| 1. |
- Drevhammar, Thomas, et al.
(författare)
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Comparison of Nasal Continuous Positive Airway Pressure Delivered by Seven Ventilators Using Simulated Neonatal Breathing
- 2013
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Ingår i: Pediatric Critical Care Medicine. - 1529-7535 .- 1947-3893. ; 14:4, s. E196-E201
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: Nasal continuous positive airway pressure (NCPAP) is an established treatment for respiratory distress in neonates. Most modern ventilators are able to provide NCPAP. There have been no large studies examining the properties of NCPAP delivered by ventilators. The aim of this study was to compare pressure stability and imposed work of breathing (iWOB) for NCPAP delivered by ventilators using simulated neonatal breathing. Design: Experimental in vitro study. Setting: Research laboratory in Sweden. Intervention: None. Measurements and Main Results: Neonatal breathing was simulated using a mechanical lung simulator. Seven ventilators were tested at different CPAP levels using two breath profiles. Pressure stability and iWOB were determined. Results from three ventilators revealed that they provided a slight pressure support. For these ventilators, iWOB could not be calculated. There were large differences in pressure stability and iWOB between the tested ventilators. For simulations using the 3.4-kg breath profile, the pressure swings around the mean pressure were more than five times greater, and iWOB more than four times higher, for the system with the highest measured values compared with the system with the lowest. Overall, the Fabian ventilator was the most pressure stable system. Evita XL and SERVO-i were found more pressure stable than Fabian in some simulations. The results for iWOB were in accordance with pressure stability for systems that allowed determination of this variable. Conclusions: Some of the tested ventilators unexpectedly provided a minor degree of pressure support. In terms of pressure stability, we have not found any advantages of ventilators as a group compared with Bubble CPAP, Neopuff, and variable flow generators that were tested in our previous study. The variation between individual systems is great within both categories. The clinical importance of these findings needs further investigation.
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| 2. |
- Drevhammar, Thomas, et al.
(författare)
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Comparison of seven infant continuous positive airway pressure systems using simulated neonatal breathing
- 2012
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Ingår i: Pediatric Critical Care Medicine. - 1529-7535 .- 1947-3893. ; 13:2, s. E113-E119
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Tidskriftsartikel (refereegranskat)abstract
- Objective: Continuous positive airway pressure is an established treatment for respiratory distress in neonates. Continuous positive airway pressure has been applied to infants using an array of devices. The aim of this experimental study was to investigate the characteristics of seven continuous positive airway pressure systems using simulated breath profiles from newborns. Design: Experimental in vitro study. Setting: Research laboratory in Sweden. Intervention: None. Measurements and Main Results: In vitro simulation of spontaneous neonatal breathing was achieved with a mechanical lung model. Simulation included two breath profiles, three levels of continuous positive airway pressure with and without short binasal prongs and different levels of constant leak. Pressure stability and imposed work of breathing were determined. Seven continuous positive airway pressure systems were tested. There were large differences in pressure stability and imposed work of breathing between tested continuous positive airway pressure systems. Neopuff and Medijet had the highest pressure instability and imposed work of breathing. Benveniste, Hamilton Universal (Arabella), and Bubble continuous positive airway pressure showed intermediate results. AirLife and Infant Flow had the lowest pressure instability and imposed work of breathing. AirLife and Infant Flow showed the least decrease in delivered pressure when challenged with constant leak. Conclusion: The seven tested continuous positive airway pressure systems showed large variations in pressure stability and imposed work of breathing. They also showed large differences in how well they maintain continuous positive airway pressure when exposed to leak. For most systems, imposed work of breathing increased with increasing continuous positive airway pressure level. The clinical importance of the difference in pressure stability is uncertain. Our results may facilitate the design of clinical studies examining the effect of pressure stability on outcome.
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| 3. |
- Gelberg, Jan, et al.
