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Bermúdez-Barrezueta L, Mayordomo-Colunga J, Miñambres-Rodríguez M, Reyes S, Valencia-Ramos J, Lopez-Fernandez YM, Mendizábal-Diez M, Vivanco-Allende A, Palacios-Cuesta A, Oviedo-Melgares L, Unzueta-Roch JL, López-González J, Jiménez-Villalta MT, Cuervas-Mons Tejedor M, Artacho González L, Jiménez Olmos A, Pons-Òdena M. Implications of sedation during the use of noninvasive ventilation in children with acute respiratory failure (SEDANIV Study). Crit Care 2024; 28:235. [PMID: 38992698 PMCID: PMC11241858 DOI: 10.1186/s13054-024-04976-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2024] [Accepted: 05/29/2024] [Indexed: 07/13/2024] Open
Abstract
BACKGROUND The objective of this study was to analyze the effects of sedation administration on clinical parameters, comfort status, intubation requirements, and the pediatric intensive care unit (PICU) length of stay (LOS) in children with acute respiratory failure (ARF) receiving noninvasive ventilation (NIV). METHODS Thirteen PICUs in Spain participated in a prospective, multicenter, observational trial from January to December 2021. Children with ARF under the age of five who were receiving NIV were included. Clinical information and comfort levels were documented at the time of NIV initiation, as well as at 3, 6, 12, 24, and 48 h. The COMFORT-behavior (COMFORT-B) scale was used to assess the patients' level of comfort. NIV failure was considered to be a requirement for endotracheal intubation. RESULTS A total of 457 patients were included, with a median age of 3.3 months (IQR 1.3-16.1). Two hundred and thirteen children (46.6%) received sedation (sedation group); these patients had a higher heart rate, higher COMFORT-B score, and lower SpO2/FiO2 ratio than did those who did not receive sedation (non-sedation group). A significantly greater improvement in the COMFORT-B score at 3, 6, 12, and 24 h, heart rate at 6 and 12 h, and SpO2/FiO2 ratio at 6 h was observed in the sedation group. Overall, the NIV success rate was 95.6%-intubation was required in 6.1% of the sedation group and in 2.9% of the other group (p = 0.092). Multivariate analysis revealed that the PRISM III score at NIV initiation (OR 1.408; 95% CI 1.230-1.611) and respiratory rate at 3 h (OR 1.043; 95% CI 1.009-1.079) were found to be independent predictors of NIV failure. The PICU LOS was correlated with weight, PRISM III score, respiratory rate at 12 h, SpO2 at 3 h, FiO2 at 12 h, NIV failure and NIV duration. Sedation use was not found to be independently related to NIV failure or to the PICU LOS. CONCLUSIONS Sedation use may be useful in children with ARF treated with NIV, as it seems to improve clinical parameters and comfort status but may not increase the NIV failure rate or PICU LOS, even though sedated children were more severe at technique initiation in the present sample.
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Affiliation(s)
- Lorena Bermúdez-Barrezueta
- Pediatric and Neonatal Intensive Care, Department of Pediatrics, Hospital Clínico Universitario de Valladolid, Av. Ramón y Cajal, 3, 47003, Valladolid, Spain.
- Department of Pediatrics, Faculty of Medicine, Valladolid University, Valladolid, Spain.
| | - Juan Mayordomo-Colunga
- Pediatric Intensive Care Unit, Hospital Universitario Central de Asturias, Oviedo, Spain
- Department of Pediatrics, University of Oviedo, Oviedo, Spain
- Centro de Investigación Biomédica en Red Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
- Primary Care Interventions to Prevent Maternal and Child Chronic Diseases of Perinatal and Developmental Origin (RICORS), Instituto de Salud Carlos III, RD21/0012/0020, Madrid, Spain
- Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo, Spain
| | - María Miñambres-Rodríguez
- Pediatric Intensive Care Unit, Department of Pediatrics, Hospital Universitario Virgen de la Arrixaca, Murcia, Spain
| | - Susana Reyes
- Pediatric Intensive Care Unit, Department of Pediatrics, Hospital Universitario Virgen de la Arrixaca, Murcia, Spain
| | - Juan Valencia-Ramos
- Pediatric Intensive Care Unit, Department of Pediatrics, Complejo Asistencial Universitario de Burgos, Burgos, Spain
- Ciencias de la Salud, University of Burgos, Burgos, Spain
| | - Yolanda Margarita Lopez-Fernandez
- Pediatric Intensive Care Unit, Department of Pediatrics, Hospital Universitario de Cruces, BioBizkaia-Bizkaia Health Research Institute, Bizkaia, Spain
| | - Mikel Mendizábal-Diez
- Pediatric Intensive Care Unit, Department of Pediatrics, Hospital Universitario de Navarra, Pamplona, Spain
| | - Ana Vivanco-Allende
- Pediatric Intensive Care Unit, Hospital Universitario Central de Asturias, Oviedo, Spain
- Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo, Spain
| | - Alba Palacios-Cuesta
- Pediatric Intensive Care Unit, Department of Pediatrics, Hospital Universitario, 12 de Octubre, Madrid, Spain
| | - Lidia Oviedo-Melgares
- Pediatric Intensive Care Unit, Department of Pediatrics, Hospital Universitario, 12 de Octubre, Madrid, Spain
| | - José Luis Unzueta-Roch
- Pediatric Intensive Care Unit, Department of Pediatrics, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
| | - Jorge López-González
- Pediatric Intensive Care Unit Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | | | - Maite Cuervas-Mons Tejedor
- Pediatric Intensive Care Unit, Department of Pediatrics, Complejo Asistencial Universitario de Burgos, Burgos, Spain
| | - Lourdes Artacho González
- Pediatric Intensive Care Unit, Department of Pediatrics, Hospital Regional Universitario de Málaga, Málaga, Spain
| | - Ainhoa Jiménez Olmos
- Pediatric Intensive Care Unit, Department of Pediatrics, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | - Martí Pons-Òdena
- Inmune and Respiratory Dysfunction 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, Hospital Universitario Sant Joan de Déu, Universitat de Barcelona, Esplugues de Llobregat, Spain
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Westhoff M, Neumann P, Geiseler J, Bickenbach J, Arzt M, Bachmann M, Braune S, Delis S, Dellweg D, Dreher M, Dubb R, Fuchs H, Hämäläinen N, Heppner H, Kluge S, Kochanek M, Lepper PM, Meyer FJ, Neumann B, Putensen C, Schimandl D, Schönhofer B, Schreiter D, Walterspacher S, Windisch W. [Non-invasive Mechanical Ventilation in Acute Respiratory Failure. Clinical Practice Guidelines - on behalf of the German Society of Pneumology and Ventilatory Medicine]. Pneumologie 2024; 78:453-514. [PMID: 37832578 DOI: 10.1055/a-2148-3323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2023]
Abstract
The guideline update outlines the advantages as well as the limitations of NIV in the treatment of acute respiratory failure in daily clinical practice and in different indications.Non-invasive ventilation (NIV) has a high value in therapy of hypercapnic acute respiratory failure, as it significantly reduces the length of ICU stay and hospitalization as well as mortality.Patients with cardiopulmonary edema and acute respiratory failure should be treated with continuous positive airway pressure (CPAP) and oxygen in addition to necessary cardiological interventions. This should be done already prehospital and in the emergency department.In case of other forms of acute hypoxaemic respiratory failure with only mild or moderately disturbed gas exchange (PaO2/FiO2 > 150 mmHg) there is no significant advantage or disadvantage compared to high flow nasal oxygen (HFNO). In severe forms of ARDS NIV is associated with high rates of treatment failure and mortality, especially in cases with NIV-failure and delayed intubation.NIV should be used for preoxygenation before intubation. In patients at risk, NIV is recommended to reduce extubation failure. In the weaning process from invasive ventilation NIV essentially reduces the risk of reintubation in hypercapnic patients. NIV is regarded useful within palliative care for reduction of dyspnea and improving quality of life, but here in concurrence to HFNO, which is regarded as more comfortable. Meanwhile NIV is also recommended in prehospital setting, especially in hypercapnic respiratory failure and pulmonary edema.With appropriate monitoring in an intensive care unit NIV can also be successfully applied in pediatric patients with acute respiratory insufficiency.
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Affiliation(s)
- Michael Westhoff
- Klinik für Pneumologie, Lungenklinik Hemer - Zentrum für Pneumologie und Thoraxchirurgie, Hemer
| | - Peter Neumann
- Abteilung für Klinische Anästhesiologie und Operative Intensivmedizin, Evangelisches Krankenhaus Göttingen-Weende gGmbH
| | - Jens Geiseler
- Medizinische Klinik IV - Pneumologie, Beatmungs- und Schlafmedizin, Paracelsus-Klinik Marl, Marl
| | - Johannes Bickenbach
- Klinik für Operative Intensivmedizin und Intermediate Care, Uniklinik RWTH Aachen, Aachen
| | - Michael Arzt
- Schlafmedizinisches Zentrum der Klinik und Poliklinik für Innere Medizin II, Universitätsklinikum Regensburg, Regensburg
| | - Martin Bachmann
- Klinik für Atemwegs-, Lungen- und Thoraxmedizin, Beatmungszentrum Hamburg-Harburg, Asklepios Klinikum Harburg, Hamburg
| | - Stephan Braune
- IV. Medizinische Klinik: Akut-, Notfall- und Intensivmedizin, St. Franziskus-Hospital, Münster
| | - Sandra Delis
- Klinik für Pneumologie, Palliativmedizin und Geriatrie, Helios Klinikum Emil von Behring GmbH, Berlin
| | - Dominic Dellweg
- Klinik für Innere Medizin, Pneumologie und Gastroenterologie, Pius-Hospital Oldenburg, Universitätsmedizin Oldenburg
| | - Michael Dreher
- Klinik für Pneumologie und Internistische Intensivmedizin, Uniklinik RWTH Aachen
| | - Rolf Dubb
- Akademie der Kreiskliniken Reutlingen GmbH, Reutlingen
| | - Hans Fuchs
- Zentrum für Kinder- und Jugendmedizin, Neonatologie und pädiatrische Intensivmedizin, Universitätsklinikum Freiburg
| | | | - Hans Heppner
- Klinik für Geriatrie und Geriatrische Tagesklinik Klinikum Bayreuth, Medizincampus Oberfranken Friedrich-Alexander-Universität Erlangen-Nürnberg, Bayreuth
| | - Stefan Kluge
- Klinik für Intensivmedizin, Universitätsklinikum Hamburg-Eppendorf, Hamburg
| | - Matthias Kochanek
- Klinik I für Innere Medizin, Hämatologie und Onkologie, Universitätsklinikum Köln, Köln
| | - Philipp M Lepper
- Klinik für Innere Medizin V - Pneumologie, Allergologie und Intensivmedizin, Universitätsklinikum des Saarlandes und Medizinische Fakultät der Universität des Saarlandes, Homburg
| | - F Joachim Meyer
- Lungenzentrum München - Bogenhausen-Harlaching) München Klinik gGmbH, München
| | - Bernhard Neumann
- Klinik für Neurologie, Donauisar Klinikum Deggendorf, und Klinik für Neurologie der Universitätsklinik Regensburg am BKH Regensburg, Regensburg
| | - Christian Putensen
- Klinik und Poliklinik für Anästhesiologie und Operative Intensivmedizin, Universitätsklinikum Bonn, Bonn
| | - Dorit Schimandl
- Klinik für Pneumologie, Beatmungszentrum, Zentralklinik Bad Berka GmbH, Bad Berka
| | - Bernd Schönhofer
- Klinik für Innere Medizin, Pneumologie und Intensivmedizin, Evangelisches Klinikum Bethel, Universitätsklinikum Ost Westphalen-Lippe, Bielefeld
| | | | - Stephan Walterspacher
- Medizinische Klinik - Sektion Pneumologie, Klinikum Konstanz und Lehrstuhl für Pneumologie, Universität Witten-Herdecke, Witten
| | - Wolfram Windisch
- Lungenklinik, Kliniken der Stadt Köln gGmbH, Lehrstuhl für Pneumologie Universität Witten/Herdecke, Köln
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Cheon EC, Cheon JM, Chun Y. Risk factors and outcomes associated with unplanned intraoperative extubation of the pediatric surgical patient: An analysis of the NSQIP-P database. Paediatr Anaesth 2023; 33:746-753. [PMID: 37334550 DOI: 10.1111/pan.14709] [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: 08/15/2022] [Revised: 05/18/2023] [Accepted: 06/05/2023] [Indexed: 06/20/2023]
Abstract
BACKGROUND Unplanned intraoperative extubation is a rare but potentially catastrophic safety event. Inadvertent extubation in the neonatal and pediatric critical care setting is a recognized quality improvement metric whereas literature for intraoperative extubation is scarce. The aim of this study was to identify risk factors and outcomes associated with unplanned intraoperative extubation. METHODS We queried the National Surgical Quality Improvement Program-Pediatric database from 2019 to 2020 for patients <18 years of age. A total of 253 673 patients were included in the analysis. Associations between demographics, clinical variables, and unplanned intraoperative extubation were evaluated with univariable and multivariable logistic regression models. The primary outcome was unplanned intraoperative extubation. Secondary outcomes were postoperative pulmonary complication, unplanned reintubation within 24 h, cardiac arrest on day of surgery, and surgical site infection. RESULTS Unplanned intraoperative extubation occurred in 163 (0.06%) patients. Specific procedures experienced unplanned intraoperative extubation at a higher rate such as bilateral cleft lip repair (1.31% of procedure type) and thoracic repair of tracheoesophageal fistula (1.11% of procedure type). Age, operative time (z-score), American Society of Anesthesiologists Classification 3 and 4, neurosurgery, plastic surgery, thoracic surgery, otolaryngology, and structural pulmonary/airway abnormalities were independent risk factors. Unplanned intraoperative extubation was associated with an increased unadjusted risk for postoperative pulmonary complication (p < .005; OR, 6.05; 95% confidence interval [CI]: 1.93-14.44), unplanned reintubation within 24 h (p < .005; OR, 8.41; 95% CI: 2.08-34.03), cardiac arrest on day of surgery (p < .05; OR, 22.67; 95% CI: 0.56-132.35), and surgical site infection (p < .0005; OR, 3.27; 95% CI 1.74-5.67). CONCLUSIONS Unplanned intraoperative extubation occurs at a higher frequency in a subset of procedures and patient types. Identifying and targeting at-risk patients with preventative measures may decrease the incidence of unplanned intraoperative extubation and its associated outcomes.
