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Kempsell-Smith M, Fitzsimons C. Managing the deteriorating child with suspected group A Streptococcus infection. Nurs Child Young People 2023; 35:35-42. [PMID: 37599641 DOI: 10.7748/ncyp.2023.e1467] [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] [Accepted: 03/20/2023] [Indexed: 08/22/2023]
Abstract
Group A Streptococcus bacteria can cause various pyogenic infections such as tonsillitis, pharyngitis, scarlet fever, impetigo, erysipelas, cellulitis and pneumonia. Most group A Streptococcus infections in children are mild and respond positively to treatment with antibiotics. However, some children develop severe infection accompanied by complications such as sepsis and will require urgent treatment, which may include non-invasive or invasive ventilation and the administration of fluids and vasoactive agents. In some instances, for example if there are no beds available in the paediatric intensive care unit, these interventions may be undertaken in a ward setting. This article gives an overview of group A Streptococcus infection, including two rare but severe complications, streptococcal toxic shock syndrome and necrotising fasciitis. It uses a fictionalised case study to examine the management of the deteriorating child with suspected group A Streptococcus infection, including respiratory support, haemodynamic support and symptom management.
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Affiliation(s)
| | - Claire Fitzsimons
- Birmingham Women's and Children's NHS Foundation Trust, Birmingham, England
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2
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Viegas P, Ageno E, Corsi G, Tagariello F, Razakamanantsoa L, Vilde R, Ribeiro C, Heunks L, Patout M, Fisser C. Highlights from the Respiratory Failure and Mechanical Ventilation 2022 Conference. ERJ Open Res 2023; 9:00467-2022. [PMID: 36949961 PMCID: PMC10026011 DOI: 10.1183/23120541.00467-2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 11/10/2022] [Indexed: 11/25/2022] Open
Abstract
The Respiratory Intensive Care Assembly of the European Respiratory Society gathered in Berlin to organise the second Respiratory Failure and Mechanical Ventilation Conference in June 2022. The conference covered several key points of acute and chronic respiratory failure in adults. During the 3-day conference, ventilatory strategies, patient selection, diagnostic approaches, treatment and health-related quality of life topics were addressed by a panel of international experts. Lectures delivered during the event have been summarised by Early Career Members of the Assembly and take-home messages highlighted.
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Affiliation(s)
- Pedro Viegas
- Pulmonology Department, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - Elisa Ageno
- Respiratory and Critical Care Unit, IRCCS Azienda Ospedaliero Universitaria di Bologna, University Hospital Sant'Orsola-Malpighi, Bologna, Italy
- Department of Clinical, Integrated and Experimental Medicine (DIMES), Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Gabriele Corsi
- Respiratory and Critical Care Unit, IRCCS Azienda Ospedaliero Universitaria di Bologna, University Hospital Sant'Orsola-Malpighi, Bologna, Italy
- Department of Clinical, Integrated and Experimental Medicine (DIMES), Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Federico Tagariello
- Respiratory and Critical Care Unit, IRCCS Azienda Ospedaliero Universitaria di Bologna, University Hospital Sant'Orsola-Malpighi, Bologna, Italy
- Department of Clinical, Integrated and Experimental Medicine (DIMES), Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Léa Razakamanantsoa
- Unité Ambulatoire d'Appareillage Respiratoire de Domicile (UAARD), Service de Pneumologie (Département R3S), AP-HP, Groupe Hospitalier Universitaire APHP-Sorbonne Université, Paris, France
| | - Rudolfs Vilde
- Centre of Pulmonology and Thoracic Surgery, Pauls Stradiņš Clinical University Hospital, Riga, Latvia
- Riga Stradiņš University, Riga, Latvia
| | - Carla Ribeiro
- Pulmonology Department, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - Leo Heunks
- Department of Intensive Care, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Maxime Patout
- Service des Pathologies du Sommeil (Département R3S), AP-HP, Groupe Hospitalier Universitaire APHP-Sorbonne Université, site Pitié-Salpêtrière, Paris, France
- Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France
| | - Christoph Fisser
- Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany
- Corresponding author: Christoph Fisser ()
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3
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Baumgartner J, Schmidt J, Klotz D, Schneider H, Schumann S, Fuchs H. Trigger performance of five pediatric home ventilators and one ICU ventilator depending on circuit type and system leak in a physical model of the lung. Pediatr Pulmonol 2022; 57:744-753. [PMID: 34910384 DOI: 10.1002/ppul.25791] [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: 05/14/2021] [Revised: 11/22/2021] [Accepted: 12/10/2021] [Indexed: 11/08/2022]
Abstract
BACKGROUND The population of children with chronic respiratory failure requiring long-term mechanical ventilation in the home has grown worldwide. The optimal choice from an increasing number of home ventilators commercialized for children is often challenging for the attending physicians. The aim of the present study was to compare the trigger performance of five pediatric bilevel home ventilators and one intensive care unit ventilator depending on circuit type and system leak. METHODS The trigger performances of the ventilators were compared in combination with all compatible circuits using a physical model of the lung with increasing system leak. The flow generator simulated the patient's breathing effort with flow rates of 2.7-6.4 L/min at a frequency of 30 breaths/min. All ventilators were set to deliver 16 cmH2 O inspiratory pressure support and 4 cmH2 O positive end-expiratory pressure. RESULTS Trigger thresholds varied from 1.5 to 8 L/min, the pressure rise time to 90% of the maximum from 140 to 385 ms and the trigger work from 0.5 to 6.6 mbar · s. All devices had very short trigger delays below 40 ms. The leak compensation depended on the circuit type. The internal diameter of the circuit had no relevant impact on the trigger performance or the leak compensation. CONCLUSION We observed considerable differences in the triggering performance of the evaluated home ventilators depending on leak size and type of circuit. Therefore, an optimal combination of device and circuit should consider the patient's age and condition and the probability of system leak.
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Affiliation(s)
- Jana Baumgartner
- Division of Neonatology and Pediatric Intensive Care Medicine, Center for Pediatrics and Adolescent Medicine, Faculty of Medicine, Medical Center, University of Freiburg, Freiburg, Germany
| | - Johanna Schmidt
- Department of General Pediatrics, Neonatology and Pediatric Cardiology, University Children's Hospital Duesseldorf, Medical Faculty, Heinrich Heine University, Duesseldorf, Germany
| | - Daniel Klotz
- Division of Neonatology and Pediatric Intensive Care Medicine, Center for Pediatrics and Adolescent Medicine, Faculty of Medicine, Medical Center, University of Freiburg, Freiburg, Germany
| | - Hendryk Schneider
- Division of Neonatology and Pediatric Intensive Care Medicine, Center for Pediatrics and Adolescent Medicine, Faculty of Medicine, Medical Center, University of Freiburg, Freiburg, Germany
| | - Stefan Schumann
- Department of Anesthesiology and Critical Care, Faculty of Medicine, Medical Center, University of Freiburg, Freiburg, Germany
| | - Hans Fuchs
- Division of Neonatology and Pediatric Intensive Care Medicine, Center for Pediatrics and Adolescent Medicine, Faculty of Medicine, Medical Center, University of Freiburg, Freiburg, Germany
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4
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Liu E, Smyth RL, Li Q, Qaseem A, Florez ID, Mathew JL, Amer YS, Estill J, Lu Q, Fu Z, Lu X, Chan ESY, Schwarze J, Wong GWK, Fukuoka T, Ahn HS, Lee MS, Nurdiati D, Cao B, Tu W, Qian Y, Zhao S, Dong X, Luo X, Chen Z, Li G, Zhang X, Zhao X, Xu H, Xu F, Shi Y, Zhao R, Zhao Y, Lei J, Zheng X, Wang M, Yang S, Feng X, Wu L, He Z, Liu S, Wang Q, Song Y, Luo Z, Zhou Q, Guyatt G, Chen Y, Li Q. Guidelines for the prevention and management of children and adolescents with COVID-19. Eur J Pediatr 2022; 181:4019-4037. [PMID: 36109390 PMCID: PMC9483317 DOI: 10.1007/s00431-022-04615-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Revised: 07/26/2022] [Accepted: 09/04/2022] [Indexed: 12/15/2022]
Abstract
UNLABELLED Children are the future of the world, but their health and future are facing great uncertainty because of the coronavirus disease 2019 (COVID-19) pandemic. In order to improve the management of children with COVID-19, an international, multidisciplinary panel of experts developed a rapid advice guideline at the beginning of the outbreak of COVID-19 in 2020. After publishing the first version of the rapid advice guideline, the panel has updated the guideline by including additional stakeholders in the panel and a comprehensive search of the latest evidence. All recommendations were supported by systematic reviews and graded using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system. Expert judgment was used to develop good practice statements supplementary to the graded evidence-based recommendations. The updated guideline comprises nine recommendations and one good practice statement. It focuses on the key recommendations pertinent to the following issues: identification of prognostic factors for death or pediatric intensive care unit admission; the use of remdesivir, systemic glucocorticoids and antipyretics, intravenous immunoglobulin (IVIG) for multisystem inflammatory syndrome in children, and high-flow oxygen by nasal cannula or non-invasive ventilation for acute hypoxemic respiratory failure; breastfeeding; vaccination; and the management of pediatric mental health. CONCLUSION This updated evidence-based guideline intends to provide clinicians, pediatricians, patients and other stakeholders with evidence-based recommendations for the prevention and management of COVID-19 in children and adolescents. Larger studies with longer follow-up to determine the effectiveness and safety of systemic glucocorticoids, IVIG, noninvasive ventilation, and the vaccines for COVID-19 in children and adolescents are encouraged. WHAT IS KNOWN • Several clinical practice guidelines for children with COVID-19 have been developed, but only few of them have been recently updated. • We developed an evidence-based guideline at the beginning of the COVID-19 outbreak and have now updated it based on the results of a comprehensive search of the latest evidence. WHAT IS NEW • The updated guideline provides key recommendations pertinent to the following issues: identification of prognostic factors for death or pediatric intensive care unit admission; the use of remdesivir, systemic glucocorticoids and antipyretics, intravenous immunoglobulin for multisystem inflammatory syndrome in children, and high-flow oxygen by nasal cannula or non-invasive ventilation for acute hypoxemic respiratory failure; breastfeeding; vaccination; and the management of pediatric mental health.