(författare)
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Improving survival and neurologic function for younger age groups after out-of-hospital cardiac arrest in Sweden : a 20-year comparison
- 2015
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Ingår i: Pediatric Critical Care Medicine. - 1529-7535 .- 1947-3893. ; 16:8, s. 750-757
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To describe changes in the epidemiology of out-of-hospital cardiac arrest in Sweden with the emphasis on the younger age groups.Design: Prospective observational study. Setting: Sweden.Patients: Patients were recruited from the Swedish Registry of Cardiopulmonary Resuscitation from 1990 to 2012. Only non-crew-witnessed cases were included.Intervention: Cardiopulmonary resuscitation.Measurement and Main Results: The endpoint was 30-day survival. Cerebral function among survivors was estimated according to the cerebral performance category scores. In all, 50,879 patients in the survey had an out-of-hospital cardiac arrest, of which 1,321 (2.6%) were 21 years old or younger and 1,543 (3.0%) were 22-35 years old. On the basis of results from 2011 and 2012, we estimated that there are 4.9 cases per 100,000 person-years in the age group 0-21 years. The highest survival was found in the 13- to 21-year age group (12.6%). Among patients 21 years old or younger, the following were associated with an increased chance of survival: increasing age, male gender, witnessed out-of-hospital cardiac arrest, ventricular-fibrillation, and a short emergency medical service response time. Among patients 21 years old or younger, there was an increase in survival from 6.2% in 1992-1998 to 14.0% in 2007-2012. Among 30-day survivors, 91% had a cerebral performance category score of 1 or 2 (good cerebral performance or moderate cerebral disability) at hospital discharge.Conclusions: In Sweden, among patients 21 years old or younger, five out-of-hospital cardiac arrests per 100,000 person-years occur and survival in this patient group has more than doubled during the past two decades. The majority of survivors have good or relatively good cerebral function.
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| 4. |
- Hanson, Angela, et al.
(författare)
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Lung aeration during ventilation after recruitment guided by tidal elimination of carbon dioxide and dynamic compliance was better than after end-tidal carbon dioxide targeted ventilation : A computed tomography study in surfactant-depleted piglets
- 2011
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Ingår i: Pediatric Critical Care Medicine. - 1529-7535 .- 1947-3893. ; 12:6, s. E362-E368
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To test the hypothesis that tidal elimination of carbon dioxide and dynamic compliance guided lung recruitment and positive end-expiratory pressure titration in surfactant-depleted piglets result in improved aeration (repeated computed tomography scans) and reduced ventilation pressures compared to those of a control group with conventional end-tidal carbon dioxide targeted ventilation. Design: Prospective animal investigation. Setting: Clinical physiology research laboratory. Subjects: Seventeen saline-lavaged piglets. Interventions: The piglets were initially ventilated at an end-inspiratory pressure of 20 cm H(2)O, a positive end-expiratory pressure of 5 cm H(2)O, and a tidal volume of 10 mL kg(-1) for an end-tidal carbon dioxide target of 30-45 torr followed by 5 mins of ventilation without positive end-expiratory pressure. After this, the control group was ventilated for the same end-tidal carbon dioxide target during the study period. In the recruitment group, the protocol started with an increase of the positive end-expiratory pressure to 15 cm H(2)O. The end-inspiratory pressure was then increased in steps of 3 cm H(2)O to a tidal elimination of carbon dioxide peak/plateau in one recruitment group and further increased in two steps in a second recruitment group. A downward positive end-expiratory pressure titration was followed by continuous dynamic compliance monitoring. The "open lung positive end-expiratory pressure" was set 2 cm H(2)O above the positive end-expiratory pressure at the first dynamic compliance decline and used for a final "open lung ventilation" period. Measurements and Main Results: The recruitment groups showed better aeration, lower ventilatory pressure amplitude, and better dynamic compliance than the control group at the end of the study. Recruitment using airway pressures above the tidal elimination of carbon dioxide peak/plateau did not improve aeration. Using end-tidal carbon dioxide targeted ventilation in the control group restored aeration after the ventilation without positive end-expiratory pressure, but no recruitment or improvement of dynamic compliance was measured. Conclusions: Aeration was significantly better after recruitment and positive end-expiratory pressure titration than in a control group managed by "conventional" end-tidal carbon dioxide targeted ventilation. An increase of the end-inspiratory pressure above the tidal elimination of carbon dioxide peak/plateau did not result in an increased amount of normally aerated lung. A recruitment maneuver resulted in a lower ventilatory amplitude for achieving a target tidal volume and better dynamic compliance at the end of the study period compared to those of the control group.
