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Wu AG, Luch S, Slusher TM, Fischer GA, Lunos SA, Bjorklund AR. The novel LESS (low-cost entrainment syringe system) O 2 blender for use in modified bubble CPAP circuits: a clinical study of safety. Front Pediatr 2024; 12:1313781. [PMID: 38410763 PMCID: PMC10894966 DOI: 10.3389/fped.2024.1313781] [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: 10/10/2023] [Accepted: 01/25/2024] [Indexed: 02/28/2024] Open
Abstract
Background Bubble continuous positive airway pressure (bCPAP) is used in resource-limited settings for children with respiratory distress. Low-cost modifications of bCPAP use 100% oxygen and may cause morbidity from oxygen toxicity. We sought to test a novel constructible low-cost entrainment syringe system (LESS) oxygen blender with low-cost modified bCPAP in a relevant clinical setting. Methods We conducted a clinical trial evaluating safety of the LESS O2 blender among hospitalized children under five years old in rural Cambodia evaluating the rate of clinical failure within one hour of initiation of the LESS O2 blender and monitoring for any other blender-related complications. Findings Thirty-two patients were included. The primary outcome (clinical failure) occurred in one patient (3.1%, 95% CI = 0.1-16.2%). Clinical failure was defined as intubation, death, transfer to another hospital, or two of the following: oxygen saturation <85% after 30 min of treatment; new signs of respiratory distress; or partial pressure of carbon dioxide ≥60 mmHg and pH <7.2 on a capillary blood gas. Secondary outcomes included average generated FiO2's with blender use, which were 59% and 52% when a 5 mm entrainment was used vs. a 10 mm entrainment port with 5-7 cm H2O of CPAP and 1-7 L/min (LPM) of flow; and adverse events including loss of CPAP bubbling (64% of all adverse events), frequency of repair or adjustment (44%), replacement (25%), and median time of respiratory support (44 h). Interpretation Overall the LESS O2 blender was safe for clinical use. The design could be modified for improved performance including less repair needs and improved nasal interface, which requires modification for the blender to function more consistently.
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Affiliation(s)
- Andrew G Wu
- Division of Critical Care Medicine, Boston Children's Hospital, Boston, MA, United States
- Department of Pediatrics, Division of Pediatric Critical Care, Hennepin Healthcare, Minneapolis, MN, United States
| | - Sreyleak Luch
- Department of Pediatrics, Chenla Children's Healthcare, Kratie, Cambodia
| | - Tina M Slusher
- Department of Pediatrics, Division of Pediatric Critical Care, Hennepin Healthcare, Minneapolis, MN, United States
- Department of Pediatrics Global Pediatrics, University of Minnesota, Minneapolis, MN, United States
- Department of Pediatrics, Division of Pediatric Critical Care, University of Minnesota, Minneapolis, MN, United States
| | - Gwenyth A Fischer
- Department of Pediatrics, Division of Pediatric Critical Care, University of Minnesota, Minneapolis, MN, United States
| | - Scott A Lunos
- Biostatistical Design and Analysis Center, University of Minnesota, Minneapolis, MN, United States
| | - Ashley R Bjorklund
- Department of Pediatrics, Division of Pediatric Critical Care, Hennepin Healthcare, Minneapolis, MN, United States
- Department of Pediatrics Global Pediatrics, University of Minnesota, Minneapolis, MN, United States
- Department of Pediatrics, Division of Pediatric Critical Care, University of Minnesota, Minneapolis, MN, United States
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Meier K, Riepl A, Voitl P, Lischka L, Voitl JJM, Langer K, Kuzio U, Redlberger-Fritz M, Diesner-Treiber SC. Characterisation of RSV infections in children without chronic diseases aged 0-36 months during the post-COVID-19 winter season 2022/2023. Front Pediatr 2024; 12:1342399. [PMID: 38379907 PMCID: PMC10876782 DOI: 10.3389/fped.2024.1342399] [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: 11/21/2023] [Accepted: 01/25/2024] [Indexed: 02/22/2024] Open
Abstract
Background Respiratory syncytial virus (RSV) is one of the leading causes of hospitalisation, morbidity, and mortality due to respiratory infection in the first years of life. This longitudinal prospective study outlines the 2022/23 season's viral patterns in Austria after the epidemiological changes determined by public health measures. We aimed to highlight differences within the RSV subtypes and genotypes in 0-36-month-old children without chronic diseases in the outpatient setting. Methods From November 2022 to March 2023 children younger than 36 months admitted to Vienna's largest paediatric primary healthcare centre with an acute respiratory infection were enrolled in this study. Nasal swabs and multiplex PCR panels detected 20 viruses including RSV subtypes and genotypes. Clinical presentation, features, and treatment of the participants were documented and analysed using the Modified Tal Score (MTS). Patients were scheduled for a telemedical follow-up one week after the initial appointment. Analysis was done using descriptive statistics, including Cramér V and binominal logarithmic regression. Results Among the 345 samples from 329 children, RSV was the most common virus (31.9%), followed by influenza (17.5%) and rhinovirus infections (20.58%). Of the RSV positive samples, only 13 cases were RSV subtype A (11.8%), whereas 97 were of subtype B (87.3%); ON1 and BA9 were the only detectable RSV genotypes (ON1: BA9 = 1:9.25). RSV was the main predictor of hospitalisation (OR: 7.5, 95% CI: (1.46-38.40), and age had a significant but smaller effect (OR: 0.89, 95% CI: (0.81-0.99). Almost all patients' clinical status improved within the first days. Conclusion RSV cases showed a rapid onset in late November 2022, and subtype B was predominant throughout the season. RSV infection was associated with higher hospitalisation rates, even after excluding high-risk patients (preterm and severe chronic diseases population).Further testing in the upcoming winter seasons will improve our knowledge of the dominant subtype and its association with disease severity, especially with the development of novel RSV vaccine candidates.
