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Emami Zeydi A, Zare‐Kaseb A, Nazari AM, Ghazanfari MJ, Sarmadi S. Mask-related pressure injury prevention associated with non-invasive ventilation: A systematic review. Int Wound J 2024; 21:e14909. [PMID: 38826030 PMCID: PMC11144948 DOI: 10.1111/iwj.14909] [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: 03/23/2024] [Revised: 04/24/2024] [Accepted: 04/25/2024] [Indexed: 06/04/2024] Open
Abstract
Noninvasive ventilation interfaces are one of the main factors contributing to pressure injuries caused by medical devices. Prevention is still the best course of action when discussing noninvasive ventilation-induced pressure injuries. A systematic review was designed to summarize and analyse all published literature on strategies to prevent pressure injuries caused by masks in patients undergoing noninvasive ventilation. The protocol of the systematic review followed the PRISMA guideline. An extensive search from the beginning to May 16, 2023, using current articles in databases such as Web of Science (WOS), Scopus, PubMed, and Cochrane Library was conducted. Medical Subject Headings (MESH) were used as follows: "Pressure Injury," "Noninvasive Ventilation," "Prevention," and "Pressure Sore." Any language-published studies that met the inclusion criteria were included in this review. A risk of bias assessment was conducted using the Joanna Briggs Institute tool, including evaluation methodologies for all studies. Database searches yielded 2546 articles, which were reduced to 23 that met our criteria after reviewing full texts. A narrative synthesis was conducted. As a result, type of interface (14 studies), dressings (4 studies), adjustment of mask leakage (1 study), humidity (1 study), positioning (1 study), and design of personalized masks (2 studies) seem to be a practical approach to prevent pressure injuries caused by masks in patients undergoing noninvasive ventilation. The results of our study show the effectiveness of preventive methods in reducing the incidence of pressure injuries caused by masks. Given the significant occurrence of pressure injury related to noninvasive ventilation and the crucial role of prevention and treatment, it is imperative to conduct more rigorous studies to ascertain the efficacy of each strategy.
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Affiliation(s)
- Amir Emami Zeydi
- Department of Medical‐Surgical Nursing, Nasibeh School of Nursing and MidwiferyMazandaran University of Medical SciencesSariIran
| | - Akbar Zare‐Kaseb
- Nursing and Midwifery SchoolShahid Beheshti University of Medical SciencesTehranIran
| | - Amir Mohamad Nazari
- Nursing and Midwifery SchoolShahid Beheshti University of Medical SciencesTehranIran
| | - Mohammad Javad Ghazanfari
- Department of Medical‐Surgical Nursing, School of Nursing and MidwiferyShahid Beheshti University of Medical SciencesTehranIran
| | - Sogand Sarmadi
- Nursing and Midwifery SchoolShahid Beheshti University of Medical SciencesTehranIran
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2
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Chua KY, Paranchothy M, Ng SF, Lee CC. Short-term Non-invasive Ventilation for Children with Palliative Care Needs. Indian J Palliat Care 2024; 30:182-186. [PMID: 38846132 PMCID: PMC11152513 DOI: 10.25259/ijpc_304_2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 02/28/2024] [Indexed: 06/09/2024] Open
Abstract
Objectives Non-invasive ventilation (NIV), namely continuous positive airway pressure (CPAP) and bi-level positive airway pressure (BiPAP), delivers mechanical ventilation without endotracheal intubation. Short-term NIV (planned for <21 days during initiation) can be used for the management of acute respiratory distress (ARD) among paediatric palliative patients with "Do Not Resuscitate or Intubate" (DNI) as the ceiling of care. This study aimed to describe the usage of short-term NIV among paediatric palliative patients in a woman and child hospital with a paediatric palliative subspecialty. Materials and Methods A retrospective and observational study was conducted on all paediatric palliative patients who received short-term NIV in Tunku Azizah Hospital Kuala Lumpur, Malaysia, from March 2020 to May 2022. Results During the study period, short-term NIV was offered on 23 occasions for 20 different children. Indications for short-term NIV include 16 (69.6%) occasions of potentially reversible ARD (NIV Category 1) and 7 (30.4%) occasions of comfort care at the end of life (NIV Category 2). The main cause of ARD was pneumonia (90.3%) due to either aspiration or infection. The modality of NIV used was BiPAP only (14 occasions, 60.9%), CPAP only (three occasions, 13%) and both BiPAP and CPAP (six occasions, 26.1%). The median duration of NIV usage was four days (minimum one day and maximum 15 days). NIV was initiated as an escalation from nasal prong, Ventimask or high-flow mask oxygen on 22 occasions and as weaning down post-extubation on one occasion. For the 22 occasions of escalating therapy, there was significant improvement at six hours compared to pre-NIV in the median heart rate (136 to 121, P=0.002), respiratory rate (40 to 31, P=0.002) and oxygen saturation (96% to 99%, P=0.025). All 17 documented parental impressions of the child's condition post six hours of NIV were that the child had improved. Adverse events during short-term NIV include five episodes (21.7%) of stomach distension, four episodes (17.4%) of skin sores on the face and one episode (4.3%) of excessive drooling. Three patients passed away while on NIV in the hospital. For the other 20 (87%) occasions, patients were able to wean off NIV. Post-weaning off NIV, three patients passed away during the same admission. On 17 occasions, patients were discharged home after weaning off NIV. Conclusion Usage of short-term NIV in paediatric palliative care, where children have an advanced directive in place indicating DNI, as seen in our study, can be a valuable modality of management for distressing symptoms, in addition to the pharmacological management of breathlessness. This is shown through our study to be of benefit in potentially reversible ARD as well as comfort care at the end of life. Further rigorous studies will need to be conducted for a clearer understanding of short-term NIV that would enable the formulation of guidelines to improve the quality of life and death in children.
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Affiliation(s)
- Ker Yang Chua
- Department of Paediatrics, Hospital Tunku Azizah, Ministry of Health, Malaysia
| | - Malini Paranchothy
- Department of Paediatrics, Hospital Tunku Azizah, Ministry of Health, Malaysia
| | - Su Fang Ng
- Department of Paediatrics, Hospital Likas, Ministry of Health, Malaysia
| | - Chee Chan Lee
- Department of Paediatrics, Hospital Tunku Azizah, Ministry of Health, Malaysia
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3
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Barnes C, Herbert TL, Bonilha HS. Parameters for Orally Feeding Neonates Who Require Noninvasive Ventilation: A Systematic Review. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2023:1-20. [PMID: 37098117 DOI: 10.1044/2023_ajslp-22-00259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/19/2023]
Abstract
PURPOSE Infants hospitalized in the neonatal intensive care unit (NICU) may be orally fed while receiving noninvasive ventilation (NIV), but the practice is variable and decision criteria are not well understood. This systematic review examines the evidence regarding this practice, including type and level of NIV used during NICU oral feeding, protocols, and safety of this practice. METHOD The PubMed, Scopus, and Cumulative Index to Nursing and Allied Health Literature (CINAHL) databases were searched to identify publications relevant to this review. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed to ensure the appropriate inclusion of articles. RESULTS Fourteen articles were included. Seven studies (50%) were retrospective. Two were quality improvement projects, and the remaining five (35.7%) were prospective. Continuous positive airway pressure and high-flow nasal cannula were commonly used. Levels of respiratory support were variable between studies, if reported at all. Three studies (21.4%) included feeding protocols. Six studies (42.9%) identified use of feeding experts. While many studies commented that orally feeding neonates on NIV is safe, the only study to instrumentally assess swallow safety found that a significant number of neonates silently aspirated during feeding on continuous positive airway pressure. CONCLUSIONS Strong data supporting practices related to orally feeding infants in the NICU who require NIV are scarce. The types and levels of NIV, and decision-making criteria, are variable across studies and preclude clinically useful conclusions. There is a pressing need for additional research pertaining to orally feeding this population so that an evidence-based standard of care can be established. Specifically, this research should elucidate the impact of different types and levels of NIV on the mechanistic properties of swallowing as defined via instrumental assessment.