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| 5. |
- Hanson, Angela, et al.
(författare)
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VTCO2 and dynamic compliance-guided lung recruitment in surfactant-depleted piglets: a computed tomography study.
- 2009
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Ingår i: Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies. - 1529-7535 .- 1947-3893. ; 10:6, s. 687-92
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: Using computed tomography (CT) as reference, our primary objectives were to test if maximal tidal elimination of carbon dioxide (VTCO2) could be used as a marker of "optimal recruitment," indicating maximal available lung tissue for gas exchange and if a decrease in dynamic compliance (Cdyn) indicated the beginning of lung collapse during a downward positive end-expiratory pressure (PEEP) titration. DESIGN: Prospective laboratory animal investigation. SETTING: Clinical physiology research laboratory. SUBJECTS: Six piglets undergoing lung lavage. INTERVENTIONS: Saline-lavaged piglets were initially ventilated without PEEP at a tidal volume (VT) of 10 mL/kg followed by baseline ventilation at end-inspiratory pressure (EIP) 25 cm H2O and PEEP 6 cm H2O. PEEP was increased to 12 or 15 cm H2O. Then EIP was increased in steps of 5 cm H2O and the EIP where VTCO2 peaked or leveled off was assumed to define optimally recruited lungs. A downward PEEP titration followed from 12 or 15 to 4 cm H2O in steps of 1 cm H2O. First decline of Cdyn was assumed to define onset of lung collapse. VTCO2 and Cdyn were continuously recorded and CT scans iterated for each change of ventilation. "Open-lung PEEP" was set 2 cm H2O above PEEP at the first Cdyn decline and was used for a final period of "open-lung ventilation." MEASUREMENTS AND MAIN RESULTS: CT images showed recruited lungs at peak VTCO2 and that a minimal amount of normally aerated lung was added by further increase in EIP. Cdyn declined just before CT scans indicated lung collapse. Compared with baseline, the target VT of 10 mL/kg was achieved at lower EIP and pressure amplitude (EIP-PEEP) during the final open-lung ventilation with more normally aerated and fewer collapsed lungs. Cdyn was doubled after recruitment. CONCLUSIONS: The lung recruitment maneuver was effective and lungs optimally recruited at maximal VTCO2. A fall in Cdyn indicated lung collapse during downward PEEP titration as confirmed by CT.
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| 7. |
- Mattsson, Janet, Docent, Ph.D, 1967-, et al.
(författare)
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Delirium, How Do Nurses Cope In The PICU
- 2022
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Ingår i: Pediatric Critical Care Medicine. - : Lippincott Williams & Wilkins. - 1529-7535 .- 1947-3893. ; 23:Supplement 1 11S
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)
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| 8. |
- Mattsson, Janet, Docent, Ph.D, 1967-
(författare)
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I Am Afraid To Let You Stay
- 2022
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Ingår i: Pediatric Critical Care Medicine. - : Lippincott Williams & Wilkins. - 1529-7535 .- 1947-3893. ; 23:Supplement 1 11S
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)
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| 9. |
- Ranta, Susanna, et al.
