures led to the disruption of all virus distribution. Bronchiolitis-related hospitalizations shrank during 2020-2021, rebounding to pre-pandemic numbers the following year. This study aims to describe the trend in bronchiolitis-related hospitalization this year, focusing on severity and viral epidemiology. METHODS We conducted a retrospective investigation collecting clinical records data from all infants hospitalized for bronchiolitis during winter (1st September-31th March) from September 2018 to March 2023 in six Italian hospitals. No trial registration was necessary according to authorization no.9/2014 of the Italian law. RESULTS Nine hundred fifty-three infants were hospitalized for bronchiolitis this last winter, 563 in 2021-2022, 34 in 2020-2021, 395 in 2019-2020 and 483 in 2018-2019. The mean length of stay was significantly longer this year compared to all previous years (mean 7.2 ± 6 days in 2022-2023), compared to 5.7 ± 4 in 2021-2022, 5.3 ± 4 in 2020-2021, 6.4 ± 5 in 2019-2020 and 5.5 ± 4 in 2018-2019 (p < 0.001), respectively. More patients required mechanical ventilation this winter 38 (4%), compared to 6 (1%) in 2021-2022, 0 in 2020-2021, 11 (2%) in 2019-2020 and 6 (1%) in 2018-2019 (p < 0.05), respectively. High-flow nasal cannula and non-invasive respiratory supports were statistically more common last winter (p = 0.001 or less). RSV prevalence and distribution did not differ this winter, but coinfections were more prevalent 307 (42%), 138 (31%) in 2021-2022, 1 (33%) in 2020-2021, 68 (23%) in 2019-2020, 61 (28%) in 2018-2019 (p = 0.001). CONCLUSIONS This study shows a growth of nearly 70% in hospitalisations for bronchiolitis, and an increase in invasive respiratory support and coinfections, suggesting a more severe disease course this winter compared to the last five years.
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Affiliation(s)
- Sergio Ghirardo
- Department of Medicine, Surgery and Health Sciences, University of Trieste, via dell'Istria 65/1, Trieste, Italy.
| | - Nicola Ullmann
- Pediatric Pulmonology and Cystic Fibrosis Unit, Respiratory Intermediate Care Unit, Sleep and Long-Term Ventilation Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Alessandro Zago
- Department of Medicine, Surgery and Health Sciences, University of Trieste, via dell'Istria 65/1, Trieste, Italy
| | - Michele Ghezzi
- Department of Pediatrics, Buzzi Children's Hospital, Milan, Italy
| | - Marta Minute
- Ospedale Regionale Ca Foncello Treviso, Treviso, Italy
| | - Barbara Madini
- S.C. Pediatria Pneumoinfettivologia Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Enza D'Auria
- Department of Pediatrics, Buzzi Children's Hospital, Milan, Italy
| | - Cecilia Basile
- Department of Pediatrics, Buzzi Children's Hospital, Milan, Italy
| | | | - Federica Chironi
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, 20122, Italy
| | - Agata Capodiferro
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, 20122, Italy
| | - Beatrice Andrenacci
- Department of Clinical and Experimental Medicine, Section of Pediatrics, University of Pisa, Pisa, Italy
| | - Francesco Maria Risso
- Neonatal Intensive Care Unit, Children's Hospital, ASST Spedali Civili, Brescia, Italy
| | - Salvatore Aversa
- Neonatal Intensive Care Unit, Children's Hospital, ASST Spedali Civili, Brescia, Italy
| | - Laura Dotta
- Department of Pediatrics and "A. Nocivelli" Institute for Molecular Medicine, Department of Clinical and Experimental Sciences, ASST Spedali Civili of Brescia, University of Brescia, Brescia, Italy
| | - Antonella Coretti
- Pediatric Pulmonology and Cystic Fibrosis Unit, Respiratory Intermediate Care Unit, Sleep and Long-Term Ventilation Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Anna Chiara Vittucci
- Pediatric Pulmonology and Cystic Fibrosis Unit, Respiratory Intermediate Care Unit, Sleep and Long-Term Ventilation Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Raffaele Badolato
- Department of Pediatrics and "A. Nocivelli" Institute for Molecular Medicine, Department of Clinical and Experimental Sciences, ASST Spedali Civili of Brescia, University of Brescia, Brescia, Italy
| | - Alessandro Amaddeo
- Institute for Maternal and Child Health-IRCCS "Burlo Garofolo", Trieste, 34137, Italy
| | - Egidio Barbi
- Department of Medicine, Surgery and Health Sciences, University of Trieste, via dell'Istria 65/1, Trieste, Italy
- Institute for Maternal and Child Health-IRCCS "Burlo Garofolo", Trieste, 34137, Italy
| | - Renato Cutrera
- Pediatric Pulmonology and Cystic Fibrosis Unit, Respiratory Intermediate Care Unit, Sleep and Long-Term Ventilation Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
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Mortamet G, Milési C, Baudin F, Yalindag N, Kneyber M, Pons-Odena M. Weaning from noninvasive respiratory support in children in acute settings: Expert consensus statement using modified Delphi methodology. Pediatr Pulmonol 2024; 59:348-354. [PMID: 37942833 DOI: 10.1002/ppul.26753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 10/29/2023] [Accepted: 11/01/2023] [Indexed: 11/10/2023]
Abstract
OBJECTIVE To reach a consensus on the definition and modalities of weaning from noninvasive ventilation in acute settings. DESIGN A modified Delphi survey using closed and open-ended questions. SETTING Three rounds of consensus determination were sent via electronic mail survey to 33 experts. The survey questionnaire had four sections: definition of weaning, definition of weaning failure, criteria to initiate weaning, and modalities of weaning. Questions where agreement had been reached on round 1 were no longer part of the survey in rounds 2 and 3. SUBJECTS Twenty-five international experts from 10 countries. MEASUREMENT AND MAIN RESULTS Overall, this survey generated positive consensus from experts for 19/35 statements (9 with strong agreement and 10 with weak agreement) about weaning from noninvasive respiratory support. No negative consensus could be identified. CONCLUSION The clinical practice statements issued address important aspects of definition of weaning, definition of weaning failure, criteria to initiate weaning, and modalities of weaning in acute settings.
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Affiliation(s)
- Guillaume Mortamet
- Pediatric Intensive Care Unit, Grenoble-Alpes University Hospital, Grenoble, France
| | - Christophe Milési
- Pediatric Intensive Care Unit, Montpellier University Hospital, Montpellier, France
| | - Florent Baudin
- Pediatric Intensive Care Unit, Women Mother Children Hospital, Bron, France
| | - Nilufer Yalindag
- Pediatric Intensive Care Unit, Marmara University Faculty of Medicine, Istanbul, Turkey
| | - Martin Kneyber
- Department of Pediatrics, Division of Paediatric Critical Care Medicine, Beatrix Children's Hospital Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Critical Care, Anaesthesiology, Peri-operative & Emergency Medicine (CAPE), University of Groningen, Groningen, The Netherlands
| | - Marti Pons-Odena
- Immune and Respiratory Dysfunction Research Group, Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain
- Pediatric Intensive Care and Intermediate Care Department, Sant Joan de Déu University Hospital, Esplugues de Llobregat, Spain
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4
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Emeriaud G, Pons-Òdena M, Bhalla AK, Shein SL, Killien EY, Alapont VMI, Rowan C, Baudin F, Lin JC, Grégoire G, Napolitano N, Mayordomo-Colunga J, Diaz F, Cruces P, Medina A, Smith L, Khemani RG. Noninvasive Ventilation for Pediatric Acute Respiratory Distress Syndrome: Experience From the 2016/2017 Pediatric Acute Respiratory Distress Syndrome Incidence and Epidemiology Prospective Cohort Study. Pediatr Crit Care Med 2023; 24:715-726. [PMID: 37255352 PMCID: PMC10524424 DOI: 10.1097/pcc.0000000000003281] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
OBJECTIVES The worldwide practice and impact of noninvasive ventilation (NIV) in pediatric acute respiratory distress syndrome (PARDS) is unknown. We sought to describe NIV use and associated clinical outcomes in PARDS. DESIGN Planned ancillary study to the 2016/2017 prospective Pediatric Acute Respiratory Distress Syndrome Incidence and Epidemiology study. SETTING One hundred five international PICUs. PATIENTS Patients with newly diagnosed PARDS admitted during 10 study weeks. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Children were categorized by their respiratory support at PARDS diagnosis into NIV or invasive mechanical ventilation (IMV) groups. Of 708 subjects with PARDS, 160 patients (23%) received NIV at PARDS diagnosis (NIV group). NIV failure rate (defined as tracheal intubation or death) was 84 of 160 patients (53%). Higher nonrespiratory pediatric logistic organ dysfunction (PELOD-2) score, Pa o2 /F io2 was less than 100 at PARDS diagnosis, immunosuppression, and male sex were independently associated with NIV failure. NIV failure was 100% among patients with nonrespiratory PELOD-2 score greater than 2, Pa o2 /F io2 less than 100, and immunosuppression all present. Among patients with Pa o2 /F io2 greater than 100, children in the NIV group had shorter total duration of NIV and IMV, than the IMV at initial diagnosis group. We failed to identify associations between NIV use and PICU survival in a multivariable Cox regression analysis (hazard ratio 1.04 [95% CI, 0.61-1.80]) or mortality in a propensity score matched analysis ( p = 0.369). CONCLUSIONS Use of NIV at PARDS diagnosis was associated with shorter exposure to IMV in children with mild to moderate hypoxemia. Even though risk of NIV failure was high in some children, we failed to identify greater hazard of mortality in these patients.