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Affiliation(s)
- Enmei Liu
- grid.488412.3Department 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
| | - Rosalind Louise Smyth
- grid.83440.3b0000000121901201UCL Great Ormond St Institute of Child Health, London, UK ,grid.420468.cGreat Ormond Street Hospital, London, UK
| | - Qinyuan Li
- grid.488412.3Department 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
| | - Amir Qaseem
- grid.417947.80000 0000 8606 7660Clinical Policy and Center for Evidence Reviews, American College of Physicians, Philadelphia, USA
| | - Ivan D. Florez
- grid.25073.330000 0004 1936 8227School of Rehabilitation Science, McMaster University, Hamilton, ON Canada ,grid.412881.60000 0000 8882 5269Department of Pediatrics, University of Antioquia, Medellin, Antioquia Colombia ,Pediatric Intensive Care Unit, Clinica Las Americas, Medellin, Colombia
| | - Joseph L. Mathew
- grid.415131.30000 0004 1767 2903Advanced Pediatrics Centre, PGIMER Chandigarh, Chandigarh, India
| | - Yasser Sami Amer
- grid.56302.320000 0004 1773 5396Research Chair for Evidence-Based Health Care and Knowledge Translation, King Saud University, Riyadh, Saudi Arabia ,grid.56302.320000 0004 1773 5396Clinical Practice Guidelines & Quality Research Unit, Quality Management Department, King Saud University Medical City, Riyadh, Saudi Arabia ,grid.56302.320000 0004 1773 5396Pediatrics Department, King Saud University Medical City, Riyadh, Saudi Arabia ,grid.7155.60000 0001 2260 6941Alexandria Center for Evidence-Based Clinical Practice Guidelines, Alexandria University, Alexandria, Egypt
| | - Janne Estill
- grid.8591.50000 0001 2322 4988Institute of Global Health, University of Geneva, Geneva, Switzerland
| | - Quan Lu
- grid.16821.3c0000 0004 0368 8293Shanghai Children’s Hospital Affiliated to Shanghai Jiaotong University, Shanghai, China
| | - Zhou Fu
- grid.488412.3Department 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
| | - Xiaoxia Lu
- grid.33199.310000 0004 0368 7223Department of Respiratory Medicine, Wuhan Children’s Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei China
| | - Edwin Shih-Yen Chan
- grid.428397.30000 0004 0385 0924Centre for Quantitative Medicine, Office of Clinical Sciences, Duke-National University of Singapore Medical School, Singapore, Singapore ,grid.452814.e0000 0004 0451 6530Singapore Clinical Research Institute, Singapore, Singapore
| | - Jürgen Schwarze
- grid.4305.20000 0004 1936 7988Children’s Research Network and Department of Child Life and Health, Centre for Inflammation Research, The University of Edinburgh, Edinburgh, UK
| | - Gary Wing-Kin Wong
- grid.10784.3a0000 0004 1937 0482Department of Pediatrics, The Chinese University of Hong Kong, Hong Kong, China
| | - Toshio Fukuoka
- grid.415565.60000 0001 0688 6269Emergency and Critical Care Center, the Department of General Medicine, Department of Research and Medical Education at Kurashiki Central Hospital, Kurashiki, Japan ,Advisory Committee in Cochrane Japan, Tokyo, Japan
| | - Hyeong Sik Ahn
- grid.222754.40000 0001 0840 2678Department of Preventive Medicine, Korea University, Seoul, South Korea ,grid.512461.50000 0004 5935 134XKorea Cochrane Centre, Seoul, South Korea ,grid.222754.40000 0001 0840 2678Institute for Evidence-Based Medicine, Korea University College of Medicine, Seoul, South Korea ,grid.222754.40000 0001 0840 2678Korea University School of Medicine, Seoul, South Korea
| | - Myeong Soo Lee
- grid.418980.c0000 0000 8749 5149Clinical Medicine Division, Korea Institute of Oriental Medicine, Daejeon, South Korea ,grid.412786.e0000 0004 1791 8264Korean Convergence Medicine, University of Science and Technology, Daejeon, South Korea ,grid.410648.f0000 0001 1816 6218Tianjin University of Traditional Chinese Medicine, Tianjin, China ,grid.32566.340000 0000 8571 0482Research Unit of Evidence-Based Evaluation and Guidelines, Chinese Academy of Medical Sciences (2021RU017), School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
| | - Detty Nurdiati
- grid.8570.a0000 0001 2152 4506Cochrane Indonesia, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Bin Cao
- grid.415954.80000 0004 1771 3349Department of Pulmonary and Critical Care Medicine, National Center for Respiratory Medicine, Center of Respiratory Medicine, National Clinical Research Center for Respiratory Diseases, China-Japan Friendship Hospital, Beijing, China ,grid.506261.60000 0001 0706 7839Institute of Respiratory Medicine, Chinese Academy of Medical Science, Beijing, China ,grid.452723.50000 0004 7887 9190Tsinghua University-Peking University Joint Center for Life Sciences, Beijing, China
| | - Wenwei Tu
- grid.194645.b0000000121742757Department of Pediatrics & Adolescent Medicine, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong SAR, China
| | - Yuan Qian
- grid.418633.b0000 0004 1771 7032Capital Institute of Pediatrics, Beijing, China
| | - Shunying Zhao
- grid.411609.b0000 0004 1758 4735Beijing Children’s Hospital, Beijing, China
| | - Xiaoyan Dong
- grid.16821.3c0000 0004 0368 8293Shanghai Children’s Hospital Affiliated to Shanghai Jiaotong University, Shanghai, China
| | - Xiaoping Luo
- grid.412793.a0000 0004 1799 5032Department of Pediatrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zhimin Chen
- grid.411360.1Department of Pulmonology, Children’s Hospital Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Guobao Li
- National Clinical Research Center for Infectious Disease, Shenzhen, China ,grid.410741.7Shenzhen Third People’s Hospital, Shenzhen, China
| | - Xiaobo Zhang
- grid.411333.70000 0004 0407 2968Children’s Hospital of Fudan University, National Children’s Medical Center, Shanghai, China
| | - Xiaodong Zhao
- grid.488412.3Department of Pediatric Research Institute, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Children’s Hospital of Chongqing Medical University, Chongqing, China ,grid.488412.3Chongqing Key Laboratory of Child Infection and Immunity, Children’s Hospital of Chongqing Medical University, Chongqing, China
| | - Hongmei Xu
- grid.488412.3Department of Infection Diseases 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
| | - Feng Xu
- grid.488412.3Department of Critical Care Medicine Children’s Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Yuan Shi
- grid.488412.3Department of Neonatology 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
| | - Ruiqiu Zhao
- grid.488412.3Department of Infection Diseases 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
| | - Yao Zhao
- grid.488412.3National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Child Infection and Immunity, Children’s Hospital of Chongqing Medical University, Chongqing, China
| | - Junqiang Lei
- grid.412643.60000 0004 1757 2902Department of Radiology, the First Hospital of Lanzhou University, Lanzhou, China
| | - Xianlan Zheng
- grid.488412.3Department of Nursing, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Children’s Hospital of Chongqing Medical University, Chongqing, China
| | - Mengshu Wang
- grid.412643.60000 0004 1757 2902Department of Radiology, the First Hospital of Lanzhou University, Lanzhou, China
| | - Shu Yang
- grid.411304.30000 0001 0376 205XChengdu University of TCM, Chengdu, China
| | - Xixi Feng
- grid.413856.d0000 0004 1799 3643Chengdu Medical College, Chengdu, China
| | - Liqun Wu
- Shenzhen Health Development Research Center, Shenzhen, China
| | - Zhihui He
- Chongqing Ninth People’s Hospital, Chongqing, China
| | - Shihui Liu
- grid.414360.40000 0004 0605 7104Beijing Jishuitan Hospital, Beijing, China
| | - Qi Wang
- grid.25073.330000 0004 1936 8227Department of Health Research Methods, Evidence & Impact (HEI), McMaster University, Hamilton, Canada ,grid.25073.330000 0004 1936 8227McMaster Health Forum, McMaster University, Hamilton, Canada
| | - Yang Song
- grid.413396.a0000 0004 1768 8905Iberoamerican Cochrane Centre-Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain
| | - Zhengxiu Luo
- grid.488412.3Department 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
| | - Qi Zhou
- grid.32566.340000 0000 8571 0482Research Unit of Evidence-Based Evaluation and Guidelines, Chinese Academy of Medical Sciences (2021RU017), School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
| | - Gordon Guyatt
- grid.25073.330000 0004 1936 8227Department of Health Research Methods, Evidence & Impact (HEI), McMaster University, Hamilton, Canada
| | - Yaolong Chen
- Research Unit of Evidence-Based Evaluation and Guidelines, Chinese Academy of Medical Sciences (2021RU017), School of Basic Medical Sciences, Lanzhou University, Lanzhou, China. .,Institute of Health Data Science, Lanzhou University, Lanzhou, China. .,WHO Collaborating Centre for Guideline Implementation and Knowledge Translation, Lanzhou, China. .,Lanzhou University GRADE Centre, Lanzhou, China.
| | - Qiu Li
- Department of Nephrology 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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5
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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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6
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Fauroux B, Abel F, Amaddeo A, Bignamini E, Chan E, Corel L, Cutrera R, Ersu R, Installe S, Khirani S, Krivec U, Narayan O, MacLean J, Perez De Sa V, Pons-Odena M, Stehling F, Trindade Ferreira R, Verhulst S. ERS Statement on pediatric long term noninvasive respiratory support. Eur Respir J 2021; 59:13993003.01404-2021. [PMID: 34916265 DOI: 10.1183/13993003.01404-2021] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 10/03/2021] [Indexed: 11/05/2022]
Abstract
Long term noninvasive respiratory support, comprising continuous positive airway pressure (CPAP) and noninvasive ventilation (NIV), in children is expanding worldwide, with increasing complexities of children being considered for this type of ventilator support and expanding indications such as palliative care. There have been improvements in equipment and interfaces. Despite growing experience, there are still gaps in a significant number of areas: there is a lack of validated criteria for CPAP/NIV initiation, optimal follow-up and monitoring; weaning and long term benefits have not been evaluated. Therapeutic education of the caregivers and the patient is of paramount importance, as well as continuous support and assistance, in order to achieve optimal adherence. The preservation or improvement of the quality of life of the patient and caregivers should be a concern for all children treated with long term CPAP/NIV. As NIV is a highly specialised treatment, patients are usually managed by an experienced pediatric multidisciplinary team. This Statement written by experts in the field of pediatric long term CPAP/NIV aims to emphasize on the most recent scientific input and should open up to new perspectives and research areas.