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Affiliation(s)
- Eric C Cheon
- Department of Pediatric Anesthesiology, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - James M Cheon
- Department of Pediatric Anesthesiology, Children's Hospital of Orange County, Orange County, California, USA
| | - Yeona Chun
- Department of Pediatric Anesthesiology, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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Sierra-Colomina M, Yehia NA, Mahmood F, Parshuram C, Mtaweh H. A Retrospective Study of Complications of Enteral Feeding in Critically Ill Children on Noninvasive Ventilation. Nutrients 2023; 15:2817. [PMID: 37375722 DOI: 10.3390/nu15122817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 06/14/2023] [Accepted: 06/17/2023] [Indexed: 06/29/2023] Open
Abstract
The utilization of noninvasive ventilation (NIV) in pediatric intensive care units (PICUs), to support children with respiratory failure and avoid endotracheal intubation, has increased. Current guidelines recommend initiating enteral nutrition (EN) within the first 24-48 h post admission. This practice remains variable among PICUs due to perceptions of a lack of safety data and the potential increase in respiratory and gastric complications. The objective of this retrospective study was to evaluate the association between EN and development of extraintestinal complications in children 0-18 years of age on NIV for acute respiratory failure. Of 332 patients supported with NIV, 249 (75%) were enterally fed within the first 48 h of admission. Respiratory complications occurred in 132 (40%) of the total cohort and predominantly in non-enterally fed patients (60/83, 72% vs. 72/249, 29%; p < 0.01), and they occurred earlier during ICU admission (0 vs. 2 days; p < 0.01). The majority of complications were changes in the fraction of inspired oxygen (220/290, 76%). In the multivariate evaluation, children on bilevel positive airway pressure (BiPAP) (23/132, 17% vs. 96/200, 48%; odds ratio [OR] = 5.3; p < 0.01), receiving a higher fraction of inspired oxygen (FiO2) (0.42 vs. 0.35; OR = 6; p = 0.03), and with lower oxygen saturation (SpO2) (91% vs. 97%; OR = 0.8; p < 0.01) were more likely to develop a complication. Time to discharge from the intensive care unit (ICU) was longer for patients with complications (11 vs. 3 days; OR = 1.12; p < 0.01). The large majority of patients requiring NIV can be enterally fed without an increase in respiratory complications after an initial period of ICU stabilization.
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Affiliation(s)
| | - Nagam Anna Yehia
- Department of Nutritional Sciences, University of Toronto, Toronto, ON M5S 1A8, Canada
| | - Farhan Mahmood
- Faculty of Medicine, University of Ottawa, Ottawa, ON K1H 8M5, Canada
| | - Christopher Parshuram
- Department of Critical Care Medicine, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada
| | - Haifa Mtaweh
- Department of Critical Care Medicine, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada
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5
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Celik NB, Tanyildiz M, Yetimakman F, Kesici S, Bayrakci B. Comparison of high flow oxygen therapy versus noninvasive mechanical ventilation for successful weaning from invasive ventilation in children: An observational study. Medicine (Baltimore) 2022; 101:e30889. [PMID: 36181066 PMCID: PMC9524993 DOI: 10.1097/md.0000000000030889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Post-extubation respiratory failure is associated with a poor prognosis due to increased ventilator-associated pneumonia, and longer length of stay in the ICU and hospital. In this study, we aimed to evaluate the efficacy of high-flow nasal cannula (HFNC) and noninvasive mechanical ventilation (NIMV) on extubation success in children. A total of 48 patients, aged between 1 month and 18 years, who were weaned to either NIMV or HFNC were included. Patients who had tracheostomy or were not weaned and underwent unplanned extubation were excluded. Age, gender, anthropometric parameters, Pediatric Risk of Mortality and Pediatric Logistic Organ Dysfunction scores, oxygenation index, mechanical ventilation length of stay (LOS), HFNC/NIMV LOS, Modified Downes-Silverman score (MDS), and venous blood gas parameters, pediatric intensive care unit (PICU) LOS were recorded. 24 patients were extubated to NIMV, and 24 patients to HFNC. HFNC LOS and NIMV LOS were similar (P = .621). The failure rates at the 48th hour of HFNC and NIMV were 33% (n = 8), and 33% respectively (n = 8) (P = 1.0). PICU LOS and mortality rate was also similar (P = .06, P = .312 respectively). MDS decreased significantly in both groups (P < .001, P = .02 respectively). Changes in blood gas parameters and MDS within the first 48-hour of device application were similar between the 2 groups. HFNC is not inferior to NIMV in patients with extubation difficulty or those expected to have such difficulty in terms of treatment success, PICU LOS, and mortality. Therefore, HFNC appears to be a weaning technique alternative to NIMV after extubation.
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Affiliation(s)
- Nur Berna Celik
- Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Murat Tanyildiz
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Filiz Yetimakman
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Selman Kesici
- Department of Pediatric Critical Care Medicine, Life Support Practice and Research Center, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Benan Bayrakci
- Department of Pediatric Critical Care Medicine, Life Support Practice and Research Center, Hacettepe University Faculty of Medicine, Ankara, Turkey
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Wang BC, Lion RP, Avesar M, Abdala J, Deming DD, Wilson CG. Comparison of Local and Systemic Inflammation During Invasive Versus Noninvasive Ventilation in Rats. J Interferon Cytokine Res 2022; 42:343-348. [PMID: 35704907 DOI: 10.1089/jir.2022.0040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The impact of noninvasive ventilation (NIV) on local and systemic inflammation is poorly characterized, particularly when compared with invasive mechanical ventilation (IMV). We sought to quantify the local and systemic inflammatory response of these 2 respiratory treatments in rats with lipopolysaccharide (LPS)-induced lung injury (LPS-injured) and healthy rats. Animals were subjected to 4 h of NIV or IMV treatments at noninjurious settings, or 4 h of control treatment in which healthy or LPS-injured animals remained spontaneously breathing under isoflurane anesthesia with no respiratory support. Cytokines were then quantified in the serum and lung tissue by multiplex enzyme-linked immunosorbent assay. Contrary to our hypothesis, there were no significant differences in cytokine levels in serum or lung when comparing the NIV- and IMV-treated groups; this was true in both LPS-injured and healthy rats. However, within the LPS-injured group, pulmonary levels of interleukin (IL)-1α, IL-6, and tumor necrosis factor α were significantly lower in the NIV-treated group than in control but not in the IMV-treated group compared with control. We conclude that NIV, unlike IMV, could attenuate local inflammation.
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Affiliation(s)
- Billy C Wang
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, OSF Children's Hospital of Illinois, Peoria, Illinois, USA
| | - Richard P Lion
- Department of Pediatrics, Texas Center for Pediatric and Congenital Heart Disease, UT Health Austin/Dell Children's Medical Center, University of Texas Dell Medical School, Austin, Texas, USA
| | - Michael Avesar
- Division of Pediatric Critical Care Medicine, Loma Linda University Children's Hospital, Loma Linda, California, USA
| | - Jonathan Abdala
- Lawrence D. Longo, MD Center for Perinatal Biology, Loma Linda University School of Medicine, Loma Linda, California, USA
| | - Douglas D Deming
- Division of Neonatology, Loma Linda University Children's Hospital, Loma Linda, California, USA
| | - Christopher G Wilson
- Lawrence D. Longo, MD Center for Perinatal Biology, Loma Linda University School of Medicine, Loma Linda, California, USA
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7
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Arslan G, Besci T, Duman M. Point of care diaphragm ultrasound in mechanically ventilated children: A predictive tool to detect extubation failure. Pediatr Pulmonol 2022; 57:1432-1439. [PMID: 35362674 DOI: 10.1002/ppul.25916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 03/29/2022] [Accepted: 03/30/2022] [Indexed: 11/11/2022]
Abstract
BACKGROUND Children should be weaned from the ventilator once their clinical condition improves. Extubation failure is associated with poorer clinical outcomes in children. Predictive indicators of successful extubation are needed. This study aims to evaluate the predictive value of ultrasonographic diaphragm imaging could help predict weaning success. METHODS In this prospective, observational study conducted between March and December 2021, children between 1 month and 10 years of age who were mechanically ventilated for more than 48 h were included. Diaphragm ultrasound (DUS) examinations were performed at the end of 2-h extubation readiness test (ERT). The end-inspiratory thickness (DTi), end-expiratory thickness (DTe), diaphragmatic thickening fraction (DTF), diaphragmatic excursion (DE), inspiratory slope (IS), and expiratory slope (ES) were evaluated. RESULTS Twenty-four (60%) patients were successfully extubated, while 16 (40%) required invasive or noninvasive mechanical ventilation support which were classified as failed extubation group. Three of the sixteen patients in the failed extubation group required reintubation. DTF was significantly greater in the successful weaning group (55.05 ± 23.75% vs. 30.9 ± 10.38%) (p < 0.001). DE was significantly greater in the successful weaning group (14 ± 4.4 mm vs. 11.05 ± 3.25 mm) (p < 0.001). DTF and DE were found to have a sensitivity and specificity of 91.67%, 87.50%, 83.33%, and 81.25%, respectively. CONCLUSION Diaphragm ultrasound is a feasible and promising tool to guide physicians during weaning from invasive mechanical ventilation. Among all DUS measurements, the DE and DTF indexes showed better performance in extubation failure than other diaphragmatic parameters.
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Affiliation(s)
- Gazi Arslan
- Division of Pediatric Intensive Care, Department of Pediatrics, Dokuz Eylul University School of Medicine, Izmir, Turkey
| | - Tolga Besci
- Division of Pediatric Intensive Care, Department of Pediatrics, Dokuz Eylul University School of Medicine, Izmir, Turkey
| | - Murat Duman
- Division of Pediatric Emergency, Department of Pediatrics, Dokuz Eylul University School of Medicine, Izmir, Turkey
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8
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Im DD, Laksana E, Ledbetter DR, Aczon MD, Khemani RG, Wetzel RC. Development of a deep learning model that predicts Bi-level positive airway pressure failure. Sci Rep 2022; 12:8907. [PMID: 35618738 PMCID: PMC9135753 DOI: 10.1038/s41598-022-12984-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Accepted: 05/16/2022] [Indexed: 11/09/2022] Open
Abstract
Delaying intubation for patients failing Bi-Level Positive Airway Pressure (BIPAP) may be associated with harm. The objective of this study was to develop a deep learning model capable of aiding clinical decision making by predicting Bi-Level Positive Airway Pressure (BIPAP) failure. This was a retrospective cohort study in a tertiary pediatric intensive care unit (PICU) between 2010 and 2020. Three machine learning models were developed to predict BIPAP failure: two logistic regression models and one deep learning model, a recurrent neural network with a Long Short-Term Memory (LSTM-RNN) architecture. Model performance was evaluated in a holdout test set. 175 (27.7%) of 630 total BIPAP sessions were BIPAP failures. Patients in the BIPAP failure group were on BIPAP for a median of 32.8 (9.2-91.3) hours prior to intubation. Late BIPAP failure (intubation after using BIPAP > 24 h) patients had fewer 28-day Ventilator Free Days (13.40 [0.68-20.96]), longer ICU length of stay and more post-extubation BIPAP days compared to those who were intubated ≤ 24 h from BIPAP initiation. An AUROC above 0.5 indicates that a model has extracted new information, potentially valuable to the clinical team, about BIPAP failure. Within 6 h of BIPAP initiation, the LSTM-RNN model predicted which patients were likely to fail BIPAP with an AUROC of 0.81 (0.80, 0.82), superior to all other models. Within 6 h of BIPAP initiation, the LSTM-RNN model would identify nearly 80% of BIPAP failures with a 50% false alarm rate, equal to an NNA of 2. In conclusion, a deep learning method using readily available data from the electronic health record can identify which patients on BIPAP are likely to fail with good discrimination, oftentimes days before they are intubated in usual practice.
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Affiliation(s)
- Daniel D Im
- Department of Pediatrics, Keck School of Medicine, University of Southern California, 2020 Zonal Ave, IRD 114, Los Angeles, CA, 90089, USA.
| | - Eugene Laksana
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital Los Angeles, Los Angeles, CA, USA.,Laura P. and Leland K. Whittier Virtual Pediatric Intensive Care Unit, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - David R Ledbetter
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital Los Angeles, Los Angeles, CA, USA.,Laura P. and Leland K. Whittier Virtual Pediatric Intensive Care Unit, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Melissa D Aczon
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital Los Angeles, Los Angeles, CA, USA.,Laura P. and Leland K. Whittier Virtual Pediatric Intensive Care Unit, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Robinder G Khemani
- Department of Pediatrics, Keck School of Medicine, University of Southern California, 2020 Zonal Ave, IRD 114, Los Angeles, CA, 90089, USA.,Department of Anesthesiology and Critical Care Medicine, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Randall C Wetzel
- Department of Pediatrics, Keck School of Medicine, University of Southern California, 2020 Zonal Ave, IRD 114, Los Angeles, CA, 90089, USA.,Department of Anesthesiology and Critical Care Medicine, Children's Hospital Los Angeles, Los Angeles, CA, USA.,Laura P. and Leland K. Whittier Virtual Pediatric Intensive Care Unit, Children's Hospital Los Angeles, Los Angeles, CA, USA.,Department of Anesthesiology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
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9
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Egbuta C, Evans F. Weaning from ventilation and extubation of children in critical care. BJA Educ 2022; 22:104-110. [PMID: 35211327 PMCID: PMC8847847 DOI: 10.1016/j.bjae.2021.11.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/03/2021] [Indexed: 01/22/2023] Open
Affiliation(s)
- C. Egbuta
- Boston Children's Hospital, Boston, MA, USA,Harvard Medical School, Boston, MA, USA,Corresponding author:
| | - F. Evans
- Boston Children's Hospital, Boston, MA, USA,Harvard Medical School, Boston, MA, USA
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10
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Harris M, Lyng JW, Mandt M, Moore B, Gross T, Gausche-Hill M, Donofrio-Odmann JJ. Prehospital Pediatric Respiratory Distress and Airway Management Interventions: An NAEMSP Position Statement and Resource Document. PREHOSP EMERG CARE 2022; 26:118-128. [PMID: 35001823 DOI: 10.1080/10903127.2021.1994675] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Devices and techniques such as bag-valve-mask ventilation, endotracheal intubation, supraglottic airway devices, and noninvasive ventilation offer important tools for airway management in critically ill EMS patients. Over the past decade the tools, technology, and strategies used to assess and manage pediatric respiratory and airway emergencies have evolved, and evidence regarding their use continues to grow.NAEMSP recommends:Methods and tools used to properly size pediatric equipment for ages ranging from newborns to adolescents should be available to all EMS clinicians. All pediatric equipment should be routinely checked and clearly identifiable in EMS equipment supply bags and vehicles.EMS agencies should train and equip their clinicians with age-appropriate pulse oximetry and capnography equipment to aid in the assessment and management of pediatric respiratory distress and airway emergencies.EMS agencies should emphasize noninvasive positive pressure ventilation and effective bag-valve-mask ventilation strategies in children.Supraglottic airways can be used as primary or secondary airway management interventions for pediatric respiratory failure and cardiac arrest in the EMS setting.Pediatric endotracheal intubation has unclear benefit in the EMS setting. Advanced approaches to pediatric ETI including drug-assisted airway management, apneic oxygenation, and use of direct and video laryngoscopy require further research to more clearly define their risks and benefits prior to widespread implementation.If considering the use of pediatric endotracheal intubation, the EMS medical director must ensure the program provides pediatric-specific initial training and ongoing competency and quality management activities to ensure that EMS clinicians attain and maintain mastery of the intervention.Paramedic use of direct laryngoscopy paired with Magill forceps to facilitate foreign body removal in the pediatric patient should be maintained even when pediatric endotracheal intubation is not approved as a local clinical intervention.