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Affiliation(s)
- Carolyn Barnes
- Department of Health Sciences & Research, Medical University of South Carolina, Charleston
| | - Teri Lynn Herbert
- Academic Affairs Faculty, Medical University of South Carolina, Charleston
| | - Heather S Bonilha
- Department of Health Sciences & Research, Medical University of South Carolina, Charleston
- Department of Rehabilitation Medicine, Emory University, Atlanta, GA
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4
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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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5
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Wu A, Mukhtar-Yola M, Luch S, John S, Adhikari BR, Bakker C, Slusher T, Bjorklund A, Winter J, Ezeaka C. Innovations and adaptations in neonatal and pediatric respiratory care for resource constrained settings. Front Pediatr 2022; 10:954975. [PMID: 36389382 PMCID: PMC9659573 DOI: 10.3389/fped.2022.954975] [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: 05/27/2022] [Accepted: 10/10/2022] [Indexed: 11/13/2022] Open
Abstract
Respiratory disease is a leading cause of death in children under 5 years of age worldwide, and most of these deaths occur in low- to middle-income countries (LMICs) where advanced respiratory care technology is often limited. Much of the equipment required to provide advanced respiratory care is unavailable in these areas due to high costs, the need for specialty trained personnel, and myriad other resource constraints that limit uptake and sustainable use of these devices, including reliable access to electricity, sensitive equipment needing frequent maintenance, single-patient-use supplies, and lack of access to sterilization equipment. Compounding the problem, pediatrics is uniquely challenging in that one size does not fit all, or even most patients. Despite these substantial barriers, numerous innovations in respiratory care technology have been made in recent years that have brought increasing access to high quality respiratory care in some of the most remote areas of the world. In this article, we intend to review the global burden of respiratory diseases for children, highlight the prototypical innovations that have been made in bringing respiratory care to LMICs, spotlight some of the technologies being actively developed to improve respiratory care in resource-constrained settings, and conclude with a discussion highlighting areas where further innovation is still needed.
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Affiliation(s)
- Andrew Wu
- Division of Critical Care Medicine, Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Boston, MA, United States
| | | | - Sreyleak Luch
- Department of Pediatrics, Chenla Children's Healthcare, Kratie, Cambodia
| | - Stephen John
- Department of Pediatrics, University of Minnesota Medical School, Minneapolis, MN, United States
| | - Bikash Raj Adhikari
- Department of Pediatrics, United Mission Hospital Tansen, Tansen, Palpa, Nepal
| | - Caitlin Bakker
- Discovery Technologies, Health Sciences Libraries, University of Minnesota, Minneapolis, MN, United States
| | - Tina Slusher
- Department of Pediatrics, University of Minnesota Medical School, Minneapolis, MN, United States.,Department of Pediatrics, Hennepin Healthcare, Minneapolis, MN, United States
| | - Ashley Bjorklund
- Department of Pediatrics, University of Minnesota Medical School, Minneapolis, MN, United States.,Department of Pediatrics, Hennepin Healthcare, Minneapolis, MN, United States
| | - Jameel Winter
- Department of Pediatrics, University of Minnesota Medical School, Minneapolis, MN, United States
| | - Chinyere Ezeaka
- Department of Paediatrics, College of Medicine, University of Lagos, Lagos, Nigeria
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6
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Hovenier R, Goto L, Huysmans T, van Gestel M, Klein-Blommert R, Markhorst D, Dijkman C, Bem RA. Reduced Air Leakage During Non-Invasive Ventilation Using a Simple Anesthetic Mask With 3D-Printed Adaptor in an Anthropometric Based Pediatric Head-Lung Model. Front Pediatr 2022; 10:873426. [PMID: 35573957 PMCID: PMC9096156 DOI: 10.3389/fped.2022.873426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 03/29/2022] [Indexed: 11/16/2022] Open
Abstract
Non-invasive ventilation (NIV) is increasingly used in the support of acute respiratory failure in critically ill children admitted to the pediatric intensive care unit (PICU). One of the major challenges in pediatric NIV is finding an optimal fitting mask that limits air leakage, in particular for young children and those with specific facial features. Here, we describe the development of a pediatric head-lung model, based on 3D anthropometric data, to simulate pediatric NIV in a 1-year-old child, which can serve as a tool to investigate the effectiveness of NIV masks. Using this model, the primary aim of this study was to determine the extent of air leakage during NIV with our recently described simple anesthetic mask with a 3D-printed quick-release adaptor, as compared with a commercially available pediatric NIV mask. The simple anesthetic mask provided a better seal resulting in lower air leakage at various positive pressure levels as compared with the commercial mask. These data further support the use of the simple anesthetic mask as a reasonable alternative during pediatric NIV in the acute setting. Moreover, the pediatric head-lung model provides a promising tool to study the applicability and effectiveness of customized pediatric NIV masks in the future.
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Affiliation(s)
- Renée Hovenier
- Pediatric Intensive Care Unit, Emma Children's Hospital, Amsterdam University Medical Centers, Location AMC, Amsterdam, Netherlands.,Department of Technical Medicine, University of Twente, Enschede, Netherlands
| | - Lyè Goto
- Faculty of Industrial Design Engineering, Delft University of Technology, Delft, Netherlands
| | - Toon Huysmans
- Faculty of Industrial Design Engineering, Delft University of Technology, Delft, Netherlands.,Imec-Vision Lab, Department of Physics, University of Antwerp, Antwerp, Belgium
| | - Monica van Gestel
- Pediatric Intensive Care Unit, Emma Children's Hospital, Amsterdam University Medical Centers, Location AMC, Amsterdam, Netherlands
| | - Rozalinde Klein-Blommert
- Pediatric Intensive Care Unit, Emma Children's Hospital, Amsterdam University Medical Centers, Location AMC, Amsterdam, Netherlands
| | - Dick Markhorst
- Pediatric Intensive Care Unit, Emma Children's Hospital, Amsterdam University Medical Centers, Location AMC, Amsterdam, Netherlands
| | - Coen Dijkman
- Department for Medical Innovation and Development, Amsterdam University Medical Centers, Location AMC, Amsterdam, Netherlands
| | - Reinout A Bem
- Pediatric Intensive Care Unit, Emma Children's Hospital, Amsterdam University Medical Centers, Location AMC, Amsterdam, Netherlands
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7
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Wang Z, He Y, Zhang X, Luo Z. Non-Invasive Ventilation Strategies in Children With Acute Lower Respiratory Infection: A Systematic Review and Bayesian Network Meta-Analysis. Front Pediatr 2021; 9:749975. [PMID: 34926341 PMCID: PMC8677331 DOI: 10.3389/fped.2021.749975] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 10/13/2021] [Indexed: 11/28/2022] Open
Abstract
Background: Multiple non-invasive ventilation (NIV) modalities have been identified that may improve the prognosis of pediatric patients with acute lower respiratory infection (ALRI). However, the effect of NIV in children with ALRI remains inconclusive. Hence, this study aimed to evaluate the efficacy of various NIV strategies including continuous positive airway pressure (CPAP), high flow nasal cannula (HFNC), bilevel positive airway pressure (BIPAP), and standard oxygen therapy in children with ALRI and the need for supplemental oxygen. Methods: Embase, PubMed, Cochrane Library, and Web of Science databases were searched from inception to July 2021. Randomized controlled trials (RCTs) that compared different NIV modalities for children with ALRI and the need for supplemental oxygen were included. Data were independently extracted by two reviewers. Primary outcomes were intubation and treatment failure rates. Secondary outcome was in-hospital mortality. Pairwise and Bayesian network meta-analyses within the random-effects model were used to synthesize data. The certainty of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation framework. Results: A total of 21 RCTs involving 5,342 children were included. Compared with standard oxygen therapy, CPAP (OR: 0.40, 95% CrI: 0.16-0.90, moderate quality) was associated with a lower risk of intubation. Furthermore, both CPAP (OR: 0.42, 95% CrI: 0.19-0.81, low quality) and HFNC (OR: 0.51, 95% CrI: 0.29-0.81, low quality) reduced treatment failure compared with standard oxygen therapy. There were no significant differences among all interventions for in-hospital mortality. Network meta-regression showed that there were no statistically significant subgroup effects. Conclusion: Among children with ALRI and the need for supplemental oxygen, CPAP reduced the risk of intubation when compared to standard oxygen therapy. Both CPAP and HFNC were associated with a lower risk of treatment failure than standard oxygen therapy. However, evidence is still lacking to show benefits concerning mortality between different interventions. Further large-scale, multicenter studies are needed to confirm our results. Systematic Review Registration: https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=172156, identifier: CRD42020172156.
