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Damam S, Meshram RJ, Taksande A, Lohiya S, Khurana A, Patel A, Khandelwal R, Nath R, Javvaji CK, Kakkat S. Navigating Pediatric Capnography: A Comprehensive Review of Scope and Limitations. Cureus 2024; 16:e53289. [PMID: 38435961 PMCID: PMC10905056 DOI: 10.7759/cureus.53289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Accepted: 01/31/2024] [Indexed: 03/05/2024] Open
Abstract
This review comprehensively explores pediatric capnography, a vital tool in contemporary respiratory monitoring. The overview encompasses the foundational principles of capnography, elucidating its real-time measurement of carbon dioxide (CO2) in respiratory gases. The review emphasizes its paramount role in pediatric care and underscores capnography's significance in detecting respiratory abnormalities and guiding timely interventions. The distinctions between mainstream and sidestream capnography, the key to understanding their applications, are meticulously outlined. Addressing the importance of ongoing research and education, the review advocates for a dynamic approach to refine guidelines and optimize capnography utilization in pediatric settings. The conclusion reflects on the scope and limitations of pediatric capnography, acknowledging its transformative impact while advocating for a judicious recognition of constraints. As we navigate the future of pediatric respiratory care, the synergy of research, education, and clinical application emerges as the cornerstone for advancing pediatric capnography to new horizons.
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Affiliation(s)
- SreeHarsha Damam
- Pediatrics, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Revat J Meshram
- Pediatrics, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Amar Taksande
- Pediatrics, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Sham Lohiya
- Pediatrics, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Astha Khurana
- Pediatrics, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Ankita Patel
- Pediatrics, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Rahul Khandelwal
- Pediatrics, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Ritwik Nath
- Pediatrics, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Chaitanya Kumar Javvaji
- Pediatrics, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Shikha Kakkat
- Pediatrics, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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Lietz A, Kraller J, Hoffelner A, Ritschl V, Berger A, Wagner M. Dose-response of virtual reality training of paediatric emergencies in a randomised simulation-based setting. Acta Paediatr 2023; 112:1995-2005. [PMID: 37195147 DOI: 10.1111/apa.16847] [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: 10/31/2022] [Revised: 05/09/2023] [Accepted: 05/15/2023] [Indexed: 05/18/2023]
Abstract
AIM To determine the effect of different virtual reality training intervals on individual performance to facilitate the optimal implementation of medical virtual reality training. METHODS Emergency scenarios in virtual reality were performed by 36 medical students from the Medical University of Vienna. After baseline training, the participants were randomised into three groups of equal size and underwent virtual reality training at different time intervals (monthly, one training after 3 months, and no further training) before undergoing final assessment training after 6 months. RESULTS Group A, with monthly training exercises, improved their performance score significantly by 1.75 mean score points compared with Group B, who repeated baseline training after 3 months. Statistically significant difference was indicated when comparing Group A with Group C, which was not further trained and served as the control group. CONCLUSION One-month intervals are associated with statistically significant performance improvements compared with additional training after 3 months and to a control group without regular training. The results show that training intervals of 3 months or longer are insufficient to achieve high performance scores. Virtual reality training is a cost-effective alternative to conventional simulation-based training for regular practice.
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Affiliation(s)
- Andrea Lietz
- Division of Neonatology, Department of Pediatrics and Adolescent Medicine, Pediatric Intensive Care and Neuropediatrics, Comprehensive Center for Paediatrics, Medical University Vienna, Vienna, Austria
| | - Julian Kraller
- Division of Neonatology, Department of Pediatrics and Adolescent Medicine, Pediatric Intensive Care and Neuropediatrics, Comprehensive Center for Paediatrics, Medical University Vienna, Vienna, Austria
| | - Alexander Hoffelner
- Division of Neonatology, Department of Pediatrics and Adolescent Medicine, Pediatric Intensive Care and Neuropediatrics, Comprehensive Center for Paediatrics, Medical University Vienna, Vienna, Austria
| | - Valentin Ritschl
- Section for Outcomes Research, Center for Medical Statistics, Informatics, and Intelligent Systems, Medical University of Vienna, Vienna, Austria
- Ludwig Boltzmann Institute for Arthritis and Rehabilitation, Vienna, Austria
| | - Angelika Berger