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11
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Risk Factors Associated with Mechanical Ventilation in Critical Bronchiolitis. CHILDREN 2021; 8:children8111035. [PMID: 34828749 PMCID: PMC8618830 DOI: 10.3390/children8111035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 11/06/2021] [Accepted: 11/09/2021] [Indexed: 11/17/2022]
Abstract
The American Academy of Pediatrics (AAP) recommends supportive care for the management of bronchiolitis. However, patients admitted to the intensive care unit with severe (critical) bronchiolitis define a unique group with varying needs for both non-invasive and invasive respiratory support. Currently, no guidance exists to help clinicians discern who will progress to invasive mechanical support. Here, we sought to identify key clinical features that distinguish pediatric patients with critical bronchiolitis requiring invasive mechanical ventilation from those that did not. We conducted a retrospective cohort study at a tertiary pediatric medical center. Children ≤2 years old admitted to the pediatric intensive care unit (PICU) from January 2015 to December 2019 with acute bronchiolitis were studied. Patients were divided into non-invasive respiratory support (NRS) and invasive mechanical ventilation (IMV) groups; the IMV group was further subdivided depending on timing of intubation relative to PICU admission. Of the 573 qualifying patients, 133 (23%) required invasive mechanical ventilation. Median age and weight were lower in the IMV group, while incidence of prematurity and pre-existing neurologic or genetic conditions were higher compared to the NRS group. Multi-microbial pneumonias were diagnosed more commonly in the IMV group, in turn associated with higher severity of illness scores, longer PICU lengths of stay, and more antibiotic usage. Within the IMV group, those intubated earlier had a shorter duration of mechanical ventilation and PICU length of stay, associated with lower pathogen load and, in turn, shorter antibiotic duration. Taken together, our data reveal that critically ill patients with bronchiolitis who require mechanical ventilation possess high risk features, including younger age, history of prematurity, neurologic or genetic co-morbidities, and a propensity for multi-microbial infections.
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12
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ONGUN EA, DURSUN O, ANIL AB, ALTUĞ Ü, TEMEL KÖKSOY Ö, AKYILDIZ BN, ÖZSOYLU S, KENDİRLİ T, ÖZCAN S, YILDIZDAŞ RD, TOLUNAY İ, KARAPINAR B, KILINÇ MA, DEMİRKOL D. A multicentered study on efficiency of noninvasive ventilation procedures (SAFE-NIV). Turk J Med Sci 2021; 51:1159-1171. [PMID: 33512813 PMCID: PMC8283467 DOI: 10.3906/sag-2004-35] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Accepted: 01/28/2021] [Indexed: 11/22/2022] Open
Abstract
Background/aim To characterize the clinical course of noninvasive positive pressure ventilation (NIPPV) and high flow humidified nasal cannula ventilation (HFNC) procedures; perform risk analysis for ventilation failure. Material and methods This prospective, multi-centered, observational study was conducted in 352 PICU admissions (1 month-18 years) between 2016 and 2017. SPSS-22 was used to assess clinical data, define thresholds for ventilation parameters and perform risk analysis. Results Patient age, onset of disease, previous intubation and hypoxia influenced the choice of therapy mode: NIPPV was preferred in older children (p = 0.002) with longer intubation (p < 0.001), ARDS (p = 0.001), lower respiratory tract infections (p < 0.001), chronic respiratory disease, (p = 0.005), malignancy (p = 0.048) and immune deficiency (p = 0.026). The failure rate was 13.4%. sepsis, ARDS, prolonged intubation, and use of nasal masks were associated with NIV failure (p = 0.001, p < 0.001, p < 0.001, p = 0.025). The call of intubation or re-intubation was given due to respiratory failure in twenty-seven (57.5%), hemodynamic instability in eight (17%), bulbar dysfunction or aspiration in 5 (10.6%), neurological deterioration in 4 (8.5%) and developing ARDS in 3 (6.4%) children. A reduction of less than 10% in the respiration within an hour increased the odds of failure by 9.841 times (OR: 9.841, 95% CI: 2.0021–48.3742). FiO2 > 55% at 6th hours and PRISM-3 >8 were other failure predictors. Of the 9.9% complication rate, the most common complication was pressure ulcerations (4.8%) and mainly observed when using full-face masks (p = 0.047). Fifteen (4.3%) patients died of miscellaneous causes. Tracheostomy cannulation was performed on 16 children due to prolonged mechanical ventilation (8% in NIPPV, 2.6% in HFNC) Conclusion Absence of reduction in the respiration rate within an hour, FiO2 requirement >55% at 6th hours and PRISM-3 score >8 predict NIV failure.
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Affiliation(s)
- Ebru Atike ONGUN
- Division of Pediatric Critical Care, Department of Pediatrics, Faculty of Medicine, Akdeniz University AntalyaTurkey
| | - Oğuz DURSUN
- Division of Pediatric Critical Care, Department of Pediatrics, Faculty of Medicine, Akdeniz University AntalyaTurkey
| | - Ayşe Berna ANIL
- Division of Pediatric Critical Care, Faculty of Medicine, Department of Pediatrics, İzmir Katip Celebi University and Tepecik Research and Training Hospital, İzmirTurkey
| | - Ümit ALTUĞ
- Division of Pediatric Critical Care, Faculty of Medicine, Department of Pediatrics, İzmir Katip Celebi University and Tepecik Research and Training Hospital, İzmirTurkey
| | - Özlem TEMEL KÖKSOY
- Division of Pediatric Critical Care, Department of Pediatrics, Faculty of Medicine, Samsun Ondokuz Mayıs University, SamsunTurkey
| | - Başak Nur AKYILDIZ
- Division of Pediatric Critical Care, Department of Pediatrics, Faculty of Medicine, Erciyes University, KayseriTurkey
| | - Serkan ÖZSOYLU
- Division of Pediatric Critical Care, Department of Pediatrics, Faculty of Medicine, Erciyes University, KayseriTurkey
| | - Tanıl KENDİRLİ
- Division of Pediatric Critical Care, Department of Pediatrics, Faculty of Medicine, Ankara University, AnkaraTurkey
| | - Serhan ÖZCAN
- Division of Pediatric Critical Care, Department of Pediatrics, Faculty of Medicine, Ankara University, AnkaraTurkey
| | - Rıza Dinçer YILDIZDAŞ
- Division of Pediatric Critical Care, Department of Pediatrics, Faculty of Medicine, Çukurova University, AdanaTurkey
| | - İlknur TOLUNAY
- Division of Pediatric Critical Care, Department of Pediatrics, Faculty of Medicine, Çukurova University, AdanaTurkey
| | - Bülent KARAPINAR
- Division of Pediatric Critical Care, Department of Pediatrics, Faculty of Medicine, Ege University, İzmirTurkey
| | - Mehmet Arda KILINÇ
- Division of Pediatric Critical Care, Department of Pediatrics, Faculty of Medicine, Ege University, İzmirTurkey
| | - Demet DEMİRKOL
- Division of Pediatric Critical Care, Department of Pediatrics, Faculty of Medicine, İstanbul University, İstanbulTurkey
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13
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Luján M, Peñuelas Ó, Cinesi Gómez C, García-Salido A, Moreno Hernando J, Romero Berrocal A, Gutiérrez Ibarluzea I, Masa Jiménez JF, Mas A, Carratalá Perales JM, Gaboli M, Concheiro Guisán A, García Fernández J, Escámez J, Parrilla Parrilla J, Farrero Muñoz E, González M, Heili-Frades SB, Sánchez Quiroga MÁ, Rialp Cervera G, Hernández G, Sánchez Torres A, Uña R, Ortolà CF, Ferrer Monreal M, Egea Santaolalla C. Summary of recommendations and key points of the consensus of Spanish scientific societies (SEPAR, SEMICYUC, SEMES; SECIP, SENEO, SEDAR, SENP) on the use of non-invasive ventilation and high-flow oxygen therapy with nasal cannulas in adult, pediatric, and neonatal patients with severe acute respiratory failure. Med Intensiva 2021; 45:298-312. [PMID: 34059220 DOI: 10.1016/j.medine.2021.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 08/25/2020] [Indexed: 11/28/2022]
Abstract
Non-invasive respiratory support (NIRS) in adult, pediatric, and neonatal patients with acute respiratory failure (ARF) comprises two treatment modalities, non-invasive mechanical ventilation (NIMV) and high-flow nasal cannula (HFNC) therapy. However, experts from different specialties disagree on the benefit of these techniques in different clinical settings. The objective of this consensus was to develop a series of good clinical practice recommendations for the application of non-invasive support in patients with ARF, endorsed by all scientific societies involved in the management of adult and pediatric/neonatal patients with ARF. To this end, the different societies involved were contacted, and they in turn appointed a group of 26 professionals with sufficient experience in the use of these techniques. Three face-to-face meetings were held to agree on recommendations (up to a total of 71) based on a literature review and the latest evidence associated with 3 categories: indications, monitoring and follow-up of NIRS. Finally, the experts from each scientific society involved voted telematically on each of the recommendations. To classify the degree of agreement, an analogue classification system was chosen that was easy and intuitive to use and that clearly stated whether the each NIRS intervention should be applied, could be applied, or should not be applied.
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Affiliation(s)
- M Luján
- Servicio de Neumología, Hospital Universitari Parc Taulí de Sabadell, Sabadell, Barcelona; Universitat Autònoma de Barcelona, Barcelona; CIBER de Enfermedades Respiratorias (CIBERES), Madrid, Spain
| | - Ó Peñuelas
- Servicio de Medicina Intensiva y Grandes Quemados, Hospital Universitario de Getafe, Getafe, Madrid; CIBER de Enfermedades Respiratorias (CIBERES), Madrid; Grupo de Trabajo de la SEMICUYC de Insuficiencia Respiratoria Aguda, Spain.
| | - C Cinesi Gómez
- Servicio de Urgencias, Hospital General Universitario Reina Sofía, Director del Máster en Medicina de Urgencias y Emergencias de la Universidad Católica de Murcia (UCAM), Murcia, Spain
| | - A García-Salido
- Servicio de Cuidados Intensivos Pediátricos e Investigador Posdoctoral en el Laboratorio de Investigación Biomédica, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
| | - J Moreno Hernando
- Servicio de Neonatología, Hospital Universitari Sant Joan de Déu, Barcelona, Spain
| | - A Romero Berrocal
- Servicio de Anestesia y Reanimación, Hospital Universitario Puerta de Hierro-Majadahonda, Majadahonda, Madrid, Spain
| | | | - J F Masa Jiménez
- Servicio de Neumología, Hospital San Pedro de Alcántara, Cáceres; CIBER de Enfermedades Respiratorias (CIBERES), Madrid, Instituto Universitario de Investigación Biosanitaria de Extremadura (INUBE), Cáceres, Spain
| | - A Mas
- Servei de Medicina Intensiva, Hospital de Sant Joan Despí Moisès Broggi, Sant Joan Despí, Barcelona; Hospital General d'Hospitalet, L'Hospitalet de Llobregat, Barcelona; Grupo de Trabajo de la SEMICUYC de Insuficiencia Respiratoria Aguda, Spain
| | - J M Carratalá Perales
- Servicio de Urgencias, Unidad de Corta Estancia, Hospital General Universitario, Alicante, Spain
| | - M Gaboli
- Neumología Pediátrica y Unidad de Cuidados Intensivos Pediátricos, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - A Concheiro Guisán
- Unidad de Neonatología, Hospital Alvaro Cunqueiro, Vigo, Pontevedra, Spain
| | - J García Fernández
- Servicio de Anestesia, Cuidados Críticos Quirúrgicos y Dolor, Hospital Universitario Puerta de Hierro-Majadahonda, Majadahonda, Madrid, Spain
| | - J Escámez
- Servicio de Urgencias, Hospital Virgen de los Lirios, Alcoy, Alicante, Spain
| | - J Parrilla Parrilla
- Unidad de Cuidados Intensivos Pediátricos, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - E Farrero Muñoz
- Servei de Pneumologia, Hospital Universitari de Bellvitge, Hospitalet de Llobregat, Barcelona, Spain
| | - M González
- Unidad de Sueño y Ventilación, Servicio de Neumología, Hospital Universitario Marqués de Valdecilla, Universidad de Cantabria, Instituto de investigación Marqués de Valdecilla, IDIVAL, Santander, Cantabria, Spain
| | - S B Heili-Frades
- Neumología, Unidad de Cuidados Respiratorios Intermedios, Hospital Universitario Fundación Jiménez, Madrid; Díaz Quirón Salud. IIS. CIBERES, REVA Network, EMDOS, Spain
| | - M Á Sánchez Quiroga
- Servicio de Neumología, Hospital Virgen del Puerto de Plasencia, Plasencia, Cáceres; CIBER de Enfermedades Respiratorias (CIBERES), ISCIII, Madrid; Instituto Universitario de Investigación Biosanitaria en Extremadura (INUBE), Cáceres, Spain
| | - G Rialp Cervera
- Servicio de Medicina Intensiva, Hospital Universitari Son Llàtzer, Palma de Mallorca, Grupo de Trabajo de SEMICUYC de Insuficiencia Respiratoria Aguda, Spain
| | - G Hernández
- Servicio de Medicina Intensiva, Hospital Virgen de la Salud, Toledo; Grupo de Trabajo de la SEMICUYC de Insuficiencia Respiratoria Aguda, Spain
| | - A Sánchez Torres
- Servicio de Neonatología, Hospital Universitario La Paz, Madrid, Spain
| | - R Uña
- Servicio de Anestesia y Reanimación, Hospital Universitario La Paz, Madrid, Spain
| | - C F Ortolà
- Sección Área de Cuidados Intensivos Quirúrgicos, Servicio de Anestesia y Cuidados Intensivos, Hospital Clínic, Barcelona, Spain
| | - M Ferrer Monreal
- Servei de Pneumologia, Institut del Tòrax, Hospital Clínic de Barcelona, IDIBAPS, CibeRes (CB06/06/0028), Universitat de Barcelona, Barcelona, Spain
| | - C Egea Santaolalla
- Unidad Funcional de Sueño, Hospital Universitario Araba, OSI Araba, Vitoria-Gasteiz, Araba, Spain
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14
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Luján M, Peñuelas Ó, Cinesi Gómez C, García-Salido A, Moreno Hernando J, Romero Berrocal A, Gutiérrez Ibarluzea I, Masa Jiménez JF, Mas A, Carratalá Perales JM, Gaboli M, Concheiro Guisán A, García Fernández J, Escámez J, Parrilla Parrilla J, Farrero Muñoz E, González M, Heili-Frades SB, Sánchez Quiroga MÁ, Rialp Cervera G, Hernández G, Sánchez Torres A, Uña R, Ferrando Ortolà C, Ferrer Monreal M, Egea Santaolalla C. Summary of Recommendations and Key Points of the Consensus of Spanish Scientific Societies (SEPAR, SEMICYUC, SEMES; SECIP, SENEO, SEDAR, SENP) on the Use of Non-Invasive Ventilation and High-Flow Oxygen Therapy with Nasal Cannulas in Adult, Pediatric, and Neonatal Patients With Severe Acute Respiratory Failure. Arch Bronconeumol 2021; 57:415-427. [PMID: 34088393 DOI: 10.1016/j.arbr.2021.04.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 08/25/2020] [Indexed: 11/30/2022]
Abstract
Non-invasive respiratory support (NIRS) in adult, pediatric, and neonatal patients with acute respiratory failure (ARF) comprises two treatment modalities, non-invasive mechanical ventilation (NIMV) and high-flow nasal cannula (HFNC) therapy. However, experts from different specialties disagree on the benefit of these techniques in different clinical settings. The objective of this consensus was to develop a series of good clinical practice recommendations for the application of non-invasive support in patients with ARF, endorsed by all scientific societies involved in the management of adult and pediatric/neonatal patients with ARF. To this end, the different societies involved were contacted, and they in turn appointed a group of 26 professionals with sufficient experience in the use of these techniques. Three face-to-face meetings were held to agree on recommendations (up to a total of 71) based on a literature review and the latest evidence associated with 3 categories: indications, monitoring and follow-up of NIRS. Finally, the experts from each scientific society involved voted telematically on each of the recommendations. To classify the degree of agreement, an analog classification system was chosen that was easy and intuitive to use and that clearly stated whether the each NIRS intervention should be applied, could be applied, or should not be applied.
