| 1. |
- Karlsson, Lina, et al.
(författare)
-
Neonatal Resuscitation : A Critical Incident Technique Study Exploring Pediatric Registered Nurses' Experiences and Actions
- 2023
-
Ingår i: Advances in Neonatal Care. - : Wolters Kluwer. - 1536-0903 .- 1536-0911. ; 23:3, s. 220-228
-
Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Teamwork during neonatal resuscitation is essential. Situations arise quickly and unexpectedly and are highly stressful, requiring pediatric registered nurses (pRN) to respond effectively and in a structured manner. In Sweden, pRNs work in all pediatric settings including the neonatal intensive care unit. The experience and actions of pRNs are seldom explored, and studies within this area could develop and improve strategies for neonatal resuscitation situations.PURPOSE: To describe pRNs' experiences and actions during neonatal resuscitation.METHODS: A qualitative interview study based on the critical incident technique was performed. Sixteen pRNs from 4 neonatal intensive care units in Sweden were interviewed.RESULTS: Critical situations were divided into 306 experiences and 271 actions. pRNs' experiences were divided into 2 categories: individual- and team-focused experiences. Critical situations were managed by individual- or team-focused actions.Experiences revealed were variation of alarms, psychological impact, parental presence, structured working methods, the team's interactions, professional experience and resource availability, and the impact of the environment. Actions revealed were being prepared, managing the psychological impact, adopting a professional attitude toward parents, working in a structured way, and competence/resource reinforcement.IMPLICATIONS FOR PRACTICE: Developing a structured role distribution within the neonatal resuscitation program and ensuring clear communication in the team during simulation training and in intense situations can increase pRNs' feeling of safety and allow them to further develop their professional role in neonatal resuscitation situations.
|
|
| 2. |
- Lee, Juyoung, et al.
(författare)
-
NIV-NAVA versus NCPAP immediately after birth in premature infants : A randomized controlled trial
- 2022
-
Ingår i: Respiratory Physiology & Neurobiology. - : Elsevier. - 1569-9048 .- 1878-1519. ; 302
-
Tidskriftsartikel (refereegranskat)abstract
- Objective: To evaluate whether noninvasive-neurally adjusted ventilatory assist (NIV-NAVA) decrease respiratory efforts compared to nasal continuous positive airway pressure (NCPAP) during the first hours of life.Methods: Twenty infants born between 28+0 and 31+6 weeks were randomized to NIV-NAVA or NCPAP. Positive end-expiratory pressure was constantly kept at 6 cmH(2)O for both groups and the NAVA level was 1.0 cmH(2)O/mu V for NIV-NAVA group. The electrical activity of diaphragm (Edi) were recorded for the first two hours.Results: Peak and minimum Edi decreased similarly in both groups (P = 0.98 and P = 0.59, respectively). Leakages were higher in the NIV-NAVA group than in the NCPAP group (P < 0.001). The neural apnea defined as a flat Edi for >= 5 s were less frequent in NIV-NAVA group than in NCPAP group (P = 0.046).Conclusions: Immediately applied NIV-NAVA in premature infants did not reduce breathing effort, measured as peak Edi. However, NIV-NAVA decreased neural apneic episodes compared to NCPAP.
|
|
| 3. |
- McKinney, Robin L., et al.