- Division of Neonatology, Department of Pediatrics and Adolescent Medicine, Pediatric Intensive Care and Neuropediatrics, Comprehensive Center for Paediatrics, Medical University Vienna, Vienna, Austria
| | - Michael Wagner
- Division of Neonatology, Department of Pediatrics and Adolescent Medicine, Pediatric Intensive Care and Neuropediatrics, Comprehensive Center for Paediatrics, Medical University Vienna, Vienna, Austria
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Posovszky C, Buderus S, Classen M, Lawrenz B, Keller KM, Koletzko S. Acute Infectious Gastroenteritis in Infancy and Childhood. DEUTSCHES ARZTEBLATT INTERNATIONAL 2020; 117:615-624. [PMID: 33263539 PMCID: PMC7805585 DOI: 10.3238/arztebl.2020.0615] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/26/2020] [Revised: 01/26/2020] [Accepted: 06/29/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND Despite the introduction of vaccination against rotavirus, and even though it can often be treated on an outpatient basis, acute infectious gastroenteritis is nevertheless the second most common non-traumatic cause of emergency hospitaliza - tion in children aged 1 to 5 years, accounting for approximately 9% of cases (39 410 cases in 2017). The most common path - ogens are viruses (47% rotavirus, 29% norovirus, and 14% adenovirus). METHODS This review is based on publications retrieved by a selective search in PubMed employing the terms "acute gastro - enteritis children" AND "dehydration" OR "rehydration" OR "prevention," and by manual searching (based, for example, on reference lists and expert knowledge), with subsequent evaluation including consideration of the relevant guidelines. RESULTS The degree of dehydration can be judged from weight loss and other clinical findings. In 17 randomized controlled trials conducted on a total of 1811 children with mild or moderate dehydration, oral rehydration with oral rehydration solution was just as effective as intravenous rehydration with respect to weight gain, duration of diarrhea, and fluid administration, and was associated with shorter hospital stays (weighted mean difference, -1.2 days; 95% confidence interval [-2.38; -0.02]). Oral rehydration therapy failed in 4% of patients [1; 7]. In children who are vomiting or who refuse oral rehydration solution, continuous nasogastric application is just as effective as intravenous rehydration and is the treatment of first choice. CONCLUSION In Germany, children with mild or moderate dehydration are often hospitalized for intravenous rehydration therapy, despite the good evidence supporting ambulatory oral rehydration. Obstacles to intersectoral care, the nursing shortage, and inadequate reimbursement must all be overcome in order to reduce unnecessary hospitalizations and thereby lessen the risk of nosocomial infection.
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Affiliation(s)
- Carsten Posovszky
- Department of Pediatric and Adolescent Medicine, University Medical Center Ulm
| | - Stephan Buderus
- Department of Pediatrics, GFO-Kliniken Bonn, St. Marienhospital Bonn
| | - Martin Classen
- Department of Pediatric and Adolescent Medicine, Klinikum Links der Weser and Klinikum Bremen-Mitte, Bremen
| | | | | | - Sibylle Koletzko
- Department of Pediatric and Adolescent Medicine, Dr. von Hauner Children’s Hospital, LMU Klinikum der Universität München
- Department of Pediatrics, Gastroenterology and Nutrition, School of Medicine Collegium Medicum University of Warmia and Mazury, Olsztyn, Poland
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Dörr HG, Wollmann HA, Hauffa BP, Woelfle J. Mortality in children with classic congenital adrenal hyperplasia and 21-hydroxylase deficiency (CAH) in Germany. BMC Endocr Disord 2018; 18:37. [PMID: 29884168 PMCID: PMC5994009 DOI: 10.1186/s12902-018-0263-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Accepted: 05/24/2018] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Adrenal crises in children with classic congenital adrenal hyperplasia due to 21-hydroxylase deficiency (CAH) are life-threatening and have the potential to death. METHODS A survey was performed among Paediatric Endocrinologists in Germany to report on deceased children with CAH. Our survey covered the whole of Germany. RESULTS The participating centres reported 14 cases of death (9 female, 5 male) from 1973 until 2004, but no deaths thereafter. 11 children had the SW form and 3 the simple virilizing (SV) form. All patients were on glucocorticoid replacement, and the SW forms additionally on mineralocorticoid replacement. The age at death varied between 6 weeks and 16.5 years. Seven children died before introduction of general neonatal screening, and 7 children thereafter. Before death, the clinical signs of impending crisis were nonspecific. Five patients developed hypoglycaemia and convulsions with cerebral oedema. Half of the deceased patients died at home. The hydrocortisone dosage was only doubled in two of the 14 cases. CONCLUSIONS According to the assessments by the attending centres, almost all deaths could be related to an inadequate administration of stress doses of hydrocortisone. Since no deceased CAH children were reported in Germany from 2005 on, we assume the effectiveness of educational programs over the past years.
