1
|
Nascimento MS, Leite FS, Silva PAL, Zamberlan GC, de Souza PM, Eid RAC, Zacharias RSB, do Prado C, Batista CL. Reliability and reference values for diaphragmatic excursion, thickness, and thickening fraction and quadriceps femoris muscle thickness in full-term newborns evaluated by ultrasound. Eur J Pediatr 2024; 183:3453-3460. [PMID: 38771374 DOI: 10.1007/s00431-024-05608-1] [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: 04/04/2024] [Revised: 05/06/2024] [Accepted: 05/11/2024] [Indexed: 05/22/2024]
Abstract
To determine the diaphragm thickness, thickening fraction, and excursion and thickness of the quadriceps femoris muscle in full-term newborns and to evaluate the intra- and interrater reliability of these measurements. This was a prospective, observational clinical study including full-term newborns born within the first 48 h after birth. Serial measurements of the thickness, thickening fraction, and mobility of the diaphragm muscles and the thickness of the quadriceps muscle were obtained using ultrasound images. A total of 69 newborns with a mean gestational age of 39 weeks were included. The following measurements were obtained and are expressed as the mean (standard deviation): inspiratory diaphragm thickness, 0.19 cm (0.04); expiratory diaphragm thickness, 0.16 cm (0.04); diaphragm thickness fraction, 16.70 cm (10.27); diaphragmatic excursion, 0.68 cm (0.22); and quadriceps thickness, 0.99 cm (0.14). Intrarater reliability was assessed using intraclass correlation coefficients (ICCs). Excellent intrarater agreement was observed for the two groups of operators (ICC > 0.86, p < 0.001) for all measurements except for the diaphragm thickening fraction, which showed good agreement for both operator groups (ICC = 0.70, p < 0.001). Regarding interrater reliability, moderate agreement between the raters was observed in the means of all measures (ICC > 0.49, p < 0.001), except for the diaphragm thickening fraction, which showed poor agreement. Conclusion: Good intrarater and moderate interrater reliability were achieved in ultrasound evaluations of the thickness and mobility of the diaphragm and quadriceps femoris muscles in full-term newborns, demonstrating the feasibility of this technique for clinical use. This pioneering study offers reference values for these muscles in a single study, allowing comparisons between different clinical conditions. What is Known: • Ultrasound is a highly reliable tool for muscle assessment that can be used to assess muscular atrophy in critically ill patients. • Muscle atrophy worsens the patient's condition and has been associated with worse outcomes. What is New: • To our knowledge, this is the first study to jointly evaluate the diaphragm and quadriceps muscle thickness and evaluate the reliability of all measurements. • Our study presents reference values for both muscles, enabling comparisons between different clinical conditions.
Collapse
Affiliation(s)
- Milena Siciliano Nascimento
- Departamento de Práticas Assistenciais, Hospital Israelita Albert Einstein, Avenue Albert Einstein, 627-701, 05651-901, São Paulo, Brazil.
| | - Flávia Sales Leite
- Departamento de Pacientes Graves, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | | | | | - Priscila Monteiro de Souza
- Departamento de Práticas Assistenciais, Hospital Israelita Albert Einstein, Avenue Albert Einstein, 627-701, 05651-901, São Paulo, Brazil
- Corpo Discente da Faculdade Israelita de Ciências da Saúde Albert Einstein, São Paulo, Brazil
| | | | | | - Cristiane do Prado
- Departamento Materno-infantil, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Carla Luciana Batista
- Departamento de Pacientes Graves, Hospital Israelita Albert Einstein, São Paulo, Brazil
| |
Collapse
|
2
|
Dassios T, Vervenioti A, Tsintoni A, Fouzas S, Karatza AA, Dimitriou G. Flow-resistive loading and diaphragmatic muscle function in term and preterm infants. Pediatr Pulmonol 2024; 59:1274-1280. [PMID: 38353341 DOI: 10.1002/ppul.26899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Revised: 01/21/2024] [Accepted: 01/27/2024] [Indexed: 04/30/2024]
Abstract