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Affiliation(s)
- Guillaume Emeriaud
- Department of Pediatrics, Pediatric Intensive Care Unit, CHU Sainte-Justine, Université de Montréal, Montreal, QC, Canada
| | - Marti Pons-Òdena
- Inmune and Respiratory dysfunction in the child research group. Institut de Recerca Sant Joan de Déu, Santa Rosa 39-57, 08950 Esplugues de Llobregat, Spain
- Pediatric Intensive Care and Intermediate care Department, Sant Joan de Déu University Hospital, Universitat de Barcelona, Esplugues de Llobregat, Spain
| | - Anoopindar K Bhalla
- Department of Anesthesiology and Critical Care Medicine, Children’s Hospital Los Angeles, USA
- Department of Pediatrics, Keck School of Medicine, University of Southern California, USA
| | - Steven L Shein
- Rainbow Babies and Children’s Hospital, Division of Pediatric Critical Care Medicine, Cleveland Ohio USA
| | - Elizabeth Y Killien
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Washington School of Medicine, USA
| | | | - Courtney Rowan
- Department of Pediatrics, Division of Pediatric Critical Care Medicine, Indiana University School of Medicine, Riley Hospital for Children, Indianapolis, IN, USA
| | - Florent Baudin
- Réanimation Pédiatrique, Hospices Civils de Lyon, Hôpital Femme Mère Enfant, Lyon, France
| | - John C Lin
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Washington University School of Medicine, USA
| | - Gabrielle Grégoire
- Applied Clinical Research Unit, CHU Sainte-Justine, Montreal, QC, Canada
| | - Natalie Napolitano
- Respiratory Therapy Department, Children’s Hospital of Philadelphia, USA
| | - Juan Mayordomo-Colunga
- Pediatric Intensive Care Unit. Hospital Universitario Central de Asturias, Spain
- Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Spain
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Spain
| | - Franco Diaz
- Instituto de Ciencias e innovación en medicina (ICIM), Universidad del Desarrollo, Santiago de Chile
- Unidad de Paciente Crítico Pediátrico, Hospital El Carmen de Maipú, Santiago de Chile
| | - Pablo Cruces
- Unidad de Paciente Crítico Pediátrico, Hospital El Carmen de Maipú, Santiago de Chile
- Escuela de Medicina Veterinaria, Facultad de Ciencias de la Vida, Universidad Andres Bello, Santiago, Chile
| | - Alberto Medina
- Pediatric Intensive Care Unit. Hospital Universitario Central de Asturias, Spain
- Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Spain
| | - Lincoln Smith
- Department of Pediatrics, University of Washington, Seattle Children’s Hospital, USA
| | - Robinder G Khemani
- Department of Anesthesiology and Critical Care Medicine, Children’s Hospital Los Angeles, USA
- Department of Pediatrics, Keck School of Medicine, University of Southern California, USA
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Cassibba J, Fumagalli A, Alexandre A, Chauveau A, Milési C, Mortamet G. How crucial is the role of pediatric critical care nurses in the management of patients with noninvasive ventilatory support. Pediatr Pulmonol 2023; 58:2678-2680. [PMID: 37283239 DOI: 10.1002/ppul.26549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 05/26/2023] [Accepted: 05/29/2023] [Indexed: 06/08/2023]
Affiliation(s)
- Julie Cassibba
- Pediatric Intensive Care Unit, Grenoble Alpes University Hospital, Grenoble, France
| | - Alice Fumagalli
- Pediatric Intensive Care Unit, Grenoble Alpes University Hospital, Grenoble, France
| | - Aurélie Alexandre
- Pediatric Intensive Care Unit, Grenoble Alpes University Hospital, Grenoble, France
| | - Anne Chauveau
- Pediatric Intensive Care Unit, Nantes University Hospital, Nantes, France
| | - Christophe Milési
- Department of Neonatal Medicine and Pediatric Intensive Care, Arnaud de Villeneuve Hospital, Montpellier University Hospital Centre, Montpellier, France
| | - Guillaume Mortamet
- Pediatric Intensive Care Unit, Grenoble Alpes University Hospital, Grenoble, France
- Inserm 1042 Unit, Grenoble Alpes University, Grenoble, France
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MacLean JE, Fauroux B. Long-term non-invasive ventilation in children: Transition from hospital to home. Paediatr Respir Rev 2023; 47:3-10. [PMID: 36806331 DOI: 10.1016/j.prrv.2023.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 01/10/2023] [Indexed: 01/13/2023]
Abstract
Long-term non-invasive ventilation (NIV) is an accepted therapy for sleep-related respiratory disorders and respiratory insufficiency or failure. Increase in the use of long-term NIV may, in part, be driven by an increase in the number of children surviving critical illness with comorbidities. As a result, some children start on long-term NIV as part of transitioning from hospital to home. NIV may be used in acute illness to avoid intubation, facilitate extubation or support tracheostomy decannulation, and to avoid the need for a tracheostomy for long-term invasive ventilation. The decision about whether long-term NIV is appropriate for an individual child and their family needs to be made with care. Preparing for transition from the hospital to home involves understanding how NIV equipment is obtained and set-up, education and training for parents/caregivers, and arranging a plan for clinical follow-up. While planning for these transitions is challenging, the goals of a shorter time in hospital and a child living well at home with their family are important.
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Affiliation(s)
- Joanna E MacLean
- Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Canada; Women and Children's Health Research Institute, University of Alberta, Canada; Stollery Children's Hospital, Edmonton, Alberta, Canada
| | - Brigitte Fauroux
- Pediatric Noninvasive Ventilation and Sleep Unit, Necker University Hospital, AP-HP, Paris, France; Université de Paris, EA 7330 VIFASOM, F-75004 Paris, France
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7
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Cassibba J, Freycon C, Doutau J, Pin I, Bellier A, Fauroux B, Mortamet G. Weaning from noninvasive ventilatory support in infants with severe bronchiolitis: An observational study. Arch Pediatr 2023; 30:201-205. [PMID: 36990935 DOI: 10.1016/j.arcped.2023.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 11/24/2022] [Accepted: 03/04/2023] [Indexed: 03/29/2023]
Abstract
BACKGROUND The aim of the study was to analyze the weaning success, the type of weaning procedures, and weaning duration in consecutive infants hospitalized in a pediatric intensive care unit over a winter season. METHODS A retrospective observational study was conducted in a pediatric intensive care unit in a tertiary center. Infants hospitalized for severe bronchiolitis were included and the weaning procedure from continuous positive airway pressure (CPAP), noninvasive ventilation (NIV), or high-flow nasal cannula (HFNC) was analyzed. RESULTS Data from 95 infants (median age, 47 days) were analyzed. On admission, 26 (27%), 46 (49%), and 23 (24%) infants were supported with CPAP, NIV, and HFNC, respectively. Weaning failed in one (4%), nine (20%), and one (4%) infants while supported with CPAP, NIV, or HFNC, respectively (p = 0.1). In infants supported with CPAP, CPAP was stopped directly in five patients (19%) while HFNC was used as an intermediate ventilatory support in 21 (81%). The duration of weaning was shorter for HFNC (17 h, [IQR: 0-26]) than for CPAP (24 h, [14-40]) and NIV (28 h, [19-49]) (p < 0.01). CONCLUSIONS The weaning phase corresponds to a large proportion of noninvasive ventilatory support duration in infants with bronchiolitis. The weaning procedure following a "step-down" strategy may lead to an increase in the duration of weaning.