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Affiliation(s)
- Brigitte Fauroux
- AP-HP, Hôpital Necker, Pediatric noninvasive ventilation and sleep unit, Paris, France .,Université de Paris, EA 7330 VIFASOM, Paris, France
| | - François Abel
- Respiratory Department, Sleep & Long-term Ventilation Unit, Great Ormond Street Hospital for Children, London, UK
| | - Alessandro Amaddeo
- Emergency department, Institute for Maternal and Child Health IRCCS Burlo Garofolo, Trieste, Italy
| | - Elisabetta Bignamini
- Pediatric Pulmonology Unit Regina Margherita Hospital AOU Città della Salute e della Scienza Turin Italy
| | - Elaine Chan
- Respiratory Department, Sleep & Long-term Ventilation Unit, Great Ormond Street Hospital for Children, London, UK
| | - Linda Corel
- Pediatric ICU, Centre for Home Ventilation in Children, Erasmus university Hospital, Rotterdam, the Netherlands
| | - Renato Cutrera
- Pediatric Pulmonology Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Refika Ersu
- Division of Respiratory Medicine, Department of Pediatrics, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa Canada
| | - Sophie Installe
- Department of Pediatrics, Antwerp University Hospital, Edegem, Belgium
| | - Sonia Khirani
- AP-HP, Hôpital Necker, Pediatric noninvasive ventilation and sleep unit, Paris, France.,Université de Paris, EA 7330 VIFASOM, Paris, France.,ASV Santé, Gennevilliers, France
| | - Uros Krivec
- Department of Paediatric Pulmonology, University Children's Hospital Ljubljana, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Omendra Narayan
- Sleep and Long Term Ventilation unit, Royal Manchester Children's Hospital and University of Manchester, Manchester, UK
| | - Joanna MacLean
- Division of Respiratory Medicine, Department of Pediatrics, University of Alberta, Edmonton Canada
| | - Valeria Perez De Sa
- Department of Pediatric Anesthesia and Intensive Care, Children's Heart Center, Skåne University Hospital, Lund, Sweden
| | - Marti Pons-Odena
- Pediatric Home Ventilation Programme, University Hospital Sant Joan de Déu, Barcelona, Spain.,Respiratory and Immune dysfunction research group, Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain
| | - Florian Stehling
- Pediatric Pulmonology and Sleep Medicine, Cystic Fibrosis Center, Childreńs Hospital, University of Duisburg-Essen, Essen, Germany
| | - Rosario Trindade Ferreira
- Pediatric Respiratory Unit, Department of Paediatrics, Hospital de Santa Maria, Academic Medical Centre of Lisbon, Portugal
| | - Stijn Verhulst
- Department of Pediatrics, Antwerp University Hospital, Edegem, Belgium.,Laboratory of Experimental Medicine and Pediatrics, University of Antwerp, Antwerp, Belgium
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7
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Walsh A, Furlong M, Mc Nally P, O'Reilly R, Javadpour S, Cox DW. Pediatric invasive long-term ventilation-A 10-year review. Pediatr Pulmonol 2021; 56:3410-3416. [PMID: 34357690 DOI: 10.1002/ppul.25618] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 07/20/2021] [Accepted: 08/04/2021] [Indexed: 11/06/2022]
Abstract
INTRODUCTION The number of children with complex physical and developmental pathologies, including chronic respiratory insufficiency, surviving and growing beyond early childhood continues to rise. No study has examined the clinical pathway of children on invasive long-term mechanical ventilation (LTMV) in an Irish setting. Our data over a 10-year period were reviewed to see if our demographics and outcomes are in line with global trends. METHODS Children's Health Ireland (CHI) at Crumlin, Dublin is Ireland's largest tertiary pediatric hospital. A retrospective review analyzed data from children in our center commenced on LTMV via a tracheostomy over 10 years (2009-2018). This data was subdivided into two epochs for statistical analysis of longitudinal trends. RESULTS Forty-six children were commenced on LTMV from 2009 to 2018. Many had complex medical diagnoses with associated comorbidities. Far less children, 30.4% (n = 14) commenced LTMV in the latter half of the 10-year period, they also fared better in all aspects of their treatment course. Focusing solely on children who have needed LTMV over this timeframe we have been able to isolate trends specific to this cohort. Less patients commenced LTMV on a year-on-year basis, and for those that require tracheostomy and LTMV, their journey to decannulation tends to be shorter. CONCLUSION Over the period reviewed, less patients over time necessitated LTMV, and those patients are being weaned and decannulated with ever more success. This has implications in terms of predicting numbers transitioning to adult services and allocation of hospital and community care resources.
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Affiliation(s)
- Aoibhinn Walsh
- Department of Respiratory Medicine, Children's Health Ireland at Crumlin, Dublin, Ireland
| | - Mairead Furlong
- Department of Respiratory Medicine, Children's Health Ireland at Crumlin, Dublin, Ireland
| | - Paul Mc Nally
- Department of Respiratory Medicine, Children's Health Ireland at Crumlin, Dublin, Ireland.,Department of Paediatrics, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Ruth O'Reilly
- Department of Respiratory Medicine, Children's Health Ireland at Crumlin, Dublin, Ireland
| | - Sheila Javadpour
- Department of Respiratory Medicine, Children's Health Ireland at Crumlin, Dublin, Ireland
| | - Desmond W Cox
- Department of Respiratory Medicine, Children's Health Ireland at Crumlin, Dublin, Ireland.,School of Medicine, University College Dublin, Dublin, Ireland
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8
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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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9
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Abstract
Long-term non-invasive ventilation (LTNIV) has been increasingly used in children to manage chronic respiratory failure and airway obstruction. Interfaces are of paramount importance for non-invasive ventilation (NIV) effectiveness and patient compliance. However, historically, the choice of pediatric mask has been limited by the scarce availability of commercial interfaces. In recent years, an increasing number of different masks have been commercialized for children, allowing to increase the number of patients who could benefit from LTNIV. Factors such as the age of the child, disease, craniofacial conformation, type of ventilator and mode of ventilation, and children's and family's preferences should be taken into account when selecting the appropriate mask. Adverse events such as skin lesions, facial growth impairment, and leaks must be prevented and promptly corrected. Humidification is a controversial issue on NIV, but it may be useful in certain circumstances. Regular cleaning and disinfection of interfaces and equipment must be addressed. During follow-up, educational programs, close supervision, and continuous support to children and families are crucial to the success of LTNIV therapy.
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Affiliation(s)
- Rosario Ferreira
- Pediatric Pulmonology Unit, Department of Pediatrics, Santa Maria Hospital, Academic Medical Centre of Lisbon, Lisbon, Portugal
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10
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Khirani S, Amaddeo A, Griffon L, Lanzeray A, Teng T, Fauroux B. Follow-Up and Monitoring of Children Needing Long Term Home Ventilation. Front Pediatr 2020; 8:330. [PMID: 32656168 PMCID: PMC7322995 DOI: 10.3389/fped.2020.00330] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Accepted: 05/20/2020] [Indexed: 12/23/2022] Open
Abstract
Once continuous positive airway pressure (CPAP) or noninvasive ventilation (NIV) is started in a child, and the child is discharged home, follow-up needs to be organized with regular visits in order to check the tolerance and efficacy of the treatment. But there is a lack of validated clinical guidelines, mainly because of the heterogeneity of the ventilator servicing, the costs and health care systems among countries. Therefore, visits timing and strategies to monitor CPAP/NIV are not clearly defined. Moreover, depending on various factors such as the underlying disorder, the medical stability, the age of the child, and socio-economic factors, follow-up usually ranges between 1 month and 3-6 months, or even 1 year following treatment initiation, with an overnight hospital stay, an out-patient visit, a home visit, via telemonitoring or telemedicine, alone or in combination. Apart from clinical evaluation, nocturnal oximetry and capnography monitoring and/or poly(somno)graphy (P(S)G) are usually carried out during the follow-up visits to monitor the delivered pressure, leaks, residual respiratory events and synchrony between the patient and the ventilator. Built-in software data of CPAP/NIV devices can be used to assess the adherence of treatment, to monitor pressure efficiency, leaks, asynchronies, and to estimate the presence of residual respiratory events under CPAP/NIV if P(S)G is not available or in alternance with P(S)G. The possibility of CPAP/NIV weaning should be assessed on a regular basis, but no criteria for the timing and procedures have been validated. Weaning timing depends on the clinical condition that justified CPAP/NIV initiation, spontaneous improvement with growth, and the possibility and efficacy of various upper airway, maxillofacial and/or neurosurgical procedures. Weaning may be allowed in case of the disappearance of nocturnal and daytime symptoms of sleep-disordered breathing (SDB) after several nights without CPAP/NIV and the objective correction of SDB on a P(S)G. But no parameters are defined. In any case, a long term follow-up is necessary to ascertain the weaning success. Large prospective studies, together with international and national guidelines, are required in order to build evidence for standardizing practice for the follow-up and weaning of CPAP/NIV in children.