PURPOSE We aimed to assess diaphragmatic function in term and preterm infants with and without history of bronchopulmonary dysplasia (BPD), before and after the application of inspiratory flow resistive loading. METHODS Forty infants of a median (range) gestational age of 34 (25-40) weeks were studied. BPD was defined as supplemental oxygen requirement for >28 days of life. Seventeen infants were term, 17 preterm without history of BPD, and six preterm with a history of BPD. The diaphragmatic pressure-time index (PTIdi) was calculated as the mean to maximum trans-diaphragmatic pressure ratio times the inspiratory duty cycle. The PTIdi was calculated before and after the application of an inspiratory-flow resistance for 120 s. Airflow was measured by a pneumotachograph and the transdiaphragmatic pressure by a dual pressure catheter. RESULTS The median (interquartile range [IQR]) pre-resistance PTIdi was higher in preterm infants without BPD (0.064 [0.050-0.077]) compared with term infants (0.052 [0.044-0.062], p = .029) and was higher in preterm infants with BPD (0.119 [0.086-0.132]) compared with a subgroup of preterm infants without BPD (0.062 [0.056-0.072], p = .004). The median (IQR) postresistance PTIdi was higher in preterm infants without BPD (0.101 [0.084-0.132]) compared with term infants (0.067 [0.055-0.083], p < .001) and was higher in preterm infants with BPD [0.201(0.172-0.272)] compared with the preterm subgroup without BPD (0.091 [0.081-0.108],p = .004). The median (IQR) percentage change of the PTIdi after the application of the resistance was higher in preterm infants without BPD (65 [51-92] %) compared with term infants (34 [20-39] %, p < .001). CONCLUSIONS Preterm infants, especially those recovering from BPD, are at increased risk of diaphragmatic muscle fatigue under conditions of increased inspiratory loading.
Collapse
Affiliation(s)
- Theodore Dassios
- Neonatal Intensive Care Unit, University Hospital of Patras, Rio, Greece
| | - Aggeliki Vervenioti
- Neonatal Intensive Care Unit, University Hospital of Patras, Rio, Greece
- Department of Pediatrics, Pediatric Respiratory Unit, University Hospital of Patras, Rio, Greece
| | - Asimina Tsintoni
- Neonatal Intensive Care Unit, University Hospital of Patras, Rio, Greece
| | - Sotirios Fouzas
- Department of Pediatrics, Pediatric Respiratory Unit, University Hospital of Patras, Rio, Greece
| | - Ageliki A Karatza
- Neonatal Intensive Care Unit, University Hospital of Patras, Rio, Greece
| | - Gabriel Dimitriou
- Neonatal Intensive Care Unit, University Hospital of Patras, Rio, Greece
| |
Collapse
|
3
|
Radicioni M, Pennoni S, Fantauzzi A, Bini V, Camerini P. Ultrasound evaluation of diaphragm kinetics after minimally invasive surfactant administration. J Ultrasound 2024; 27:87-96. [PMID: 37660325 PMCID: PMC10908957 DOI: 10.1007/s40477-023-00820-5] [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: 06/16/2023] [Accepted: 07/29/2023] [Indexed: 09/05/2023] Open
Abstract
PURPOSE Concerns remain on different alveolar deposition of surfactant between LISA and INSURE methods. Ultrasound evaluation of diaphragm kinetics may provide clinical evidence on this issue, as indirect representation of the respiratory system compliance. METHODS This was a prospective-observational pilot study. The inclusion criterion was CPAP-supported infants ≤ 32 weeks with RDS receiving surfactant via minimally invasive technique. 52 patients randomized for surfactant administration via LISA or INSURE methods were enrolled. Right diaphragm (RD) global mean peak velocity (MPV) by Pulsed-Wave Tissue Doppler Imaging (PTDI) was recorded before and two hours after surfactant administration with simultaneous measurements of oxygen saturation (SpO2)/fraction of inspired oxygen (FiO2) (SF ratio). Mechanical ventilation ≤ 72 h from birth represented treatment failure. RESULTS LISA infants had significantly higher gestational age (p = 0.029) and birth weight (p = 0.030) with lower CRIB-II scores (p = 0.030) than INSURE infants. LISA infants showed higher median MPV at baseline RD-PTDI US assessment (p = 0.024), but post-surfactant median MPV and other the investigated variables were similar at the adjusted analysis for gestational age and sedation. 8/52 (15%) infants who failed treatment had a significantly lower SF ratio (p = 0.002) and higher median MPV at RD-PTDI US (p = 0.004) after surfactant administration, despite the higher CPAP support level before (p = 0.007) and after (p = 0.001) surfactant administration. A full course of antenatal steroids was protective against mechanical ventilation (p = 0.038). CONCLUSIONS Different minimally invasive surfactant administration techniques do not appear to influence diaphragm kinetics evaluated by RD-PTDI US.