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Affiliation(s)
- Zhili Wang
- Department of Respiratory 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 Key Laboratory of Pediatrics, Chongqing, China
| | - Yu He
- Department of Respiratory 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 Key Laboratory of Pediatrics, Chongqing, China
| | - Xiaolong Zhang
- Department of Pediatrics, Jiangjin District Central Hospital, Chongqing, China
| | - Zhengxiu Luo
- Department of Respiratory 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 Key Laboratory of Pediatrics, Chongqing, China
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Andellini M, Faggiano F, Picardo SG, Testa G, Perrotta D, Bianchi R, Nocchi F, Capussotto C, Bassanelli E, Derrico P, Pirozzi N, Pecchia L, Ritrovato M. Health Technology Assessment of Intensive Care Ventilators for Pediatric Patients. CHILDREN (BASEL, SWITZERLAND) 2021; 8:986. [PMID: 34828698 PMCID: PMC8621341 DOI: 10.3390/children8110986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 10/26/2021] [Accepted: 10/26/2021] [Indexed: 11/17/2022]
Abstract
This paper is aimed at addressing all the critical aspects linked to the implementation of intensive care ventilators in a pediatric setting, highlighting the most relevant technical features and describing the methodology to conduct health technology assessment (HTA) for supporting the decision-making process. Four ventilator models were included in the assessment process. A decision-making support tool (DoHTA method) was applied. Twenty-eight Key Performance Indicators (KPIs) were identified, defining the safety, clinical effectiveness, organizational, technical, and economic aspects. The Performance scores of each ventilator have been measured with respect to KPIs integrated with the total cost of ownership analysis, leading to a final rank of the four possible technological solutions. The final technologies' performance scores reflected a deliver valued, contextualized, and shared outputs, detecting the most performant technological solution for the specific hospital context. HTA results had informed and supported the pediatric hospital decision-making process. This study, critically identifying the pros and cons of innovative features of ventilators and the evaluation criteria and aspects to be taken into account during HTA, can be considered as a valuable proof of evidence as well as a reliable and transferable method for conducting decision-making processes in a hospital context.
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Affiliation(s)
- Martina Andellini
- HTA Unit, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (F.F.); (M.R.)
| | - Francesco Faggiano
- HTA Unit, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (F.F.); (M.R.)
| | - Sergio Giuseppe Picardo
- Department of Anesthesia and Critical Care, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (S.G.P.); (D.P.); (R.B.)
| | - Giuseppina Testa
- Paediatric Cardiac Anesthesia and Intensive Care Unit, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy;
| | - Daniela Perrotta
- Department of Anesthesia and Critical Care, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (S.G.P.); (D.P.); (R.B.)
| | - Roberto Bianchi
- Department of Anesthesia and Critical Care, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (S.G.P.); (D.P.); (R.B.)
| | - Federico Nocchi
- Clinical Engineering Department, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (F.N.); (C.C.)
| | - Carlo Capussotto
- Clinical Engineering Department, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (F.N.); (C.C.)
| | - Elena Bassanelli
- HTA and Safety Research Unit, Scientific Directorate, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (E.B.); (P.D.)
| | - Pietro Derrico
- HTA and Safety Research Unit, Scientific Directorate, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (E.B.); (P.D.)
| | - Nicola Pirozzi
- Paediatric Emergency Department, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy;
| | - Leandro Pecchia
- School of Engineering, University of Warwick, Coventry CV4 7AL, UK;
| | - Matteo Ritrovato
- HTA Unit, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (F.F.); (M.R.)
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9
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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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10
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López J, Pons-Òdena M, Medina A, Molinos-Norniella C, Palanca-Arias D, Demirkol D, León-González JS, López-Fernández YM, Perez-Baena L, López-Herce J. Early factors related to mortality in children treated with bi-level noninvasive ventilation and CPAP. Pediatr Pulmonol 2021; 56:1237-1244. [PMID: 33382190 DOI: 10.1002/ppul.25246] [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: 05/05/2020] [Revised: 11/26/2020] [Accepted: 12/19/2020] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To describe and analyze the characteristics and the early risk factors for mortality of noninvasive ventilation (NIV) in critically ill children. STUDY DESIGN A multicenter, prospective, observational 2-year study carried out with critically ill patients (1 month - 18 years of age) who needed NIV. Clinical data and NIV parameters during the first 12 h of admission were collected. A multilevel mixed-effects logistic regression was performed to identify mortality risk factors. RESULTS A total of 781 patients (44.2 ± 57.7 months) were studied (57.8% male). Of them, 53.7% had an underlying condition, and 47.1% needed NIV for lower airway respiratory pathologies. Bi-level NIV was the initial support in 78.2% of the patients. Continuous positive airway pressure (CPAP) was used more in younger patients (33.7%) than in older ones (9.7%; p < .001). About 16.7% had to be intubated and 6.2% died. The risk factors for mortality were immunodeficiency (odds ratio [OR] = 11.79; 95% confidence interval [CI] = 2.95-47.13); cerebral palsy (OR = 5.86; 95% CI = 1.94-17.65); presence of apneas on admission (OR = 5.57; 95% CI = 2.13-14.58); tachypnea 6 h after NIV onset (OR = 2.59; 95% CI = 1.30-6.94); and NIV failure (OR = 6.54; 95% CI = 2.79-15.34). CONCLUSION NIV is used with great variability in types of support. Younger children receive CPAP more frequently than older children. Immunodeficiency, cerebral palsy, apneas on admission, tachypnea 6 h after NIV onset, and NIV failure are the early factors associated with mortality.