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Affiliation(s)
- Sonia Khirani
- ASV Santé, Gennevilliers, France.,Pediatric Noninvasive Ventilation and Sleep Unit, AP-HP, Hôpital Necker-Enfants Malades, Paris, France.,Université de Paris, VIFASOM, Paris, France
| | - Alessandro Amaddeo
- Pediatric Noninvasive Ventilation and Sleep Unit, AP-HP, Hôpital Necker-Enfants Malades, Paris, France.,Université de Paris, VIFASOM, Paris, France
| | - Lucie Griffon
- Pediatric Noninvasive Ventilation and Sleep Unit, AP-HP, Hôpital Necker-Enfants Malades, Paris, France.,Université de Paris, VIFASOM, Paris, France
| | - Agathe Lanzeray
- Pediatric Noninvasive Ventilation and Sleep Unit, AP-HP, Hôpital Necker-Enfants Malades, Paris, France
| | - Theo Teng
- Pediatric Noninvasive Ventilation and Sleep Unit, AP-HP, Hôpital Necker-Enfants Malades, Paris, France
| | - Brigitte Fauroux
- Pediatric Noninvasive Ventilation and Sleep Unit, AP-HP, Hôpital Necker-Enfants Malades, Paris, France.,Université de Paris, VIFASOM, Paris, France
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11
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Lee BR, Shin SH, Kim MJ, Kim E, Choi YJ, Park JD, Suh DI. Clinical characteristics of pediatric pneumothorax during a noninvasive positive pressure ventilation. ALLERGY ASTHMA & RESPIRATORY DISEASE 2019. [DOI: 10.4168/aard.2019.7.1.51] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Bo Ra Lee
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul, Korea
| | - So Hyun Shin
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul, Korea
| | - Min Jung Kim
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul, Korea
| | - Eunji Kim
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul, Korea
| | | | - June Dong Park
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul, Korea
| | - Dong In Suh
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul, Korea
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12
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Wolfler A, Raimondi G, Pagan de Paganis C, Zoia E. The infant with severe bronchiolitis: from high flow nasal cannula to continuous positive airway pressure and mechanical ventilation. Minerva Pediatr 2018; 70:612-622. [DOI: 10.23736/s0026-4946.18.05358-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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13
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Abstract
Sleep breathing issues in children have been described for some considerable time and it is well established that children with neurodisability such as cerebral palsy are at increased risk of sleep disturbances [1, 2] when compared to the general population. However, there are concerns that awareness amongst clinicians remains patchy, and that many children with neurodisability have sleep breathing problems that remain undiagnosed and untreated. This case study illustrates that these issues remain challenging, highlighting the multifactorial approach required when dealing with sleep in this patient subgroup. Despite the known correlation between neurodisability and sleep disordered breathing, cases are still missedhttp://ow.ly/2pNS305Kll3
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Affiliation(s)
- Andrew Morley
- Royal Hospital for Children, Sleep Department, Glasgow, UK
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14
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Dryden-Palmer K, Macartney J, Davidson L, Syed F, Daniels C, Alexander S. Special Considerations in the Nursing Care of Mechanically Ventilated Children. Crit Care Nurs Clin North Am 2016; 28:463-475. [PMID: 28236393 DOI: 10.1016/j.cnc.2016.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Mechanical ventilation is often required to support the recovery of critically ill children. Critical care nurses must understand the unique needs of the children and design supportive care that is sensitive to their changing physiology, developmental stage, and socioemotional needs. This article describes the unique considerations in providing care for mechanically ventilated children. It addresses invasive and noninvasive ventilation and the needs of long-term ventilated children and family in critical care. Supportive nursing care that is aligned with the unique needs of the critically ill child is paramount to ensuring best outcomes for these vulnerable patients.
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Affiliation(s)
- Karen Dryden-Palmer
- Paediatric Critical Care Unit, The Hospital for Sick Children, Room 2898, 555 University Avenue, Toronto, Ontario M5G 1X8, Canada.
| | - Jason Macartney
- Respiratory Therapy, Paediatric Critical Care Unit, Paediatric Intensive Care Unit, The Hospital for Sick Children, Room 2849, 555 University Avenue, Toronto, Ontario M5G 1X8, Canada
| | - Leanne Davidson
- Respiratory Therapy, Cardiac Critical Care Unit, The Hospital for Sick Children, Room 2849, 555 University Avenue, Toronto, Ontario M5G 1X8, Canada
| | - Faiza Syed
- Long-term Ventilation Program, Division of Respiratory Medicine, The Hospital for Sick Children, 4th Floor Hill Wing, 555 University Avenue, Toronto, Ontario M5G 1X8, Canada
| | - Cathy Daniels
- Long-term Ventilation Program, Division of Respiratory Medicine, The Hospital for Sick Children, 4th Floor Hill Wing, 555 University Avenue, Toronto, Ontario M5G 1X8, Canada
| | - Shaindy Alexander
- Child Life Department, The Hospital for Sick Children, 555 University Avenue, Toronto, Ontario M5G 1X8, Canada
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15
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Amin R, Al-Saleh S, Narang I. Domiciliary noninvasive positive airway pressure therapy in children. Pediatr Pulmonol 2016; 51:335-48. [PMID: 26663667 DOI: 10.1002/ppul.23353] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Revised: 11/09/2015] [Accepted: 11/21/2015] [Indexed: 12/28/2022]
Abstract
There has been a dramatic increase in the past few decades in the number of children receiving noninvasive positive airway pressure (PAP) therapy at home. Although PAP therapy was first prescribed for children with obstructive sleep apnea, the indications have rapidly widened to include treatment for central hypoventilation syndromes, neuromuscular and chest wall disorders as well as primary respiratory diseases. Given the rapidly expanding use of PAP therapy in children, pediatric pulmonologists need to be familiar with the indications, technical and safety considerations as well as potential complications and challenges that may arise when caring for children using PAP therapy. This review article covers the definition of PAP therapy, modes, interfaces, devices, indications, contraindications, suggested settings, complications as well as the factors influencing the adherence.
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Affiliation(s)
- Reshma Amin
- Division of Respiratory Medicine, The Hospital for Sick Children, Toronto, Canada.,Department of Paediatrics, University of Toronto, Toronto, Canada.,Department of Child Health and Evaluative Sciences, The Hospital for Sick Children, Toronto, Canada
| | - Suhail Al-Saleh
- Division of Respiratory Medicine, The Hospital for Sick Children, Toronto, Canada.,Department of Paediatrics, University of Toronto, Toronto, Canada.,Department of Physiology and Experimental Medicine, The Hospital for Sick Children, Toronto, Canada
| | - Indra Narang
- Division of Respiratory Medicine, The Hospital for Sick Children, Toronto, Canada.,Department of Paediatrics, University of Toronto, Toronto, Canada.,Department of Physiology and Experimental Medicine, The Hospital for Sick Children, Toronto, Canada
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16
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Abstract
OBJECTIVE To assess how clinical practice of noninvasive ventilation has evolved in the Italian PICUs. DESIGN National, multicentre, retrospective, observational cohort. SETTING Thirteen Italian medical/surgical PICUs that participated in the Italian PICU Network. PATIENTS Seven thousand one-hundred eleven admissions of children with 0-16 years old admitted from January 1, 2011, to December 31, 2012. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Cause of respiratory failure, length and mode of noninvasive ventilation, type of interfaces, incidence of treatment failure, and outcome were recorded. Data were compared with an historical cohort of children enrolled along 6 months from November 1, 2006, to April 30, 2007, over the viral respiratory season. Seven thousand one-hundred eleven PICU admissions were analyzed, and an overall noninvasive ventilation use of 8.8% (n = 630) was observed. Among children who were admitted in the PICU without mechanical ventilation (n = 3,819), noninvasive ventilation was used in 585 patients (15.3%) with a significant increment among the three study years (from 11.6% in 2006 to 18.2% in 2012). In the endotracheally intubated group, 17.2% children received noninvasive ventilation at the end of the weaning process to avoid reintubation: 11.9% in 2006, 15.3% in 2011, and 21.6% in 2012. Noninvasive ventilation failure rate raised from 10% in 2006 to 16.1% in 2012. CONCLUSIONS Noninvasive ventilation is increasingly and successfully used as first respiratory approach in several, but not all, Italian PICUs. The current study shows that noninvasive ventilation represents a feasible and safe technique of ventilatory assistance for the treatment of mild acute respiratory failure. Noninvasive ventilation was used as primary mode of ventilation in children with low respiratory tract infection (mainly in bronchiolitis and pneumonia), in acute on chronic respiratory failure or to prevent reintubation.
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17
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Chidini G, Piastra M, Marchesi T, De Luca D, Napolitano L, Salvo I, Wolfler A, Pelosi P, Damasco M, Conti G, Calderini E. Continuous positive airway pressure with helmet versus mask in infants with bronchiolitis: an RCT. Pediatrics 2015; 135:e868-75. [PMID: 25780074 DOI: 10.1542/peds.2014-1142] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/23/2014] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Noninvasive continuous positive airway pressure (CPAP) is usually applied with a nasal or facial mask to treat mild acute respiratory failure (ARF) in infants. A pediatric helmet has now been introduced in clinical practice to deliver CPAP. This study compared treatment failure rates during CPAP delivered by helmet or facial mask in infants with respiratory syncytial virus-induced ARF. METHODS In this multicenter randomized controlled trial, 30 infants with respiratory syncytial virus-induced ARF were randomized to receive CPAP by helmet (n = 17) or facial mask (n = 13). The primary endpoint was treatment failure rate (defined as due to intolerance or need for intubation). Secondary outcomes were CPAP application time, number of patients requiring sedation, and complications with each interface. RESULTS Compared with the facial mask, CPAP by helmet had a lower treatment failure rate due to intolerance (3/17 [17%] vs 7/13 [54%], P = .009), and fewer infants required sedation (6/17 [35%] vs 13/13 [100%], P = .023); the intubation rates were similar. In successfully treated patients, CPAP resulted in better gas exchange and breathing pattern with both interfaces. No major complications due to the interfaces occurred, but CPAP by mask had higher rates of cutaneous sores and leaks. CONCLUSIONS These findings confirm that CPAP delivered by helmet is better tolerated than CPAP delivered by facial mask and requires less sedation. In addition, it is safe to use and free from adverse events, even in a prolonged clinical setting.
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Affiliation(s)
- Giovanna Chidini
- Pediatric ICU, Department of Anesthesia and Critical Care, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy;
| | - Marco Piastra
- Pediatric ICU, Department of Anaesthesiology and Intensive Care, University Hospital "A. Gemelli," Catholic University of the Sacred Heart, Rome, Italy
| | | | - Daniele De Luca
- Pediatric ICU, Department of Anaesthesiology and Intensive Care, University Hospital "A. Gemelli," Catholic University of the Sacred Heart, Rome, Italy
| | - Luisa Napolitano
- Pediatric ICU, Department of Anesthesia and Critical Care, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Ida Salvo
- Department of Anesthesia and Intensive Care, Children's Hospital Vittore Buzzi, Istituti Clinici di Perfezionamento, Milan, Italy; and
| | - Andrea Wolfler
- Department of Anesthesia and Intensive Care, Children's Hospital Vittore Buzzi, Istituti Clinici di Perfezionamento, Milan, Italy; and
| | - Paolo Pelosi
- Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, IRCCS AOU San Martino - IST, Genoa, Italy
| | | | - Giorgio Conti
- Pediatric ICU, Department of Anaesthesiology and Intensive Care, University Hospital "A. Gemelli," Catholic University of the Sacred Heart, Rome, Italy
| | - Edoardo Calderini
- Pediatric ICU, Department of Anesthesia and Critical Care, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
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18
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Cancelinha C, Madureira N, Mação P, Pleno P, Silva T, Estêvão MH, Félix M. Long-term ventilation in children: ten years later. REVISTA PORTUGUESA DE PNEUMOLOGIA 2015; 21:16-21. [PMID: 25854131 DOI: 10.1016/j.rppnen.2014.03.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2014] [Accepted: 03/28/2014] [Indexed: 10/24/2022] Open
Abstract
INTRODUCTION Home mechanical ventilation (HMV) represents a treatment option for patients with chronic respiratory failure and has changed prognosis and survival of many disorders in children. The aim of this study was to characterize a group of children on long-term mechanical ventilation (LTMV) for a period longer than 10 years. METHODS A retrospective analysis was carried out including patients on LTMV for more than 10 years (LTMV-10) in a tertiary pediatric hospital. STATISTICAL ANALYSIS PASW Statistics 18(®). RESULTS Thirty-one children (61% female) belong to the LTMV-10 group. Median age at the beginning of ventilatory support was 3 years (birth to 13 years). Main indications for assisted ventilation were neuromuscular disease (n=12, 39%), metabolic disease (n=7, 23%) and central hypoventilation (n=6, 19%). Volume ventilation was used in 2 children, and positive pressure ventilation in the others, mainly bilevel positive airway pressure (n=25, 81%). Invasive ventilation via tracheostomy was used since the beginning in four cases, and subsequently in two other children. The mean time of ventilatory support was 146 months and the maximum was 219 months. Respiratory morbidity was the most frequent cause of hospitalization and the annual rate of such episodes was 0.17 per child. Global mortality rate was 19%. CONCLUSIONS HMV programs provide necessary and safe assistance for children with severe chronic respiratory failure. As shown in our series, it is possible to be kept on this respiratory support modality for long periods with good compliance and a small number of hospitalizations.