Collapse
Affiliation(s)
- Maurizio Radicioni
- Neonatal Intensive Care Unit and Neonatal Pathology, S. Maria Della Misericordia Hospital, Piazzale Giorgio Menghini 1, 06129, Perugia, Italy.
| | | | - Ambra Fantauzzi
- Neonatal Intensive Care Unit and Neonatal Pathology, S. Maria Della Misericordia Hospital, Piazzale Giorgio Menghini 1, 06129, Perugia, Italy
| | - Vittorio Bini
- Department of Medicine, University of Perugia, Perugia, Italy
| | - Piergiorgio Camerini
- Neonatal Intensive Care Unit and Neonatal Pathology, S. Maria Della Misericordia Hospital, Piazzale Giorgio Menghini 1, 06129, Perugia, Italy
| |
Collapse
|
4
|
Zhao Z, Mi Y, Ur Rehman H, Sun E, Cao X, Wang N. From Body Monitoring to Biomolecular Sensing: Current Progress and Future Perspectives of Triboelectric Nanogenerators in Point-of-Care Diagnostics. SENSORS (BASEL, SWITZERLAND) 2024; 24:511. [PMID: 38257606 PMCID: PMC10818951 DOI: 10.3390/s24020511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 01/07/2024] [Accepted: 01/11/2024] [Indexed: 01/24/2024]
Abstract
In the constantly evolving field of medical diagnostics, triboelectric nanogenerators (TENGs) stand out as a groundbreaking innovation for simultaneously harnessing mechanical energy from micromovements and sensing stimuli from both the human body and the ambient environment. This advancement diminishes the dependence of biosensors on external power sources and paves the way for the application of TENGs in self-powered medical devices, especially in the realm of point-of-care diagnostics. In this review, we delve into the functionality of TENGs in point-of-care diagnostics. First, from the basic principle of how TENGs effectively transform subtle physical movements into electrical energy, thereby promoting the development of self-powered biosensors and medical devices that are particularly advantageous for real-time biological monitoring. Then, the adaptable design of TENGs that facilitate customization to meet individual patient needs is introduced, with a focus on their biocompatibility and safety in medical applications. Our in-depth analysis also covers TENG-based biosensor designs moving toward exceptional sensitivity and specificity in biomarker detection, for accurate and efficient diagnoses. Challenges and future prospects such as the integration of TENGs into wearable and implantable devices are also discussed. We aim for this review to illuminate the burgeoning field of TENG-based intelligent devices for continuous, real-time health monitoring; and to inspire further innovation in this captivating area of research that is in line with patient-centered healthcare.
Collapse
Affiliation(s)
- Zequan Zhao
- Center for Green Innovation, School of Mathematics and Physics, University of Science and Technology Beijing, Beijing 100083, China; (Z.Z.); (Y.M.); (H.U.R.); (E.S.)
| | - Yajun Mi
- Center for Green Innovation, School of Mathematics and Physics, University of Science and Technology Beijing, Beijing 100083, China; (Z.Z.); (Y.M.); (H.U.R.); (E.S.)
| | - Hafeez Ur Rehman
- Center for Green Innovation, School of Mathematics and Physics, University of Science and Technology Beijing, Beijing 100083, China; (Z.Z.); (Y.M.); (H.U.R.); (E.S.)
| | - Enqi Sun
- Center for Green Innovation, School of Mathematics and Physics, University of Science and Technology Beijing, Beijing 100083, China; (Z.Z.); (Y.M.); (H.U.R.); (E.S.)
| | - Xia Cao
- Beijing Institute of Nanoenergy and Nanosystems, Chinese Academy of Sciences, Beijing 100083, China
- School of Chemistry and Biological Engineering, University of Science and Technology Beijing, Beijing 100083, China
| | - Ning Wang
- Center for Green Innovation, School of Mathematics and Physics, University of Science and Technology Beijing, Beijing 100083, China; (Z.Z.); (Y.M.); (H.U.R.); (E.S.)