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Affiliation(s)
- J Cassibba
- Pediatric Department, Grenoble Alpes University Hospital, Grenoble, France.
| | - C Freycon
- Pediatric Department, Grenoble Alpes University Hospital, Grenoble, France
| | - J Doutau
- Neonatal Intensive Care Unit, Grenoble Alpes University Hospital, Grenoble, France
| | - I Pin
- Pediatric Department, Grenoble Alpes University Hospital, Grenoble, France
| | - A Bellier
- Public Health Department, Grenoble Alpes University Hospital, Grenoble, France
| | - B Fauroux
- Pediatric Noninvasive Ventilation and Sleep Unit, AP-HP, Hôpital Necker-Enfants Malades, Paris, France; Université de Paris, VIFASOM, Paris, France
| | - G Mortamet
- Inserm U1042 unit, Grenoble Alpes University, Grenoble, France; Pediatric Intensive Care Unit, Grenoble Alpes University Hospital, Grenoble, France
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8
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Milési C, Baudin F, Durand P, Emeriaud G, Essouri S, Pouyau R, Baleine J, Beldjilali S, Bordessoule A, Breinig S, Demaret P, Desprez P, Gaillard-Leroux B, Guichoux J, Guilbert AS, Guillot C, Jean S, Levy M, Noizet-Yverneau O, Rambaud J, Recher M, Reynaud S, Valla F, Radoui K, Faure MA, Ferraro G, Mortamet G. Clinical practice guidelines: management of severe bronchiolitis in infants under 12 months old admitted to a pediatric critical care unit. Intensive Care Med 2023; 49:5-25. [PMID: 36592200 DOI: 10.1007/s00134-022-06918-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 10/13/2022] [Indexed: 01/03/2023]
Abstract
PURPOSE We present guidelines for the management of infants under 12 months of age with severe bronchiolitis with the aim of creating a series of pragmatic recommendations for a patient subgroup that is poorly individualized in national and international guidelines. METHODS Twenty-five French-speaking experts, all members of the Groupe Francophone de Réanimation et Urgence Pédiatriques (French-speaking group of paediatric intensive and emergency care; GFRUP) (Algeria, Belgium, Canada, France, Switzerland), collaborated from 2021 to 2022 through teleconferences and face-to-face meetings. The guidelines cover five areas: (1) criteria for admission to a pediatric critical care unit, (2) environment and monitoring, (3) feeding and hydration, (4) ventilatory support and (5) adjuvant therapies. The questions were written in the Patient-Intervention-Comparison-Outcome (PICO) format. An extensive Anglophone and Francophone literature search indexed in the MEDLINE database via PubMed, Web of Science, Cochrane and Embase was performed using pre-established keywords. The texts were analyzed and classified according to the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology. When this method did not apply, an expert opinion was given. Each of these recommendations was voted on by all the experts according to the Delphi methodology. RESULTS This group proposes 40 recommendations. The GRADE methodology could be applied for 17 of them (3 strong, 14 conditional) and an expert opinion was given for the remaining 23. All received strong approval during the first round of voting. CONCLUSION These guidelines cover the different aspects in the management of severe bronchiolitis in infants admitted to pediatric critical care units. Compared to the different ways to manage patients with severe bronchiolitis described in the literature, our original work proposes an overall less invasive approach in terms of monitoring and treatment.
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Affiliation(s)
- Christophe Milési
- Pediatric Intensive Care Unit, Montpellier University Hospital, Montpellier, France.
| | - Florent Baudin
- Pediatric Intensive Care Unit, Lyon Hospital Femme-Mère-Enfants, Bron, France
| | - Philippe Durand
- Pediatric Intensive Care Unit, Bicêtre Hospital, Assistance Publique des Hôpitaux de Paris, Kremlin-Bicêtre, France
| | - Guillaume Emeriaud
- Pediatric Intensive Care Unit, Sainte-Justine University Hospital, Montreal, Canada
| | - Sandrine Essouri
- Pediatric Department, Sainte-Justine University Hospital, Montreal, Canada
| | - Robin Pouyau
- Pediatric Intensive Care Unit, Lyon Hospital Femme-Mère-Enfants, Bron, France
| | - Julien Baleine
- Pediatric Intensive Care Unit, Montpellier University Hospital, Montpellier, France
| | - Sophie Beldjilali
- Pediatric Intensive Care Unit, La Timone University Hospital, Assistance Publique des Hôpitaux de Marseille, Marseille, France
| | - Alice Bordessoule
- Pediatric Intensive Care Unit, Geneva University Hospital, Geneva, Switzerland
| | - Sophie Breinig
- Pediatric Intensive Care Unit, Toulouse University Hospital, Toulouse, France
| | - Pierre Demaret
- Intensive Care Unit, Liège University Hospital, Liège, Belgium
| | - Philippe Desprez
- Pediatric Intensive Care Unit, Point-à-Pitre University Hospital, Point-à-Pitre, France
| | | | - Julie Guichoux
- Pediatric Intensive Care Unit, Bordeaux University Hospital, Bordeaux, France
| | - Anne-Sophie Guilbert
- Pediatric Intensive Care Unit, Strasbourg University Hospital, Strasbourg, France
| | - Camille Guillot
- Pediatric Intensive Care Unit, Lille University Hospital, Lille, France
| | - Sandrine Jean
- Pediatric Intensive Care Unit, Trousseau Hospital, Assistance Publique des Hôpitaux de Paris, Paris, France
| | - Michael Levy
- Pediatric Intensive Care Unit, Robert Debré Hospital, Assistance Publique des Hôpitaux de Paris, Paris, France
| | | | - Jérôme Rambaud
- Pediatric Intensive Care Unit, Trousseau Hospital, Assistance Publique des Hôpitaux de Paris, Paris, France
| | - Morgan Recher
- Pediatric Intensive Care Unit, Lille University Hospital, Lille, France
| | - Stéphanie Reynaud
- Pediatric Intensive Care Unit, Lyon Hospital Femme-Mère-Enfants, Bron, France
| | - Fréderic Valla
- Pediatric Intensive Care Unit, Lyon Hospital Femme-Mère-Enfants, Bron, France
| | - Karim Radoui
- Pneumology EHS Pediatric Department, Faculté de Médecine d'Oran, Canastel, Oran, Algeria
| | | | - Guillaume Ferraro
- Pediatric Emergency Department, Nice University Hospital, Nice, France
| | - Guillaume Mortamet
- Pediatric Intensive Care Unit, Grenoble-Alpes University Hospital, Grenoble, France
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Bockstedte M, Xepapadeas AB, Spintzyk S, Poets CF, Koos B, Aretxabaleta M. Development of Personalized Non-Invasive Ventilation Interfaces for Neonatal and Pediatric Application Using Additive Manufacturing. J Pers Med 2022; 12:jpm12040604. [PMID: 35455720 PMCID: PMC9026706 DOI: 10.3390/jpm12040604] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 03/31/2022] [Accepted: 04/06/2022] [Indexed: 11/16/2022] Open
Abstract
The objective of this study was to present a methodology and manufacturing workflow for non-invasive ventilation interfaces (NIV) for neonates and small infants. It aimed to procure a fast and feasible solution for personalized NIV produced in-house with the aim of improving fit and comfort for the patient. Three-dimensional scans were obtained by means of an intraoral (Trios 3) and a facial scanner (3dMd Flex System). Fusion 360 3D-modelling software was employed to automatize the design of the masks and their respective casting molds. These molds were additively manufactured by stereolithography (SLA) and fused filament fabrication (FFF) technologies. Silicone was poured into the molds to produce the medical device. In this way, patient individualized oronasal and nasal masks were produced. An automated design workflow and use of additive manufacturing enabled a fast and feasible procedure. Despite the cost for individualization likely being higher than for standard masks, a user-friendly workflow for in-house manufacturing of these medical appliances proved to have potential for improving NIV in neonates and infants, as well as increasing comfort.
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Affiliation(s)
- Marit Bockstedte
- Department of Orthodontics, University Centre of Dentistry, Oral Medicine and Maxillofacial Surgery within the University Hospital Tübingen, Osianderstr. 2-8, 72076 Tübingen, Germany; (A.B.X.); (B.K.); (M.A.)
- Correspondence:
| | - Alexander B. Xepapadeas
- Department of Orthodontics, University Centre of Dentistry, Oral Medicine and Maxillofacial Surgery within the University Hospital Tübingen, Osianderstr. 2-8, 72076 Tübingen, Germany; (A.B.X.); (B.K.); (M.A.)
| | - Sebastian Spintzyk
- Section Medical Materials Science and Technology, University Hospital Tübingen, Osianderstr. 2-8, 72076 Tübingen, Germany;
- ADMiRE Lab-Additive Manufacturing, Intelligent Robotics, Sensors and Engineering, School of Engineering and IT, Carinthia University of Applied Sciences, 9524 Villach, Austria
| | - Christian F. Poets
- Department of Neonatology, University Children’s Hospital, Calwerstr. 7, 72076 Tübingen, Germany;
| | - Bernd Koos
- Department of Orthodontics, University Centre of Dentistry, Oral Medicine and Maxillofacial Surgery within the University Hospital Tübingen, Osianderstr. 2-8, 72076 Tübingen, Germany; (A.B.X.); (B.K.); (M.A.)
| | - Maite Aretxabaleta
- Department of Orthodontics, University Centre of Dentistry, Oral Medicine and Maxillofacial Surgery within the University Hospital Tübingen, Osianderstr. 2-8, 72076 Tübingen, Germany; (A.B.X.); (B.K.); (M.A.)