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Affiliation(s)
- Manel Luján
- Servicio de Neumología, Hospital Universitari Parc Taulí de Sabadell, Sabadell, Barcelona, Spain; Universitat Autònoma de Barcelona, Barcelona, Spain; CIBER de Enfermedades Respiratorias (CIBERES), Madrid, Spain.
| | - Óscar Peñuelas
- Servicio de Medicina Intensiva y Grandes Quemados, Hospital Universitario de Getafe, Getafe, Madrid, Spain; CIBER de Enfermedades Respiratorias (CIBERES), Madrid, Spain; Grupo de Trabajo de la SEMICUYC de Insuficiencia Respiratoria Aguda, Spain
| | - César Cinesi Gómez
- Servicio de Urgencias, Hospital General Universitario Reina Sofía, Director del Máster en Medicina de Urgencias y Emergencias de la Universidad Católica de Murcia (UCAM), Murcia, Spain
| | - Alberto García-Salido
- Servicio de Cuidados Intensivos Pediátricos e Investigador Posdoctoral en el Laboratorio de Investigación Biomédica, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
| | | | - Antonio Romero Berrocal
- Servicio de Anestesia y Reanimación, Hospital Universitario Puerta de Hierro-Majadahonda, Majadahonda, Madrid, Spain
| | | | - Juan Fernando Masa Jiménez
- Servicio de Neumología, Hospital San Pedro de Alcántara, Cáceres, Spain; CIBER de Enfermedades Respiratorias (CIBERES), Madrid, Instituto Universitario de Investigación Biosanitaria de Extremadura (INUBE), Cáceres, Spain
| | - Arantxa Mas
- Servei de Medicina Intensiva, Hospital de Sant Joan Despí Moisès Broggi, Sant Joan Despí, Barcelona, Spain; Hospital General d'Hospitalet, L'Hospitalet de Llobregat, Barcelona, Spain; Grupo de Trabajo de la SEMICUYC de Insuficiencia Respiratoria Aguda, Spain
| | | | - Mirella Gaboli
- Neumología Pediátrica y Unidad de Cuidados Intensivos Pediátricos, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | | | - Javier García Fernández
- Servicio de Anestesia, Cuidados Críticos Quirúrgicos y Dolor, Hospital Universitario Puerta de Hierro-Majadahonda, Majadahonda, Madrid, Spain
| | - Joaquín Escámez
- Servicio de Urgencias, Hospital Virgen de los Lirios, Alcoy, Alicante, Spain
| | - Julio Parrilla Parrilla
- Unidad de Cuidados Intensivos Pediátricos, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - Eva Farrero Muñoz
- Servei de Pneumologia, Hospital Universitari de Bellvitge, Hospitalet de Llobregat, Barcelona, Spain
| | - Mónica González
- Unidad de Sueño y Ventilación, Servicio de Neumología, Hospital Universitario Marqués de Valdecilla, Universidad de Cantabria, Instituto de investigación Marqués de Valdecilla, IDIVAL, Santander, Cantabria, Spain
| | - Sarah Béatrice Heili-Frades
- Neumología, Unidad de Cuidados Respiratorios Intermedios, Hospital Universitario Fundación Jiménez, Madrid, Spain; Díaz Quirón Salud. IIS. CIBERES, REVA Network, EMDOS, Spain
| | - María Ángeles Sánchez Quiroga
- Servicio de Neumología, Hospital Virgen del Puerto de Plasencia, Plasencia, Cáceres, Spain; CIBER de Enfermedades Respiratorias (CIBERES), ISCIII, Madrid, Spain; Instituto Universitario de Investigación Biosanitaria en Extremadura (INUBE), Cáceres, Spain
| | - Gemma Rialp Cervera
- Servicio de Medicina Intensiva, Hospital Universitari Son Llàtzer, Palma de Mallorca, Spain; Grupo de Trabajo de SEMICUYC de Insuficiencia Respiratoria Aguda, Spain
| | - Gonzalo Hernández
- Servicio de Medicina Intensiva, Hospital Virgen de la Salud, Toledo, Spain; Grupo de Trabajo de la SEMICUYC de Insuficiencia Respiratoria Aguda, Spain
| | | | - Rafael Uña
- Servicio de Anestesia y Reanimación, Hospital Universitario La Paz, Madrid, Spain
| | - Carlos Ferrando Ortolà
- Sección Área de Cuidados Intensivos Quirúrgicos, Servicio de Anestesia y Cuidados Intensivos, Hospital Clínic, Barcelona, Spain
| | - Miquel Ferrer Monreal
- Servei de Pneumologia, Institut del Tòrax, Hospital Clínic de Barcelona, IDIBAPS, CibeRes (CB06/06/0028), Universitat de Barcelona, Barcelona, Spain
| | - Carlos Egea Santaolalla
- Unidad Funcional de Sueño, Hospital Universitario Araba, OSI Araba, Vitoria-Gasteiz, Araba, Spain
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15
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Tang G, Lin J, Zhang Y, Shi Q. The Effects and Safety of Continuous Positive Airway Pressure in Children with Bronchiolitis: A Systematic Review and Meta-Analysis. J Trop Pediatr 2021; 67:6284363. [PMID: 34037790 DOI: 10.1093/tropej/fmaa128] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES To evaluate the effects and safety of continuous positive airway pressure (CPAP) for initial respiratory management of bronchiolitis. METHODS PubMed, EMBASE, Cochrane Library, CNKI, Wanfang data and CQ VIP were searched until 17 June 2020. Randomized controlled trials (RCTs) which investigated the effect of CPAP for bronchiolitis were included. RESULTS Twenty-seven RCTs met the eligibility criteria. In the comparison of CPAP versus standard oxygen therapy, CPAP can reduce the length of stay (LOS) in hospital, respiratory rate (RR), PaCO2, heart rate, mechanical ventilation and increase PaO2, but the SpO2 and PH were not improved. In the comparison of CPAP versus high-flow nasal cannula, CPAP can reduce treatment failure, but the PICU LOS, Incidence of intubation, RR, Modified Woods Clinical Asthma Score were not decreased. Treatment failure may be less in helmet comparing with the mask though there was no quantitative analysis. CONCLUSION CPAP for the initial respiratory management significantly benefit children with bronchiolitis, the delivery of CPAP by helmet may be a better choice. More high-quality research is needed to confirm the conclusion.
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Affiliation(s)
- Guojing Tang
- Department of Critical Care Medicine Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China.,Chongqing Key Laboratory of Pediatrics, Ministry of Education, Key Laboratory of Child Development and Disorders, Chongqing, China
| | - Jilei Lin
- Department of Respiration Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China.,Chongqing Key Laboratory of Pediatrics, Ministry of Education, Key Laboratory of Child Development and Disorders, Chongqing, China
| | - Yin Zhang
- Department of Respiration Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China.,Chongqing Key Laboratory of Pediatrics, Ministry of Education, Key Laboratory of Child Development and Disorders, Chongqing, China
| | - Qingxia Shi
- Department of Respiration Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China.,Chongqing Key Laboratory of Pediatrics, Ministry of Education, Key Laboratory of Child Development and Disorders, Chongqing, China
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16
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Linssen RS, Bem RA, Kapitein B, Rengerink KO, Otten MH, den Hollander B, Bont L, van Woensel JBM. Burden of respiratory syncytial virus bronchiolitis on the Dutch pediatric intensive care units. Eur J Pediatr 2021; 180:3141-3149. [PMID: 33891158 PMCID: PMC8429147 DOI: 10.1007/s00431-021-04079-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 04/06/2021] [Accepted: 04/09/2021] [Indexed: 11/28/2022]
Abstract
Respiratory syncytial virus (RSV) bronchiolitis causes substantial morbidity and mortality in young children, but insight into the burden of RSV bronchiolitis on pediatric intensive care units (PICUs) is limited. We aimed to determine the burden of RSV bronchiolitis on the PICUs in the Netherlands. Therefore, we identified all children ≤ 24 months of age with RSV bronchiolitis between 2003 and 2016 from a nationwide PICU registry. Subsequently we manually checked their patient records for correct diagnosis and collected patient characteristics, additional clinical data, respiratory support modes, and outcome. In total, 2161 children were admitted to the PICU for RSV bronchiolitis. The annual number of admissions increased significantly during the study period (β 4.05, SE 1.27, p = 0.01), and this increase was mostly driven by increased admissions in children up to 3 months old. Concomitantly, non-invasive respiratory support significantly increased (β 7.71, SE 0.92, p < 0.01), in particular the use of high flow nasal cannula (HFNC) (β 6.69, SE 0.96, p < 0.01), whereas the use of invasive ventilation remained stable.Conclusion: The burden of severe RSV bronchiolitis on PICUs has increased in the Netherlands. Concomitantly, the use of non-invasive respiratory support, especially HFNC, has increased. What is Known: • RSV bronchiolitis is a major cause of childhood morbidity and mortality and may require pediatric intensive care unit admission. • The field of pediatric critical care for severe bronchiolitis has changed due to increased non-invasive respiratory support options. What is New: • The burden of RSV bronchiolitis for the Dutch PICUs has increased. These data inform future strategic PICU resource planning and implementation of RSV preventive strategies. • There was a significant increase in the use of high flow nasal cannula at the PICU, but the use of invasive mechanical ventilation did not decrease.
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Affiliation(s)
- Rosalie S. Linssen
- Pediatric Intensive Care Unit, Emma Children’s Hospital, Amsterdam University Medical Centers, location AMC, Meibergdreef 9, 1105 Amsterdam, AZ the Netherlands
| | - Reinout A. Bem
- Pediatric Intensive Care Unit, Emma Children’s Hospital, Amsterdam University Medical Centers, location AMC, Meibergdreef 9, 1105 Amsterdam, AZ the Netherlands
| | - Berber Kapitein
- Pediatric Intensive Care Unit, Emma Children’s Hospital, Amsterdam University Medical Centers, location AMC, Meibergdreef 9, 1105 Amsterdam, AZ the Netherlands
| | - Katrien Oude Rengerink
- Department of Pediatric Infectious Diseases and Immunology, Wilhelmina Children’s Hospital, University Medical Center Utrecht, Utrecht, the Netherlands ,Department of Biostatistics and Research Support, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Marieke H. Otten
- Pediatric Intensive Care Unit, Emma Children’s Hospital, Amsterdam University Medical Centers, location AMC, Meibergdreef 9, 1105 Amsterdam, AZ the Netherlands
| | - Bibiche den Hollander
- Pediatric Intensive Care Unit, Emma Children’s Hospital, Amsterdam University Medical Centers, location AMC, Meibergdreef 9, 1105 Amsterdam, AZ the Netherlands
| | - Louis Bont
- Department of Pediatric Infectious Diseases and Immunology, Wilhelmina Children’s Hospital, University Medical Center Utrecht, Utrecht, the Netherlands ,UMCU Laboratory of Translational Immunology, University Medical Center Utrecht, Wilhelmina Children’s Hospital, Utrecht, the Netherlands ,Respiratory Syncytial Virus Network (ReSViNET) Foundation, Zeist, the Netherlands
| | - Job B. M. van Woensel
- Pediatric Intensive Care Unit, Emma Children’s Hospital, Amsterdam University Medical Centers, location AMC, Meibergdreef 9, 1105 Amsterdam, AZ the Netherlands
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17
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Sochet AA, Nunez M, Maamari M, McKinley S, Morrison JM, Nakagawa TA. Physiometric Response to High-Flow Nasal Cannula Support in Acute Bronchiolitis. Hosp Pediatr 2020; 11:94-99. [PMID: 33372047 DOI: 10.1542/hpeds.2020-001602] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVES To describe the rate of high-flow nasal cannula (HFNC) nonresponse and paired physiometric responses (changes [∆] in heart rate [HR] and respiratory rate [RR]) before and after HFNC initiation in hospitalized children with bronchiolitis. METHODS We performed a single-center, prospective descriptive study in a PICU within a quaternary referral center, assessing children aged ≤2 years admitted for bronchiolitis on HFNC from November 2017 to March 2020. We excluded for cystic fibrosis, airway anomalies, pulmonary hypertension, tracheostomy, neuromuscular disease, congenital heart disease, or preadmission intubation. Primary outcomes were paired ∆ and %∆ in HR and RR before and after HFNC initiation. Secondary outcomes were HFNC nonresponse rate (ie, intubation or transition to noninvasive positive pressure ventilation). Analyses included χ2, Student's t, Wilcoxon rank, and paired testing. RESULTS Of the 172 children studied, 56 (32.6%) experienced HFNC nonresponse at a median of 14.4 (interquartile range: 4.8-36) hours and 11 (6.4%) were intubated. Nonresponders had a greater frequency of bacterial pneumonia, but otherwise no major differences in demographics, comorbidities, or viral pathogens were noted. Responders experienced reductions in both %ΔRR (-17.1% ± 15.8% vs +5.3% ± 22.3%) and %ΔHR (-6.5% ± 10.5% vs 0% ± 10.9%) compared with nonresponders. CONCLUSIONS In this prospective, observational cohort study, we provide baseline data describing expected physiologic changes after initiation of HFNC for children admitted to the PICU for bronchiolitis. In our descriptive analysis, patients with comorbid bacterial pneumonia appear to be at additional risk for subsequent HFNC nonresponse.