- Beijing Institute of Nanoenergy and Nanosystems, Chinese Academy of Sciences, Beijing 100083, China
| |
Collapse
|
5
|
Fouzas S, Vervenioti A, Tsintoni A, Dassios T, Karatza AA, Dimitriou G. Diaphragmatic muscle function in term and preterm infants. Eur J Pediatr 2023; 182:5693-5699. [PMID: 37831303 PMCID: PMC10746574 DOI: 10.1007/s00431-023-05247-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 09/27/2023] [Accepted: 09/28/2023] [Indexed: 10/14/2023]
Abstract
We aimed to assess the determinants of diaphragmatic function in term and preterm infants. 149 infants (56 term; 93 preterm, of whom 14 were diagnosed with bronchopulmonary dysplasia-BPD) were studied before discharge. Diaphragmatic function was assessed by measurement of the maximum transdiaphragmatic pressure (Pdimax)-a measure of diaphragmatic strength, and the pressure-time index of the diaphragm (PTIdi)-a measure of the load-to-capacity ratio of the diaphragm. The Pdimax was higher in term than preterm infants without BPD (90.1 ± 16.3 vs 81.1 ± 11.8 cmH2O; P = 0.001). Term-born infants also had lower PTIdi compared to preterms without BPD (0.052 ± 0.014 vs 0.060 ± 0.017; P = 0.006). In term and preterm infants without BPD, GA was the most significant predictor of Pdimax and PTIdi, independently of the duration of mechanical ventilation and oxygen support. In infants with GA < 32 weeks (n = 30), the Pdimax was higher in infants without BPD compared to those with BPD (76.1 ± 11.1 vs 65.2 ± 11.9 cmH2O; P = 0.015). Preterms without BPD also had lower PTIdi compared to those with BPD (0.069 ± 0.016 vs 0.109 ± 0.017; P < 0.001). In this subgroup, GA was the only significant independent determinant of Pdimax, while BPD and the GA were significant determinants of the PTIdi. Conclusions: Preterm infants present lower diaphragmatic strength and impaired ability to sustain the generated force over time, which renders them prone to diaphragmatic fatigue. In very preterm infants, BPD may further aggravate diaphragmatic function. What is Known: • The diaphragm of preterm infants has limited capacity to undertake the work of breathing effectively. • The maximum transdiaphragmatic pressure (a measure of diaphragmatic strength) and the pressure-time index of the diaphragm (a measure of the load-to-capacity ratio of the muscle) have not been extensively assessed in small infants. What is New: • Preterm infants have lower diaphragmatic strength and impaired ability to sustain the generated force over time, which renders them prone to diaphragmatic fatigue. • In very preterm infants, bronchopulmonary dysplasia may further impair diaphragmatic function.
Collapse
Affiliation(s)
- Sotirios Fouzas
- Neonatal Intensive Care Unit, Department of Paediatrics, University of Patras School of Medicine, Rio, Patras, 26500, Greece
| | - Aggeliki Vervenioti
- Neonatal Intensive Care Unit, Department of Paediatrics, University of Patras School of Medicine, Rio, Patras, 26500, Greece
| | - Asimina Tsintoni
- Neonatal Intensive Care Unit, Department of Paediatrics, University of Patras School of Medicine, Rio, Patras, 26500, Greece
| | - Theodore Dassios
- Neonatal Intensive Care Unit, Department of Paediatrics, University of Patras School of Medicine, Rio, Patras, 26500, Greece.