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10
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Hutton H, Sherif A, Ari A, Ramnarayan P, Jones A. Non-Invasive Respiratory Support During Pediatric Critical Care Transport: A Retrospective Cohort Study. J Pediatr Intensive Care 2022. [DOI: 10.1055/s-0041-1741426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
AbstractNon-invasive respiratory support (NRS) including high flow nasal cannula (HFNC), continuous positive airway pressure (CPAP), and bilevel positive airway pressure (BiPAP) is increasingly used for children with respiratory failure requiring interhospital transport by pediatric critical care transport (PCCT) teams. In this retrospective observational study of children receiving NRS on transport between January 1st, 2017 and December 31st, 2019 by a single PCCT service in England, we describe a cohort of children, looking at patient characteristics, journey logistics, adverse events, and failure of NRS (as defined by emergency intubation on transport or within 24 hours of arriving on the pediatric intensive care unit), and to attempt to identify risk factors that were associated with NRS failure. A total of 3,504 patients were transported during the study period. Three hundred and seventeen (9%) received NRS. Median age was 4.9 months (IQR 1.0–18.2); median weight was 5.1 kg (IQR 3.1–13). The primary diagnostic category was cardiorespiratory in 244/317 (77%) patients. Comorbidities were recorded in 189/317 (59.6%) patients. Median Pediatric Index of Mortality-3 (PIM3) score was 0.024 (IQR 0.012–0.045). Median stabilization time was 80 minutes while median patient journey time was 40 minutes. Nineteen adverse events were described (clinical deterioration, equipment failure/interface issues) affecting 6% of transports. The incidence of NRS failure was 6.6%. No risk factors associated with NRS failure were identified. We concluded that NRS can be considered safe during pediatric transport for children with a wide range of diagnoses and varying clinical severity, with a low rate of adverse events and need for intubation on transport or on the PICU.
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Affiliation(s)
- Hayley Hutton
- Department of Pediatric Intensive Care, Great Ormond Street Hospital for Children, London, United Kingdom
| | - Ahmed Sherif
- Department of Pediatric Intensive Care, Great Ormond Street Hospital for Children, London, United Kingdom
| | - Abhijit Ari
- Department of Pediatric Intensive Care, Great Ormond Street Hospital for Children, London, United Kingdom
| | - Padmanabhan Ramnarayan
- Department of Clinical Service, Children's Acute Transport Service, Great Ormond Street Hospital for Children, London, United Kingdom
| | - Andrew Jones
- Children's Acute Transport Service, Great Ormond Street Hospital for Children, London, United Kingdom
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11
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Mu SC, Chien YH, Lai PZ, Chao KY. Helmet Ventilation for Pediatric Patients During the COVID-19 Pandemic: A Narrative Review. Front Pediatr 2022; 10:839476. [PMID: 35186812 PMCID: PMC8847782 DOI: 10.3389/fped.2022.839476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 01/11/2022] [Indexed: 12/15/2022] Open
Abstract
The air dispersion of exhaled droplets from patients is currently considered a major route of coronavirus disease 2019 (COVID-19) transmission, the use of non-invasive ventilation (NIV) should be more cautiously employed during the COVID-19 pandemic. Recently, helmet ventilation has been identified as the optimal treatment for acute hypoxia respiratory failure caused by COVID-19 due to its ability to deliver NIV respiratory support with high tolerability, low air leakage, and improved seal integrity. In the present review, we provide an evidence-based overview of the use of helmet ventilation in children with respiratory failure.
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Affiliation(s)
- Shu-Chi Mu
- Department of Pediatrics, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan.,School of Medicine, College of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan
| | - Yu-Hsuan Chien
- Department of Pediatrics, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan.,Department of Pediatrics, Fu Jen Catholic University Hospital, Fu Jen Catholic University, New Taipei City, Taiwan
| | - Pin-Zhen Lai
- Department of Respiratory Therapy, Fu Jen Catholic University Hospital, Fu Jen Catholic University, New Taipei City, Taiwan
| | - Ke-Yun Chao
- Department of Respiratory Therapy, Fu Jen Catholic University Hospital, Fu Jen Catholic University, New Taipei City, Taiwan.,School of Physical Therapy, Graduate Institute of Rehabilitation Sciences, Chang Gung University, Taoyuan, Taiwan
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12
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Hovenier R, Goto L, Huysmans T, van Gestel M, Klein-Blommert R, Markhorst D, Dijkman C, Bem RA. Reduced Air Leakage During Non-Invasive Ventilation Using a Simple Anesthetic Mask With 3D-Printed Adaptor in an Anthropometric Based Pediatric Head-Lung Model. Front Pediatr 2022; 10:873426. [PMID: 35573957 PMCID: PMC9096156 DOI: 10.3389/fped.2022.873426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 03/29/2022] [Indexed: 11/16/2022] Open
Abstract
Non-invasive ventilation (NIV) is increasingly used in the support of acute respiratory failure in critically ill children admitted to the pediatric intensive care unit (PICU). One of the major challenges in pediatric NIV is finding an optimal fitting mask that limits air leakage, in particular for young children and those with specific facial features. Here, we describe the development of a pediatric head-lung model, based on 3D anthropometric data, to simulate pediatric NIV in a 1-year-old child, which can serve as a tool to investigate the effectiveness of NIV masks. Using this model, the primary aim of this study was to determine the extent of air leakage during NIV with our recently described simple anesthetic mask with a 3D-printed quick-release adaptor, as compared with a commercially available pediatric NIV mask. The simple anesthetic mask provided a better seal resulting in lower air leakage at various positive pressure levels as compared with the commercial mask. These data further support the use of the simple anesthetic mask as a reasonable alternative during pediatric NIV in the acute setting. Moreover, the pediatric head-lung model provides a promising tool to study the applicability and effectiveness of customized pediatric NIV masks in the future.
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Affiliation(s)
- Renée Hovenier
- Pediatric Intensive Care Unit, Emma Children's Hospital, Amsterdam University Medical Centers, Location AMC, Amsterdam, Netherlands.,Department of Technical Medicine, University of Twente, Enschede, Netherlands
| | - Lyè Goto
- Faculty of Industrial Design Engineering, Delft University of Technology, Delft, Netherlands
| | - Toon Huysmans
- Faculty of Industrial Design Engineering, Delft University of Technology, Delft, Netherlands.,Imec-Vision Lab, Department of Physics, University of Antwerp, Antwerp, Belgium
| | - Monica van Gestel
- Pediatric Intensive Care Unit, Emma Children's Hospital, Amsterdam University Medical Centers, Location AMC, Amsterdam, Netherlands
| | - Rozalinde Klein-Blommert
- Pediatric Intensive Care Unit, Emma Children's Hospital, Amsterdam University Medical Centers, Location AMC, Amsterdam, Netherlands
| | - Dick Markhorst
- Pediatric Intensive Care Unit, Emma Children's Hospital, Amsterdam University Medical Centers, Location AMC, Amsterdam, Netherlands
| | - Coen Dijkman
- Department for Medical Innovation and Development, Amsterdam University Medical Centers, Location AMC, Amsterdam, Netherlands
| | - Reinout A Bem
- Pediatric Intensive Care Unit, Emma Children's Hospital, Amsterdam University Medical Centers, Location AMC, Amsterdam, Netherlands
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13
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Walsh A, Furlong M, Mc Nally P, O'Reilly R, Javadpour S, Cox DW. Pediatric invasive long-term ventilation-A 10-year review. Pediatr Pulmonol 2021; 56:3410-3416. [PMID: 34357690 DOI: 10.1002/ppul.25618] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 07/20/2021] [Accepted: 08/04/2021] [Indexed: 11/06/2022]
Abstract
INTRODUCTION The number of children with complex physical and developmental pathologies, including chronic respiratory insufficiency, surviving and growing beyond early childhood continues to rise. No study has examined the clinical pathway of children on invasive long-term mechanical ventilation (LTMV) in an Irish setting. Our data over a 10-year period were reviewed to see if our demographics and outcomes are in line with global trends. METHODS Children's Health Ireland (CHI) at Crumlin, Dublin is Ireland's largest tertiary pediatric hospital. A retrospective review analyzed data from children in our center commenced on LTMV via a tracheostomy over 10 years (2009-2018). This data was subdivided into two epochs for statistical analysis of longitudinal trends. RESULTS Forty-six children were commenced on LTMV from 2009 to 2018. Many had complex medical diagnoses with associated comorbidities. Far less children, 30.4% (n = 14) commenced LTMV in the latter half of the 10-year period, they also fared better in all aspects of their treatment course. Focusing solely on children who have needed LTMV over this timeframe we have been able to isolate trends specific to this cohort. Less patients commenced LTMV on a year-on-year basis, and for those that require tracheostomy and LTMV, their journey to decannulation tends to be shorter. CONCLUSION Over the period reviewed, less patients over time necessitated LTMV, and those patients are being weaned and decannulated with ever more success. This has implications in terms of predicting numbers transitioning to adult services and allocation of hospital and community care resources.