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Affiliation(s)
- C Cancelinha
- Pediatric Pulmonology Unit, Pediatric Hospital, Coimbra University and Hospital Centre, Coimbra, Portugal.
| | - N Madureira
- Pediatric Pulmonology Unit, Pediatric Hospital, Coimbra University and Hospital Centre, Coimbra, Portugal; Sleep and Ventilation Laboratory, Pediatric Hospital, Coimbra University and Hospital Centre, Coimbra, Portugal
| | - P Mação
- Pediatric Pulmonology Unit, Pediatric Hospital, Coimbra University and Hospital Centre, Coimbra, Portugal
| | - P Pleno
- Pediatric Pulmonology Unit, Pediatric Hospital, Coimbra University and Hospital Centre, Coimbra, Portugal
| | - T Silva
- Pediatric Pulmonology Unit, Pediatric Hospital, Coimbra University and Hospital Centre, Coimbra, Portugal
| | - M H Estêvão
- Pediatric Pulmonology Unit, Pediatric Hospital, Coimbra University and Hospital Centre, Coimbra, Portugal; Sleep and Ventilation Laboratory, Pediatric Hospital, Coimbra University and Hospital Centre, Coimbra, Portugal
| | - M Félix
- Pediatric Pulmonology Unit, Pediatric Hospital, Coimbra University and Hospital Centre, Coimbra, Portugal
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19
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Deshpande SR, Maher KO. Long term negative pressure ventilation: Rescue for the failing fontan? World J Cardiol 2014; 6:861-864. [PMID: 25228965 PMCID: PMC4163715 DOI: 10.4330/wjc.v6.i8.861] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2014] [Revised: 05/20/2014] [Accepted: 06/18/2014] [Indexed: 02/06/2023] Open
Abstract
Current treatment strategies for single ventricle patients include non-intervention strategy, surgical palliation or primary transplantation. Surgical palliation includes a staged operative course culminating in the Fontan operation. With progress in surgical techniques, the survival has been improving. However, almost all of these Fontan patients will demonstrate pathophysiologic changes that ultimately constitute “Fontan failure physiology”. This article reviews the pathophysiologic changes, current approach to management of these patients and proposes a novel way of reversing some of the pathophysiologic changes by utilization of negative pressure ventilation.
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20
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Amin R, Sayal P, Syed F, Chaves A, Moraes TJ, MacLusky I. Pediatric long-term home mechanical ventilation: twenty years of follow-up from one Canadian center. Pediatr Pulmonol 2014; 49:816-24. [PMID: 24000198 DOI: 10.1002/ppul.22868] [Citation(s) in RCA: 99] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2013] [Accepted: 06/29/2013] [Indexed: 11/10/2022]
Abstract
BACKGROUND Canadian longitudinal data from a pediatric domiciliary long-term mechanical ventilation (LTMV) program is lacking. OBJECTIVE Our aim was to report on the clinical characteristics and trends of children followed in one of Canada's pediatric home ventilation programs over the past 20 years. METHODS A retrospective chart review was conducted on patients receiving long-term domociliary mechanical ventilation between January 1, 1991 and December 31, 2011 in a single center. Domiciliary long-term mechanical ventilation was defined as the daily use of invasive mechanical ventilation (IMV) or noninvasive positive pressure ventilation (NiPPV) for at least 3 months, in the users' home or in a long-term residential facility. RESULTS Between 1991 and 2011, a total of 379 children were identified (313 [83%] with noninvasive ventilation). The median age at initiation was 9.6 years (interquartile range [IQR] 2.9-13.9), the median duration of ventilation was 2.2 years (IQR 0.8-4.9) and 53% were male. Ninety-nine percent of children were cared for at home. The reason for ventilation was "musculoskeletal" in origin for the majority of children. The number of children receiving long-term mechanical ventilation at home increased from 2 in 1991 to 156 children as of December 2011. There was a twofold increase in the number of invasive ventilation initiations in the second 10 years, n = 45 (2001-2011) as compared to the first 10 years, n = 21 (1991-2000). However, there was more than a fivefold increase in the number of noninvasive initiations in the first 10 years, n = 50 (1991-2000) as compared to the second 10 years, n = 263 (2001-2011). The largest growth was in the 13-18 years age group. There were 55 (15%) mortalities over the study period. CONCLUSIONS In summary, our 20-year retrospective study has shown that there has been an exponential growth in the number of children receiving domiciliary LTMV with the majority of children having favorable outcomes. Our study represents a step towards developing a Canadian registry to design and implement programmatic change for this medically complex population to ensure best practice for these children as well as their families.
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Affiliation(s)
- Reshma Amin
- Division of Respiratory Medicine, Department of Paediatrics, The Hospital for Sick Children, Toronto, Canada; University of Toronto, Toronto, Canada
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21
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Cancelinha C, Madureira N, Mação P, Pleno P, Silva T, Estêvão MH, Félix M. WITHDRAWN: Long-term ventilation in children: Ten years later. REVISTA PORTUGUESA DE PNEUMOLOGIA 2014:S0873-2159(14)00070-1. [PMID: 24932698 DOI: 10.1016/j.rppneu.2014.03.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2014] [Revised: 03/14/2014] [Accepted: 03/28/2014] [Indexed: 12/01/2022] Open
Abstract
This article has been withdrawn for editorial reasons because the journal will be published only in English. In order to avoid duplicated records, this article can be found at http://dx.doi.org/10.1016/j.rppnen.2014.03.017. The Publisher apologizes for any inconvenience this may cause. The full Elsevier Policy on Article Withdrawal can be found at http://www.elsevier.com/locate/withdrawalpolicy.
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Affiliation(s)
- Cândida Cancelinha
- Pediatric Pulmonology Unit, Pediatric Hospital, Coimbra University and Hospital Centre, Coimbra, Portugal.
| | - Núria Madureira
- Pediatric Pulmonology Unit, Pediatric Hospital, Coimbra University and Hospital Centre, Coimbra, Portugal; Sleep and Ventilation Laboratory, Pediatric Hospital, Coimbra University and Hospital Centre, Coimbra, Portugal
| | - Patrícia Mação
- Pediatric Pulmonology Unit, Pediatric Hospital, Coimbra University and Hospital Centre, Coimbra, Portugal
| | - Paula Pleno
- Pediatric Pulmonology Unit, Pediatric Hospital, Coimbra University and Hospital Centre, Coimbra, Portugal
| | - Teresa Silva
- Pediatric Pulmonology Unit, Pediatric Hospital, Coimbra University and Hospital Centre, Coimbra, Portugal
| | - M Helena Estêvão
- Pediatric Pulmonology Unit, Pediatric Hospital, Coimbra University and Hospital Centre, Coimbra, Portugal; Sleep and Ventilation Laboratory, Pediatric Hospital, Coimbra University and Hospital Centre, Coimbra, Portugal
| | - Miguel Félix
- Pediatric Pulmonology Unit, Pediatric Hospital, Coimbra University and Hospital Centre, Coimbra, Portugal
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Abstract
Non-invasive positive pressure ventilation is increasingly used in children both in acute and in chronic setting. Clinical data supporting safety, efficacy and limitations in children are growing. Technical problems related to the ventilators performance and interfaces selection have not been fully resolved, especially for younger children. Non-invasive ventilation can be applied at home. Its use at home requires appropriate diagnostic procedures, accurate titration of the ventilators, cooperative and educated families and careful, well-organized follow-up programs.
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Noninvasive Respiratory Support in Pediatrics. ANESTHESIA, INTENSIVE CARE AND PAIN IN NEONATES AND CHILDREN 2013. [PMCID: PMC7121359 DOI: 10.1007/978-88-470-2685-8_4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The conventional management of acute respiratory failure (ARF) consists of endotracheal intubation; this carries potential risks, including ventilator-associated pneumonia and laryngeal-tracheal damage [1,2]. Noninvasive respiratory support (NRS) is an alternative form of respiratory treatment which incorporates various techniques aimed at improving alveolar ventilation, oxygenation, and unloading of the respiratory muscles without the need for an invasive tracheal device. Because of its safety and effectiveness, the use of NRS has been adopted throughout the world. During the last 25 years, NRS techniques have increasingly been used in the treatment of both chronic respiratory failure and ARF in adult patients in several pathological conditions. NRS applied to adults in the acute setting has been found to improve outcome, reduce the rate of intubation, and decrease the rate of complications [3].