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Affiliation(s)
| | - Angela Riepl
- First Vienna Pediatric Medical Center, Vienna, Austria
| | - Peter Voitl
- First Vienna Pediatric Medical Center, Vienna, Austria
- Sigmund Freud University Vienna, Vienna, Austria
| | - Lena Lischka
- First Vienna Pediatric Medical Center, Vienna, Austria
| | | | - Klara Langer
- First Vienna Pediatric Medical Center, Vienna, Austria
| | - Ulrike Kuzio
- First Vienna Pediatric Medical Center, Vienna, Austria
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Martín-Latorre MDM, Martínez-Campos L, Martín-González M, Castro-Luna G, Lozano-Paniagua D, Nievas-Soriano BJ. Comparison of Easy-to-Use Bronchiolitis Scores in the Post-COVID-19 Era-An Observational Study. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1834. [PMID: 38136036 PMCID: PMC10742179 DOI: 10.3390/children10121834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 11/16/2023] [Accepted: 11/20/2023] [Indexed: 12/24/2023]
Abstract
In the post-restrictions COVID-19 period, the incidence of bronchiolitis in infants has increased considerably. Several scores determine the degree of severity of the bronchiolitis episode, but few are clinician-friendly. The main aim of this research was to find the easy-to-use score that most accurately estimated the severity of patients' infections according to their clinical situations and most accurately predicted the need for hospital admission. An observational cross-sectional study was performed in a reference pediatric hospital during the post-restrictions period of the COVID-19 pandemic (2021 and 2022). A comparison was made between the severity estimate provided by five international acute bronchiolitis scales and the clinical severity of the acute bronchiolitis episode. Three hundred and seventy-seven patients participated in the investigation, with a mean age of 5.68 months; 68.7% of the participants had a mild episode of bronchiolitis, 24.5% had a moderate episode, and 6.9% had a severe episode. The severity estimated by the Tal scale modified by McCallum showed a statistically significant correlation with the clinical severity established by clinical criteria (0.836; p < 0.001). It showed a high correlation with other international scores, such as the Wang score (0.820; p < 0.05) and the Wood-Downes-Ferrés score (0.936; p < 0.001). In the multivariate analysis, the constituent variables of the modified Tal score appeared in the final model that predicts the need for hospital admission. In the context of increased incidence after COVID-19, the Tal score modified by McCallum is an easy-to-use measuring instrument that presents an excellent concordance with the clinical severity estimated at first care contact. It also offers a more significant prediction of the need for hospital admission.
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Affiliation(s)
- María del Mar Martín-Latorre
- Department of Pediatrics, Torrecárdenas University Hospital, 04009 Almeria, Spain; (M.d.M.M.-L.); (L.M.-C.); (M.M.-G.); (G.C.-L.)
| | - Leticia Martínez-Campos
- Department of Pediatrics, Torrecárdenas University Hospital, 04009 Almeria, Spain; (M.d.M.M.-L.); (L.M.-C.); (M.M.-G.); (G.C.-L.)
| | - Manuel Martín-González
- Department of Pediatrics, Torrecárdenas University Hospital, 04009 Almeria, Spain; (M.d.M.M.-L.); (L.M.-C.); (M.M.-G.); (G.C.-L.)