(författare)
-
Multicenter Experience with Neurally Adjusted Ventilatory Assist in Infants with Severe Bronchopulmonary Dysplasia
- 2021
-
Ingår i: American Journal of Perinatology. - : Georg Thieme Verlag KG. - 0735-1631 .- 1098-8785. ; 38, s. E162-E166
-
Tidskriftsartikel (refereegranskat)abstract
- Objective The aim of this study is to determine patterns of neurally adjusted ventilatory assist (NAVA) use in ventilator-dependent preterm infants with evolving or established severe bronchopulmonary dysplasia (sBPD) among centers of the BPD Collaborative, including indications for its initiation, discontinuation, and outcomes.Study Design Retrospective review of infants with developing or established sBPD who were placed on NAVA after ≥4 weeks of mechanical ventilation and were ≥ 30 weeks of postmenstrual age (PMA).Results Among the 13 sites of the BPD collaborative, only four centers (31%) used NAVA in the management of infants with evolving or established BPD. A total of 112 patients met inclusion criteria from these four centers. PMA, weight at the start of NAVA and median number of days on NAVA, were different among the four centers. The impact of NAVA therapy was assessed as being successful in 67% of infants, as defined by the ability to achieve respiratory stability at a lower level of ventilator support, including extubation to noninvasive positive pressure ventilation or support with a home ventilator. In total 87% (range: 78–100%) of patients survived until discharge.Conclusion We conclude that NAVA can be used safely and effectively in selective infants with sBPD. Indications and current strategies for the application of NAVA in infants with evolving or established BPD, however, are highly variable between centers. Although this pilot study suggests that NAVA may be successfully used for the management of infants with BPD, sufficient experience and well-designed clinical studies are needed to establish standards of care for defining the role of NAVA in the care of infants with sBPD.
|
|
| 4. |
- McKinney, R. L., et al.
(författare)
-
Novel forms of ventilation in neonates : Neurally adjusted ventilatory assist and proportional assist ventilation
- 2024
-
Ingår i: Seminars in Perinatology. - : Elsevier. - 0146-0005 .- 1558-075X. ; 48:2
-
Forskningsöversikt (refereegranskat)abstract
- Patient-triggered modes of ventilation are currently the standard of practice in the care of term and preterm infants. Maintaining spontaneous breathing during mechanical ventilation promotes earlier weaning and possibly reduces ventilator-induced diaphragmatic dysfunction. A further development of assisted ventilation provides support in proportion to the respiratory effort and enables the patient to have full control of their ventilatory cycle. In this paper we will review the literature on two of these modes of ventilation: neurally adjusted ventilatory assist (NAVA) and proportional assist ventilation (PAV), propose future studies and suggest clinical applications of these modes.
|
|
| 5. |
- Munsters, Josanne, 1986-, et al.
(författare)
-
Skin conductance measurements as pain assessment in newborn infants born at 22-27 weeks gestational age at different postnatal age
- 2012
-
Ingår i: Early Human Development. - : Elsevier BV. - 0378-3782 .- 1872-6232. ; 88:1, s. 21-26
-
Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: To assess pain or stress in newborn infants submitted to intensive care is important but difficult, as different observational pain scales are not always reliable in premature infants. As an indicator of pain, skin conductance (SC) measurements have detected increased sweating in newborn infants >28 gestational age (GA) submitted to heel lancing. OBJECTIVE: To measure SC during heel lancing and routine care in newborn infants, born at 22 to 27 GA, with special relation to postnatal age (PNA). METHODS: In six infants <28+0 GA and 4 infants ≥28+0 GA spontaneous SC activity and behavioural state (Neonatal Pain Agitation and Sedation Scale (N-PASS)) was measured before, during and after each intervention. Measurements were repeated in each patient at different PNA. RESULTS: Baseline SC prior to intervention took longer time to stabilise and was higher in <28 than in ≥28+0 PNA. The combination of heel lancing and squeezing gave an increased SC in <28 PNA, whereas heel lancing alone gave the same SC response in ≥28+0 PNA. A possibly continued immature response in SC measurements was not observed. Oral glucose admission prior to heel lancing increased SC. Routine care did not give any changes in SC. Except during orogastric tube placement no signs of discomfort or pain could be detected by the neonatal pain, agitation and sedation scale (N-PASS) in <28 PNA. to the combination of heel lancing and squeezing. A maturational development of the SC was observed in infants born <28 GA. SC seems to be able to differentiate between pain and discomfort.
|
|
| 6. |
- Norman, Mikael, et al.