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Murase K, Chihara Y, Takahashi K, Okamoto S, Segawa H, Fukuda K, Tanaka K, Uemoto S, Mishima M, Chin K. Use of noninvasive ventilation for pediatric patients after liver transplantation: decrease in the need for reintubation. Liver Transpl 2012; 18:1217-25. [PMID: 22692821 DOI: 10.1002/lt.23491] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Noninvasive ventilation (NIV) refers to ventilation delivered through a noninvasive interface (a nasal or face mask) rather than an invasive interface (an endotracheal tube or tracheostomy). The role of NIV in preventing reintubation after abdominal surgery in pediatric patients is uncertain. Therefore, we evaluated the role of NIV for this purpose in pediatric patients after liver transplantation. We successfully started using NIV for respiratory complications (RCs) in pediatric patients undergoing liver transplantation in 1999. For this report, we screened all medical records of patients under the age of 12 years who underwent liver transplantation between 2001 and 2009, and we retrieved data for cases at high risk of extubation failure. We retrospectively compared the clinical outcomes of patients who received NIV during their intensive care unit (ICU) stay and patients who did not. Data for 94 cases (92 patients) were included in this analysis. NIV was used in 47 patients during their ICU stay. The rate of reintubation for RCs was significantly lower in NIV patients versus non-NIV patients [3/47 (6.4%) versus 11/47 (23.4%), P = 0.02]. Furthermore, the discharge rate from the ICU was significantly better for NIV patients versus non-NIV patients. The use of NIV after extubation prevented the worsening of atelectasis and stabilized respiratory conditions in this cohort. No major changes in operative procedures or other treatments during the examined period were found. In conclusion, NIV is acceptable and promising for the respiratory management of pediatric patients undergoing liver transplantation. Its use may stabilize respiratory conditions and decrease the need for reintubation in pediatric liver transplant patients, and it may also facilitate an early ICU discharge.
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Affiliation(s)
- Kimihiko Murase
- Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, Sakyo, Kyoto, Japan
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25
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Lu FL. Extending the respiratory care of children into long-term support. Pediatr Neonatol 2012; 53:273-4. [PMID: 23084716 DOI: 10.1016/j.pedneo.2012.08.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2012] [Accepted: 08/17/2012] [Indexed: 11/26/2022] Open
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Daily JC, Wang HE. Noninvasive positive pressure ventilation: resource document for the National Association of EMS Physicians position statement. PREHOSP EMERG CARE 2011; 15:432-8. [PMID: 21612390 DOI: 10.3109/10903127.2011.569851] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The National Association of EMS Physicians (NAEMSP) believes that noninvasive positive pressure ventilation (NIPPV) is an important treatment modality for the prehospital management of acute dyspnea. This document serves as a resource to the NAEMSP position on prehospital NIPPV.
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Affiliation(s)
- Josiah C Daily
- Department of Emergency Medicine, Cullman Regional Medical Center, Cullman, Alabama, USA
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Negative pressure ventilation as a therapy for post-operative complications in a patient with single ventricle physiology. Heart Lung Circ 2011; 20:763-5. [PMID: 21493139 DOI: 10.1016/j.hlc.2011.03.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2010] [Accepted: 03/10/2011] [Indexed: 01/01/2023]
Abstract
OBJECTIVE To report the use of negative pressure ventilation as a therapeutic rescue in a patient with post-operative complications of Kawashima procedure. DESIGN Case report. SETTING Paediatric cardiac critical care unit in a tertiary care teaching hospital. PATIENT Nine month-old patient with single ventricle physiology developed complications after Kawashima procedure that were worsened by use of positive pressure ventilation. INTERVENTION Utilisation of negative pressure ventilation due to its unique cardiopulmonary interactions and haemodynamic effects. MEASUREMENTS AND MAIN RESULTS There was gradual and persistent improvement in the passive diastolic pulmonary blood flow through the Kawashima circuit along with improvement in oxygenation and ventilation. The patient was successfully weaned off ventilator support and discharged to home. CONCLUSION Patients with single ventricle physiology depend on passive diastolic blood flow to the lungs through surgical pathways such as Fontan or Kawashima circuits. Prolonged use of positive pressure ventilation can significantly affect this forward flow and result in haemodynamic compromise. Use of negative pressure ventilation with its unique cardiopulmonary interactions can be an effective rescue as demonstrated in our case.
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Robert D, Argaud L. Noninvasive positive ventilation in the treatment of sleep-related breathing disorders. HANDBOOK OF CLINICAL NEUROLOGY 2010; 98:459-69. [PMID: 21056205 DOI: 10.1016/b978-0-444-52006-7.00030-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Dominique Robert
- Emergency and Intensive Care Department, Edoward Herriot Hopsital, Lyon, France.
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Ruza F. Noninvasive ventilation in pediatric acute respiratory failure: a challenge in pediatric intensive care units. Pediatr Crit Care Med 2010; 11:750-1. [PMID: 21057264 DOI: 10.1097/pcc.0b013e3181d9c6e9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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30
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Noninvasive Positive Pressure Ventilation in the Treatment of Hypoventilation in Children. Sleep Med Clin 2010. [DOI: 10.1016/j.jsmc.2010.05.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Chidini G, Calderini E, Cesana BM, Gandini C, Prandi E, Pelosi P. Noninvasive continuous positive airway pressure in acute respiratory failure: helmet versus facial mask. Pediatrics 2010; 126:e330-6. [PMID: 20660548 DOI: 10.1542/peds.2009-3357] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Noninvasive continuous positive airway pressure (nCPAP) is applied through different interfaces to treat mild acute respiratory failure (ARF) in infants. Recently a new pediatric helmet was introduced in clinical practice to deliver nCPAP. The objective of this study was to compare the feasibility of the delivery of nCPAP by the pediatric helmet with delivery by a conventional facial mask in infants with ARF. PATIENTS AND METHODS We conducted a single-center physiologic, randomized, controlled study with a crossover design on 20 consecutive infants with ARF. All patients received nCPAP by helmet and facial mask in random order for 90 minutes. In infants in both trials, nCPAP treatment was preceded by periods of unassisted spontaneous breathing through a Venturi mask. The primary end point was the feasibility of nCPAP administered with the 2 interfaces (helmet and facial mask). Feasibility was evaluated by the number of trial failures defined as the occurrence of 1 of the following: intolerance to the interface; persistent air leak; gas-exchange derangement; or major adverse events. nCPAP application time, number of patients who required sedation, and the type of complications with each interface were also recorded. The secondary end point was gas-exchange improvement. RESULTS Feasibility of nCPAP delivery was enhanced by the helmet compared with the mask, as indicated by a lower number of trial failures (P < .001), less patient intolerance (P < .001), longer application time (P < .001), and reduced need for patient sedation (P < .001). For both delivery methods, no major patient complications occurred. CONCLUSIONS The results of this current study revealed that the helmet is a feasible alternative to the facial mask for delivery of nCPAP to infants with mild ARF.
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Affiliation(s)
- Giovanna Chidini
- Pediatric Intensive Care Unit, Department of Anesthesia and Critical Care, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy.
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Treatment of acute hypoxemic respiratory failure with continuous positive airway pressure delivered by a new pediatric helmet in comparison with a standard full face mask: a prospective pilot study. Pediatr Crit Care Med 2010; 11:502-8. [PMID: 19794328 DOI: 10.1097/pcc.0b013e3181b8063b] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To evaluate the feasibility and efficacy of continuous positive airway pressure delivered by a new pediatric helmet in comparison with a standard facial mask in infants with acute hypoxemic respiratory failure. DESIGN A single-center prospective case-control study. SETTING Pediatric intensive care unit in a tertiary children hospital. PATIENTS AND INTERVENTIONS Twenty consecutive infants treated with continuous positive airway pressure by a helmet matched with a control patient treated with continuous positive airway pressure by facial mask and selected by age, weight, PaO2:Fio2, and PaCO2 on pediatric intensive care unit admission. MEASUREMENTS AND MAIN RESULTS Feasibility was defined as the incidence of continuous positive airway pressure protocol failure secondary to 1) failure to administer continuous positive airway pressure because of intolerance to the interface; 2) deterioration in gas exchange soon after continuous positive airway pressure institution; and 3) major clinical adverse events such as pneumothorax or any hemodynamic instability related to the continuous positive airway pressure safety system device's failure. Evaluation of feasibility included also the total application time of respiratory treatment, the number of continuous positive airway pressure discontinuations/first 24 hrs. Interface-related complications included air leaks, cutaneous pressure sores, eye irritation, inhalation, and gastric distension. The 20 patients and control subjects had similar matching characteristics. Continuous positive airway pressure delivered by a helmet compared with a facial mask reduced continuous positive airway pressure trial failure rate (p = .02), increased application time (p = .001) with less discontinuations (p = .001), and was not associated with an increased rate of major adverse events, resulting in decreased air leaks (p = .04) and pressure sores (p = .002). Both continuous positive airway pressure systems resulted in early and sustained improvement in oxygenation. CONCLUSIONS The helmet might be considered a viable and safe alternative to a standard facial mask to deliver continuous positive airway pressure in hypoxemic infants in the pediatric intensive care unit setting. In our study, the helmet allowed more prolonged application of continuous positive airway pressure compared with a facial mask, ensuring similar improvement in oxygenation without any adverse events and clinical intolerance.
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Abstract
Avian influenza is a disease characterized with severe pneumonia caused by virus influenza A. Birds and poultry are vectors for spread of this disease. It is diagnosed by clinical evidence and reverse transcription-polymerase chain reaction. Here, we discuss the treatment procedures of a child diagnosed as avian influenza.
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Affiliation(s)
- Nazim Dogan
- Department of Anaesthesia and Reanimation, Medical School of Atatürk University, Erzurum, Turkey.
| | - Behzat Özkan
- Department of Pediatrics, The School of Medicine, Atatürk University, Erzurum, Turkey
| | - İbrahim Boga
- Department of Anaesthesia and Reanimation, Medical School of Atatürk University, Erzurum, Turkey
| | - Mehmet Kizilkaya
- Department of Anaesthesia and Reanimation, Medical School of Atatürk University, Erzurum, Turkey
| | - Hakan Altindağ
- Department of Pediatrics, The School of Medicine, Atatürk University, Erzurum, Turkey
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Non-invasive ventilation in children with upper airway obstruction. Int J Pediatr Otorhinolaryngol 2009; 73:551-4. [PMID: 19144413 DOI: 10.1016/j.ijporl.2008.12.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2008] [Revised: 12/02/2008] [Accepted: 12/04/2008] [Indexed: 11/20/2022]
Abstract
OBJECTIVE The aim of this paper is to highlight our experience with the use of non-invasive positive pressure ventilation (NIPPV) in children, neonates and pre-term infants with upper airway obstruction. METHODS This was a retrospective review of our recent experience in using NIPPV for the management of upper airway obstruction in paediatric patients. RESULTS NIPPV was successful in preventing tracheostomy in patients with significant laryngo-tracheomalacia as well as being used to optimise the timing of surgery in subglottic stenosis. Furthermore, it proved beneficial in stabilising the airway after aryepiglottoplasty and also had a role in the management of obstructive sleep apnoea. CONCLUSION The use of NIPPV in children with upper airway obstruction can be a safe and effective alternative to invasive mechanical ventilation. NIPPV can potentially be beneficial in avoiding prolonged invasive ventilation, avoiding tracheostomy, stabilizing the airway after extubation or decannulation, and management of obstructive sleep apnoea.