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Affiliation(s)
- Helmuth G. Dörr
- Paediatric Endocrinology, Department Paediatrics, University Hospital of Erlangen, Erlangen, Germany
| | | | - Berthold P. Hauffa
- Paediatric Endocrinology, Department Paediatrics, University Hospital of Essen, Essen, Germany
| | - Joachim Woelfle
- Paediatric Endocrinology, Department Paediatrics, University Hospital of Bonn, Bonn, Germany
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Mathew JL, Singhi SC. Approach to a child with breathing difficulty. Indian J Pediatr 2011; 78:1118-26. [PMID: 21630076 DOI: 10.1007/s12098-011-0424-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2011] [Accepted: 04/08/2011] [Indexed: 11/28/2022]
Abstract
Breathing difficulty and respiratory distress is the most common cause of admission to the Pediatric Emergency. Respiratory distress presents as altered breathing pattern, forced breathing efforts or obstructed breathing, and chest indrawing; respiratory failure is defined as paCO(2) >50 mmHg (inadequate ventilation) and/or a paO(2) < 60 mmHg (inadequate oxygenation). Rapid assessment is aimed to ascertain adequacy of airway patency, breathing, and circulation. Immediate care is directed at (a) restoration of airway patency- by positioning (head tilt -chin lift), cleaning the oropharynx, and/or insertion of oropharyngeal airway; (b) supporting breathing- with high flow oxygen and assisted ventilation (with bag and mask or endotracheal intubation and ventilation), and (c) restoration of circulation- using fluid boluses and inotropes, if necessary. Immediate specific management may require endotracheal intubation/tracheostomy for upper airway obstruction; needle thoracotomy and drainage of pneumothorax; and first dose of antibiotic for febrile children. Thereafter meticulous history, focused physical examination, and specific laboratory/radiological investigations are undertaken to identify the underlying cause. At the end of this, one should be able to categorize the child to one of the following: (a) upper airway obstruction, (b) pneumonia (syndrome of cough, fever and breathing difficulty), (c) lower airway obstruction, (d) slow or irregular breathing without pulmonary signs, and (e) respiratory distress with cardiac findings, to initiate specific treatment. Further respiratory support by Continuous Positive Airways Pressure (CPAP) and mechanical ventilation may be required in some cases. All children with respiratory distress must be monitored for early detection of worsening/complications, assessment of response to therapy and rapid documentation of clinical state.
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Affiliation(s)
- Joseph L Mathew
- Department of Pediatrics, Advanced Pediatrics Centre, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India
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Müller-Lobeck L. Correspondence (letter to the editor): additions are needed. DEUTSCHES ARZTEBLATT INTERNATIONAL 2010; 107:303-4; author reply 304-5. [PMID: 20490342 DOI: 10.3238/arztebl.2010.0303c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Genzwürker H, Gernoth C, Hinkelbein J. Correspondence (letter to the editor): use of developed products preferable. DEUTSCHES ARZTEBLATT INTERNATIONAL 2010; 107:302; author reply 304-5. [PMID: 20490341 DOI: 10.3238/arztebl.2010.0302b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Mader T. Correspondence (letter to the editor): pay attention to the target group. DEUTSCHES ARZTEBLATT INTERNATIONAL 2010; 107:303-305. [PMID: 20490343 PMCID: PMC2872825 DOI: 10.3238/arztebl.2010.0303b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
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Lukowski T. Correspondence (letter to the editor): useless therapeutic option. DEUTSCHES ARZTEBLATT INTERNATIONAL 2010; 107:302-305. [PMID: 20490340 PMCID: PMC2872822 DOI: 10.3238/arztebl.2010.0302a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
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Seewi O. Correspondence (letter to the editor): isotonic is better. DEUTSCHES ARZTEBLATT INTERNATIONAL 2010; 107:302-305. [PMID: 20490339 PMCID: PMC2872824 DOI: 10.3238/arztebl.2010.0303a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Affiliation(s)
- Ora Seewi
- *Kinder-Endokrinologie und Diabetologie, Klinik und Poliklinik für Allgemeine Kinderheilkunde der Universität zu Köln Kerpener Str. 62, 50924 Köln, Köln,
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Strauß J, Becke K. Correspondence (letter to the editor): use familiar material. DEUTSCHES ARZTEBLATT INTERNATIONAL 2010; 107:304-305. [PMID: 20490344 PMCID: PMC2872827 DOI: 10.3238/arztebl.2010.0304a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Affiliation(s)
- Jochen Strauß
- *Wissenschaftlicher Arbeitskreis Kinderanästhesie der DGAI, HELIOS-Klinikum Berlin Buch, Klinik für Anästhesie, Perioperative Medizin und Schmerztherapie, Schwanebecker Chaussee 50, 13125 Berlin, Germany,
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