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Affiliation(s)
- Anthony A Sochet
- Divisions of Pediatric Critical Care Medicine, .,Department of Anesthesiology and Critical Care Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland; and
| | | | - Mia Maamari
- Division of Pediatric Critical Care Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
| | | | - John M Morrison
- Pediatric Hospital Medicine, Johns Hopkins All Children's Hospital, St Petersburg, Florida.,Division of Hospital Medicine and
| | - Thomas A Nakagawa
- Divisions of Pediatric Critical Care Medicine.,Department of Anesthesiology and Critical Care Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland; and
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18
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Luján M, Peñuelas Ó, Cinesi Gómez C, García-Salido A, Moreno Hernando J, Romero Berrocal A, Gutiérrez Ibarluzea I, Masa Jiménez JF, Mas A, Carratalá Perales JM, Gaboli M, Concheiro Guisán A, García Fernández J, Escámez J, Parrilla Parrilla J, Farrero Muñoz E, González M, Heili-Frades SB, Sánchez Quiroga MÁ, Rialp Cervera G, Hernández G, Sánchez Torres A, Uña R, Ferrando Ortolà C, Ferrer Monreal M, Egea Santaolalla C. Summary of Recommendations and Key Points of the Consensus of Spanish Scientific Societies (SEPAR, SEMICYUC, SEMES; SECIP, SENEO, SEDAR, SENP) on the Use of Non-Invasive Ventilation and High-Flow Oxygen Therapy with Nasal Cannulas in Adult, Pediatric, and Neonatal Patients with Severe Acute Respiratory Failure. Arch Bronconeumol 2020. [PMID: 33309418 DOI: 10.1016/j.arbres.2020.08.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Non-invasive respiratory support (NIRS) in adult, pediatric, and neonatal patients with acute respiratory failure (ARF) comprises two treatment modalities, non-invasive mechanical ventilation (NIMV) and high-flow nasal cannula (HFNC) therapy. However, experts from different specialties disagree on the benefit of these techniques in different clinical settings. The objective of this consensus was to develop a series of good clinical practice recommendations for the application of non-invasive support in patients with ARF, endorsed by all scientific societies involved in the management of adult and pediatric/neonatal patients with ARF. To this end, the different societies involved were contacted, and they in turn appointed a group of 26 professionals with sufficient experience in the use of these techniques. Three face-to-face meetings were held to agree on recommendations (up to a total of 71) based on a literature review and the latest evidence associated with 3 categories: indications, monitoring and follow-up of NIRS. Finally, the experts from each scientific society involved voted telematically on each of the recommendations. To classify the degree of agreement, an analogue classification system was chosen that was easy and intuitive to use and that clearly stated whether the each NIRS intervention should be applied, could be applied, or should not be applied.
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Affiliation(s)
- Manel Luján
- Servicio de Neumología, Hospital Universitari Parc Taulí de Sabadell, Sabadell, Barcelona; Universitat Autònoma de Barcelona, Barcelona; CIBER de Enfermedades Respiratorias (CIBERES), Madrid, España.
| | - Óscar Peñuelas
- Servicio de Medicina Intensiva y Grandes Quemados, Hospital Universitario de Getafe, Getafe, Madrid; CIBER de Enfermedades Respiratorias (CIBERES), Madrid; Grupo de Trabajo de la SEMICUYC de Insuficiencia Respiratoria Aguda, España
| | - César Cinesi Gómez
- Servicio de Urgencias, Hospital General Universitario Reina Sofía. Director del Máster en Medicina de Urgencias y Emergencias de la Universidad Católica de Murcia (UCAM), Murcia, España
| | - Alberto García-Salido
- Servicio de Cuidados Intensivos Pediátricos e Investigador Posdoctoral en el Laboratorio de Investigación Biomédica, Hospital Infantil Universitario Niño Jesús, Madrid, España
| | | | - Antonio Romero Berrocal
- Servicio de Anestesia y Reanimación, Hospital Universitario Puerta de Hierro-Majadahonda, Majadahonda, Madrid, España
| | | | - Juan Fernando Masa Jiménez
- Servicio de Neumología, Hospital San Pedro de Alcántara, Cáceres; CIBER de Enfermedades Respiratorias (CIBERES), Madrid, Instituto Universitario de Investigación Biosanitaria de Extremadura (INUBE), Cáceres, España
| | - Arantxa Mas
- Servei de Medicina Intensiva, Hospital de Sant Joan Despí Moisès Broggi, Sant Joan Despí, Barcelona; Hospital General d'Hospitalet, L'Hospitalet de Llobregat, Barcelona; Grupo de Trabajo de la SEMICUYC de Insuficiencia Respiratoria Aguda, España
| | | | - Mirella Gaboli
- Neumología Pediátrica y Unidad de Cuidados Intensivos Pediátricos, Hospital Universitario Virgen del Rocío, Sevilla, España
| | | | - Javier García Fernández
- Servicio de Anestesia, Cuidados Críticos Quirúrgicos y Dolor, Hospital Universitario Puerta de Hierro-Majadahonda, Majadahonda, Madrid, España
| | - Joaquín Escámez
- Servicio de Urgencias, Hospital Virgen de los Lirios, Alcoy, Alicante, España
| | - Julio Parrilla Parrilla
- Unidad de Cuidados Intensivos Pediátricos, Hospital Universitario Virgen del Rocío, Sevilla, España
| | - Eva Farrero Muñoz
- Servei de Pneumologia, Hospital Universitari de Bellvitge, Hospitalet de Llobregat, Barcelona, España
| | - Mónica González
- Unidad de Sueño y Ventilación, Servicio de Neumología, Hospital Universitario Marqués de Valdecilla, Universidad de Cantabria, Instituto de investigación Marqués de Valdecilla, IDIVAL, Santander, Cantabria, España
| | - Sarah Béatrice Heili-Frades
- Neumología, Unidad de Cuidados Respiratorios Intermedios, Hospital Universitario Fundación Jiménez, Madrid; Díaz Quirón Salud. IIS. CIBERES, REVA Network, EMDOS, España
| | - María Ángeles Sánchez Quiroga
- Servicio de Neumología, Hospital Virgen del Puerto de Plasencia, Plasencia, Cáceres; CIBER de Enfermedades Respiratorias (CIBERES), ISCIII, Madrid; Instituto Universitario de Investigación Biosanitaria en Extremadura (INUBE), Cáceres, España
| | - Gemma Rialp Cervera
- Servicio de Medicina Intensiva, Hospital Universitari Son Llàtzer, Palma de Mallorca; Grupo de Trabajo de SEMICUYC de Insuficiencia Respiratoria Aguda, España
| | - Gonzalo Hernández
- Servicio de Medicina Intensiva, Hospital Virgen de la Salud, Toledo; Grupo de Trabajo de la SEMICUYC de Insuficiencia Respiratoria Aguda, España
| | | | - Rafael Uña
- Servicio de Anestesia y Reanimación, Hospital Universitario La Paz, Madrid, España
| | - Carlos Ferrando Ortolà
- Sección Área de Cuidados Intensivos Quirúrgicos, Servicio de Anestesia y Cuidados Intensivos, Hospital Clínic, Barcelona, España
| | - Miquel Ferrer Monreal
- Servei de Pneumologia, Institut del Tòrax, Hospital Clínic de Barcelona, IDIBAPS, CibeRes (CB06/06/0028), Universitat de Barcelona, Barcelona, España
| | - Carlos Egea Santaolalla
- Unidad Funcional de Sueño, Hospital Universitario Araba, OSI Araba, Vitoria-Gasteiz, Araba, España
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19
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Luján M, Peñuelas Ó, Cinesi Gómez C, García-Salido A, Moreno Hernando J, Romero Berrocal A, Gutiérrez Ibarluzea I, Masa Jiménez JF, Mas A, Carratalá Perales JM, Gaboli M, Concheiro Guisán A, García Fernández J, Escámez J, Parrilla Parrilla J, Farrero Muñoz E, González M, Heili-Frades SB, Sánchez Quiroga MÁ, Rialp Cervera G, Hernández G, Sánchez Torres A, Uña R, Ortolà CF, Ferrer Monreal M, Egea Santaolalla C. Summary of recommendations and key points of the consensus of Spanish scientific societies (SEPAR, SEMICYUC, SEMES; SECIP, SENEO, SEDAR, SENP) on the use of non-invasive ventilation and high-flow oxygen therapy with nasal cannulas in adult, pediatric, and neonatal patients with severe acute respiratory failure. Med Intensiva 2020; 45:298-312. [PMID: 33309463 DOI: 10.1016/j.medin.2020.08.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 08/25/2020] [Indexed: 11/28/2022]
Abstract
Non-invasive respiratory support (NIRS) in adult, pediatric, and neonatal patients with acute respiratory failure (ARF) comprises two treatment modalities, non-invasive mechanical ventilation (NIMV) and high-flow nasal cannula (HFNC) therapy. However, experts from different specialties disagree on the benefit of these techniques in different clinical settings. The objective of this consensus was to develop a series of good clinical practice recommendations for the application of non-invasive support in patients with ARF, endorsed by all scientific societies involved in the management of adult and pediatric/neonatal patients with ARF. To this end, the different societies involved were contacted, and they in turn appointed a group of 26 professionals with sufficient experience in the use of these techniques. Three face-to-face meetings were held to agree on recommendations (up to a total of 71) based on a literature review and the latest evidence associated with 3 categories: indications, monitoring and follow-up of NIRS. Finally, the experts from each scientific society involved voted telematically on each of the recommendations. To classify the degree of agreement, an analogue classification system was chosen that was easy and intuitive to use and that clearly stated whether the each NIRS intervention should be applied, could be applied, or should not be applied.
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Affiliation(s)
- M Luján
- Servicio de Neumología, Hospital Universitari Parc Taulí de Sabadell, Sabadell, Barcelona; Universitat Autònoma de Barcelona, Barcelona; CIBER de Enfermedades Respiratorias (CIBERES), Madrid, España
| | - Ó Peñuelas
- Servicio de Medicina Intensiva y Grandes Quemados, Hospital Universitario de Getafe, Getafe, Madrid; CIBER de Enfermedades Respiratorias (CIBERES), Madrid; Grupo de Trabajo de la SEMICYUC de Insuficiencia Respiratoria Aguda, España.
| | - C Cinesi Gómez
- Servicio de Urgencias, Hospital General Universitario Reina Sofía. Director del Máster en Medicina de Urgencias y Emergencias de la Universidad Católica de Murcia (UCAM), Murcia, España
| | - A García-Salido
- Servicio de Cuidados Intensivos Pediátricos e Investigador Posdoctoral en el Laboratorio de Investigación Biomédica, Hospital Infantil Universitario Niño Jesús, Madrid, España
| | - J Moreno Hernando
- Servicio de Neonatología, Hospital Universitari Sant Joan de Déu, Barcelona, España
| | - A Romero Berrocal
- Servicio de Anestesia y Reanimación, Hospital Universitario Puerta de Hierro-Majadahonda, Majadahonda, Madrid, España
| | - I Gutiérrez Ibarluzea
- Fundación vasca de Innovación e Investigación Sanitarias, Barakaldo, Vizcaya, España
| | - J F Masa Jiménez
- Servicio de Neumología, Hospital San Pedro de Alcántara, Cáceres; CIBER de Enfermedades Respiratorias (CIBERES), Madrid, Instituto Universitario de Investigación Biosanitaria deExtremadura (INUBE), Cáceres, España
| | - A Mas
- Servei de Medicina Intensiva, Hospital de Sant Joan Despí Moisès Broggi, Sant Joan Despí, Barcelona; Hospital General d'Hospitalet, L'Hospitalet de Llobregat, Barcelona; Grupo deTrabajo de la SEMICYUC de Insuficiencia Respiratoria Aguda, España
| | - J M Carratalá Perales
- Servicio de Urgencias, Unidad de Corta Estancia, Hospital General Universitario, Alicante, España
| | - M Gaboli
- Neumología Pediátrica y Unidad de Cuidados Intensivos Pediátricos, Hospital Universitario Virgen del Rocío, Sevilla, España
| | - A Concheiro Guisán
- Unidad de Neonatología, Hospital Alvaro Cunqueiro, Vigo, Pontevedra, España
| | - J García Fernández
- Servicio de Anestesia, Cuidados Críticos Quirúrgicos y Dolor, Hospital Universitario Puerta de Hierro-Majadahonda, Majadahonda, Madrid, España
| | - J Escámez
- Servicio de Urgencias, Hospital Virgen de los Lirios, Alcoy, Alicante, España
| | - J Parrilla Parrilla
- Unidad de Cuidados Intensivos Pediátricos, Hospital Universitario Virgen del Rocío, Sevilla, España
| | - E Farrero Muñoz
- Servei de Pneumologia, Hospital Universitari de Bellvitge, Hospitalet de Llobregat, Madrid, España
| | - M González
- Unidad de Sueño y Ventilación, Servicio de Neumología, Hospital Universitario Marqués de Valdecilla, Universidad de Cantabria, Instituto de investigación Marqués de Valdecilla, IDIVAL, Santander, Cantabria, España
| | - S B Heili-Frades
- Neumología, Unidad de Cuidados Respiratorios Intermedios, Hospital Universitario Fundación Jiménez, Madrid; Díaz Quirón Salud. IIS. CIBERES, REVA Network, EMDOS, España
| | - M Á Sánchez Quiroga
- Servicio de Neumología, Hospital Virgen del Puerto de Plasencia, Plasencia, Cáceres; CIBER de Enfermedades Respiratorias (CIBERES), ISCIII, Madrid; Instituto Universitario de Investigación Biosanitaria en Extremadura (INUBE), Cáceres, España
| | - G Rialp Cervera
- Servicio de Medicina Intensiva, Hospital Universitari Son Llàtzer, Palma de Mallorca; Grupo de Trabajo de SEMICYUC de Insuficiencia Respiratoria Aguda, España
| | - G Hernández
- Servicio de Medicina Intensiva, Hospital Virgen de la Salud, Toledo; Grupo de Trabajo de la SEMICYUC de Insuficiencia Respiratoria Aguda, España
| | - A Sánchez Torres
- Servicio de Neonatología, Hospital Universitario La Paz, Madrid, España
| | - R Uña
- Servicio de Anestesia y Reanimación, Hospital Universitario La Paz, Madrid, España
| | - C F Ortolà
- Sección Área de Cuidados Intensivos Quirúrgicos, Servicio de Anestesia y Cuidados Intensivos, Hospital Clínic, Madrid, España
| | - M Ferrer Monreal
- Servei de Pneumologia, Institut del Tòrax, Hospital Clínic de Barcelona, IDIBAPS, CibeRes (CB06/06/0028), Universitat de Barcelona, Madrid, España
| | - C Egea Santaolalla
- Unidad Funcional de Sueño, Hospital Universitario Araba, OSI Araba, Vitoria-Gasteiz, Araba, España
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20
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Carvalho HTD, Fioretto JR, Bonatto RC, Ribeiro CF, Martin JG, Carpi MF. Use of Dexamethasone to Prevent Extubation Failure in Pediatric Intensive Care Unit: A Randomized Controlled Clinical Trial. J Pediatr Intensive Care 2020; 11:41-47. [DOI: 10.1055/s-0040-1719044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 09/24/2020] [Indexed: 10/23/2022] Open
Abstract
AbstractExtubation failure is a common event in intensive care units. Corticosteroids are effective in preventing failure in adults, but no consensus has been reached on this matter in pediatrics. We assessed the efficacy of intravenous dexamethasone in mechanically ventilated children and adolescents for more than 48 hours, with at least one risk factor for failure. Extubations were scheduled 24 hours in advance when possible, and patients were randomly assigned into two groups: one group received a loading dose followed by up to four doses of dexamethasone, and the other group received no corticosteroids. Need for reintubation and length of stay in the pediatric intensive care unit were similar in both groups, and frequency of reintubation was 12.9%.