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Affiliation(s)
- Jorge López
- Department of Pediatric Intensive Care, Gregorio Marañón General University Hospital, Madrid, Spain.,School of Medicine, Complutense University of Madrid, Madrid, Spain.,Gregorio Marañón Health Research Institute, Madrid, Spain.,Mother-Child Health and Development Network (RedSAMID) of Carlos III Health Institute, Madrid, Spain
| | - Martí Pons-Òdena
- Department of Pediatric Intensive and Intermediate Care, Sant Joan de Déu University Hospital, Universitat de Barcelona, Esplugues de Llobregat, Spain.,Critical Care Research Group, Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain
| | - Alberto Medina
- Pediatric Intensive Care Unit, CIBERes, Hospital Universitario Central de Asturias, Oviedo, Spain
| | | | - Daniel Palanca-Arias
- Pediatric Intensive Care Unit, Miguel Servet University Hospital, Zaragoza, Spain
| | - Demet Demirkol
- Pediatric Intensive Care Unit, Koç University School of Medicine, Istanbul, Turkey
| | - José S León-González
- Pediatric Intensive Care Unit, Hospital Universitario Nuestra Señora de la Candelaria, Santa Cruz de Tenerife, Spain
| | | | - Luis Perez-Baena
- Pediatric Intensive Care Unit, Hospital Universitario Nuestra Señora de la Candelaria, Santa Cruz de Tenerife, Spain
| | - Jesús López-Herce
- Department of Pediatric Intensive Care, Gregorio Marañón General University Hospital, Madrid, Spain.,School of Medicine, Complutense University of Madrid, Madrid, Spain.,Gregorio Marañón Health Research Institute, Madrid, Spain.,Mother-Child Health and Development Network (RedSAMID) of Carlos III Health Institute, Madrid, Spain
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11
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Ragoonanan D, Khazal SJ, Abdel-Azim H, McCall D, Cuglievan B, Tambaro FP, Ahmad AH, Rowan CM, Gutierrez C, Schadler K, Li S, Di Nardo M, Chi L, Gulbis AM, Shoberu B, Mireles ME, McArthur J, Kapoor N, Miller J, Fitzgerald JC, Tewari P, Petropoulos D, Gill JB, Duncan CN, Lehmann LE, Hingorani S, Angelo JR, Swinford RD, Steiner ME, Hernandez Tejada FN, Martin PL, Auletta J, Choi SW, Bajwa R, Dailey Garnes N, Kebriaei P, Rezvani K, Wierda WG, Neelapu SS, Shpall EJ, Corbacioglu S, Mahadeo KM. Diagnosis, grading and management of toxicities from immunotherapies in children, adolescents and young adults with cancer. Nat Rev Clin Oncol 2021; 18:435-453. [PMID: 33608690 PMCID: PMC9393856 DOI: 10.1038/s41571-021-00474-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/13/2021] [Indexed: 02/07/2023]
Abstract
Cancer immunotherapies are associated with remarkable therapeutic response rates but also with unique and severe toxicities, which potentially result in rapid deterioration in health. The number of clinical applications for novel immune effector-cell therapies, including chimeric antigen receptor (CAR)-expressing cells, and other immunotherapies, such as immune-checkpoint inhibitors, is increasing. In this Consensus Statement, members of the Pediatric Acute Lung Injury and Sepsis Investigators (PALISI) Network Hematopoietic Cell Transplantation-Cancer Immunotherapy (HCT-CI) Subgroup, Paediatric Diseases Working Party (PDWP) of the European Society of Blood and Marrow Transplantation (EBMT), Supportive Care Committee of the Pediatric Transplantation and Cellular Therapy Consortium (PTCTC) and MD Anderson Cancer Center CAR T Cell Therapy-Associated Toxicity (CARTOX) Program collaborated to provide updated comprehensive recommendations for the care of children, adolescents and young adults receiving cancer immunotherapies. With these recommendations, we address emerging toxicity mitigation strategies, we advocate for the characterization of baseline organ function according to age and discipline-specific criteria, we recommend early critical care assessment when indicated, with consideration of reversibility of underlying pathology (instead of organ failure scores) to guide critical care interventions, and we call for researchers, regulatory agencies and sponsors to support and facilitate early inclusion of young patients with cancer in well-designed clinical trials.
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Affiliation(s)
- Dristhi Ragoonanan
- Department of Pediatrics, CARTOX Program, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
| | - Sajad J Khazal
- Department of Pediatrics, CARTOX Program, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Hisham Abdel-Azim
- Department of Pediatrics, Blood and Marrow Transplantation Program, Keck School of Medicine, University of Southern California, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - David McCall
- Department of Pediatrics, CARTOX Program, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Branko Cuglievan
- Department of Pediatrics, CARTOX Program, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | - Ali Haider Ahmad
- Department of Pediatrics, CARTOX Program, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Courtney M Rowan
- Department of Pediatrics, Division of Critical Care, Indiana University School of Medicine, Riley Hospital for Children, Indianapolis, IN, USA
| | - Cristina Gutierrez
- Department of Critical Care, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Keri Schadler
- Department of Pediatrics Research, Center for Energy Balance in Cancer Prevention and Survivorship, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Shulin Li
- Department of Pediatrics Research, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Matteo Di Nardo
- Pediatric Intensive Care Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Linda Chi
- Division of Diagnostic Imaging, Neuroradiology Department, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Alison M Gulbis
- Division of Pharmacy, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Basirat Shoberu
- Department of Pediatrics, CARTOX Program, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Maria E Mireles
- Division of Pharmacy, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jennifer McArthur
- Department of Pediatrics, Division of Critical Care, St Jude Children's Research Hospital, Memphis, TN, USA.,Department of Pediatrics, Division of Critical Care, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Neena Kapoor
- Department of Pediatrics, Blood and Marrow Transplantation Program, Keck School of Medicine, University of Southern California, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Jeffrey Miller
- Department of Pediatrics, CARTOX Program, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Julie C Fitzgerald
- Department of Anesthesia and Critical Care, University of Pennsylvania Perelman School of Medicine, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Priti Tewari
- Department of Pediatrics, CARTOX Program, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Demetrios Petropoulos
- Department of Pediatrics, CARTOX Program, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jonathan B Gill
- Department of Pediatrics, CARTOX Program, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Christine N Duncan
- Pediatric Hematology-Oncology, Dana-Farber Cancer Institute, Harvard University, Boston, MA, USA
| | - Leslie E Lehmann
- Pediatric Hematology-Oncology, Dana-Farber Cancer Institute, Harvard University, Boston, MA, USA
| | - Sangeeta Hingorani
- Department of Pediatrics, University of Washington School of Medicine, Division of Nephrology, Seattle Childrens and the Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Joseph R Angelo
- Renal Section, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA
| | - Rita D Swinford
- Department of Pediatrics, Division of Pediatric Nephrology, McGovern Medical School, The University of Texas Health Science Center, Houston, TX, USA
| | - Marie E Steiner
- Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA
| | - Fiorela N Hernandez Tejada
- Department of Pediatrics, CARTOX Program, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Paul L Martin
- Department of Pediatrics, Division of Transplant and Cellular Therapy, Duke Children's Hospital, Duke University, Durham, NC, USA
| | - Jeffery Auletta
- Division of Hematology, Oncology, Bone Marrow Transplant and Infectious Diseases, Nationwide Children's Hospital, Ohio State University, Columbus, OH, USA
| | - Sung Won Choi
- Department of Pediatrics, University of Michigan, Ann Arbor, MI, USA
| | - Rajinder Bajwa
- Division of Pediatric Hematology/Oncology/Blood and Marrow Transplantation, Nationwide Children's Hospital, The Ohio State University, Columbus, OH, USA
| | - Natalie Dailey Garnes
- Department of Infectious Disease, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Partow Kebriaei