| | - Ageliki A Karatza
- Neonatal Intensive Care Unit, Department of Paediatrics, University of Patras School of Medicine, Rio, Patras, 26500, Greece
| | - Gabriel Dimitriou
- Neonatal Intensive Care Unit, Department of Paediatrics, University of Patras School of Medicine, Rio, Patras, 26500, Greece
| |
Collapse
|
6
|
Gupta R, Bandyopadhyay T, Yadav B, Guleria M, Maria A. Sonographic assessment of diaphragmatic thickness and excursion to predict CPAP failure in neonates below 34 weeks of gestation: A prospective cohort study. Pediatr Pulmonol 2023; 58:2889-2898. [PMID: 37530492 DOI: 10.1002/ppul.26608] [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: 04/03/2023] [Revised: 06/26/2023] [Accepted: 07/10/2023] [Indexed: 08/03/2023]
Abstract
BACKGROUND To evaluate the diagnostic accuracy of sonographic assessment of diaphragmatic dimensions and excursions in predicting Continuous Positive Airway Pressure (CPAP) failure in preterm neonates with respiratory distress. METHODS Prospective cohort study among preterm neonates less than 34 weeks of gestation who were hemodynamically stable and either admitted with respiratory distress or who developed respiratory distress shortly after admission to the NICU and having Silverman-Anderson Score (SAS) ≥ 3/10 were included. We performed sonographic assessment of diaphragmatic dimensions and excursions before and one hour ±30 minutes after application of CPAP. 'CPAP failure' was defined as combined outcome of the need of surfactant and/or upgradation of respiratory support within first 72 hours after a trial of CPAP. Clinical parameters and diaphragmatic measurements were compared between CPAP failure and success groups. RESULTS Of 62 participants, 20 (32%) failed CPAP. On binomial logistic regression (after adjustment for gestational age and birth weight), initial SAS, higher diaphragmatic excursion (both left and right, before and after CPAP application), lower left hemidiaphragm diaphragmatic thickness fraction (DTF) (before CPAP application) and lower right DTF (after CPAP application) were independent predictors of CPAP failure. However, the receiver-operating characteristics curves showed that excursions of right and left hemi-diaphragm both before and after CPAP application, had highest accuracies in predicting CPAP failure (AUC 0.84, 0.80 and 0.86, 0.78, respectively; p < .001). CONCLUSION Diaphragmatic excursion can be a useful parameter to predict the failure of CPAP in preterm neonates with respiratory distress.
Collapse
Affiliation(s)
- Rashi Gupta
- Department of Neonatology, ABVIMS & Dr. RML Hospital, New Delhi, India
| | | | - Bharti Yadav
- Department of Neonatology, ABVIMS & Dr. RML Hospital, New Delhi, India
| | - Munish Guleria
- Department of Radiodiagnosis, ABVIMS & Dr. RML Hospital, New Delhi, India
| | - Arti Maria
- Department of Neonatology, ABVIMS & Dr. RML Hospital, New Delhi, India
| |
Collapse
|
7
|
Gao Y, Yin H, Wang MH, Gao YH. Accuracy of lung and diaphragm ultrasound in predicting infant weaning outcomes: a systematic review and meta-analysis. Front Pediatr 2023; 11:1211306. [PMID: 37744441 PMCID: PMC10511769 DOI: 10.3389/fped.2023.1211306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 08/28/2023] [Indexed: 09/26/2023] Open
Abstract
Background Although lung and diaphragm ultrasound are valuable tools for predicting weaning results in adults with MV, their relevance in children is debatable. The goal of this meta-analysis was to determine the predictive value of lung and diaphragm ultrasound in newborn weaning outcomes. Methods For eligible studies, the databases MEDLINE, Web of Science, Cochrane Library, PubMed, and Embase were thoroughly searched. The Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) method was used to evaluate the study's quality. Results were gathered for sensitivity, specificity, diagnostic odds ratio (DOR), and the area under the curve of summary receiver operating characteristic curves (AUSROC). To investigate the causes of heterogeneity, subgroup analyses and meta-regression were conducted. Results A total of 11 studies were suitable for inclusion in the meta-analysis, which included 828 patients. The pooled sensitivity and specificity of lung ultrasound (LUS) were 0.88 (95%CI, 0.85-0.90) and 0.81 (95%CI, 0.75-0.87), respectively. The DOR for diaphragmatic excursion (DE) is 13.17 (95%CI, 5.65-30.71). The AUSROC for diaphragm thickening fraction (DTF) is 0.86 (95%CI, 0.82-0.89). The most sensitive and specific method is LUS. The DE and DTF were the key areas where study heterogeneity was evident. Conclusions Lung ultrasonography is an extremely accurate method for predicting weaning results in MV infants. DTF outperforms DE in terms of diaphragm ultrasound predictive power.