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Affiliation(s)
- Haroldo Teófilo de Carvalho
- Department of Pediatrics, Botucatu School of Medicine, São Paulo State University, Botucatu, São Paulo, Brazil
| | - José Roberto Fioretto
- Department of Pediatrics, Botucatu School of Medicine, São Paulo State University, Botucatu, São Paulo, Brazil
| | - Rossano Cesar Bonatto
- Department of Pediatrics, Botucatu School of Medicine, São Paulo State University, Botucatu, São Paulo, Brazil
| | - Cristiane Franco Ribeiro
- Department of Pediatrics, Botucatu School of Medicine, São Paulo State University, Botucatu, São Paulo, Brazil
| | - Joelma Gonçalves Martin
- Department of Pediatrics, Botucatu School of Medicine, São Paulo State University, Botucatu, São Paulo, Brazil
| | - Mário Ferreira Carpi
- Department of Pediatrics, Botucatu School of Medicine, São Paulo State University, Botucatu, São Paulo, Brazil
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21
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Chong SL, Dang TK, Loh TF, Mok YH, Bin Mohamed Atan MS, Montanez E, Lee JH, Feng M. Timing of tracheal intubation on mortality and duration of mechanical ventilation in critically ill children: A propensity score analysis. Pediatr Pulmonol 2020; 55:3126-3133. [PMID: 32797663 DOI: 10.1002/ppul.25026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 08/10/2020] [Indexed: 11/08/2022]
Abstract
OBJECTIVE We aimed to investigate whether early tracheal intubation (TI) is associated with a reduced risk of mortality and increased ventilator-free days (VFD). METHODS We performed a retrospective cohort study of children 0 to 18 years old in a pediatric intensive care unit (PICU), between 2008 and 2017. Patient demographics, vital signs, and laboratory findings were extracted. Using a time-dependent propensity score-matched algorithm, each patient was matched with another equally likely to be intubated within the same hour but was actually intubated with ≤2 hours, 2 to 4 hours, and 4 to 6 hours delays. Outcomes were mortality and VFD. RESULTS Among 333 patients, the median age was 1.72 years (interquartile range [IQR] 0.17-7.75). Thirty children died (9.0%) and the median PICU length of stay was 6.7 days (IQR 3.9-13.2). Early TI did not decrease mortality significantly when compared to a ≤2 hour delay (odds ratios [OR] 0.86; 95% CI, 0.40-1.85), a 2 to 4 hour delay (OR, 0.81; 95% CI, 0.39-1.69), or a 4 to 6 hour delay (OR, 0.87; 95% CI, 0.43-1.79). Similarly, early TI did not significantly increase VFD. Patients with early TI had 0.09 more VFD (95% CI -1.83 to 2.01) when compared to a delay within 2 hours, 0.23 more VFD (95% CI -1.66 to 2.13) when compared to a 2 to 4-hour delay and 0.56 more VFD (95% CI -1.49-2.61) when compared to a 4 to 6-hour delay. CONCLUSIONS We did not find a significant association between the timing of TI and mortality or VFD in critically ill children.
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Affiliation(s)
- Shu-Ling Chong
- Department of Emergency Medicine, KK Women's and Children's Hospital, Singapore.,Duke-NUS Medical School, Singapore
| | - Trung Kien Dang
- Saw Swee Hock School of Public Health, National University Health System, National University of Singapore, Singapore
| | - Tsee Foong Loh
- Duke-NUS Medical School, Singapore.,Children's Intensive Care Unit, KK Women's and Children's Hospital, Singapore
| | - Yee Hui Mok
- Duke-NUS Medical School, Singapore.,Children's Intensive Care Unit, KK Women's and Children's Hospital, Singapore
| | | | - Eugene Montanez
- Services Innovation, Solutions and Support, Phillips Healthcare System, Singapore
| | - Jan Hau Lee
- Duke-NUS Medical School, Singapore.,Children's Intensive Care Unit, KK Women's and Children's Hospital, Singapore
| | - Mengling Feng
- Saw Swee Hock School of Public Health, National University Health System, National University of Singapore, Singapore
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22
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Szmit Z, Kośmider-Żurawska M, Król A, Łobos M, Miśkiewicz-Bujna J, Zielińska M, Kałwak K, Mielcarek-Siedziuk M, Salamonowicz-Bodzioch M, Frączkiewicz J, Ussowicz M, Owoc-Lempach J, Gorczyńska E. Factors affecting survival in children requiring intensive care after hematopoietic stem cell transplantation. A retrospective single-center study. Pediatr Transplant 2020; 24:e13765. [PMID: 32558076 DOI: 10.1111/petr.13765] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Revised: 05/18/2020] [Accepted: 05/20/2020] [Indexed: 12/18/2022]
Abstract
Allo-HSCT is associated with life-threatening complications. Therefore, a considerable number of patients require admission to a PICU. We evaluated the incidence and outcome of PICU admissions after allo-HSCT in children, along with the potential factors influencing PICU survival. A retrospective chart review of 668 children who underwent first allo-HSCT in the Department of Pediatric Hematology/Oncology and BMT in Wrocław during years 2005-2017, particularly focusing on patients admitted to the PICU within 1-year post-HSCT. Fifty-eight (8.7%) patients required 64 admissions to the PICU. Twenty-four (41.5%) were discharged, and 34 (58.6%) patients died. Among the discharged patients, 6-month survival was 66.7%. Compared with survivors, death cases were more likely to have required MV (31/34; 91.2% vs. 16/24; 66.7% P = .049), received more aggressive cardiac support (17/34; 50% vs. 2/24; 8.3% P = .002), and had a lower ANC on the last day of their PICU stay (P = .004). Five patients were successfully treated with NIV and survived longer than 6 months post-discharge. The intensity of cardiac support and ANC on the last day of PICU treatment was independent factors influencing PICU survival. Children admitted to the PICU after allo-HSCT have a high mortality rate. Mainly those who needed a more aggressive approach and had a lower ANC on the last day of treatment had a greater risk of death. While requiring MV is associated with decreased PICU survival, early implementation of NIV might be considered.
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Affiliation(s)
- Zofia Szmit
- Department of Pediatric Hematology/Oncology and BMT, Supraregional Center of Pediatric Oncology "Cape of Hope", Wrocław Medical University, Wrocław, Poland.,Department of Anesthesiology and Intensive Care, Wrocław Medical University, Wrocław, Poland
| | | | - Anna Król
- Department of Pediatric Hematology/Oncology and BMT, Supraregional Center of Pediatric Oncology "Cape of Hope", Wrocław Medical University, Wrocław, Poland
| | - Monika Łobos
- Department of Pediatric Hematology/Oncology and BMT, Supraregional Center of Pediatric Oncology "Cape of Hope", Wrocław Medical University, Wrocław, Poland
| | - Justyna Miśkiewicz-Bujna
- Department of Pediatric Hematology/Oncology and BMT, Supraregional Center of Pediatric Oncology "Cape of Hope", Wrocław Medical University, Wrocław, Poland
| | - Marzena Zielińska
- Department of Anesthesiology and Intensive Care, Wrocław Medical University, Wrocław, Poland
| | - Krzysztof Kałwak
- Department of Pediatric Hematology/Oncology and BMT, Supraregional Center of Pediatric Oncology "Cape of Hope", Wrocław Medical University, Wrocław, Poland
| | - Monika Mielcarek-Siedziuk
- Department of Pediatric Hematology/Oncology and BMT, Supraregional Center of Pediatric Oncology "Cape of Hope", Wrocław Medical University, Wrocław, Poland
| | - Małgorzata Salamonowicz-Bodzioch
- Department of Pediatric Hematology/Oncology and BMT, Supraregional Center of Pediatric Oncology "Cape of Hope", Wrocław Medical University, Wrocław, Poland
| | - Jowita Frączkiewicz
- Department of Pediatric Hematology/Oncology and BMT, Supraregional Center of Pediatric Oncology "Cape of Hope", Wrocław Medical University, Wrocław, Poland
| | - Marek Ussowicz
- Department of Pediatric Hematology/Oncology and BMT, Supraregional Center of Pediatric Oncology "Cape of Hope", Wrocław Medical University, Wrocław, Poland
| | - Joanna Owoc-Lempach
- Department of Pediatric Hematology/Oncology and BMT, Supraregional Center of Pediatric Oncology "Cape of Hope", Wrocław Medical University, Wrocław, Poland
| | - Ewa Gorczyńska
- Department of Pediatric Hematology/Oncology and BMT, Supraregional Center of Pediatric Oncology "Cape of Hope", Wrocław Medical University, Wrocław, Poland
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23
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Camillo Ribeiro DDF, Barros FS, Fernandes BL, Nakato AM, Nohama P. Hydrocolloid versus silicone gel for the prevention of nasal injury in newborns submitted to noninvasive ventilation: A randomized clinical trial. Heliyon 2020; 6:e04366. [PMID: 32642588 PMCID: PMC7334427 DOI: 10.1016/j.heliyon.2020.e04366] [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] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Revised: 02/20/2020] [Accepted: 06/25/2020] [Indexed: 12/03/2022] Open
Abstract
Purpose To compare the effectiveness of the hydrocolloid and the silicone gel on the nasal protection of the newborns (NBs) during the use of noninvasive ventilation (NIV). Materials and methods Thirty-three NBs were selected. They were randomly divided into three groups of 11 NBs, according to the type of nasal protection used: hydrocolloid, thick silicone gel, and thin silicone gel. The stage of the nasal injury and need for exchanging nasal protection were assessed before the connection to the NIV and every 24 h until the physician's authorization for NIV's suspension. Results The mean gestational age was 32.03 ± 3.93 weeks, and the median birth weight was 1760 g (750–3535 g). The incidence of nasal injury using hydrocolloid, thick silicone gel, and a thin silicone gel group was 36.36%, 81.81%, and 72.72%, respectively (p = 0.06). Regarding the injury stage, there was no statistical significance between the three study groups. The hydrocolloid protection type had the best adhesion (p = 0.03) on the NBs' skin. Conclusions Although this study was conducted by local practice patterns, the results showed that the hydrocolloid could be the best choice to prevent the nasal septum base injury in the NB submitted to NIV.
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Affiliation(s)
- Débora de Fátima Camillo Ribeiro
- Neonatal Services, Waldemar Monastier Hospital, Rua XV de Novembro 3701, Bom Jesus, Campo Largo, Paraná, Brazil.,Graduate Program on Biomedical Engineering, Universidade Tecnológica Federal do Paraná, Avenida Sete de Setembro 3165, Rebouças, Curitiba, Paraná, Brazil.,Graduate Program on Health Technology, Pontifícia Universidade Católica do Paraná, Rua Imaculada Conceição 1155, Prado Velho, Curitiba, Paraná, Brazil
| | - Frieda Saicla Barros
- Graduate Program on Biomedical Engineering, Universidade Tecnológica Federal do Paraná, Avenida Sete de Setembro 3165, Rebouças, Curitiba, Paraná, Brazil
| | - Beatriz Luci Fernandes
- Graduate Program on Health Technology, Pontifícia Universidade Católica do Paraná, Rua Imaculada Conceição 1155, Prado Velho, Curitiba, Paraná, Brazil
| | - Adriane Muller Nakato
- Graduate Program on Health Technology, Pontifícia Universidade Católica do Paraná, Rua Imaculada Conceição 1155, Prado Velho, Curitiba, Paraná, Brazil
| | - Percy Nohama
- Graduate Program on Biomedical Engineering, Universidade Tecnológica Federal do Paraná, Avenida Sete de Setembro 3165, Rebouças, Curitiba, Paraná, Brazil.,Graduate Program on Health Technology, Pontifícia Universidade Católica do Paraná, Rua Imaculada Conceição 1155, Prado Velho, Curitiba, Paraná, Brazil
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24
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Smith A, Kelly DP, Hurlbut J, Melvin P, Russ CM. Initiation of Noninvasive Ventilation for Acute Respiratory Failure in a Pediatric Intermediate Care Unit. Hosp Pediatr 2020; 9:538-544. [PMID: 31253646 DOI: 10.1542/hpeds.2019-0034] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND Noninvasive ventilation (NIV) is increasingly used to manage acute respiratory failure in children, decreasing the need for mechanical ventilation. Safely managing these patients outside of the ICU improves ICU resource use. We measured the impact of a guideline permitting initiation of NIV in an intermediate care unit (IMCU) on ICU bed use. METHODS A guideline for an NIV trial for acute respiratory failure was implemented in a 10-bed IMCU. The guideline stipulated criteria for initiation and maintenance of NIV. There were 4.5 years of intervention data collected. Baseline data were gathered for patients with acute respiratory failure who were transferred from the IMCU to the ICU for NIV initiation in the 3.25 years before guideline implementation. RESULTS Three hundred eight patients were included: 101 in the baseline group and 207 in the intervention group. In the intervention group, 143 patients (69%) remained in the IMCU after NIV initiation, and 64 (31%) transferred to the ICU. A total of 656.4 ICU bed-days were saved in the intervention period (3.3 days per patient initiated on NIV in the IMCU). There was a significant decrease in the rate of intubation in the IMCU for patients awaiting ICU transfer (3 patients in the baseline group versus 0 patients in the intervention group; P = .035). CONCLUSIONS The initiation of NIV in the IMCU for pediatric patients with acute respiratory failure saved ICU bed-days without increasing intubation in the IMCU for patients awaiting transfer. Close monitoring of these critically ill patients is a key component of their safe care.
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Affiliation(s)
| | | | | | - Patrice Melvin
- Program for Patient Safety and Quality, Boston Children's Hospital, Boston, Massachusetts
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25
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Weiss SL, Peters MJ, Alhazzani W, Agus MSD, Flori HR, Inwald DP, Nadel S, Schlapbach LJ, Tasker RC, Argent AC, Brierley J, Carcillo J, Carrol ED, Carroll CL, Cheifetz IM, Choong K, Cies JJ, Cruz AT, De Luca D, Deep A, Faust SN, De Oliveira CF, Hall MW, Ishimine P, Javouhey E, Joosten KFM, Joshi P, Karam O, Kneyber MCJ, Lemson J, MacLaren G, Mehta NM, Møller MH, Newth CJL, Nguyen TC, Nishisaki A, Nunnally ME, Parker MM, Paul RM, Randolph AG, Ranjit S, Romer LH, Scott HF, Tume LN, Verger JT, Williams EA, Wolf J, Wong HR, Zimmerman JJ, Kissoon N, Tissieres P. Surviving sepsis campaign international guidelines for the management of septic shock and sepsis-associated organ dysfunction in children. Intensive Care Med 2020; 46:10-67. [PMID: 32030529 PMCID: PMC7095013 DOI: 10.1007/s00134-019-05878-6] [Citation(s) in RCA: 275] [Impact Index Per Article: 68.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVES To develop evidence-based recommendations for clinicians caring for children (including infants, school-aged children, and adolescents) with septic shock and other sepsis-associated organ dysfunction. DESIGN A panel of 49 international experts, representing 12 international organizations, as well as three methodologists and three public members was convened. Panel members assembled at key international meetings (for those panel members attending the conference), and a stand-alone meeting was held for all panel members in November 2018. A formal conflict-of-interest policy was developed at the onset of the process and enforced throughout. Teleconferences and electronic-based discussion among the chairs, co-chairs, methodologists, and group heads, as well as within subgroups, served as an integral part of the guideline development process. METHODS The panel consisted of six subgroups: recognition and management of infection, hemodynamics and resuscitation, ventilation, endocrine and metabolic therapies, adjunctive therapies, and research priorities. We conducted a systematic review for each Population, Intervention, Control, and Outcomes question to identify the best available evidence, statistically summarized the evidence, and then assessed the quality of evidence using the Grading of Recommendations Assessment, Development, and Evaluation approach. We used the evidence-to-decision framework to formulate recommendations as strong or weak, or as a best practice statement. In addition, "in our practice" statements were included when evidence was inconclusive to issue a recommendation, but the panel felt that some guidance based on practice patterns may be appropriate. RESULTS The panel provided 77 statements on the management and resuscitation of children with septic shock and other sepsis-associated organ dysfunction. Overall, six were strong recommendations, 49 were weak recommendations, and nine were best-practice statements. For 13 questions, no recommendations could be made; but, for 10 of these, "in our practice" statements were provided. In addition, 52 research priorities were identified. CONCLUSIONS A large cohort of international experts was able to achieve consensus regarding many recommendations for the best care of children with sepsis, acknowledging that most aspects of care had relatively low quality of evidence resulting in the frequent issuance of weak recommendations. Despite this challenge, these recommendations regarding the management of children with septic shock and other sepsis-associated organ dysfunction provide a foundation for consistent care to improve outcomes and inform future research.