- Department of Stem Cell Transplantation and Cellular Therapy, CARTOX Program, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Katayoun Rezvani
- Department of Stem Cell Transplantation and Cellular Therapy, CARTOX Program, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - William G Wierda
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Sattva S Neelapu
- Department of Lymphoma and Myeloma, CARTOX Program, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Elizabeth J Shpall
- Department of Stem Cell Transplantation and Cellular Therapy, CARTOX Program, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Selim Corbacioglu
- Department of Pediatric Hematology, Oncology and Stem Cell Transplantation, University of Regensburg, Regensburg, Germany
| | - Kris M Mahadeo
- Department of Pediatrics, CARTOX Program, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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12
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Canning A, Clarke S, Thorning S, Chauhan M, Weir KA. Oral feeding for infants and children receiving nasal continuous positive airway pressure and high flow nasal cannula: a systematic review. BMC Pediatr 2021; 21:83. [PMID: 33596866 PMCID: PMC7887825 DOI: 10.1186/s12887-021-02531-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 01/05/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The aim of this systematic review was to determine whether introduction of oral feeding for infants and children receiving nasal continuous positive airway pressure (nCPAP) or high flow nasal cannula (HFNC) respiratory support facilitates achievement of full oral feeding without adverse effects, compared to no oral feeding (NPO; nil per oral) on CPAP or HFNC. METHODS A protocol was lodged with the PROSPERO International Prospective Register of Systematic Reviews. We searched Medline, Embase, CINAHL, CENTRAL and AustHealth from database inception to 10th June 2020. Study population included children (preterm to < 18 years) on nCPAP or HFNC who were orally feeding. Primary outcomes included full or partial oral feeding and oropharyngeal aspiration. Secondary outcomes examined adverse events including clinical signs of aspiration, aspiration pneumonia and deterioration in respiratory status. RESULTS The search retrieved 1684 studies following duplicate removal. Title and abstract screening identified 70 studies for full text screening and of these, 16 were included in the review for data extraction. Methods of non-invasive ventilation (NIV) included nCPAP (n = 6), nCPAP and HFNC (n = 5) and HFNC (n = 5). A metanalysis was not possible as respiratory modes and cohorts were not comparable. Eleven studies reported on adverse events. Oral feeding safety was predominantly based on retrospective data from chart entries and clinical signs, with only one study using an instrumental swallow evaluation (VFSS) to determine aspiration status. CONCLUSIONS Findings are insufficient to conclude whether commencing oral feeding whilst on nCPAP or HFNC facilitates transition to full oral feeding without adverse effects, including oropharyngeal aspiration. Further research is required to determine the safety and efficacy of oral feeding on CPAP and HFNC for infants and children. TRIAL REGISTRATION PROSPERO registration number: CRD42016039325 .
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Affiliation(s)
- Angie Canning
- Speech Pathology, Gold Coast University Hospital, Gold Coast Health, Gold Coast, Australia.
| | - Sally Clarke
- Queensland Children's Hospital, Children's Health Queensland, Brisbane, Australia
| | - Sarah Thorning
- Library Services, Gold Coast University Hospital, Gold Coast Health, Gold Cost, Australia
| | - Manbir Chauhan
- Newborn Care Unit, Gold Coast University Hospital, Gold Coast Health, Gold Coast, Australia
| | - Kelly A Weir
- Allied Health Sciences & Menzies Health Institute Queensland Griffith University, Gold Coast, Australia.,Allied Health Research Gold Coast Health, Gold Coast, Australia
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13
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Muller GJ, Hovenier R, Spijker J, van Gestel M, Klein-Blommert R, Markhorst D, Dijkman C, Bem RA. Non-invasive Ventilation for Pediatric Hypoxic Acute Respiratory Failure Using a Simple Anesthetic Mask With 3D Printed Adaptor: A Case Report. Front Pediatr 2021; 9:710829. [PMID: 34504814 PMCID: PMC8421850 DOI: 10.3389/fped.2021.710829] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 08/06/2021] [Indexed: 11/13/2022] Open
Abstract
Non-invasive ventilation (NIV) is increasingly used in the supportive treatment of acute respiratory failure in children in the pediatric intensive care unit (PICU). However, finding an optimal fitting commercial available NIV face mask is one of the major challenges in daily practice, in particular for young children and those with specific facial features. Large air leaks and pressure-related skin injury due to suboptimal fit are important complications associated with NIV failure. Here, we describe a case of a 4-year old boy with cardiofaciocutaneous syndrome and rhinovirus-associated hypoxic acute respiratory failure who was successfully supported with NIV delivered by a simple anesthetic mask connected to a headgear by an in-house developed and 3D printed adaptor. This case is an example of the clinical challenge related to pediatric NIV masks in the PICU, but also shows the potential of alternative NIV interfaces e.g., by using a widely available and relatively cheap simple anesthetic mask. Further personalized strategies (e.g., by using 3D scanning and printing techniques) that optimize NIV mask fitting in children are warranted.
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Affiliation(s)
- Gerrit J Muller
- Pediatric Intensive Care Unit, Emma Children's Hospital, Amsterdam University Medical Centers, Amsterdam, Netherlands
| | - Renee Hovenier
- Pediatric Intensive Care Unit, Emma Children's Hospital, Amsterdam University Medical Centers, Amsterdam, Netherlands.,Technical Medicine, University of Twente, Enschede, Netherlands
| | - Jip Spijker
- Industrial Design Engineering, Technical University of Delft, Delft, Netherlands
| | - Monica van Gestel
- Pediatric Intensive Care Unit, Emma Children's Hospital, Amsterdam University Medical Centers, Amsterdam, Netherlands
| | - Rozalinde Klein-Blommert
- Pediatric Intensive Care Unit, Emma Children's Hospital, Amsterdam University Medical Centers, Amsterdam, Netherlands
| | - Dick Markhorst
- Pediatric Intensive Care Unit, Emma Children's Hospital, Amsterdam University Medical Centers, Amsterdam, Netherlands
| | - Coen Dijkman
- Department for Medical Innovation and Development, Amsterdam University Medical Centers, Amsterdam, Netherlands
| | - Reinout A Bem
- Pediatric Intensive Care Unit, Emma Children's Hospital, Amsterdam University Medical Centers, Amsterdam, Netherlands
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14
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Ide N, Allen G, Ashworth HC, Dada S. Critical Breaths in Transit: A Review of Non-invasive Ventilation (NIV) for Neonatal and Pediatric Patients During Transportation. Front Pediatr 2021; 9:667404. [PMID: 34055699 PMCID: PMC8155575 DOI: 10.3389/fped.2021.667404] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Accepted: 04/15/2021] [Indexed: 12/24/2022] Open
Abstract
Respiratory illnesses are a leading cause of death for children worldwide, with the majority of these cases occurring from preterm birth complications or acute respiratory infections. Appropriate respiratory intervention must be provided quickly to lower the chances of death or permanent harm. As a result, respiratory support given in prehospital and interfacility transport can substantially improve health outcomes for these patients, particularly in areas where transportation time to appropriate facilities is lengthy. Existing literature supports the use of non-invasive ventilation (NIV), such as nasal or bilevel continuous positive airway pressure, as a safe form of respiratory support for children under 18 years old in certain transportation settings. This mini review summarizes the literature on pediatric NIV in transport and highlights significant gaps that future researchers should address. In particular, we identify the need to: solidify clinical guidelines for the selection of eligible pediatric patients for transport on NIV; explore the range of factors influencing successful NIV implementation during transportation; and apply appropriate best practices in low and middle income countries.