Collapse
Affiliation(s)
- Yang Gao
- Department of Ultrasound, Shandong Provincial Maternal and Child Health Care Hospital, Jinan, China
| | - Hong Yin
- Department of Ultrasound, Shandong Provincial Maternal and Child Health Care Hospital, Jinan, China
| | - Mei-Huan Wang
- Department of Ultrasound, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Yue-Hua Gao
- Department of Ultrasound, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| |
Collapse
|
8
|
Shimizu T, Kanazawa T, Sakura T, Shioji N, Shimizu K, Fukuhara R, Shinya T, Iwasaki T, Morimatsu H. Efficacy of prophylactic high-flow nasal cannula therapy for postoperative pulmonary complications after pediatric cardiac surgery: a prospective single-arm study. J Anesth 2023; 37:433-441. [PMID: 37058243 DOI: 10.1007/s00540-023-03187-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 03/26/2023] [Indexed: 04/15/2023]
Abstract
PURPOSE This study investigated the incidence of postoperative pulmonary complications (PPC) when high-flow nasal cannula therapy (HFNC) is used prophylactically after pediatric cardiac surgery, and evaluated its efficacy. METHODS This was a single-arm prospective interventional study that was conducted in a tertiary teaching hospital with eight beds in the pediatric cardiac ICU after approval by the Ethics Committee. One-hundred children under the age of 48 months who were scheduled for cardiac surgery for congenital heart disease were recruited. HFNC was used for 24 h after extubation at a 2 L/kg/min flow rate. The primary outcome was the incidence of PPC within 48 h after extubation. PPC was defined as atelectasis and acute respiratory failure meeting certain criteria. We considered prophylactic HFNC as effective if the prevalence of PPC was < 10%, based on previous reports of reintubation rates of 6%-9% after pediatric cardiac surgery. RESULTS A total of 91 patients were finally included in the analysis. The incidence of PPC within 48 h after extubation was 18.7%, whereas atelectasis was observed in 13.2%, and acute respiratory failure in 8.8%. Reintubation rate within 48 h after extubation was 0%. CONCLUSIONS We found the incidence of PPC with prophylactic HFNC after planned extubation after pediatric cardiac surgery. However, the incidence was > 10%; therefore, we could not demonstrate its efficacy in this single-arm study. Further studies are needed to investigate whether the HFNC could be adapted as first-line oxygen therapy after pediatric cardiac surgery.
Collapse
Affiliation(s)
- Tatsuhiko Shimizu
- Department of Anesthesiology and Resuscitology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, 2-5-1, Shikata-Cho, Kita-Ku, Okayama, 700-8558, Japan
| | - Tomoyuki Kanazawa
- Department of Anesthesiology and Resuscitology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, 2-5-1, Shikata-Cho, Kita-Ku, Okayama, 700-8558, Japan.
| | - Takanobu Sakura
- Department of Anesthesiology and Resuscitology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, 2-5-1, Shikata-Cho, Kita-Ku, Okayama, 700-8558, Japan
| | - Naohiro Shioji
- Department of Anesthesia and Intensive Care, National Cancer Center Hospital, Tokyo, Japan
| | - Kazuyoshi Shimizu
- Department of Anesthesiology and Resuscitology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, 2-5-1, Shikata-Cho, Kita-Ku, Okayama, 700-8558, Japan
| | | | - Takayoshi Shinya
- Department of Community Medicine and Medical Science, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | - Tatsuo Iwasaki
- Department of Anesthesiology and Resuscitology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, 2-5-1, Shikata-Cho, Kita-Ku, Okayama, 700-8558, Japan
| | - Hiroshi Morimatsu
- Department of Anesthesiology and Resuscitology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, 2-5-1, Shikata-Cho, Kita-Ku, Okayama, 700-8558, Japan
| |
Collapse
|
9
|
Buonsenso D, Mariani F, Morello R, Cammarota G, De Rose C, Valentini P, Camporesi A, Vetrugno L. Ultrasound Imaging for Diaphragm Function in a Population of Healthy Infants: A Short Observational Report. Diagnostics (Basel) 2023; 13:diagnostics13061095. [PMID: 36980403 PMCID: PMC10047558 DOI: 10.3390/diagnostics13061095] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Revised: 03/07/2023] [Accepted: 03/10/2023] [Indexed: 03/16/2023] Open
Abstract
Introduction: Diaphragm ultrasound is increasingly used in adults, and more recently in pediatric practice. However, normal diaphragm parameters in healthy infants are unknown. This was a prospective observational pilot study aiming to define the normal diaphragm ultrasound characteristics in healthy infants during the first 6 months of life. Methods: We recruited healthy neonates at 7 to 15 days of life, who were followed until the sixth month of life, undergoing five assessments in different time points. The measurements included diaphragm thickness at end expiration (TEE) and at end inspiration (TEI). The thickening fraction (TF) was calculated as (TEI-TEE)/TEE and expressed as a percentage, and as (TEI-TEE)/TEI. Results: A total of 37 toddlers, 16 of which were females (43.2%), were enrolled. Thirty-four children (91.9%) were of Caucasian ethnicity and the median gestational age was 38.4 (35.7–40) weeks. Normal TEE, TEI, and TF have been provided for each time point. Conclusion: We provided new insight regarding data about thickness and thickening function in healthy children to be used for future physiologic and pathologic pediatric studies.