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Affiliation(s)
- Scott L Weiss
- Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.
| | - Mark J Peters
- Great Ormond Street Hospital for Children, London, UK
| | - Waleed Alhazzani
- Department of Medicine, Division of Critical Care, McMaster University, Hamilton, ON, Canada
- Department of Health Research Methods and Impact, McMaster University, Hamilton, ON, Canada
| | - Michael S D Agus
- Department of Pediatrics, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA
| | | | | | | | - Luregn J Schlapbach
- Paediatric Critical Care Research Group, The University of Queensland and Queensland Children's Hospital, Brisbane, QLD, Australia
| | - Robert C Tasker
- Department of Pediatrics, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA
| | - Andrew C Argent
- Red Cross War Memorial Children's Hospital and University of Cape Town, Cape Town, South Africa
| | - Joe Brierley
- Great Ormond Street Hospital for Children, London, UK
| | | | | | | | | | - Karen Choong
- Department of Medicine, Division of Critical Care, McMaster University, Hamilton, ON, Canada
- Department of Health Research Methods and Impact, McMaster University, Hamilton, ON, Canada
| | - Jeffry J Cies
- St. Christopher's Hospital for Children, Philadelphia, PA, USA
| | | | - Daniele De Luca
- Paris South University Hospitals-Assistance Publique Hopitaux de Paris, Paris, France
- Physiopathology and Therapeutic Innovation Unit-INSERM U999, South Paris-Saclay University, Paris, France
| | | | - Saul N Faust
- University Hospital Southampton NHS Foundation Trust and University of Southampton, Southampton, UK
| | | | - Mark W Hall
- Nationwide Children's Hospital, Columbus, OH, USA
| | | | | | | | - Poonam Joshi
- All India Institute of Medical Sciences, New Delhi, India
| | - Oliver Karam
- Children's Hospital of Richmond at VCU, Richmond, VA, USA
| | | | - Joris Lemson
- Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Graeme MacLaren
- National University Health System, Singapore, Singapore
- Royal Children's Hospital, Melbourne, VIC, Australia
| | - Nilesh M Mehta
- Department of Anesthesiology, Critical Care and Pain, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA
| | | | | | | | - Akira Nishisaki
- Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Mark E Nunnally
- New York University Langone Medical Center, New York, NY, USA
| | | | - Raina M Paul
- Advocate Children's Hospital, Park Ridge, IL, USA
| | - Adrienne G Randolph
- Department of Anesthesiology, Critical Care and Pain, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA
| | | | | | | | | | - Judy T Verger
- Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
- College of Nursing, University of Iowa, Iowa City, IA, USA
| | | | - Joshua Wolf
- St. Jude Children's Research Hospital, Memphis, TN, USA
| | | | | | | | - Pierre Tissieres
- Paris South University Hospitals-Assistance Publique Hopitaux de Paris, Paris, France
- Institute of Integrative Biology of the Cell-CNRS, CEA, Univ Paris Sud, Gif-Sur-Yvette, France
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26
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Weiss SL, Peters MJ, Alhazzani W, Agus MSD, Flori HR, Inwald DP, Nadel S, Schlapbach LJ, Tasker RC, Argent AC, Brierley J, Carcillo J, Carrol ED, Carroll CL, Cheifetz IM, Choong K, Cies JJ, Cruz AT, De Luca D, Deep A, Faust SN, De Oliveira CF, Hall MW, Ishimine P, Javouhey E, Joosten KFM, Joshi P, Karam O, Kneyber MCJ, Lemson J, MacLaren G, Mehta NM, Møller MH, Newth CJL, Nguyen TC, Nishisaki A, Nunnally ME, Parker MM, Paul RM, Randolph AG, Ranjit S, Romer LH, Scott HF, Tume LN, Verger JT, Williams EA, Wolf J, Wong HR, Zimmerman JJ, Kissoon N, Tissieres P. Surviving Sepsis Campaign International Guidelines for the Management of Septic Shock and Sepsis-Associated Organ Dysfunction in Children. Pediatr Crit Care Med 2020; 21:e52-e106. [PMID: 32032273 DOI: 10.1097/pcc.0000000000002198] [Citation(s) in RCA: 478] [Impact Index Per Article: 119.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVES To develop evidence-based recommendations for clinicians caring for children (including infants, school-aged children, and adolescents) with septic shock and other sepsis-associated organ dysfunction. DESIGN A panel of 49 international experts, representing 12 international organizations, as well as three methodologists and three public members was convened. Panel members assembled at key international meetings (for those panel members attending the conference), and a stand-alone meeting was held for all panel members in November 2018. A formal conflict-of-interest policy was developed at the onset of the process and enforced throughout. Teleconferences and electronic-based discussion among the chairs, co-chairs, methodologists, and group heads, as well as within subgroups, served as an integral part of the guideline development process. METHODS The panel consisted of six subgroups: recognition and management of infection, hemodynamics and resuscitation, ventilation, endocrine and metabolic therapies, adjunctive therapies, and research priorities. We conducted a systematic review for each Population, Intervention, Control, and Outcomes question to identify the best available evidence, statistically summarized the evidence, and then assessed the quality of evidence using the Grading of Recommendations Assessment, Development, and Evaluation approach. We used the evidence-to-decision framework to formulate recommendations as strong or weak, or as a best practice statement. In addition, "in our practice" statements were included when evidence was inconclusive to issue a recommendation, but the panel felt that some guidance based on practice patterns may be appropriate. RESULTS The panel provided 77 statements on the management and resuscitation of children with septic shock and other sepsis-associated organ dysfunction. Overall, six were strong recommendations, 52 were weak recommendations, and nine were best-practice statements. For 13 questions, no recommendations could be made; but, for 10 of these, "in our practice" statements were provided. In addition, 49 research priorities were identified. CONCLUSIONS A large cohort of international experts was able to achieve consensus regarding many recommendations for the best care of children with sepsis, acknowledging that most aspects of care had relatively low quality of evidence resulting in the frequent issuance of weak recommendations. Despite this challenge, these recommendations regarding the management of children with septic shock and other sepsis-associated organ dysfunction provide a foundation for consistent care to improve outcomes and inform future research.
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Affiliation(s)
- Scott L Weiss
- Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Mark J Peters
- Great Ormond Street Hospital for Children, London, United Kingdom
| | - Waleed Alhazzani
- Department of Medicine, Division of Critical Care, and Department of Health Research Methods and Impact, McMaster University, Hamilton, ON, Canada
| | - Michael S D Agus
- Department of Pediatrics (to Dr. Agus), Department of Anesthesiology, Critical Care and Pain (to Drs. Mehta and Randolph), Boston Children's Hospital and Harvard Medical School, Boston, MA
| | | | | | | | - Luregn J Schlapbach
- Paediatric Critical Care Research Group, The University of Queensland and Queensland Children's Hospital, Brisbane, QLD, Australia
| | - Robert C Tasker
- Department of Pediatrics (to Dr. Agus), Department of Anesthesiology, Critical Care and Pain (to Drs. Mehta and Randolph), Boston Children's Hospital and Harvard Medical School, Boston, MA
| | - Andrew C Argent
- Red Cross War Memorial Children's Hospital and University of Cape Town, Cape Town, South Africa
| | - Joe Brierley
- Great Ormond Street Hospital for Children, London, United Kingdom
| | | | | | | | | | - Karen Choong
- Department of Medicine, Division of Critical Care, and Department of Health Research Methods and Impact, McMaster University, Hamilton, ON, Canada
| | - Jeffry J Cies
- St. Christopher's Hospital for Children, Philadelphia, PA
| | | | - Daniele De Luca
- Paris South University Hospitals-Assistance Publique Hopitaux de Paris, Paris, France.,Physiopathology and Therapeutic Innovation Unit-INSERM U999, South Paris-Saclay University, Paris, France
| | - Akash Deep
- King's College Hospital, London, United Kingdom
| | - Saul N Faust
- University Hospital Southampton NHS Foundation Trust and University of Southampton, Southampton, United Kingdom
| | | | - Mark W Hall
- Nationwide Children's Hospital, Columbus, OH
| | | | | | | | - Poonam Joshi
- All India Institute of Medical Sciences, New Delhi, India
| | - Oliver Karam
- Children's Hospital of Richmond at VCU, Richmond, VA
| | | | - Joris Lemson
- Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Graeme MacLaren
- National University Health System, Singapore, and Royal Children's Hospital, Melbourne, VIC, Australia
| | - Nilesh M Mehta
- Department of Pediatrics (to Dr. Agus), Department of Anesthesiology, Critical Care and Pain (to Drs. Mehta and Randolph), Boston Children's Hospital and Harvard Medical School, Boston, MA
| | | | | | | | - Akira Nishisaki
- Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | | | | | | | - Adrienne G Randolph
- Department of Pediatrics (to Dr. Agus), Department of Anesthesiology, Critical Care and Pain (to Drs. Mehta and Randolph), Boston Children's Hospital and Harvard Medical School, Boston, MA
| | | | | | | | - Lyvonne N Tume
- University of the West of England, Bristol, United Kingdom
| | - Judy T Verger
- Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA.,College of Nursing, University of Iowa, Iowa City, IA
| | | | - Joshua Wolf
- St. Jude Children's Research Hospital, Memphis, TN
| | | | | | - Niranjan Kissoon
- British Columbia Children's Hospital, Vancouver, British Columbia, Canada
| | - Pierre Tissieres
- Paris South University Hospitals-Assistance Publique Hopitaux de Paris, Paris, France.,Institute of Integrative Biology of the Cell-CNRS, CEA, Univ Paris Sud, Gif-sur-Yvette, France
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27
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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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28
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Schlosser KR, Fiore GA, Smallwood CD, Griffin JF, Geva A, Santillana M, Arnold JH. Noninvasive Ventilation Is Interrupted Frequently and Mostly Used at Night in the Pediatric Intensive Care Unit. Respir Care 2019; 65:341-346. [PMID: 31551282 DOI: 10.4187/respcare.06883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Noninvasive ventilation (NIV) is commonly used to support children with respiratory failure, but detailed patterns of real-world use are lacking. The aim of our study was to describe use patterns of NIV via electronic medical record (EMR) data. METHODS We performed a retrospective electronic chart review in a tertiary care pediatric ICU in the United States. Subjects admitted to the pediatric ICU from 2014 to 2017 who were mechanically ventilated were included in the study. RESULTS The median number of discrete device episodes, defined as a time on support without interruption, was 20 (interquartile range [IQR] 8-49) per subject. The median duration of bi-level positive airway pressure (BPAP) support prior to interruption was 6.3 h (IQR 2.4-10.4); the median duration of CPAP was 6 h (IQR 2.1-10.4). Interruptions to BPAP had a median duration of 6.3 h (IQR 2-15.5); interruptions to CPAP had a median duration of 8.6 h (IQR 2.2-16.8). Use of NIV followed a diurnal pattern, with 44% of BPAP and 42% of CPAP subjects initiating support between 7:00 pm and midnight, and 49% of BPAP and 46% of CPAP subjects stopping support between 5:00 am and 10:00 am. CONCLUSIONS NIV was frequently interrupted, and initiation and discontinuation of NIV follows a diurnal pattern. Use of EMR data collected for routine clinical care allowed the analysis of granular details of typical use patterns. Understanding NIV use patterns may be particularly important to understanding the burden of pediatric ICU bed utilization for nocturnal NIV. To our knowledge, this is the first study to examine in detail the use of pediatric NIV and to define diurnal use and frequent interruptions to support.
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Affiliation(s)
- Katherine R Schlosser
- Division of Critical Care Medicine, Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Boston, Massachusetts. .,Division of Pediatric Critical Care, Department of Pediatrics, Columbia University Irving Medical Center, New York
| | - Gaston A Fiore
- Computational Health Informatics Program, Boston Children's Hospital, Boston, Massachusetts
| | - Craig D Smallwood
- Division of Critical Care Medicine, Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Boston, Massachusetts
| | - John F Griffin
- Division of Critical Care Medicine, Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Boston, Massachusetts
| | - Alon Geva
- Division of Critical Care Medicine, Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Boston, Massachusetts.,Computational Health Informatics Program, Boston Children's Hospital, Boston, Massachusetts
| | - Mauricio Santillana
- Computational Health Informatics Program, Boston Children's Hospital, Boston, Massachusetts
| | - John H Arnold
- Division of Critical Care Medicine, Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Boston, Massachusetts
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29
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Wolfler A, Raimondi G, Pagan de Paganis C, Zoia E. The infant with severe bronchiolitis: from high flow nasal cannula to continuous positive airway pressure and mechanical ventilation. Minerva Pediatr 2018; 70:612-622. [DOI: 10.23736/s0026-4946.18.05358-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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30
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Wang BC, Pei T, Lin CB, Guo R, Elashoff D, Lin JA, Pineda C. Clinical characteristics and outcomes associated with nasal intermittent mandatory ventilation in acute pediatric respiratory failure. World J Crit Care Med 2018; 7:46-51. [PMID: 30211019 PMCID: PMC6134265 DOI: 10.5492/wjccm.v7.i4.46] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Revised: 07/25/2018] [Accepted: 08/05/2018] [Indexed: 02/06/2023] Open
Abstract
AIM To characterize the clinical course and outcomes of nasal intermittent mandatory ventilation (NIMV) use in acute pediatric respiratory failure.
METHODS We identified all patients treated with NIMV in the pediatric intensive care unit (PICU) or inpatient general pediatrics between January 2013 and December 2015 at two academic centers. Patients who utilized NIMV with other modes of noninvasive ventilation during the same admission were included. Data included demographics, vital signs on admission and prior to initiation of NIMV, pediatric risk of mortality III (PRISM-III) scores, complications, respiratory support characteristics, PICU and hospital length of stays, duration of respiratory support, and complications. Patients who did not require escalation to mechanical ventilation were defined as NIMV responders; those who required escalation to mechanical ventilation (MV) were defined as NIMV non-responders. NIMV responders were compared to NIMV non-responders.