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Affiliation(s)
- Aoibhinn Walsh
- Department of Respiratory Medicine, Children's Health Ireland at Crumlin, Dublin, Ireland
| | - Mairead Furlong
- Department of Respiratory Medicine, Children's Health Ireland at Crumlin, Dublin, Ireland
| | - Paul Mc Nally
- Department of Respiratory Medicine, Children's Health Ireland at Crumlin, Dublin, Ireland.,Department of Paediatrics, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Ruth O'Reilly
- Department of Respiratory Medicine, Children's Health Ireland at Crumlin, Dublin, Ireland
| | - Sheila Javadpour
- Department of Respiratory Medicine, Children's Health Ireland at Crumlin, Dublin, Ireland
| | - Desmond W Cox
- Department of Respiratory Medicine, Children's Health Ireland at Crumlin, Dublin, Ireland.,School of Medicine, University College Dublin, Dublin, Ireland
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14
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Weaning and the Suitability of Retrospective Cohort Studies. Crit Care Med 2021; 49:369-372. [PMID: 33438976 DOI: 10.1097/ccm.0000000000004798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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15
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Impact of Failure of Noninvasive Ventilation on the Safety of Pediatric Tracheal Intubation. Crit Care Med 2021; 48:1503-1512. [PMID: 32701551 DOI: 10.1097/ccm.0000000000004500] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Noninvasive ventilation is widely used to avoid tracheal intubation in critically ill children. The objective of this study was to assess whether noninvasive ventilation failure was associated with severe tracheal intubation-associated events and severe oxygen desaturation during tracheal intubation. DESIGN Prospective multicenter cohort study of consecutive intubated patients using the National Emergency Airway Registry for Children registry. SETTING Thirteen PICUs (in 12 institutions) in the United States and Canada. PATIENTS All patients undergoing tracheal intubation in participating sites were included. Noninvasive ventilation failure group included children with any use of high-flow nasal cannula, continuous positive airway pressure, or bilevel noninvasive ventilation in the 6 hours prior to tracheal intubation. Primary tracheal intubation group included children without exposure to noninvasive ventilation within 6 hours before tracheal intubation. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Severe tracheal intubation-associated events (cardiac arrest, esophageal intubation with delayed recognition, emesis with aspiration, hypotension requiring intervention, laryngospasm, pneumothorax, pneumomediastinum) and severe oxygen desaturation (< 70%) were recorded prospectively. The study included 956 tracheal intubation encounters; 424 tracheal intubations (44%) occurred after noninvasive ventilation failure, with a median of 13 hours (interquartile range, 4-38 hr) of noninvasive ventilation. Noninvasive ventilation failure group included more infants (47% vs 33%; p < 0.001) and patients with a respiratory diagnosis (56% vs 30%; p < 0.001). Noninvasive ventilation failure was not associated with severe tracheal intubation-associated events (5% vs 5% without noninvasive ventilation; p = 0.96) but was associated with severe desaturation (15% vs 9% without noninvasive ventilation; p = 0.005). After controlling for baseline differences, noninvasive ventilation failure was not independently associated with severe tracheal intubation-associated events (p = 0.35) or severe desaturation (p = 0.08). In the noninvasive ventilation failure group, higher FIO2 before tracheal intubation (≥ 70%) was associated with severe tracheal intubation-associated events. CONCLUSIONS Critically ill children are frequently exposed to noninvasive ventilation before intubation. Noninvasive ventilation failure was not independently associated with severe tracheal intubation-associated events or severe oxygen desaturation compared to primary tracheal intubation.
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16
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Willox M, Metherall P, McCarthy AD, Jeays-Ward K, Barker N, Reed H, Elphick HE. Custom-made 3D printed masks for children using non-invasive ventilation: a comparison of 3D scanning technologies and specifications for future clinical service use, guided by patient and professional experience. J Med Eng Technol 2021; 45:457-472. [PMID: 34016021 DOI: 10.1080/03091902.2021.1921869] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Non-invasive ventilation (NIV) is assisted mechanical ventilation delivered via a facemask for people with chronic conditions that affect breathing. Mass-produced masks are available for both the adult and paediatric markets but masks that fit well are difficult to find for children who are small or have asymmetrical facial features. A good fit between the mask and the patient's face to minimise unintentional air leakage is essential to deliver the treatment effectively. We present an innovative use of 3D assessment and manufacturing technologies to deliver novel custom-made facemasks for children for whom a well-fitting standard mask is not available. This paper aims to describe the processes undertaken to investigate and compare currently available technologies for 3D scanning children and to explore the design of a system for creating custom-made paediatric NIV masks within the NHS. The paper therefore considers not only the quality and accuracy of the data, but also other factors such as the time and ease of process. Searches for all currently available scanning technologies were made. Photogrammetry image stitch using a smartphone and a digital camera, and two structured light scanners were selected and compared in the laboratory, in discussion with user groups, and in adult volunteers. Using the processes described, it became apparent that the optimal 3D scanning system for this purpose was the handheld structured light scanner. This option offered both superior accuracy and convenience and was more cost effective.
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Affiliation(s)
- Matt Willox
- ACES, Sheffield Hallam University, Sheffield, UK
| | - Peter Metherall
- 3D Lab, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Avril D McCarthy
- NIHR Devices for Dignity MedTech Co-operative, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Katherine Jeays-Ward
- NIHR Devices for Dignity MedTech Co-operative, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK.,Clinical Engineering, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Nicki Barker
- Sheffield Children's NHS Foundation Trust, Sheffield, UK
| | - Heath Reed
- ACES, Sheffield Hallam University, Sheffield, UK
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17
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Harwayne-Gidansky I, Emeriaud G, Nishisaki A. Noninvasive Ventilation for Pediatric Acute Respiratory Distress Syndrome: Is It Worth the Risk? Crit Care Med 2021; 49:873-875. [PMID: 33854014 DOI: 10.1097/ccm.0000000000004855] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Ilana Harwayne-Gidansky
- Department of Pediatrics, Pediatric Intensive Care Unit, Stony Brook Children's Hospital, Renaissance School of Medicine, Stony Brook, NY
| | - Guillaume Emeriaud
- Department of Pediatrics, Pediatric Intensive Care Unit, CHU Sainte-Justine Université de Montréal, Montréal, QC, Canada
| | - Akira Nishisaki
- Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, Philadelphia, PA
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18
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Abstract
OBJECTIVES To explore enteral feeding practices and the achievement of energy targets in children on noninvasive respiratory support, in four European PICUs. DESIGN A four-center retrospective cohort study. SETTING Four PICUs: Bristol, United Kingdom; Lyon, France; Madrid, Spain; and Rotterdam, The Netherlands. PATIENTS Children in PICU who required acute noninvasive respiratory support in the first 7 days. The primary outcome was achievement of standardized kcal/goal. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS A total of 325 children were included (Bristol 104; Lyon 99; Madrid 72; and Rotterdam 50). The median (interquartile range) age and weight were 3 months (1-16 mo) and 5 kg (4-10 mo), respectively, with 66% admitted with respiratory failure. There were large between-center variations in practices. Overall, 190/325 (58.5%) received noninvasive respiratory support in order to prevent intubation and 41.5% after extubation. The main modes of noninvasive respiratory support used were high-flow nasal cannula 43.6%, bilevel positive airway pressure 33.2%, and continuous positive airway pressure 21.2%. Most children (77.8%) were fed gastrically (48.4% continuously) and the median time to the first feed after noninvasive respiratory support initiation was 4 hours (interquartile range, 1-9 hr). The median percentage of time a child was nil per oral while on noninvasive respiratory support was 4 hours (2-13 hr). Overall, children received a median of 56% (25-82%) of their energy goals compared with a standardized target of 0.85 of the recommended dietary allowance. Patients receiving step-up noninvasive respiratory support (p = < 0.001), those on bilevel positive airway pressure or continuous positive airway pressure (compared with high-flow nasal cannula) (p = < 0.001), and those on continuous feeds (p = < 0.001) achieved significantly more of their kcal goal. Gastrointestinal complications varied from 4.8-20%, with the most common reported being vomiting in 54/325 (16.6%), other complications occurred in 40/325 (12.3%) children, but pulmonary aspiration was rare 5/325 (1.5%). CONCLUSIONS Children on noninvasive respiratory support tolerated feeding well, with relatively few complications, but prospective trials are now required to determine the optimal timing and feeding method for these children.