Collapse
Affiliation(s)
- Danilo Buonsenso
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168 Rome, Italy
- Centro di Salute Globale, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
- Correspondence: ; Tel.: +39-0630154390
| | - Francesco Mariani
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168 Rome, Italy
| | - Rosa Morello
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168 Rome, Italy
| | - Gianmaria Cammarota
- Department of Anaesthesia and Intensive Care Medicine, University of Perugia, 06100 Perugia, Italy
| | - Cristina De Rose
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168 Rome, Italy
| | - Piero Valentini
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168 Rome, Italy
| | - Anna Camporesi
- Department of Pediatric Anesthesia and Intensive Care, Children’s Hospital “Vittore Buzzi”, 20154 Milan, Italy
| | - Luigi Vetrugno
- Department of Anesthesia, “SS Annunziata” Hospital, Via dei Vestini, 66100 Chieti, Italy
- Department of Medical, Oral and Biotechnological Sciences, University of Chieti-Pescara, 66100 Chieti, Italy
| |
Collapse
|
10
|
Validation of a non-invasive pressure-time index of the inspiratory muscles in spontaneously breathing newborn infants. J Clin Monit Comput 2023; 37:221-226. [PMID: 35674857 PMCID: PMC9852111 DOI: 10.1007/s10877-022-00882-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Accepted: 05/16/2022] [Indexed: 01/24/2023]
Abstract
To validate the pressure-time index of the inspiratory muscles as a non-invasive index of inspiratory muscle function in spontaneously breathing infants by comparing it against the gold-standard pressure-time index of the diaphragm. Prospective observational cohort study of consecutive infants breathing unsupported in room air in a tertiary neonatal intensive care unit, studied prior to discharge from neonatal care. The invasive pressure-time index of the diaphragm was calculated using a transdiaphragmatic dual-pressure catheter that measured transdiaphragmatic pressure by subtraction of the oesophageal from the gastric pressure. The non-invasive pressure-time index of the inspiratory muscles was calculated using pressure measurements at the level of the mouth via a differential pressure transducer connected to a face mask. Both indices were calculated as the product of the ratio of the mean inspiratory pressure divided by the maximum inspiratory pressure and the ratio of the inspiratory time divided by the total time of a respiratory cycle. One hundred and thirty infants (79 male) were included with a mean (SD) gestational age of 35.2 (3.2) weeks, studied at a median (IQR) postnatal age of 9 (6-20) days. The mean (SD) pressure-time index of the diaphragm was 0.063 (0.019) and the mean (SD) pressure-time index of the inspiratory muscles was 0.065 (0.023). The correlation coefficient for the two indices was 0.509 (p < 0.001). The mean (SD) absolute difference between the pressure-time index of the inspiratory muscles and pressure-time index of the diaphragm was 0.002 (0.021). In convalescent infants, the non-invasive pressure-time index of the inspiratory muscles had a moderate degree of correlation with the invasively derived pressure time index of the diaphragm measured with a transdiaphragmatic catheter.
Collapse
|
11
|
Dassios T, Arattu Thodika FMS, Nanjundappa M, Williams E, Bell AJ, Greenough A. Diaphragmatic ultrasound and patent ductus arteriosus in the newborn: A retrospective case series. Front Pediatr 2023; 11:1123939. [PMID: 36999083 PMCID: PMC10043364 DOI: 10.3389/fped.2023.1123939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 02/27/2023] [Indexed: 04/01/2023] Open
Abstract
Background Patent ductus arteriosus (PDA) and diaphragmatic dysfunction are frequently seen in newborn infants but their relationship remains unknown. We aimed to use point of care ultrasound to compare diaphragmatic kinetics in infants with a PDA compared to in those without a PDA. Methods M-mode ultrasonography was used to measure the mean inspiratory velocity (V I) in newborn infants with and without a haemodynamically significant PDA admitted in the Neonatal Unit at King's College Hospital during a three month period. Results Seventeen diaphragmatic ultrasound studies were reviewed from 14 infants with a median (IQR) gestational age of 26.1 (25.8-30.6) weeks, birth weight of 780 (660-1385) gr at a postnatal age of 18 (14-34) days. Eight scans had evidence of a PDA. The median (IQR) VI was significantly lower in scans with a PDA [1.01 (0.78-1.86) cm/s] compared to the ones without a PDA [3.21 (2.80-3.59) cm/s, p < 0.001]. The median (IQR) gestational age was lower in infants with a PDA [25.8 (25.6-27.3) weeks] compared to infants without a PDA [29.0 (26.1-35.1) weeks, p = 0.007]. Using multivariable linear regression analysis the VI was independently associated with a PDA (adjusted p < 0.001) but not with the gestational age (adjusted p = 0.659). Conclusions Patent ductus arteriosus was associated with a lower mean inspiratory velocity in neonates and this effect was independent of gestational age.