RESULTS Forty-two patients met study criteria. Six (14%) failed treatment and required MV. The majority of the patients (74%) had a primary diagnosis of bronchiolitis. The median age of these 42 patients was 4 mo (range 0.5-28.1 mo, IQR 7, P = 0.69). No significant difference was measured in other baseline demographics and vitals on initiation of NIMV; these included age, temperature, respiratory rate, O2 saturation, heart rate, systolic blood pressure, diastolic blood pressure, and PRISM-III scores. The duration of NIMV was shorter in the NIMV non-responder vs NIMV responder group (6.5 h vs 65 h, P < 0.0005). Otherwise, NIMV failure was not associated with significant differences in PICU length of stay (LOS), hospital LOS, or total duration of respiratory support. No patients had aspiration pneumonia, pneumothorax, or skin breakdown.
CONCLUSION Most of our patients responded to NIMV. NIMV failure is not associated with differences in hospital LOS, PICU LOS, or duration of respiratory support.
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Affiliation(s)
- Billy C Wang
- Department of Pediatrics, Division of Critical Care Medicine, Loma Linda University Children’s Hospital, Loma Linda, CA 92354, United States
| | - Theodore Pei
- Department of Pediatrics, Division of Pediatric Critical Care, Floating Hospital for Children at Tufts, Boston, MA 02111, United States
| | - Cheryl B Lin
- Department of Pediatrics, Division of Pediatric Critical Care, Floating Hospital for Children at Tufts, Boston, MA 02111, United States
| | - Rong Guo
- Department of Medicine, Biostatistics Core, UCLA David Geffen School of Medicine, Los Angeles, CA 90024, United States
| | - David Elashoff
- Department of Medicine, Biostatistics Core, UCLA David Geffen School of Medicine, Los Angeles, CA 90024, United States
| | - James A Lin
- Department of Pediatrics, Mattel Children’s Hospital at UCLA, Los Angeles, CA 90095, United States
| | - Carol Pineda
- Department of Pediatrics, Division of Pediatric Critical Care, Floating Hospital for Children at Tufts, Boston, MA 02111, United States
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Failure of Invasive Airway Placement on the First Attempt Is Associated With Progression to Cardiac Arrest in Pediatric Acute Respiratory Compromise. Pediatr Crit Care Med 2018; 19:9-16. [PMID: 29135805 PMCID: PMC6262832 DOI: 10.1097/pcc.0000000000001370] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The aim of this study was to describe the proportion of acute respiratory compromise events in hospitalized pediatric patients progressing to cardiopulmonary arrest, and the clinical factors associated with progression of acute respiratory compromise to cardiopulmonary arrest. We hypothesized that failure of invasive airway placement on the first attempt (defined as multiple attempts at tracheal intubation, and/or laryngeal mask airway placement, and/or the creation of a new tracheostomy or cricothyrotomy) is independently associated with progression of acute respiratory compromise to cardiopulmonary arrest. DESIGN Multicenter, international registry of pediatric in-hospital acute respiratory compromise. SETTING American Heart Association's Get with the Guidelines-Resuscitation registry (2000-2014). PATIENTS Children younger than 18 years with an index (first) acute respiratory compromise event. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Of the 2,210 index acute respiratory compromise events, 64% required controlled ventilation, 26% had return of spontaneous ventilation, and 10% progressed to cardiopulmonary arrest. There were 762 acute respiratory compromise events (34%) that did not require an invasive airway, 1,185 acute respiratory compromise events (54%) with successful invasive airway placement on the first attempt, and 263 acute respiratory compromise events (12%) with failure of invasive airway placement on the first attempt. After adjusting for confounding variables, failure of invasive airway placement on the first attempt was independently associated with progression of acute respiratory compromise to cardiopulmonary arrest (adjusted odds ratio 1.8 [95% CIs, 1.2-2.6]). CONCLUSIONS More than 1 in 10 hospitalized pediatric patients who experienced an acute respiratory compromise event progressed to cardiopulmonary arrest. Failure of invasive airway placement on the first attempt is independently associated with progression of acute respiratory compromise to cardiopulmonary arrest.
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Noninvasive Ventilation in the Cardiac ICU: Understanding What We Are Doing as a Foundation for Studying What We Should Be Doing. Pediatr Crit Care Med 2017; 18:991-992. [PMID: 28976464 DOI: 10.1097/pcc.0000000000001295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Banasch HL, Dersch-Mills DA, Boulter LL, Gilfoyle E. Dexmedetomidine Use in a Pediatric Intensive Care Unit: A Retrospective Cohort Study. Ann Pharmacother 2017; 52:133-139. [DOI: 10.1177/1060028017734560] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
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De Jesus Rojas W, Samuels CL, Gonzales TR, McBeth KE, Yadav A, Stark JM, Jon C, Mosquera RA. Use of Nasal Non-Invasive Ventilation with a RAM Cannula in the Outpatient Home Setting. Open Respir Med J 2017; 11:41-46. [PMID: 28839496 PMCID: PMC5543681 DOI: 10.2174/1874306401711010041] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Revised: 05/17/2017] [Accepted: 07/04/2017] [Indexed: 11/22/2022] Open
Abstract
Background: Nasal non-invasive-ventilation (Nasal NIV) is a mode of ventilatory support providing positive pressure to patients via a nasal interface. The RAM Cannula is an oxygen delivery device that can be used as an alternative approach to deliver positive pressure. Together they have been successfully used to provide respiratory support in neonatal in-patient settings. Objective: To describe the outpatient use of Nasal NIV/RAM Cannula as a feasible alternative for home respiratory support in children with chronic respiratory failure. Methods: We performed a retrospective case series of 18 children (4 months to 19 years old) using the Nasal NIV/RAM Cannula in the Pediatric Pulmonary Clinic at the McGovern Medical School, UTHealth (2014-16). Consideration for Nasal NIV/RAM Cannula utilization included: inability to wean-off in-patient respiratory support, comfort for dyspnea, intolerability of conventional mask interfaces and tracheostomy avoidance. Results: Average age was 7 years. 50% were Caucasian, 38% African-American and 11% Hispanics. Pulmonary disorders included: chest wall weakness (38%), central control abnormalities (33%), obstructive lung disease (16%) and restrictive lung disease (11%). Indications for Nasal NIV/RAM Cannula initiation included: CPAP/BPAP masks intolerability (11%), dyspnea secondary to chest wall weakness (38%) and tracheostomy avoidance (50%). Average length of use of Nasal NIV/RAM Cannula was 8.4 months. Successful implementation of Nasal NIV/Ram Cannula was 94%. One patient required a tracheostomy following the use of Nasal NIV/RAM Cannula. Significant decrease in arterial PaCO2 pre and post Nasal NIV/RAM cannula initiation was notable (p=0.001). Conclusion: Outpatient use of Nasal NIV/RAM Cannula may prove to be a feasible and save treatment alternative for children with chronic respiratory failure, chest wall weakness, dyspnea and traditional nasal/face mask intolerance to avoid tracheostomy.
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Affiliation(s)
| | - Cheryl L Samuels
- University of Texas Health Science Center, McGovern Medical School, Houston, Texas, USA
| | - Traci R Gonzales
- University of Texas Health Science Center, McGovern Medical School, Houston, Texas, USA
| | - Katrina E McBeth
- University of Texas Health Science Center, McGovern Medical School, Houston, Texas, USA
| | - Aravind Yadav
- University of Texas Health Science Center, McGovern Medical School, Houston, Texas, USA
| | - James M Stark
- University of Texas Health Science Center, McGovern Medical School, Houston, Texas, USA
| | - Cindy Jon
- University of Texas Health Science Center, McGovern Medical School, Houston, Texas, USA
| | - Ricardo A Mosquera
- University of Texas Health Science Center, McGovern Medical School, Houston, Texas, USA
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Nebulized Fluticasone for Preventing Postextubation Stridor in Intubated Children: A Randomized, Double-Blind Placebo-Controlled Trial. Pediatr Crit Care Med 2017; 18:e201-e206. [PMID: 28272175 DOI: 10.1097/pcc.0000000000001124] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To evaluate the efficacy of nebulized fluticasone propionate in the prevention of postextubation stridor in children. DESIGN Double-blind, placebo-controlled randomized clinical trial. SETTING PICU in a tertiary referral center. PATIENTS Children 1 month to 15 years old who underwent mechanical ventilation. INTERVENTIONS Patients were randomly assigned into two groups after stratification based on age group receiving nebulized fluticasone 1,000 µg or normal saline solution, immediately after extubation. Vital signs and modified Westley score were evaluated for 6 hours after extubation. The primary outcome was the prevalence of postextubation stridor. MEASUREMENTS AND MAIN RESULTS One hundred forty-seven intubated children were enrolled into this study. Baseline characteristics between two groups were not different. There was no significant difference in the incidence of postextubation stridor (12/74 [16%] vs 13/73 [18%]; p = 0.797). However, when analyzing the subgroup of emergently intubated children, the fluticasone group had a longer delay median time for the initiation of noninvasive ventilation than the control group (380 [90-585] vs 60 [42-116] min; p = 0.044). The modified Westley scores at 30 and 60 minutes in the control group were significantly higher than the fluticasone group (4 vs 2, p = 0.04; 4.5 vs 0.5, p = 0.02, respectively). CONCLUSIONS The single dose of 1,000-µg nebulized fluticasone did not decrease the prevalence of postextubation stridor. However, it might be beneficial in emergently intubated children.
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Cheon EC, Palac HL, Paik KH, Hajduk J, De Oliveira GS, Jagannathan N, Suresh S. Unplanned, Postoperative Intubation in Pediatric Surgical Patients. Anesthesiology 2016; 125:914-928. [DOI: 10.1097/aln.0000000000001343] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Abstract
Background
To date, the independent predictors and outcomes of unplanned postoperative intubation (UPI) in pediatric patients after noncardiac surgery are yet to be characterized. The authors aimed to identify the incidence and predictors of this event and evaluated the effect of this event on postoperative mortality.
Methods
Data of 87,920 patients from the American College of Surgeons National Surgical Quality Improvement Program Pediatric database were analyzed and assigned to derivation (n = 58,614; 66.7%) or validation (n = 29,306; 33.3%) cohorts. The derivation cohort was analyzed for the incidence and independent predictors of early UPI. The final multivariable logistic regression model was validated using the validation cohort.
Results
Early UPI occurred with an incidence of 0.2% in both cohorts. Among the 540 patients who experienced a UPI, 178 (33.0%) were intubated within the first 72 h after surgery. The final logistic regression model indicated operation time, severe cardiac risk factors, American Society of Anesthesiologists physical status classification more than or equal to 2, tumor involving the central nervous system, developmental delay/impaired cognitive function, past or current malignancy, and neonate status as independent predictors of early UPI. Having an early UPI was associated with an increased risk of unadjusted, all-cause 30-day mortality, demonstrating an odds ratio of 11.4 (95% CI, 5.8 to 22.4).
Conclusions
Pediatric patients who experienced an early UPI after noncardiac surgery had an increased likelihood of unadjusted 30-day mortality by more than 11-fold. Identification of high-risk patients can allow for targeted intervention and potential prevention of such outcomes.
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Affiliation(s)
- Eric C. Cheon
- From the Department of Pediatric Anesthesiology, Ann & Robert H. Lurie Children’s Hospital of Chicago (E.C.C., K.H.P., J.H., G.S.D.O., N.J., S.S.); Department of Preventative Medicine (H.L.P.), and Department of Anesthesiology (K.H.P., G.S.D.O.), Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Hannah L. Palac
- From the Department of Pediatric Anesthesiology, Ann & Robert H. Lurie Children’s Hospital of Chicago (E.C.C., K.H.P., J.H., G.S.D.O., N.J., S.S.); Department of Preventative Medicine (H.L.P.), and Department of Anesthesiology (K.H.P., G.S.D.O.), Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Kristine H. Paik
- From the Department of Pediatric Anesthesiology, Ann & Robert H. Lurie Children’s Hospital of Chicago (E.C.C., K.H.P., J.H., G.S.D.O., N.J., S.S.); Department of Preventative Medicine (H.L.P.), and Department of Anesthesiology (K.H.P., G.S.D.O.), Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - John Hajduk
- From the Department of Pediatric Anesthesiology, Ann & Robert H. Lurie Children’s Hospital of Chicago (E.C.C., K.H.P., J.H., G.S.D.O., N.J., S.S.); Department of Preventative Medicine (H.L.P.), and Department of Anesthesiology (K.H.P., G.S.D.O.), Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Gildasio S. De Oliveira
- From the Department of Pediatric Anesthesiology, Ann & Robert H. Lurie Children’s Hospital of Chicago (E.C.C., K.H.P., J.H., G.S.D.O., N.J., S.S.); Department of Preventative Medicine (H.L.P.), and Department of Anesthesiology (K.H.P., G.S.D.O.), Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Narasimhan Jagannathan
- From the Department of Pediatric Anesthesiology, Ann & Robert H. Lurie Children’s Hospital of Chicago (E.C.C., K.H.P., J.H., G.S.D.O., N.J., S.S.); Department of Preventative Medicine (H.L.P.), and Department of Anesthesiology (K.H.P., G.S.D.O.), Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Santhanam Suresh
- From the Department of Pediatric Anesthesiology, Ann & Robert H. Lurie Children’s Hospital of Chicago (E.C.C., K.H.P., J.H., G.S.D.O., N.J., S.S.); Department of Preventative Medicine (H.L.P.), and Department of Anesthesiology (K.H.P., G.S.D.O.), Northwestern University Feinberg School of Medicine, Chicago, Illinois
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Predictors of Early Extubation After Pediatric Cardiac Surgery: A Single-Center Prospective Observational Study. Pediatr Cardiol 2016; 37:1241-9. [PMID: 27272692 DOI: 10.1007/s00246-016-1423-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Accepted: 05/24/2016] [Indexed: 10/21/2022]
Abstract
This prospective, observational, single-center study aimed to determine the perioperative predictors of early extubation (<24 h after cardiac surgery) in a cohort of children undergoing cardiac surgery. Children aged between 1 month and 18 years who were consecutively admitted to pediatric intensive care unit after cardiac surgery for congenital heart disease between January 2012 and June 2014. Ninety-nine patients were qualified for inclusion during the study period. The median duration of mechanical ventilation was 20 h (range 1-480), and 64 patients were extubated within 24 h. Four of them failed the initial attempt at extubation, and the success rate of early extubation was 60.6 %. Older patient age (p = .009), greater body weight (p = .009), absence of preoperative pulmonary hypertension (p = .044), lower RACHS-1 category (OR, 3.8; 95 % CI 1.35-10.7; p < .05), shorter cardiopulmonary bypass (p = .008) and cross-clamp (p = .022) times, lower PRISM III-24 (p < .05) and PELOD (p < .05) scores, lower inotropic score (p < .05) and vasoactive-inotropic score (p < .05), and lower number of organ failures (OR, 2.26; 95 % CI 1.30-3.92; p < .05) were associated with early extubation. Our study establishes that early extubation can be accomplished within the first 24 h after surgery in low- to medium-risk pediatric cardiac surgery patients, especially in older ones undergoing low-complexity procedures. A large prospective multiple institution trial is necessary to identify the predictors and benefits of early extubation and to facilitate defined guidelines for early extubation.
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