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Abstract
The outlook for children with respiratory complications of neuromuscular disease has improved significantly in the past 15 years. This has been the result of many advances in clinical care, including improved monitoring of lung function and hypoventilation during sleep; coordinated respiratory care by experienced physicians with access to specialized respiratory services, especially physiotherapy; and, most importantly, the widespread introduction of noninvasive ventilation.
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Affiliation(s)
- J Declan Kennedy
- Discipline of Paediatrics, Faculty of Health Sciences, Medical School, University of Adelaide, South Australia 5005, Australia.
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36
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Markström A, Sundell K, Stenberg N, Katz-Salamon M. Long-term non-invasive positive airway pressure ventilation in infants. Acta Paediatr 2008; 97:1658-62. [PMID: 18754825 DOI: 10.1111/j.1651-2227.2008.00990.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIM To evaluate the clinical application of long-term non-invasive ventilation (NIV) in infants with life-threatening ventilatory failure with regard to: diagnosis, age at initiation, indication for and duration of treatment, clinical outcome and mortality and adverse effects. PATIENTS AND METHODS The medical records of 18 infants treated in a home setting during a 7-year period were reviewed. The criteria for ventilatory support were: (a) transcutaneous partial pressures of carbon dioxide (TcPCO(2)) >6.5 kPa and oxygen (TcPO(2)) < 8.5 kPa and (b) decreased cough ability and/or recurrent chest infections. RESULTS The median age at initiation was 4 months (range 1-12). NIV was initiated because of hypoventilation in 12 infants and because of reduced cough ability and/or recurrent infections in six infants. Tracheotomy was eventually needed in two infants. The median duration of treatment was 24 months (range 1-84). NIV produced significant improvements, with median TcPCO(2) falling from 9.9 to 6.1 kPa, and median TcPO(2) rising from 9.8 to 11.1 kPa. CONCLUSION NIV can be successfully and safely used in infants with prolonged life-threatening ventilatory failure, potentially avoiding intubation and tracheotomy.
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Affiliation(s)
- Agneta Markström
- Karolinska Institutet, Department of Clinical Sciences, Danderyd Hospital, National Respiratory Centre, Div of Anaesthesiology and Intensive Care, Stockholm, Sweden.
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Noizet-Yverneau O, Leclerc F, Santerne B, Akhavi A, Pomédio M, Saad S, Dessioux E, Morville P. [Interfaces for pediatric noninvasive ventilation (excluding neonate)]. Arch Pediatr 2008; 15:1549-59. [PMID: 18829274 DOI: 10.1016/j.arcped.2008.07.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2007] [Revised: 03/18/2008] [Accepted: 07/25/2008] [Indexed: 11/17/2022]
Abstract
The quality of noninvasive ventilation in pediatrics is interface-dependent. Several types of interfaces are currently available: nasal and oral masks, nasal pillows and helmets. Despite material improvements in material design, shape, size and components, interfaces are still not adapted for most children. The ideal interface must fit the child's characteristics and the disease requirements. For instance, a nasal canula is recommended for infants younger than 3 months of age. If necessary, nasal masks can be used as oronasal masks. Repeated and careful evaluations are indicated to ensure interface adequacy and to detect cutaneous injuries and facial deformities. Training is required for medical and paramedical personnel. Pediatrics studies, comparing interfaces, are needed to build evidence-based recommendations.
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Affiliation(s)
- O Noizet-Yverneau
- Service de réanimation pédiatrique et néonatale, CHU de Reims, Alix-de-Champagne, rue Cognacq-Jay, 51100 Reims, France.
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Kissoon N, Rimensberger PC, Bohn D. Ventilation strategies and adjunctive therapy in severe lung disease. Pediatr Clin North Am 2008; 55:709-33, xii. [PMID: 18501762 DOI: 10.1016/j.pcl.2008.02.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Respiratory failure caused by severe lung disease is a common reason for admission to the pediatric and neonatal intensive care units. Efforts to decrease morbidity and mortality have fueled investigations into innovative methods of ventilation, kinder gentler ventilation techniques, pharmacotherapeutic adjuncts, and extracorporeal life support modalities. This article discusses the rationale for and experience with some of these techniques.
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Affiliation(s)
- Niranjan Kissoon
- Department of Pediatrics, University of British Columbia, Children's Hospital, Room K4-105, 4480 Oak Street, Vancouver, BC V6H 3V4, Canada.
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39
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Non-invasive Respiratory Support in Pre-term Neonates and Pediatric Patients with Respiratory Failure. Intensive Care Med 2007. [DOI: 10.1007/0-387-35096-9_37] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Graham RJ, Fleegler EW, Robinson WM. Chronic ventilator need in the community: a 2005 pediatric census of Massachusetts. Pediatrics 2007; 119:e1280-7. [PMID: 17485451 DOI: 10.1542/peds.2006-2471] [Citation(s) in RCA: 92] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES The purpose of this study was to describe the population of children with chronic mechanical ventilation in Massachusetts and their patterns of medical care. PATIENTS AND METHODS Investigators surveyed all of the Massachusetts home ventilator clinics, pediatric pulmonary services, hospital-based pediatric services for special health care needs, insurers, home care vendors, nursing agencies, the Massachusetts Department of Public Health, selected individual providers, and rehabilitation and long-term care facilities providing services to children with chronic respiratory support needs. Support was defined as daily use of noninvasive, negative-pressure, or invasive/transtracheal ventilators. Subsequent matching of demographic data, including date of birth, zip code, and gender supported maximal census yield without duplications. Geographic information systems were used to create distribution maps and estimate distances between children with chronic mechanical ventilator needs and key resources. RESULTS A total of 197 children were identified as requiring chronic mechanical respiratory support in Massachusetts in 2005, which was a nearly threefold increase in this population in the 15-year interval since the last census. Congenital or perinatal-acquired neurologic or neuromuscular disorders constituted the majority of primary diagnoses (n = 107 [54%]). Chronic lung disease attributed to prematurity represented only 7% of the sample. CONCLUSIONS Children receiving chronic mechanical respiratory support are a growing population. The shift in underlying diagnoses from pulmonary disease to neurogenic respiratory insufficiency has implications for hospital and community-based providers from all disciplines in extending services to the home setting. Barriers encountered when performing this study, however, reflect an overall lack of coordination among the many individuals and agencies involved in their care. Coordinated and centralized care efforts require a clear and managed flow of information; census reports such as this one are only the beginning. Direct needs assessments and quality-of-life surveys from families are needed to design and implement programmatic changes and advocacy efforts.
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Affiliation(s)
- Robert J Graham
- Division of Critical Care, Department of Anesthesiology, Perioperative, and Pain Medicine, Children's Hospital Boston, 300 Longwood Ave, Boston, MA 02115-5724, USA.
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Robert D, Argaud L. Non-invasive positive ventilation in the treatment of sleep-related breathing disorders. Sleep Med 2007; 8:441-52. [PMID: 17470410 DOI: 10.1016/j.sleep.2007.03.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2007] [Accepted: 03/12/2007] [Indexed: 12/13/2022]
Abstract
This chapter addresses the use of long-term non-invasive positive pressure ventilation (NIPPV) (to the exclusion of continuous positive airway pressure) in the different clinical settings in which it is currently proposed: principally in diseases responsible for hypoventilation characterized by elevated PaCO(2). Nasal masks are predominantly used, followed by nasal pillow and facial masks. Mouthpieces are essentially indicated in case daytime ventilation is needed. Many clinicians currently prefer pressure-preset ventilator in assist mode as the first choice for the majority of the patients with the view of offering better synchronization. Nevertheless, assist-control mode with volume-preset ventilator is also efficient. The settings of the ventilator must insure adequate ventilation assessed by continuous nocturnal records of at least oxygen saturation of haemoglobin-measured by pulse oximetry. The main categories of relevant diseases include different types of neuromuscular disorders, chest-wall deformities and even lung diseases. Depending on the underlying diseases and on individual cases, two schematic situations may be individualized. Either intermittent positive pressure ventilation (IPPV) is continuously mandatory to avoid death in the case of complete or quasi-complete paralysis or is used every day for several hours, typically during sleep, producing enough improvement to allow free time during the daylight in spontaneous breathing while hypoventilation and related symptoms are improved. In case of complete or quasi-complete need of mechanical assistance, a tracheostomy may become an alternative to non-invasive access. In neuromuscular diseases, in kyphosis and in sequela of tuberculosis patients, NIPPV always significantly increases survival. Conversely, no data support a positive effect on survival in chronic obstructive pulmonary disease.
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Affiliation(s)
- Dominique Robert
- University Claude Bernard, Lyon-Nord Medical School, 8, avenue Rockefeller, 69008 Lyon, France.
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Aaseboe K, Berstad AKH, Skadberg BT. Noninvasive treatment of bronchomalacia, successful ventilation of a severely ill infant. Acta Paediatr 2007; 96:310-2. [PMID: 17429927 DOI: 10.1111/j.1651-2227.2007.00041.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
UNLABELLED Noninvasive treatment of bronchomalacia. Successful ventilation of a severely ill infant. AIM To describe an effective treatment of a boy with bronchomalacia by noninvasive mechanical ventilation support. METHODS We describe a case of a severely ill patient with bronchomalacia from the time he was born and until the age of five. Bi-level positive airway pressure given through a specially adapted full face mask was used to treat his respiratory condition. RESULT Our patient responded well to the noninvasive treatment of bronchomalacia. CONCLUSION We found that noninvasive mechanical ventilation support is a low risk and highly effective treatment of infants and children with respiratory distress caused by bronchomalacia.
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Affiliation(s)
- K Aaseboe
- Paediatric Department, Haukeland University Hospital, Bergen, Norway.