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19
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Christophe M, Julien B, Gilles C. Improving synchrony in young infants supported by noninvasive ventilation for severe bronchiolitis: Yes, we can… so we should! Pediatr Pulmonol 2021; 56:319-322. [PMID: 33270991 DOI: 10.1002/ppul.25184] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 11/01/2020] [Accepted: 11/15/2020] [Indexed: 11/07/2022]
Affiliation(s)
- Milési Christophe
- Department of Neonatal Medicine and Pediatric Intensive Care, Arnaud de Villeneuve Hospital, Montpellier University Hospital Center, Montpellier, France
| | - Baleine Julien
- Department of Neonatal Medicine and Pediatric Intensive Care, Arnaud de Villeneuve Hospital, Montpellier University Hospital Center, Montpellier, France
| | - Cambonie Gilles
- Department of Neonatal Medicine and Pediatric Intensive Care, Arnaud de Villeneuve Hospital, Montpellier University Hospital Center, Montpellier, France
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20
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Muller GJ, Hovenier R, Spijker J, van Gestel M, Klein-Blommert R, Markhorst D, Dijkman C, Bem RA. Non-invasive Ventilation for Pediatric Hypoxic Acute Respiratory Failure Using a Simple Anesthetic Mask With 3D Printed Adaptor: A Case Report. Front Pediatr 2021; 9:710829. [PMID: 34504814 PMCID: PMC8421850 DOI: 10.3389/fped.2021.710829] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 08/06/2021] [Indexed: 11/13/2022] Open
Abstract
Non-invasive ventilation (NIV) is increasingly used in the supportive treatment of acute respiratory failure in children in the pediatric intensive care unit (PICU). However, finding an optimal fitting commercial available NIV face mask is one of the major challenges in daily practice, in particular for young children and those with specific facial features. Large air leaks and pressure-related skin injury due to suboptimal fit are important complications associated with NIV failure. Here, we describe a case of a 4-year old boy with cardiofaciocutaneous syndrome and rhinovirus-associated hypoxic acute respiratory failure who was successfully supported with NIV delivered by a simple anesthetic mask connected to a headgear by an in-house developed and 3D printed adaptor. This case is an example of the clinical challenge related to pediatric NIV masks in the PICU, but also shows the potential of alternative NIV interfaces e.g., by using a widely available and relatively cheap simple anesthetic mask. Further personalized strategies (e.g., by using 3D scanning and printing techniques) that optimize NIV mask fitting in children are warranted.
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Affiliation(s)
- Gerrit J Muller
- Pediatric Intensive Care Unit, Emma Children's Hospital, Amsterdam University Medical Centers, Amsterdam, Netherlands
| | - Renee Hovenier
- Pediatric Intensive Care Unit, Emma Children's Hospital, Amsterdam University Medical Centers, Amsterdam, Netherlands.,Technical Medicine, University of Twente, Enschede, Netherlands
| | - Jip Spijker
- Industrial Design Engineering, Technical University of Delft, Delft, Netherlands
| | - Monica van Gestel
- Pediatric Intensive Care Unit, Emma Children's Hospital, Amsterdam University Medical Centers, Amsterdam, Netherlands
| | - Rozalinde Klein-Blommert
- Pediatric Intensive Care Unit, Emma Children's Hospital, Amsterdam University Medical Centers, Amsterdam, Netherlands
| | - Dick Markhorst
- Pediatric Intensive Care Unit, Emma Children's Hospital, Amsterdam University Medical Centers, Amsterdam, Netherlands
| | - Coen Dijkman
- Department for Medical Innovation and Development, Amsterdam University Medical Centers, Amsterdam, Netherlands
| | - Reinout A Bem
- Pediatric Intensive Care Unit, Emma Children's Hospital, Amsterdam University Medical Centers, Amsterdam, Netherlands
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21
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Nagler J, Auerbach M, Monuteaux MC, Cheek JA, Babl FE, Oakley E, Nguyen L, Rao A, Dalton S, Lyttle MD, Mintegi S, Mistry RD, Dixon A, Rino P, Kohn-Loncarica G, Dalziel SR, Craig S. Exposure and confidence across critical airway procedures in pediatric emergency medicine: An international survey study. Am J Emerg Med 2020; 42:70-77. [PMID: 33453618 DOI: 10.1016/j.ajem.2020.12.075] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 12/22/2020] [Accepted: 12/27/2020] [Indexed: 10/22/2022] Open
Abstract
BACKGROUND Airway management procedures are critical for emergency medicine (EM) physicians, but rarely performed skills in pediatric patients. Worldwide experience with respect to frequency and confidence in performing airway management skills has not been previously described. OBJECTIVES Our aims were 1) to determine the frequency with which emergency medicine physicians perform airway procedures including: bag-mask ventilation (BMV), endotracheal intubation (ETI), laryngeal mask airway (LMA) insertion, tracheostomy tube change (TTC), and surgical airways, and 2) to investigate predictors of procedural confidence regarding advanced airway management in children. METHODS A web-based survey of senior emergency physicians was distributed through the six research networks associated with Pediatric Emergency Research Network (PERN). Senior physician was defined as anyone working without direct supervision at any point in a 24-h cycle. Physicians were queried regarding their most recent clinical experience performing or supervising airway procedures, as well as with hands on practice time or procedural teaching. Reponses were dichotomized to within the last year, or ≥ 1 year. Confidence was assessed using a Likert scale for each procedure, with results for ETI and LMA stratified by age. Response levels were dichotomized to "not confident" or "confident." Multivariate regression models were used to assess relevant associations. RESULTS 1602 of 2446 (65%) eligible clinicians at 96 PERN sites responded. In the previous year, 1297 (85%) physicians reported having performed bag-mask ventilation, 900 (59%) had performed intubation, 248 (17%) had placed a laryngeal mask airway, 348 (23%) had changed a tracheostomy tube, and 18 (1%) had performed a surgical airway. Of respondents, 13% of physicians reported the opportunity to supervise but not provide ETI, 5% for LMA and 5% for BMV. The percentage of physicians reporting "confidence" in performing each procedure was: BMV (95%) TTC (43%), and surgical airway (16%). Clinician confidence in ETT and LMA varied by patient age. Supervision of an airway procedure was the strongest predictor of procedural confidence across airway procedures. CONCLUSION BMV and ETI were the most commonly performed pediatric airway procedures by emergency medicine physicians, and surgical airways are very infrequent. Supervising airway procedures may serve to maintain procedural confidence for physicians despite infrequent opportunities as the primary proceduralist.
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Affiliation(s)
- Joshua Nagler
- Boston Children's Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA; Pediatric Emergency Care Applied Research Network (PECARN), USA.