(författare)
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Icu admission in children with acute lymphoblastic leukemia in sweden: Prevalence, outcome, and risk factors
- 2021
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Ingår i: Pediatric Critical Care Medicine. - Philadelphia, PA, United States : Lippincott Williams & Wilkins. - 1529-7535 .- 1947-3893. ; 22:12, s. 1050-1060
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Forskningsöversikt (refereegranskat)abstract
- OBJECTIVES: Despite progress in the treatment of childhood acute lymphoblastic leukemia, severe complications are common, and the need of supportive care is high. We explored the cumulative prevalence, clinical risk factors, and outcomes of children with acute lymphoblastic leukemia, on first-line leukemia treatment in the ICUs in Sweden.DESIGN: A nationwide prospective register and retrospective chart review study.SETTING: Children with acute lymphoblastic leukemia were identified,and demographic and clinical data were obtained from the Swedish Childhood Cancer Registry. Data on intensive care were collected from the Swedish Intensive Care Registry. Data on patients with registered ICU admission in the Swedish Childhood Cancer Registry were supplemented through questionnaires to the pediatric oncology centers.PATIENTS: All 637 children 0-17.9 years old with acute lymphoblastic leukemia diagnosed between June 2008 and December 2016 in Sweden were included.INTERVENTIONS: None.MEASUREMENTS AND MAIN RESULTS: Twenty-eight percent of the children (178/637) were admitted to an ICU at least once. The Swedish Intensive Care Registry data were available for 96% of admissions (241/252). An ICU admission was associated with poor overall survival (hazard ratio, 3.25; 95% CI, 1.97-5.36; p ≤ 0.0001). ICU admissions occurred often during early treatment; 48% (85/178) were admitted to the ICU before the end of the first month of acute lymphoblastic leukemia treatment (induction therapy). Children with T-cell acute lymphoblastic leukemia or CNS leukemia had a higher risk of being admitted to the ICU in multivariable analyses, both for early admissions before the end of induction therapy and for all admissions during the study period.CONCLUSIONS: The need for intensive care in children with acute lymphoblastic leukemia, especially for children with T cell acute lymphoblastic leukemia and CNS leukemia, is high with most admissions occurring during early treatment.
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| 10. |
- Reveiz, Ludovic, et al.
(författare)
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Stress ulcer, gastritis, and gastrointestinal bleeding prophylaxis in critically ill pediatric patients : a systematic review
- 2010
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Ingår i: Pediatric Critical Care Medicine. - : Lippincott Williams & Wilkins. - 1529-7535 .- 1947-3893. ; 11:1, s. 124-132
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To identify and evaluate the quality of evidence supporting prophylactic use of treatments for stress ulcers and upper gastrointestinal bleeding. Stress ulcers, erosions of the stomach and duodenum, and upper gastrointestinal bleeding are well-known complications of critical illness in children admitted to the pediatric intensive care unit.DATA SOURCES: Studies were identified from the Cochrane Central Register of Controlled Trials, PUBMED; LILACS; Scirus. We also scanned bibliographies of relevant studies.STUDY SELECTION: This systematic review of randomized controlled trials assessed the effects of drugs for stress-related ulcers, gastritis, and upper gastrointestinal bleeding in critically ill children admitted to the pediatric intensive care unit.DATA EXTRACTION AND SYNTHESIS: Two reviewers independently extracted the relevant data. Most randomized controlled trials were judged as having unclear risk of bias. When pooling two randomized controlled trials, treatment was significantly more effective in preventing upper gastrointestinal bleeding (macroscopic or important bleeding) compared with no treatment (two studies = 300 participants; relative risk, 0.41; 95% confidence interval, 0.19-0.91; I = 12%). Meta-analysis of two studies found no significant difference in death rates among groups (two randomized controlled trials = 132 participants; relative risk, 1.39; 95% confidence interval, 0.70-2.79; I = 4%). The rate of pneumonia was not significantly different when comparing treatment and no treatment in one study. When comparing ranitidine with no treatment, significant differences were found in the proportion of mechanically ventilated children with normal gastric mucosal endoscopic findings by histologic specimens (one randomized controlled trial = 48 participants; relative risk, 3.53; 95% confidence interval, 1.34-9.29). No significant differences were found when comparing different drugs (omeprazole, ranitidine, sucralfate, famotidine, amalgate), doses, or regimens for main outcomes (deaths, endoscopic findings of erosion or ulcers, upper gastrointestinal bleeding, or pneumonia).CONCLUSIONS: Although pooled data of two studies suggested that critically ill pediatric patients may benefit from receiving prophylactic treatment to prevent upper gastrointestinal bleeding, we found that high-quality evidence to guide clinical practice is still limited.
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| 15. |
- Hesselgard, Karin, et al.