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Piastra M, Antonelli M, Caresta E, Chiaretti A, Polidori G, Conti G. Noninvasive ventilation in childhood acute neuromuscular respiratory failure: a pilot study. Respiration 2006; 73:791-8. [PMID: 16424640 DOI: 10.1159/000090777] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2004] [Accepted: 08/22/2005] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Over a 36-month study period, 10 nonconsecutive neuromuscular pediatric patients (6 infants, mean age 10.16 months, and 4 children, mean age 9.3 years) presenting with acute respiratory failure (ARF) were treated by noninvasive positive pressure ventilation (NPPV). All patients required immediate respiratory support and fulfilled our intubation criteria. OBJECTIVE The aim of the study was to verify if early NPPV was able to avoid endotracheal intubation and to improve both oxygenation and ventilation within 24 h from admission in this clinical setting. PATIENTS AND METHODS A prospective pilot study was carried out on neuromuscular patients admitted to the pediatric intensive care unit (PICU) of the Catholic University of Rome because of ARF and managed exclusively with NPPV for at least 24 h following admission. All patients were treated using a flow-triggered mechanical ventilator through a face mask or using the new helmet interface. RESULTS Eight patients were successfully ventilated during the observation period and 2 early failures occurred. Among children undergoing face mask NPPV, the PaO(2)/FiO(2) ratio increased from a median value of 75 (range 48-149) to 240 (range 133-385; p < 0.001) and 328 (range 180-371; p < 0.001) at selected time points (3 and 12 h after NPPV introduction, respectively); the alveolar-to-arterial oxygenation difference showed a similar trend, i.e. decreasing from a median value of 589 (range 213-659) to 128 (range 62-527; p < 0.01) and 69 (range 45-207; p < 0.001), respectively. Hypercarbic ARF resolved within 6 h from admission even in the most severe cases. CONCLUSIONS NPPV was a safe and effective first-line therapeutic approach in hypoxemic ARF children/infants with neuromuscular disease. It seems of importance to identify children with neuromuscular disorders who may be able to achieve residual ventilator-free breathing and to perform an NPPV trial avoiding tracheal intubation. Life-threatening respiratory distress and very young age should not preclude NPPV application in the PICU setting. The new helmet interface represents a promising tool for noninvasive ventilation in older children.
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Affiliation(s)
- M Piastra
- Pediatric Intensive Care Unit, Catholic University Medical School, Rome, Italy.
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Abstract
OBJECTIVES To examine the trend over time, describe the disease categories treated, intervention success and outcomes of the children treated at home with continuous positive airway pressure (CPAP), non-invasive ventilation (NIV) and ventilation via tracheostomy (invasive ventilatory support, IVS) by the Respiratory Service at the Starship Children's Hospital in Auckland. METHODS A retrospective review was undertaken of the Respiratory Service records from November 1991 to February 2004. RESULTS Home CPAP, NIV or IVS was initiated in 160 children (89 boys, median age 6 years) in the study period. Sixty-nine (46 boys) remain on support and are still actively managed by the Starship Respiratory Service, of whom 46% live outside the Greater Auckland Region. Despite 42% of children being less than 5 years of age at initiation of therapy, institution of support failed in only 11%. The majority received treatment by non-invasive mask interface (68% (n = 108) CPAP, 29% (n = 47) NIV), with only 3% (n = 5) supported via tracheostomy. The numbers and complexity of support rose over the 12 years. Respiratory support was discontinued in 57% of cases, after a median of 12.5 months (range 3-52 months); in two-thirds, support was no longer required due to an improvement in the medical condition. The most common indication for support in current patients is respiratory parenchymal or airway disease followed by neuromuscular disease. Obesity is not a common indication. CONCLUSION This review documents the increasing trend in children receiving respiratory support at home. Future planning and resources are needed to address this growing need.
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Affiliation(s)
- E A Edwards
- Department of Respiratory Medicine, Starship Children's Hospital, Auckland, New Zealand
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Suresh S, Wales P, Dakin C, Harris MA, Cooper DGM. Sleep-related breathing disorder in Duchenne muscular dystrophy: disease spectrum in the paediatric population. J Paediatr Child Health 2005; 41:500-3. [PMID: 16150067 DOI: 10.1111/j.1440-1754.2005.00691.x] [Citation(s) in RCA: 106] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
UNLABELLED Duchenne muscular dystrophy (DMD) is a progressive neuromuscular disease with death usually occurring because of respiratory failure. Signs of early respiratory insufficiency are usually first detectable in sleep. OBJECTIVE To study the presentation of sleep-related breathing disorder (SRBD) in patients with DMD. METHOD A retrospective review of patients with DMD attending a tertiary paediatric sleep disorder clinic over a 5-year period. Symptoms, lung function and polysomnographic indices were reviewed. RESULTS A total of 34 patients with DMD were referred for respiratory assessment (1-15 years). Twenty-two (64%) reported sleep-related symptomatology. Forced vital capacity (FVC) was between 12 and 107% predicted (n = 29). Thirty-two progressed to have polysomnography of which 15 were normal studies (median age: 10 years) and 10 (31%) were diagnostic of obstructive sleep apnoea (OSA) (median age: 8 years). A total of 11 patients (32%) showed hypoventilation (median age: 13 years) during the 5-year period and non-invasive ventilation (NIV) was offered to them. The median FVC of this group was 27% predicted. There was a significant improvement in the apnoea/hypopnoea index (AHI) (mean difference = 11.31, 95% CI = 5.91-16.70, P = 0.001) following the institution of NIV. CONCLUSIONS The prevalence of SRBD in DMD is significant. There is a bimodal presentation of SRBD, with OSA found in the first decade and hypoventilation more commonly seen at the beginning of the second decade. Polysomnography is recommended in children with symptoms of OSA, or at the stage of becoming wheelchair-bound. In patients with the early stages of respiratory failure, assessment with polysomnography-identified sleep hypoventilation and assisted in initiating NIV.
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Affiliation(s)
- Sadasivam Suresh
- Department of Respiratory/Sleep Medicine, Mater Children's Hospital, South Brisbane, Queensland, Australia
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Chin K, Uemoto S, Takahashi KI, Egawa H, Kasahara M, Fujimoto Y, Sumi K, Mishima M, Sullivan CE, Tanaka K. Noninvasive ventilation for pediatric patients including those under 1-year-old undergoing liver transplantation. Liver Transpl 2005; 11:188-95. [PMID: 15666379 DOI: 10.1002/lt.20297] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Pulmonary complications are an important cause of the mortality associated with liver transplantation. The efficacy of noninvasive ventilation (NIV) in pediatric patients following transplantation is unknown. The purpose of this retrospective study is to investigate the effects of NIV for pediatric patients undergoing liver transplantation. Of 102 pediatric patients who underwent liver transplantation, 15 patients (aged 73 months; range 2.5-179) were supported by NIV because of atelectasis, hypercapnia, hypoxemia, pneumonia, massive effusion, or postextubation ventilatory support. Of 15 patients, 5 were under the age of 1 year (range 2.5-12 months). Of the 15 patients, 7 had required multiple intubations before NIV treatment because of pulmonary complications. NIV treatment was administered to 6 patients because of hypercapnia. Partial pressure of arterial carbon dioxide (PaCO(2)) levels improved from 56.9 (95% confidence interval [CI]: 48.4-65.4) to 41.5 (95% CI: 36.8-46.2) mmHg (P = .028) within 2 days. NIV treatment was very effective for patients with atelectasis with and without other pulmonary complications. Mean inspiratory positive pressure (IPAP) was 7.2 (95% CI: 6.0-8.3) cm H(2)O and expiratory positive pressure (EPAP) was 3.5 (95% CI: 3.2-3.9) cm of H(2)O. Mean duration of NIV was 18.5 (95% CI: 8.6-28.4) days. IPAP and EPAP levels were closely and significantly correlated with height (IPAP: r = .65, P = .016; EPAP: r = .77, P = .004). A total of 13 patients recovered and 2 patients died. However, no patient died of respiratory complications. In conclusion, NIV is effective in pediatric patients undergoing liver transplantation with subsequent pulmonary complications. The IPAP and EPAP levels may be predicted by the height of the patient.
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Affiliation(s)
- Kazuo Chin
- Department of Physical Therapeutics, Kyoto University Hospital, Kyoto 606-8507, Japan.
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Graham RJ, Dumas HM, O'Brien JE, Burns JP. Congenital neurodevelopmental diagnoses and an intensive care unit: defining a population. Pediatr Crit Care Med 2004; 5:321-8. [PMID: 15215000 DOI: 10.1097/01.pcc.0000128892.38431.2b] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To identify and describe the population of children with congenital or perinatally acquired neurodevelopmental diagnoses in a pediatric intensive care unit and to assess the nature and extent of their utilization of critical care resources. DESIGN Twelve-month, inception cohort study. SETTING Intensive care unit at an urban, tertiary care pediatric hospital. PATIENTS AND METHODS All pediatric intensive care unit admissions were screened for preexisting neurodevelopmental diagnoses. Computerized and chart-based medical records were reviewed for demographic, clinical, and outcome data. RESULTS A total of 309 children with congenital neurodevelopmental diagnoses accounted for 427 pediatric intensive care unit admissions. This represented 23% of the total 1,820 admissions in 1 yr. Trisomy 21 was the most identifiable developmental abnormality (n = 25, 8%). Eighty-five percent of the children were cared for at home before hospitalization. A total of 220 of the admissions (52%) demonstrated a preexisting technology dependence. Fewer children admitted from the home-care setting had tracheostomies or were ventilator dependent. The majority of admissions were scheduled surgical admissions (45%) or for management of acute respiratory illness (26%). Of the patients with preexisting tracheostomy, nonrespiratory conditions accounted for 70% of acute admitting diagnoses. Two hundred twenty-three of the admissions (52%) required noninvasive or transtracheal ventilatory support, yet the length of stay and mortality rate were consistent with those reported in other general pediatric intensive care unit populations. The average and median length of stay were 5.4 and 2.0 days, respectively. Mortality rate was 3%. Technology support needs at discharge increased significantly from admission for enterostomy support (p =.008) and mechanical ventilation (p =.008). CONCLUSIONS Children with congenital or perinatally acquired neurodevelopmental diagnoses represented nearly one quarter of all pediatric intensive care unit admissions at a tertiary academic center. This population has substantial ongoing medical needs, requiring utilization of intensive care resources. More rigorous investigations are needed to determine the effect of this burgeoning population in pediatric critical care, to optimize their care, and to meet the comprehensive needs of their families.
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Affiliation(s)
- Robert J Graham
- Division of Critical Care, Department of Anesthesia, Children's Hospital Boston, Boston, MA, USA
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