- Nursing, Physiotherapy, and Medicine Department, University of Almeria, 04120 Almeria, Spain;
| | - Gracia Castro-Luna
- Department of Pediatrics, Torrecárdenas University Hospital, 04009 Almeria, Spain; (M.d.M.M.-L.); (L.M.-C.); (M.M.-G.); (G.C.-L.)
| | - David Lozano-Paniagua
- Nursing, Physiotherapy, and Medicine Department, University of Almeria, 04120 Almeria, Spain;
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Hernández-Villarroel AC, Ruiz-García A, Manzanaro C, Echevarría-Zubero R, Bote-Gascón P, Gonzalez-Bertolin I, Sainz T, Calvo C, Bueno-Campaña M. Lung Ultrasound: A Useful Prognostic Tool in the Management of Bronchiolitis in the Emergency Department. J Pers Med 2023; 13:1624. [PMID: 38138851 PMCID: PMC10745017 DOI: 10.3390/jpm13121624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Revised: 11/01/2023] [Accepted: 11/13/2023] [Indexed: 12/24/2023] Open
Abstract
Lung ultrasound, a non-invasive bedside technique for assessing paediatric patients with acute respiratory diseases, is becoming increasingly widespread. The aim of this prospective, observational cohort study was to evaluate the effectiveness of a clinical ultrasound score in assessing infants with acute bronchiolitis in the emergency department and its ability to accurately identify patients at a higher risk of clinical deterioration. Infants under 6 months of age with clinical symptoms compatible with acute bronchiolitis were enrolled and underwent clinical and lung ultrasound evaluations. The study included 50 patients, the median age of which was 2.2 months (IQR: 1-5), and the primary outcome was respiratory support. Infants requiring invasive or non-invasive ventilation showed higher scores (5 points [IQR: 3.5-5.5] vs. 2.5 [IQR: 1.5-4]). The outcome had an AUC of 0.85 (95%CI: 0.7-0.98), with a sensitivity of 87%, specificity of 64%, and negative predictive value of 96.4% for a score <3.5 points. Children who scored ≥3.5 points were more likely to require respiratory support within the next 24 h (estimated event-free survival of 82.9% compared to 100%, log-rank test p-value = 0.02). The results suggest that integrating lung ultrasound findings into clinical scores when evaluating infants with acute bronchiolitis could be a promising tool for improving prognosis.
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Affiliation(s)
- Aiza C. Hernández-Villarroel
- Department of Paediatrics and Neonatology, Hospital Universitario Fundación Alcorcón, 28922 Madrid, Spain; (A.C.H.-V.); (A.R.-G.); (C.M.)
| | - Alicia Ruiz-García
- Department of Paediatrics and Neonatology, Hospital Universitario Fundación Alcorcón, 28922 Madrid, Spain; (A.C.H.-V.); (A.R.-G.); (C.M.)
| | - Carlos Manzanaro
- Department of Paediatrics and Neonatology, Hospital Universitario Fundación Alcorcón, 28922 Madrid, Spain; (A.C.H.-V.); (A.R.-G.); (C.M.)
| | - Regina Echevarría-Zubero
- Department of Paediatrics and Neonatology, Hospital Universitario Fundación Alcorcón, 28922 Madrid, Spain; (A.C.H.-V.); (A.R.-G.); (C.M.)
| | - Patricia Bote-Gascón
- Paediatric Emergency Department, Hospital Universitario La Paz, 28046 Madrid, Spain; (P.B.-G.); (I.G.-B.)
| | - Isabel Gonzalez-Bertolin
- Paediatric Emergency Department, Hospital Universitario La Paz, 28046 Madrid, Spain; (P.B.-G.); (I.G.-B.)
| | - Talía Sainz
- Department of Paediatrics, Tropical and Infectious Diseases, Hospital Universitario La Paz, 28046 Madrid, Spain; (T.S.); (C.C.)
- IdiPAZ Research Institute, Translational Research Network for Paediatric Infectious Diseases (RITIP), 28029 Madrid, Spain
- Centre for Biomedical Research in Infectious Diseases (CIBERINFEC), 28029 Madrid, Spain
- Department of Paediatrics, Autonomous University of Madrid, 28029 Madrid, Spain
| | - Cristina Calvo
- Department of Paediatrics, Tropical and Infectious Diseases, Hospital Universitario La Paz, 28046 Madrid, Spain; (T.S.); (C.C.)
- IdiPAZ Research Institute, Translational Research Network for Paediatric Infectious Diseases (RITIP), 28029 Madrid, Spain
- Centre for Biomedical Research in Infectious Diseases (CIBERINFEC), 28029 Madrid, Spain
- Department of Paediatrics, Autonomous University of Madrid, 28029 Madrid, Spain
| | - Mercedes Bueno-Campaña
- Department of Paediatrics and Neonatology, Hospital Universitario Fundación Alcorcón, 28922 Madrid, Spain; (A.C.H.-V.); (A.R.-G.); (C.M.)
- IdiPAZ Research Institute, Translational Research Network for Paediatric Infectious Diseases (RITIP), 28029 Madrid, Spain
- Centre for Biomedical Research in Infectious Diseases (CIBERINFEC), 28029 Madrid, Spain
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