(författare)
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Validity and reliability of the Behavioural Observational Pain Scale for postoperative pain measurement in children 1-7 years of age
- 2007
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Ingår i: Pediatric Critical Care Medicine. - 1529-7535. ; 8:2, s. 102-108
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Tidskriftsartikel (refereegranskat)abstract
- Objective: Pain measurement is a necessity in pain treatment but can be difficult in young children. The aim of this study was to evaluate the validity and reliability of the Behavioural Observational Pain Scale (BOPS) as a postoperative pain measurement scale for children aged 1-7 yrs. The scale assesses three elements of pain behaviors: facial expression, verbalization, and body position. Design: A prospective study. Setting. A day surgery care unit for children and a neurosurgical postoperative care unit. Patients: Seventy-six children aged 1-7 yrs (4.5 +/- 1.8) undergoing elective surgical procedures were observed. Interventions. None. Measurements and Main Results. The study was divided into interrater reliability, concurrent validity, and construct validity. The interrater reliabilities of the observers were very good with a high agreement between the different nurses' BOPS scores. Each item of the BOPS scale ranged from kappa(w) 0.86 to 0.95. In the concurrent validity, BOPS and Children's Hospital of Eastern Ontario Pain Scale scores had a positive correlation indicating that both tools described similar behaviors (r(s) =.871, p <.001). In construct validity, the effect of analgesic Was tested before analgesic administration and at 15, 30, and 60 mins after analgesic administration. The differences in BOPS score between the time intervals were significant (p <.01) before administration of analgesia and at 15, 30, and 60 mins. There was also statistical significance in the BOPS score (p <.01) between 15 and 60 mins after administration of analgesia. Conclusions. With BOPS, the caretaker can evaluate and document pain with high reliability and validity and thereby improve postoperative pain treatment in preschool children. The simple scoring system makes BOPS easy to incorporate in a postoperative unit.
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| 22. |
- Thorlacius, Elin M., 1973, et al.
(författare)
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Levosimendan Versus Milrinone and Release of Myocardial Biomarkers after Pediatric Cardiac Surgery: Post Hoc Analysis of Clinical Trial Data
- 2021
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Ingår i: Pediatric Critical Care Medicine. - 1529-7535.
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: We compared the effect of two inodilators, levosimendan and milrinone, on the plasma levels of myocardial injury biomarkers, that is, high-sensitivity troponin T and heart-type fatty acid binding protein, and on N-terminal prohormone of brain natriuretic peptide as a biomarker of ventricular function. We hypothesized that levosimendan could attenuate the degree of myocardial injury when compared with milrinone. DESIGN: A post hoc, nonprespecified exploratory secondary analysis of the Milrinone versus Levosimendan-1 trial (ClinicalTrials.gov Identifier: NCT02232399). SETTING: Two pediatric tertiary university hospitals. PATIENTS: Infants 1-12 months old, diagnosed with ventricular septal defect, complete atrioventricular septal defect, or Tetralogy of Fallot undergoing corrective surgery with cardiopulmonary bypass. INTERVENTIONS: Seventy patients received a loading dose of either levosimendan or milrinone at the start of cardiopulmonary bypass followed by an infusion of the respective drug, which continued for 26 hours. MEASUREMENTS AND MAIN RESULTS: Plasma levels of the three cardiac biomarkers were measured prior to the initiation of cardiopulmonary bypass and 2, 6, and 24 hours after weaning from cardiopulmonary bypass. In both groups, the levels of high-sensitivity troponin T and heart-type fatty acid binding protein were highest at 2 hours post cardiopulmonary bypass, whereas the highest level of N-terminal prohormone of brain natriuretic peptide occurred at 24 hours post cardiopulmonary bypass. There was no significant difference in the biomarkers' plasma levels between the study groups over time. Neither was there a significant difference in the postoperative peak plasma levels of the cardiac biomarkers. CONCLUSIONS: In this post hoc analysis of the MiLe-1 trial, there was no demonstrable difference in the postoperative cardiac biomarker profile of myocardial injury and ventricular function when comparing infants managed in the perioperative period with levosimendan versus milrinone. © 2021 Lippincott Williams and Wilkins. All rights reserved.
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| 23. |
- Thorlacius, Elin M., 1973, et al.
(författare)
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The Effect of Levosimendan Versus Milrinone on the Occurrence Rate of Acute Kidney Injury Following Congenital Heart Surgery in Infants: A Randomized Clinical Trial.