| | - Marc Auerbach
- Yale University School of Medicine, New Haven, CT, USA; Pediatric Emergency Medicine Collaborative Research Committee (PEM-CRC), USA
| | - Michael C Monuteaux
- Boston Children's Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - John A Cheek
- Emergency Research, Murdoch Children's Research Institute, Parkville, Victoria, Australia; Emergency Department, Royal Children's Hospital Melbourne, Parkville, Victoria, Australia; Paediatric Research in Emergency Departments International Collaborative (PREDICT), Australia and New Zealand
| | - Franz E Babl
- Emergency Research, Murdoch Children's Research Institute, Parkville, Victoria, Australia; Emergency Department, Royal Children's Hospital Melbourne, Parkville, Victoria, Australia; Paediatric Research in Emergency Departments International Collaborative (PREDICT), Australia and New Zealand; University of Melbourne, Melbourne, Australia
| | - Ed Oakley
- Emergency Research, Murdoch Children's Research Institute, Parkville, Victoria, Australia; Emergency Department, Royal Children's Hospital Melbourne, Parkville, Victoria, Australia; Paediatric Research in Emergency Departments International Collaborative (PREDICT), Australia and New Zealand; University of Melbourne, Melbourne, Australia
| | - Lucia Nguyen
- Peninsula Health, Frankston, Victoria, Australia
| | - Arjun Rao
- Paediatric Research in Emergency Departments International Collaborative (PREDICT), Australia and New Zealand; Sydney Children's Hospital (Randwick), NSW, Australia; University of New South Wales, Australia; Health Education Training Institute (HETI), New South Wales, Australia
| | - Sarah Dalton
- Paediatric Research in Emergency Departments International Collaborative (PREDICT), Australia and New Zealand; The Children's Hospital at Westmead, Westmead, NSW, Australia
| | - Mark D Lyttle
- Emergency Department, Bristol Royal Hospital for Children, Bristol, UK; Faculty of Health and Applied Sciences, University of the West of England, Bristol, UK; Paediatric Emergency Research in the United Kingdom & Ireland (PERUKI), UK
| | - Santiago Mintegi
- Pediatric Emergency Department, Cruces University Hospital, Bilbao, Spain; University of the Basque Country, Spain; Research in European Pediatric Emergency Medicine (REPEM), Spain; Red de Investigación de la Sociedad Española de Urgencias de Pediatría/Spanish Pediatric Emergency Research Group (RISeuP/SPERG), Spain
| | - Rakesh D Mistry
- Pediatric Emergency Medicine Collaborative Research Committee (PEM-CRC), USA; Children's Hospital Colorado, Aurora, CO, USA
| | - Andrew Dixon
- University of Alberta, Edmonton, Alberta, Canada; Stollery Children's Hospital, Edmonton, Alberta, Canada; Women's and Children's Health Research Institute, Canada; Pediatric Emergency Research Canada (PERC), Canada
| | - Pedro Rino
- Universidad de Buenos Aires, Argentina; Hospital de Pediatría "Prof. Dr. Juan P. Garrahan", Buenos Aires, Argentina; Red de Investigación y Desarrollo de la Emergencia Pediátrica Latinoamericana (RIDEPLA), Argentina
| | - Guillermo Kohn-Loncarica
- Universidad de Buenos Aires, Argentina; Hospital de Pediatría "Prof. Dr. Juan P. Garrahan", Buenos Aires, Argentina; Red de Investigación y Desarrollo de la Emergencia Pediátrica Latinoamericana (RIDEPLA), Argentina
| | - Stuart R Dalziel
- Paediatric Research in Emergency Departments International Collaborative (PREDICT), Australia and New Zealand; Starship Children's Hospital, Auckland, New Zealand; Department of Surgery, University of Auckland, Auckland, New Zealand
| | - Simon Craig
- Paediatric Research in Emergency Departments International Collaborative (PREDICT), Australia and New Zealand; Paediatric Emergency Department, Monash Medical Centre, Melbourne, Australia; Department of Paediatrics, School of Clinical Sciences at Monash Health, Monash University, Australia
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22
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Has the introduction of high-flow nasal cannula modified the clinical characteristics and outcomes of infants with bronchiolitis admitted to pediatric intensive care units? A retrospective study. Arch Pediatr 2020; 28:141-146. [PMID: 33334653 DOI: 10.1016/j.arcped.2020.11.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Revised: 09/14/2020] [Accepted: 11/21/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND This study aimed to assess how the emergence of high-flow nasal cannula (HFNC) has modified the demographic and clinical characteristics as well as outcomes of infants with bronchiolitis admitted to a pediatric intensive care unit (PICU). METHODS This was a single-center retrospective study including infants aged 1 day to 6 months with bronchiolitis requiring HFNC, noninvasive ventilation (NIV), or invasive ventilation on admission. RESULTS A total of 252 infants (mean age 53±36 days) were included in the study. The use of HFNC increased from 18 (21.4%) during 2013-2014 to 53 infants (55.2%) during 2015-2016. The length of stay in the PICU decreased over time from 4.7±2.9 to 3.5±2.7 days (P<0.01) but the hospital length of stay remained similar (P=0.17). On admission, patients supported by HFNC as the first-line therapy were older. The PICU length of stay was similar according to the type of respiratory support (P=0.16), but the hospital length of stay was longer for patients supported by HFNC (P=0.01). CONCLUSION The distribution of respiratory support has significantly changed over time for patients with bronchiolitis and HFNC is increasingly used. The demographic and clinical characteristics of the have not changed over time. However, the PICU length of stay decreased significantly.
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23
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Delacroix E, Millet A, Pin I, Mortamet G. Use of bilevel positive pressure ventilation in patients with bronchiolitis. Pediatr Pulmonol 2020; 55:3134-3138. [PMID: 32816390 DOI: 10.1002/ppul.25033] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 08/14/2020] [Indexed: 11/10/2022]
Abstract
RATIONAL This study aims at describing the use of bilevel positive airway pressure (BiPAP) in infants with severe bronchiolitis. WORKING HYPOTHESIS The use of BiPAP in infants with bronchiolitis may be associated with a worst outcome. STUDY DESIGN A single-center retrospective study performed from October 2013 to April 2016. METHODOLOGY All infants from 1 day to 6 months of age admitted in the pediatric intensive care unit (PICU) were included if they had a clinical diagnosis of bronchiolitis and if they required any type of noninvasive ventilation (NIV), including high flow nasal cannula, continuous positive airway pressure and BiPAP at admission in PICU. There was no local written protocol regarding the ventilator management during the study. RESULTS Overall, 252 infants (median age 45 (26-72) days) were included in the study and 110 infants (44%) were supported by BiPAP at admission. More infants were born preterm in the group of patients supported by BiPAP at admission. No complication related to NIV occurred. Patients in the BiPAP group had a longer duration of noninvasive support as well as a longer PICU length of stay. However, hospital length of stay did not differ according to the type of respiratory support at admission. CONCLUSION The use of BiPAP was not associated with endotracheal intubation, however it was associated with increased PICU length of stay and increased duration of NIV.
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Affiliation(s)
- Elise Delacroix
- Pediatric Intensive Care Unit, Grenoble University Hospital, Grenoble, France
| | - Anne Millet
- Pediatric Intensive Care Unit, Grenoble University Hospital, Grenoble, France
| | - Isabelle Pin
- Pediatric Department, Grenoble University Hospital, Grenoble, France
| | - Guillaume Mortamet
- Pediatric Intensive Care Unit, Grenoble University Hospital, Grenoble, France
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24
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Almukhaini KS, Al-Rahbi NM. Use of Noninvasive Ventilation and High-Flow Nasal Cannulae Therapy for Infants and Children with Acute Respiratory Distress Outside of Paediatric Intensive Care: A review article. Sultan Qaboos Univ Med J 2020; 20:e245-e250. [PMID: 33110638 PMCID: PMC7574805 DOI: 10.18295/squmj.2020.20.03.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 04/24/2020] [Accepted: 05/06/2020] [Indexed: 11/16/2022] Open
Abstract
Noninvasive ventilation (NIV) and high-flow nasal cannulae therapy (HFNCT) are first-line methods of treatment for children presenting with acute respiratory distress, with paediatric intensive care units (PICUs) providing an ideal environment for subsequent treatment monitoring. However, the availability of step-down units, where NIV and HFNCT can be safely utilised, has reduced the need for such patients to be admitted to PICUs, thereby leading to the better overall utilisation of critical care resources. In addition, NIV and HFNCT can also be used during transport instead of invasive ventilation, thus avoiding the complications associated with the latter approach. This review article examines the safety and applicability of these respiratory support approaches outside of paediatric intensive care as well as various factors associated with treatment success or failure.
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Affiliation(s)
| | - Najwa M Al-Rahbi
- Department of Child Health, Sultan Qaboos University Hospital, Muscat, Oman
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25
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Willox M, Metherall P, Jeays-Ward K, McCarthy AD, Barker N, Reed H, Elphick HE. Custom-made 3D printed masks for children using non-invasive ventilation: a feasibility study of production method and testing of outcomes in adult volunteers. J Med Eng Technol 2020; 44:213-223. [PMID: 32597695 DOI: 10.1080/03091902.2020.1769759] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Non-invasive ventilation (NIV) is assisted mechanical ventilation delivered via a facemask for people with chronic conditions that affect breathing. NIV is most commonly delivered via an interface (mask) covering the nose (nasal mask) or the nose and mouth (oronasal mask). The number of children in the UK requiring NIV is currently estimated to be around 5000. Mass-produced masks are available for both the adult and paediatric markets but masks that fit well are difficult to find for children who are small or have asymmetrical facial features. A good conforming fit between the mask and the patient's face to minimise unintentional air leakage is essential to deliver the treatment effectively; most ventilators will trigger an alarm requiring action if such leakage is detected. We present an innovative use of 3D scanning and manufacturing technologies to deliver novel mask-face interfaces to optimise mask fit to the needs of individual patients. Ahead of planned user trials with paediatric patients, the project team trialled the feasibility of the process of creating and printing bespoke masks from 3D scan data and carried out testing of the masks in adult volunteers to select the strongest design concept for the paediatric trial. The evaluation of the process of designing a bespoke mask from scan data, arranging for its manufacture and carrying out user testing has been invaluable in gaining knowledge and discovering the pitfalls and timing bottlenecks in the processes. This allowed the team to iteratively refine the techniques and methods involved, informing user trials later on in the project. It has also provided indicative cost estimates for 3D printed mask prototype components which are useful in project decision making and trial planning. The value of the process extends to considerations for future implementation of the process within a clinical pathway.