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Affiliation(s)
- Nellie Ide
- Department of Molecular and Cellular Biology, Harvard University, Cambridge, MA, United States
| | - Grace Allen
- Department of Human Evolutionary Biology, Harvard University, Cambridge, MA, United States
| | | | - Sara Dada
- UCD Centre for Interdisciplinary Research, Education and Innovation in Health Systems, School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland
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15
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Nielsen KR, Becerra MR, Mallma G, Ellington LE, Onchiri F, Roberts JS, Zunt J, Tantaleán da Fieno J. Nasal high flow therapy introduction lowers reintubation risk in a Peruvian paediatric intensive care unit. Acta Paediatr 2020; 109:2748-2754. [PMID: 32198789 DOI: 10.1111/apa.15265] [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: 11/26/2019] [Revised: 03/15/2020] [Accepted: 03/17/2020] [Indexed: 11/28/2022]
Abstract
AIM We examined the impact of introducing high-flow nasal oxygen therapy (HFNT) on children under five with post-extubation respiratory failure in a paediatric intensive care unit (PICU) in Peru. METHODS This quasi-experimental study compared clinical outcomes before and after initial HFNT deployment in the PICU at Instituto Nacional de Salud del Niño in Lima in June 2016. We compared three groups: 29 received post-extubation HFNT and 17 received continuous positive airway pressure (CPAP) from 2016-17 and 12 historical controls received CPAP from 2012-16. The primary outcome was the need for mechanical ventilation. Adjusted hazard ratios (aHR) and 95% confidence intervals (95% CI) were calculated via survival analysis. RESULTS High-flow nasal oxygen therapy and CPAP did not alter the need for mechanical ventilation after extubation (aHR 0.47, 95% CI 0.15-1.48 and 0.96, 95% CI 0.35-2.62, respectively) but did reduce the risk of reintubation (aHR 0.18, 95% CI 0.06-0.57 and 0.14, 95% CI 0.03-0.72, respectively). PICU length of stay was 11, 18 and 37 days for CPAP, HFNT and historical CPAP and mortality was 12%, 7% and 27%, respectively. There was no effect on the duration of sedative infusions. CONCLUSION High-flow nasal oxygen therapy provided effective support for some children, but larger studies in resource-constrained settings are needed.
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Affiliation(s)
- Katie R. Nielsen
- Department of Pediatrics Critical Care Medicine University of Washington Seattle, Washington
- Department of Global Health University of Washington Seattle, Washington
| | - María R. Becerra
- Departamento de Cuidados Intensivos Instituto Nacional de Salud del Niño Lima Peru
| | - Gabriela Mallma
- Departamento de Cuidados Intensivos Instituto Nacional de Salud del Niño Lima Peru
| | | | - Frankline Onchiri
- Seattle Children's Core for Biomedical Statistics Seattle Children's Research Institute Seattle, Washington
| | - Joan S. Roberts
- Department of Pediatrics Critical Care Medicine University of Washington Seattle, Washington
| | - Joseph Zunt
- Department of Global Health University of Washington Seattle, Washington
- Department of Neurology University of Washington Seattle, Washington
| | - José Tantaleán da Fieno
- Departamento de Cuidados Intensivos Instituto Nacional de Salud del Niño Lima Peru
- Universidad Nacional Federico Villarreal Lima Peru
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16
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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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17
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Ribeiro DDFC, Barros FS, Fernandes BL, Nakato AM, Nohama P. Nasal Prongs: Risks, Injuries Incidence and Preventive Approaches Associated with Their Use in Newborns. J Multidiscip Healthc 2020; 13:527-537. [PMID: 32606724 PMCID: PMC7311096 DOI: 10.2147/jmdh.s252017] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Accepted: 05/14/2020] [Indexed: 11/27/2022] Open
Abstract
Purpose To assess the incidence of nasal injury in newborns submitted to non-invasive ventilation (NIV) via binasal prongs, to identify risks that come with using this interface, and to present actions for nasal injury prevention. Patients and Methods Observational and descriptive study performed in neonatal intensive care unit (NICU) of a public hospital in the south of Brazil. This research was divided into three stages. In the first one, nasal injury incidence was assessed in 148 newborns, using data collection from medical records. In the second stage, injury incidence, severity and a preliminary analysis of risks associated with the prescription of binasal prongs were analyzed in 33 newborns who required NIV. In the third stage. recommendations were presented to prevent nasal injury during NIV with short binasal prong. Results The incidence of nasal injury in the first stage was 37.16%, and 63.64% in the second one. As for severity, 68.42% of the injuries showed Stage I severity, and 31.58% Stage II. The main risks associated with the use of binasal prongs were inappropriate prong size, inappropriate prong model, interface reuse, prolonged NIV use exclusively with binasal prongs, incorrect prong position and NIV circuit pulled. A total of 17 preventive approaches were recommended: 13 related to newborns care and not dependent on prior investment. Among them: to choose appropriate prong size; to keep the prong and the NIV circuit well positioned and periodically massages with circular movements in the nasal septum and columella. Conclusion The inappropriate prong size, interface reuse, prong model, prolonged NIV use with binasal prong and incorrect prong and NIV circuit position may be associated with the high occurrence of injury in the NICU studied. Simple approaches concerning clinical staff care actions towards the newborn in NIV, which do not require a financial investment, can prevent nasal injury.
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Affiliation(s)
- Débora de Fátima Camillo Ribeiro
- Neonatal Services, Waldemar Monastier Hospital, Campo Largo, Paraná, Brazil.,Graduate Program on Biomedical Engineering, Universidade Tecnológica Federal do Paraná, Curitiba, Paraná, Brazil.,Graduate Program on Health Technology, Pontifícia Universidade Católica do Paraná, Curitiba, Paraná, Brazil
| | - Frieda Saicla Barros
- Graduate Program on Biomedical Engineering, Universidade Tecnológica Federal do Paraná, Curitiba, Paraná, Brazil
| | - Beatriz Luci Fernandes
- Graduate Program on Health Technology, Pontifícia Universidade Católica do Paraná, Curitiba, Paraná, Brazil
| | - Adriane Muller Nakato
- Graduate Program on Health Technology, Pontifícia Universidade Católica do Paraná, Curitiba, Paraná, Brazil
| | - Percy Nohama
- Graduate Program on Biomedical Engineering, Universidade Tecnológica Federal do Paraná, Curitiba, Paraná, Brazil.,Graduate Program on Health Technology, Pontifícia Universidade Católica do Paraná, Curitiba, Paraná, Brazil
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18
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Use of Noninvasive Ventilation in Respiratory Failure After Extubation During Postoperative Care in Pediatrics. Pediatr Cardiol 2020; 41:729-735. [PMID: 32025758 PMCID: PMC7223835 DOI: 10.1007/s00246-020-02290-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Accepted: 01/17/2020] [Indexed: 11/23/2022]
Abstract
The purpose of this study was to determine the rate of failure of noninvasive ventilation (NIV) after cardiac surgery in pediatric patients with respiratory failure after extubation and to identify predictive success factors. This was a prospective cohort study of pediatric patients diagnosed with congenital heart disease who underwent heart surgery and used NIV. Data were collected from 170 patients with a median age of 2 months. No patient presented cardiorespiratory arrest nor any other complication during the use of NIV. The success rate for the use of NIV was 61.8%. Subjects were divided for analysis into successful and failed NIV groups. Statistical analysis used Chi-square, Mann-Whitney, and Student's t tests, which were performed after univariate and multivariate logistic regression for p < 0.05. In the multivariate analysis, only the minimal pressure gradient (OR 1.45 with p = 0.007), maximum oxygen saturation (OR 0.88 with p = 0.011), and maximum fraction of inspired oxygen (FiO2) (OR 1.16 with p < 0.001) influenced NIV failure. The following variables did not present a statistical difference: extracorporeal circulation time (p = 0.669), pulmonary hypertension (p = 0.254), genetic syndrome (p = 0.342), RACHS-1 score (p = 0.097), age (p = 0.098), invasive mechanical ventilation duration (p = 0.186), and NIV duration (p = 0.804). In conclusion, NIV can be successfully used in children who, after cardiac surgery, develop respiratory failure in the 48 h following extubation. Although the use of higher pressure gradients and higher FiO2 are associated with a greater failure rate for NIV use, it was found to be generally safe.