Collapse
Affiliation(s)
- Theodore Dassios
- Neonatal Intensive Care Centre, King's College Hospital NHS Foundation Trust, London, United Kingdom
- Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom
- Correspondence: Theodore Dassios
| | - Fahad M. S. Arattu Thodika
- Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom
| | - Mahesh Nanjundappa
- Neonatal Intensive Care Centre, King's College Hospital NHS Foundation Trust, London, United Kingdom
| | - Emma Williams
- Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom
| | - Aaron J. Bell
- Paediatric Cardiology, Guy's and St Thomas’ Hospitals NHS Trust, London, United Kingdom
| | - Anne Greenough
- Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom
| |
Collapse
|
12
|
Zhao Z, Lu Y, Mi Y, Meng J, Wang X, Cao X, Wang N. Adaptive Triboelectric Nanogenerators for Long-Term Self-Treatment: A Review. BIOSENSORS 2022; 12:1127. [PMID: 36551094 PMCID: PMC9775114 DOI: 10.3390/bios12121127] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 11/26/2022] [Accepted: 12/01/2022] [Indexed: 05/27/2023]
Abstract
Triboelectric nanogenerators (TENGs) were initially invented as an innovative energy-harvesting technology for scavenging mechanical energy from our bodies or the ambient environment. Through adaptive customization design, TENGs have also become a promising player in the self-powered wearable medical market for improving physical fitness and sustaining a healthy lifestyle. In addition to simultaneously harvesting our body's mechanical energy and actively detecting our physiological parameters and metabolic status, TENGs can also provide personalized medical treatment solutions in a self-powered modality. This review aims to cover the recent advances in TENG-based electronics in clinical applications, beginning from the basic working principles of TENGs and their general operation modes, continuing to the harvesting of bioenergy from the human body, and arriving at their adaptive design toward applications in chronic disease diagnosis and long-term clinical treatment. Considering the highly personalized usage scenarios, special attention is paid to customized modules that are based on TENGs and support complex medical treatments, where sustainability, biodegradability, compliance, and bio-friendliness may be critical for the operation of clinical systems. While this review provides a comprehensive understanding of TENG-based clinical devices that aims to reach a high level of technological readiness, the challenges and shortcomings of TENG-based clinical devices are also highlighted, with the expectation of providing a useful reference for the further development of such customized healthcare systems and the transfer of their technical capabilities into real-life patient care.
Collapse
Affiliation(s)
- Zequan Zhao
- Center for Green Innovation, School of Mathematics and Physics, University of Science and Technology Beijing, Beijing 100083, China
| | - Yin Lu
- Center for Green Innovation, School of Mathematics and Physics, University of Science and Technology Beijing, Beijing 100083, China
| | - Yajun Mi
- Center for Green Innovation, School of Mathematics and Physics, University of Science and Technology Beijing, Beijing 100083, China
| | - Jiajing Meng
- Center for Green Innovation, School of Mathematics and Physics, University of Science and Technology Beijing, Beijing 100083, China
| | - Xueqing Wang
- Center for Green Innovation, School of Mathematics and Physics, University of Science and Technology Beijing, Beijing 100083, China
| | - Xia Cao
- Beijing Institute of Nanoenergy and Nanosystems, Chinese Academy of Sciences, Beijing 100083, China
- School of Chemistry and Biological Engineering, University of Science and Technology Beijing, Beijing 100083, China
| | - Ning Wang
- Center for Green Innovation, School of Mathematics and Physics, University of Science and Technology Beijing, Beijing 100083, China
- Beijing Institute of Nanoenergy and Nanosystems, Chinese Academy of Sciences, Beijing 100083, China
| |
Collapse
|