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Affiliation(s)
- Matt Willox
- ACES, Sheffield Hallam University, Sheffield, UK
| | - Peter Metherall
- 3-D Lab, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Katherine Jeays-Ward
- NIHR Devices for Dignity Med Tech Co-operative, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Avril D McCarthy
- NIHR Devices for Dignity Med Tech Co-operative, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK.,Clinical Engineering, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Nicki Barker
- Sheffield Children's NHS Foundation Trust, Sheffield, UK
| | - Heath Reed
- ACES, Sheffield Hallam University, Sheffield, UK
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26
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Lins ARBDS, Duarte MDCMB, Andrade LBD. Noninvasive ventilation as the first choice of ventilatory support in children. Rev Bras Ter Intensiva 2019; 31:333-339. [PMID: 31618352 PMCID: PMC7005949 DOI: 10.5935/0103-507x.20190045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Accepted: 04/08/2019] [Indexed: 11/20/2022] Open
Abstract
Objective To describe the use of noninvasive ventilation to prevent tracheal intubation in children in a pediatric intensive care unit and to analyze the factors related to respiratory failure. Methods A retrospective cohort study was performed from January 2016 to May 2018. The study population included children aged 1 to 14 years who were subjected to noninvasive ventilation as the first therapeutic choice for acute respiratory failure. Biological, clinical and managerial data were analyzed by applying a model with the variables that obtained significance ≤ 0.20 in a bivariate analysis. Logistic regression was performed using the ENTER method. The level of significance was set at 5%. Results The children had a mean age of 68.7 ± 42.3 months, 96.6% had respiratory disease as a primary diagnosis, and 15.8% had comorbidities. Of the 209 patients, noninvasive ventilation was the first option for ventilatory support in 86.6% of the patients, and the fraction of inspired oxygen was ≥ 0.40 in 47% of the cases. The lethality rate was 1.4%. The data for the use of noninvasive ventilation showed a high success rate of 95.3% (84.32 - 106). The Pediatric Risk of Mortality (PRISM) score and the length of stay in the intensive care unit were the significant clinical variables for the success or failure of noninvasive ventilation. Conclusion A high rate of effectiveness was found for the use of noninvasive ventilation for acute episodes of respiratory failure. A higher PRISM score on admission, comorbidities associated with respiratory symptoms and oxygen use ≥ 40% were independent factors related to noninvasive ventilation failure.
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Affiliation(s)
| | | | - Lívia Barboza de Andrade
- Unidade de Terapia Intensiva Pediátrica, Hospital Esperança Recife- Recife (PE), Brasil.,Programa de Pós-Graduação, Instituto de Medicina Integral Prof. Fernando Figueira - Recife (PE), Brasil
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27
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Lee BR, Shin SH, Kim MJ, Kim E, Choi YJ, Park JD, Suh DI. Clinical characteristics of pediatric pneumothorax during a noninvasive positive pressure ventilation. ALLERGY ASTHMA & RESPIRATORY DISEASE 2019. [DOI: 10.4168/aard.2019.7.1.51] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Bo Ra Lee
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul, Korea
| | - So Hyun Shin
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul, Korea
| | - Min Jung Kim
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul, Korea
| | - Eunji Kim
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul, Korea
| | | | - June Dong Park
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul, Korea
| | - Dong In Suh
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul, Korea
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28
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Khemani RG, Smith L, Lopez-Fernandez YM, Kwok J, Morzov R, Klein MJ, Yehya N, Willson D, Kneyber MCJ, Lillie J, Fernandez A, Newth CJL, Jouvet P, Thomas NJ. Paediatric acute respiratory distress syndrome incidence and epidemiology (PARDIE): an international, observational study. THE LANCET RESPIRATORY MEDICINE 2018; 7:115-128. [PMID: 30361119 DOI: 10.1016/s2213-2600(18)30344-8] [Citation(s) in RCA: 238] [Impact Index Per Article: 39.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Revised: 08/01/2018] [Accepted: 08/13/2018] [Indexed: 12/12/2022]
Abstract
BACKGROUND Paediatric acute respiratory distress syndrome (PARDS) is associated with high mortality in children, but until recently no paediatric-specific diagnostic criteria existed. The Pediatric Acute Lung Injury Consensus Conference (PALICC) definition was developed to overcome limitations of the Berlin definition, which was designed and validated for adults. We aimed to determine the incidence and outcomes of children who meet the PALICC definition of PARDS. METHODS In this international, prospective, cross-sectional, observational study, 145 paediatric intensive care units (PICUs) from 27 countries were recruited, and over a continuous 5 day period across 10 weeks all patients were screened for enrolment. Patients were included if they had a new diagnosis of PARDS that met PALICC criteria during the study week. Exclusion criteria included meeting PARDS criteria more than 24 h before screening, cyanotic heart disease, active perinatal lung disease, and preparation or recovery from a cardiac intervention. Data were collected on the PICU characteristics, patient demographics, and elements of PARDS (ie, PARDS risk factors, hypoxaemia severity metrics, type of ventilation), comorbidities, chest imaging, arterial blood gas measurements, and pulse oximetry. The primary outcome was PICU mortality. Secondary outcomes included 90 day mortality, duration of invasive mechanical and non-invasive ventilation, and cause of death. FINDINGS Between May 9, 2016, and June 16, 2017, during the 10 study weeks, 23 280 patients were admitted to participating PICUs, of whom 744 (3·2%) were identified as having PARDS. 95% (708 of 744) of patients had complete data for analysis, with 17% (121 of 708; 95% CI 14-20) mortality, whereas only 32% (230 of 708) of patients met Berlin criteria with 27% (61 of 230) mortality. Based on hypoxaemia severity at PARDS diagnosis, mortality was similar among those who were non-invasively ventilated and with mild or moderate PARDS (10-15%), but higher for those with severe PARDS (33% [54 of 165; 95% CI 26-41]). 50% (80 of 160) of non-invasively ventilated patients with PARDS were subsequently intubated, with 25% (20 of 80; 95% CI 16-36) mortality. By use of PALICC PARDS definition, severity of PARDS at 6 h after initial diagnosis (area under the curve [AUC] 0·69, 95% CI 0·62-0·76) discriminates PICU mortality better than severity at PARDS diagnosis (AUC 0·64, 0·58-0·71), and outperforms Berlin severity groups at 6 h (0·64, 0·58-0·70; p=0·01). INTERPRETATION The PALICC definition identified more children as having PARDS than the Berlin definition, and PALICC PARDS severity groupings improved the stratification of mortality risk, particularly when applied 6 h after PARDS diagnosis. The PALICC PARDS framework should be considered for use in future epidemiological and therapeutic research among children with PARDS. FUNDING University of Southern California Clinical Translational Science Institute, Sainte Justine Children's Hospital, University of Montreal, Canada, Réseau en Santé Respiratoire du Fonds de Recherche Quebec-Santé, and Children's Hospital Los Angeles, Department of Anesthesiology and Critical Care Medicine.
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Affiliation(s)
- Robinder G Khemani
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital Los Angeles, Los Angeles, CA, USA; Department of Pediatrics, University of Southern California Keck School of Medicine, Los Angeles, CA, USA.
| | - Lincoln Smith
- University of Washington, Seattle Children's Hospital, Seattle, WA, USA
| | | | - Jeni Kwok
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Rica Morzov
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Margaret J Klein
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Nadir Yehya
- Children's Hospital Philadelphia and University of Pennsylvania School of Medicine, Philadelphia, PA, USA
| | - Douglas Willson
- Children's Hospital Richmond, Virginia Commonwealth University School of Medicine, Richmond, VA, USA
| | - Martin C J Kneyber
- Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Jon Lillie
- Evelina London Children's Hospital, London, UK
| | - Analia Fernandez
- Hospital General de Agudos "Dr C. Durand", Buenos Aires, Argentina
| | - Christopher J L Newth
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital Los Angeles, Los Angeles, CA, USA; Department of Pediatrics, University of Southern California Keck School of Medicine, Los Angeles, CA, USA
| | | | - Neal J Thomas
- Penn State Hershey Children's Hospital, Penn State University School of Medicine, Hershey, PA, USA
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29
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Abstract
This article reviews the definition, pathophysiology, etiology, assessment, and management of acute respiratory failure in children. Acute respiratory failure is the inability of the respiratory system to maintain oxygenation or eliminate carbon dioxide. Acute respiratory failure is a common cause for admission to a pediatric intensive care unit. Most causes of acute respiratory failure can be grouped into one of three categories: lung parenchymal disease, airway obstruction, or neuromuscular dysfunction. Many patients with acute respiratory failure are managed successfully with noninvasive respiratory support; however, in severe cases, patients may require intubation and mechanical ventilation. [Pediatr Ann. 2018;47(7):e268-e273.].
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