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19
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Atag E, Krivec U, Ersu R. Non-invasive Ventilation for Children With Chronic Lung Disease. Front Pediatr 2020; 8:561639. [PMID: 33262959 PMCID: PMC7687222 DOI: 10.3389/fped.2020.561639] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 10/13/2020] [Indexed: 11/24/2022] Open
Abstract
Advances in medical care and supportive care options have contributed to the survival of children with complex disorders, including children with chronic lung disease. By delivering a positive pressure or a volume during the patient's inspiration, NIV is able to reverse nocturnal alveolar hypoventilation in patients who experience hypoventilation during sleep, such as patients with chronic lung disease. Bronchopulmonary dysplasia (BPD) is a common complication of prematurity, and despite significant advances in neonatal care over recent decades its incidence has not diminished. Most affected infants have mild disease and require a short period of oxygen supplementation or respiratory support. However, severely affected infants can become dependent on positive pressure support for a prolonged period. In case of established severe BPD, respiratory support with non-invasive or invasive positive pressure ventilation is required. Patients with cystic fibrosis (CF) and advanced lung disease develop hypoxaemia and hypercapnia during sleep and hypoventilation during sleep usually predates daytime hypercapnia. Hypoxaemia and hypercapnia indicates poor prognosis and prompts referral for lung transplantation. The prevention of respiratory failure during sleep in CF may prolong survival. Long-term oxygen therapy has not been shown to improve survival in people with CF. A Cochrane review on the use NIV in CF concluded that NIV in combination with oxygen therapy improves gas exchange during sleep to a greater extent than oxygen therapy alone in people with moderate to severe CF lung disease. Uncontrolled, non-randomized studies suggest survival benefit with NIV in addition to being an effective bridge to transplantation. Complications of NIV relate mainly to prolonged use of a face or nasal mask which can lead to skin trauma, and neurodevelopmental delay by acting as a physical barrier to social interaction. Another associated risk is pulmonary aspiration caused by vomiting whilst wearing a face mask. Adherence to NIV is one of the major barriers to treatment in children. This article will review the current evidence for indications, adverse effects and long term follow up including adherence to NIV in children with chronic lung disease.
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Affiliation(s)
- Emine Atag
- Division of Pediatric Pulmonology, Medipol University, Istanbul, Turkey
| | - Uros Krivec
- Division of Pediatric Pulmonology, University Children's Hospital, University Medical Centre, Ljubljana, Slovenia
| | - Refika Ersu
- Division of Pediatric Respirology, Children's Hospital of Ontario, University of Ottawa, Ottawa, ON, Canada
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20
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McCollum ED, Mvalo T, Eckerle M, Smith AG, Kondowe D, Makonokaya D, Vaidya D, Billioux V, Chalira A, Lufesi N, Mofolo I, Hosseinipour M. Bubble continuous positive airway pressure for children with high-risk conditions and severe pneumonia in Malawi: an open label, randomised, controlled trial. THE LANCET RESPIRATORY MEDICINE 2019; 7:964-974. [PMID: 31562059 PMCID: PMC6838668 DOI: 10.1016/s2213-2600(19)30243-7] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Revised: 07/08/2019] [Accepted: 07/09/2019] [Indexed: 12/14/2022]
Abstract
Background Pneumonia is the leading cause of death among children globally. Most pneumonia deaths in low-income and middle-income countries (LMICs) occur among children with HIV infection or exposure, severe malnutrition, or hypoxaemia despite antibiotics and oxygen. Non-invasive bubble continuous positive airway pressure (bCPAP) is considered a safe ventilation modality that might improve child pneumonia survival. bCPAP outcomes for high-risk African children with severe pneumonia are unknown. Since most child pneumonia hospitalisations in Africa occur in non-tertiary district hospitals without daily physician oversight, we aimed to examine whether bCPAP improves severe pneumonia mortality in such settings. Methods This open-label, randomised, controlled trial was done in the general paediatric ward of Salima District Hospital, Malawi. We enrolled children aged 1–59 months old with WHO-defined severe pneumonia and either HIV infection or exposure, severe malnutrition, or an oxygen saturation of less than 90%. Children were randomly assigned 1:1 to low-flow nasal cannula oxygen or nasal bCPAP. Non-physicians administered care; the primary outcome was hospital survival. Primary analyses were by intention-to-treat and interim and adverse events analyses per protocol. This trial is registered with ClinicalTrials.gov, number NCT02484183, and is closed. Findings We screened 1712 children for eligibility between June 23, 2015, and March 21, 2018. The data safety and monitoring board stopped the trial for futility after 644 of the intended 900 participants were enrolled. 323 children were randomly assigned to oxygen and 321 to bCPAP. 35 (11%) of 323 children who received oxygen died in hospital, as did 53 (17%) of 321 who received bCPAP (relative risk 1·52; 95% CI 1·02–2·27; p=0·036). 13 oxygen and 17 bCPAP patients lacked hospital outcomes and were considered lost to follow-up. Suspected adverse events related to treatment occurred in 11 (3%) of 321 children receiving bCPAP and 1 (<1%) of 323 children receiving oxygen. Four bCPAP and one oxygen group deaths were classified as probable aspiration episodes, one bCPAP death as probable pneumothorax, and six non-death bCPAP events included skin breakdown around the nares. Interpretation bCPAP treatment in a paediatric ward without daily physician supervision did not reduce hospital mortality among high-risk Malawian children with severe pneumonia, compared with oxygen. The use of bCPAP within certain patient populations and non-intensive care settings might carry risk that was not previously recognised. bCPAP in LMICs needs further evaluation before wider implementation for child pneumonia care. Funding Bill & Melinda Gates Foundation, International AIDS Society, Health Empowering Humanity.