- 2019
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Ingår i: Pediatric critical care medicine. - 1529-7535. ; 20:10, s. 947-956
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Tidskriftsartikel (refereegranskat)abstract
- It has been shown that, in contrast to other inotropic agents, levosimendan improves glomerular filtration rate after adult cardiac surgery. The aim of this study was to investigate the efficacy of levosimendan, compared with milrinone, in preventing acute kidney dysfunction in infants after open-heart surgery with cardiopulmonary bypass.Two-center, double-blinded, prospective, randomized clinical trial.The study was performed in two tertiary pediatric centers, one in Sweden (Gothenburg) and one in Finland (Helsinki).Infants between 1 and 12 months old, diagnosed with Tetralogy of Fallot, complete atrioventricular septal defect or nonrestrictive ventricular septal defect, undergoing total corrective cardiac surgery with cardiopulmonary bypass.Seventy-two infants were randomized to receive a perioperative infusion of levosimendan (0.1 µg/kg/min) or milrinone (0.4 µg/kg/min). The infusion was initiated at the start of cardiopulmonary bypass and continued for 26 hours.The primary outcome variable was the absolute value of serum creatinine data on postoperative day 1. Secondary outcomes included the following: 1) acute kidney injury according to the serum creatinine criteria of the Kidney Diseases: Improving Global Outcomes; 2) acute kidney injury with serum creatinine corrected for fluid balance; 3) plasma neutrophil gelatinase-associated lipocalin; 4) cystatin C; 5) urea; 6) lactate; 7) hemodynamic variables; 8) use of diuretics in the PICU; 9) need of dialysis; 10) length of ventilator therapy; and 11) length of PICU stays. There was no significant difference in postoperative serum creatinine between the treatment groups over time (p = 0.65). The occurrence rate of acute kidney injury within 48 hours was 46.9% in the levosimendan group and 39.5% in the milrinone group (p = 0.70). There were no significant differences in other secondary outcome variables between the groups.Levosimendan compared with milrinone did not reduce the occurrence rate of acute kidney injury in infants after total corrective heart surgery for atrioventricular septal defect, ventricular septal defect, or Tetralogy of Fallot.
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| 24. |
- Tommiska, Viena, et al.
(författare)
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Economic costs of care in extremely low birthweight infants during the first 2 years of life
- 2003
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Ingår i: Pediatric Critical Care Medicine. - 1529-7535. ; 4:2, s. 157-163
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To assess the 2-yr costs of extremely low birthweight infants' (ELBWIs; birthweight, < 1000 g) care in relation to birthweight, outcome, and the costs of normal birthweight infants. DESIGN: Cost data were obtained from care-giving hospitals and by a parental questionnaire. Outcome data from the perinatal and neonatal periods and from the first 2 yrs for both ELBWIs and control infants had been prospectively collected to a national ELBWI register. PATIENTS: We studied 71 ELBWIs and 60 normal birthweight controls born in Helsinki University Hospital in 1996-1997. MEASUREMENTS: Collected data comprised costs resulting from care of ELBWIs and normal birthweight control infants and included hospital, outpatient care, medication, rehabilitation, auxiliary means, and travel costs; ancillary costs from daily care; parent's accommodation during hospitalization periods; and loss of earnings during the infant's first 2 yrs. MAIN RESULTS: The average total 2-yr healthcare cost was 104,635 Euros for surviving ELBWIs and 3,135 Euros for control infants. In ELBWIs, initial hospital costs alone accounted for 64% of total costs; the costs during the first and second postdischarge years accounted for 20% and 13%, respectively. The mean hospital cost of nonsurviving ELBWIs was 19,950 Euros. A normally developed ELBWI had costs 25-fold, a mildly disabled ELBWI had costs 33-fold, and a severely disabled ELBWI had costs 68-fold those of control infants. Birthweight correlated negatively with intensive care costs but did not correlate with costs after initial discharge. CONCLUSION: Total costs of ELBWIs decreased over time up to the age of 2 yrs, but even in normally developed ELBWIs, costs remained higher than those of normal birthweight infants. Low birthweight seemed to be related to increased initial hospital costs but not to annual costs after the first discharge.
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