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Affiliation(s)
- Eric D McCollum
- Eudowood Division of Pediatric Respiratory Sciences, Department of Pediatrics, School of Medicine, Johns Hopkins University, Baltimore, MD, USA; Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA.
| | - Tisungane Mvalo
- University of North Carolina Project Malawi, Lilongwe, Malawi; Department of Pediatrics, School of Medicine, University of North Carolina at Chapel Hill, NC, USA
| | - Michelle Eckerle
- Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Andrew G Smith
- University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Davie Kondowe
- University of North Carolina Project Malawi, Lilongwe, Malawi
| | - Don Makonokaya
- University of North Carolina Project Malawi, Lilongwe, Malawi
| | | | | | | | | | - Innocent Mofolo
- University of North Carolina Project Malawi, Lilongwe, Malawi
| | - Mina Hosseinipour
- University of North Carolina Project Malawi, Lilongwe, Malawi; Division of Infectious Disease, University of North Carolina at Chapel Hill, NC, USA
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Zeng JS, Qian SY, Wong JJM, Ong JSM, Gan CS, Anantasit N, Chor YK, Samransamruajkit R, Phuc PH, Phumeetham S, Feng X, Sultana R, Loh TF, Lee JH. Non-Invasive Ventilation in Children with Paediatric Acute Respiratory Distress Syndrome. ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE 2019. [DOI: 10.47102/annals-acadmedsg.v48n7p224] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Introduction: Evidence supporting non-invasive ventilation (NIV) in paediatric acute respiratory distress syndrome (PARDS) remains sparse. We aimed to describe characteristics of patients with PARDS supported with NIV and risk factors for NIV failure. Materials and Methods: This is a multicentre retrospective study. Only patients supported on NIV with PARDS were included. Data on epidemiology and clinical outcomes were collected. Primary outcome was NIV failure which was defined as escalation to invasive mechanical ventilation within the first 7 days of PARDS. Patients in the NIV success and failure groups were compared. Results: There were 303 patients with PARDS; 53/303 (17.5%) patients were supported with NIV. The median age was 50.7 (interquartile range: 15.7-111.9) months. The Paediatric Logistic Organ Dysfunction score and oxygen saturation/fraction of inspired oxygen (SF) ratio were 2.0 (1.0-10.0) and 155.0 (119.4-187.3), respectively. Indications for NIV use were increased work of breathing (26/53 [49.1%]) and hypoxia (22/53 [41.5%]). Overall NIV failure rate was 77.4% (41/53). All patients with sepsis who developed PARDS experienced NIV failure. NIV failure was associated with an increased median paediatric intensive care unit stay (15.0 [9.5-26.5] vs 4.5 [3.0-6.8] days; P <0.001) and hospital length of stay (26.0 [17.0-39.0] days vs 10.5 [5.5-22.3] days; P = 0.004). Overall mortality rate was 32.1% (17/53). Conclusion: The use of NIV in children with PARDS was associated with high failure rate. As such, future studies should examine the optimal selection criteria for NIV use in these children.
Key words: Bi-level positive airway pressure, Continuous positive airway pressure, Non-invasive ventilation
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Affiliation(s)
- Jian Sheng Zeng
- Beijing Children’s Hospital, Capital Medical University, People’s Republic of China
| | - Su Yun Qian
- Beijing Children’s Hospital, Capital Medical University, People’s Republic of China
| | | | - Jacqueline SM Ong
- Khoo Teck Puat-National University Children’s Medical Institute, National University Hospital, Singapore
| | | | | | | | | | | | | | - Xu Feng
- Children's Hospital of Chongqing Medical University, People’s Republic of China
| | | | - Tsee Foong Loh
- Khoo Teck Puat-National University Children’s Medical Institute, National University Hospital, Singapore
| | - Jan Hau Lee
- Khoo Teck Puat-National University Children’s Medical Institute, National University Hospital, Singapore
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22
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Myers S, Dinga P, Anderson M, Schubert C, Mlotha R, Phiri A, Colbourn T, McCollum ED, Mwansambo C, Kazembe P, Lang HJ. Use of bubble continuous positive airway pressure (bCPAP) in the management of critically ill children in a Malawian paediatric unit: an observational study. BMJ Open Respir Res 2019; 6:e000280. [PMID: 30956794 PMCID: PMC6424262 DOI: 10.1136/bmjresp-2018-000280] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Revised: 10/27/2018] [Accepted: 11/16/2018] [Indexed: 12/19/2022] Open
Abstract
Introduction In low-resource countries, respiratory failure is associated with a high mortality risk among critically ill children. We evaluated the role of bubble continuous positive airway pressure (bCPAP) in the routine care of critically ill children in Lilongwe, Malawi. Methods We conducted an observational study between 26 February and 15 April 2014, in an urban paediatric unit with approximately 20 000 admissions/year (in-hospital mortality <5% approximately during this time period). Modified oxygen concentrators or oxygen cylinders provided humidified bCPAP air/oxygen flow. Children up to the age of 59 months with signs of severe respiratory dysfunction were recruited. Survival was defined as survival during the bCPAP-treatment and during a period of 48 hours following the end of the bCPAP-weaning process. Results 117 children with signs of respiratory failure were included in this study and treated with bCPAP. Median age: 7 months. Malaria rapid diagnostic tests were positive in 25 (21%) cases, 15 (13%) had severe anaemia (Hb < 7.0 g/dL); 55 (47%) children had multiorgan failure (MOF); 22 (19%) children were HIV-infected/exposed. 28 (24%) were severely malnourished. Overall survival was 79/117 (68%); survival was 54/62 (87%) in children with very severe pneumonia (VSPNA) but without MOF. Among the 19 children with VSPNA (single-organ failure (SOF)) and negative HIV tests, all children survived. Survival rates were lower in children with MOF (including shock) (45%) as well as in children with severe malnutrition (36%) and proven HIV infection or exposure (45%). Conclusion Despite the limitations of this study, the good outcome of children with signs of severe respiratory dysfunction (SOF) suggests that it is feasible to use bCPAP in the hospital management of critically ill children in resource-limited settings. The role of bCPAP and other forms of non-invasive ventilatory support as a part of an improved care package for critically ill children with MOF at tertiary and district hospital level in low-resource countries needs further evaluation. Critically ill children with nutritional deficiencies and/or HIV infection/exposure need further study to determine bCPAP efficacy.
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Affiliation(s)
| | | | - Margot Anderson
- United States Peace Corps, Washington, DC, USA.,Malawian College of Medicine, Lilongwe, Malawi
| | - Charles Schubert
- Department of Pediatrics, University of Cincinnati, College of Medicine, Cincinnati, Ohio, USA.,Division of Emergency Medicine, Cincinnati Children Hospital Medical Center, Cincinnati, Ohio, USA
| | | | - Ajib Phiri
- Malawian College of Medicine, Lilongwe, Malawi
| | - Tim Colbourn
- University College London Institute for Global Health, London, UK
| | | | | | - Peter Kazembe
- Baylor College of Medicine, Children Clinical Centre of Excellence, Lilongwe, Malawi
| | - Hans-Joerg Lang
- Malawian College of Medicine, Lilongwe, Malawi.,Centre for International Migration and Development (CIM)/German International Cooperation (GIZ), Eschborn, Germany
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24
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McCollum ED, Smith AG, Eckerle M, Mvalo T, O'Brien KL, Baqui AH. CPAP treatment for children with pneumonia in low-resource settings. THE LANCET RESPIRATORY MEDICINE 2017; 5:924-925. [PMID: 29133034 DOI: 10.1016/s2213-2600(17)30347-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/04/2017] [Accepted: 09/04/2017] [Indexed: 01/08/2023]
Affiliation(s)
- Eric D McCollum
- Eudowood Division of Pediatric Respiratory Sciences, Johns Hopkins School of Medicine, Baltimore, MD 21287, USA; Department of International Health, International Center for Maternal and Newborn Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MA, USA.
| | - Andrew G Smith
- Paediatric Critical Care Medicine, University of Utah, Salt Lake City, UT, USA
| | - Michelle Eckerle
- Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | | | - Katherine L O'Brien
- Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, MA, USA
| | - Abdullah H Baqui
- Department of International Health, International Center for Maternal and Newborn Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MA, USA
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