(författare)
-
Respiratory support of infants born at 22-24 weeks of gestational age
- 2022
-
Ingår i: Seminars in Fetal & Neonatal Medicine. - : Elsevier. - 1744-165X .- 1878-0946. ; 27:2
-
Forskningsöversikt (refereegranskat)abstract
- Lung immaturity and acute respiratory failure are the major problems in the care of extremely preterm infants. Most infants with gestational age (GA) 22-24 weeks will need mechanical ventilation and many will depend on some type of respiratory support, invasive and non-invasive for extended periods. There is ongoing gap in knowledge regarding optimal respiratory support and applying strategies that are effective in more mature populations is not easy or even suitable because lung maturation differs in smaller infants. Better strategies on how to avoid lung damage and to promote growth and development of the immature lung are warranted since increased survival is accompanied by increasing rates of bronchopulmonary dysplasia and concerns over long-standing reductions in lung function.This review focuses on some aspects of respiratory care of infants born at 22-24 weeks of GA.
|
|
| 7. |
|
|
| 8. |
- Sindelar, Richard, Docent, 1964-, et al.
(författare)
-
Proportional assist and neurally adjusted ventilation : Clinical knowledge and future trials in newborn infants
- 2021
-
Ingår i: Pediatric Pulmonology. - : John Wiley & Sons. - 8755-6863 .- 1099-0496. ; 56:7, s. 1841-1849
-
Forskningsöversikt (refereegranskat)abstract
- Different types of patient triggered ventilator modes have become the mainstay of ventilation in term and preterm newborn infants. Maintaining spontaneous breathing has allowed for earlier weaning and the additive effects of respiratory efforts combined with pre-set mechanical inflations have reduced mean airway pressures, both of which are important components in trying to avoid lung injury and promote normal lung development. New sophisticated modes of assisted ventilation have been developed during the last decades where the control of ventilator support is turned over to the patient. The ventilator detects the respiratory effort and adjusts ventilatory assistance proportionally to each phase of the respiratory cycle, thus enabling the patient to have full control of the start, the duration and the amount of ventilatory assistance. In this paper we will review the literature on the ventilatory modes of proportional assist ventilation and neurally adjusted ventilatory assistance, examine the different ways the signals are analyzed, propose future studies, and suggest ways to apply these modes in the clinical environment.
|
|
| 9. |
- Veneroni, Chiara, et al.
(författare)
-
Oscillatory respiratory mechanics on the first day of life improves prediction of respiratory outcomes in extremely preterm newborns
- 2019
-
Ingår i: Pediatric Research. - : Springer Nature. - 0031-3998 .- 1530-0447. ; 85:3, s. 312-317
-
Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: We aimed to evaluate if lung mechanics measured by forced oscillatory technique (FOT) during the first day of life help identify extremely low gestational age newborns (ELGANs) at risk of prolonged mechanical ventilation (MV) and oxygen dependency.METHODS: Positive end-expiratory pressure (PEEP) was increased 2 cmH2O above the clinically set PEEP, then decreased by four 5-min steps of 1 cmH2O, and restored at the clinical value. At each PEEP, FOT measurements were performed bedside during MV. Changes in respiratory mechanics with PEEP, clinical parameters, and chest radiographs were evaluated.RESULTS: Twenty-two newborns (24+4 ± 1+4 wks gestational age (GA); birth weight 653 ± 166 g) on assist/control ventilation were studied. Infants were ventilated for 40 ± 36 d (range 1–155 d), 11 developed severe bronchopulmonary dysplasia (BPD) and one died before 28 d. Early lung mechanics correlated with days on MV, days of respiratory support, and BPD grade. Effects of increasing PEEP on oscillatory reactance assessed by FOT together with GA and radiographic score predicted days on MV (multilinear model, r2 = 0.73). A logistic model considering the same FOT parameter together with GA predicts BPD development.CONCLUSIONS: FOT can be applied bedside in ELGANs, where early changes in lung mechanics with PEEP improve clinical prediction of respiratory outcomes.
|
|
| 10. |
- Wallström, Linda, 1973-, et al.
(författare)
-
Early volume targeted ventilation in preterm infants born at 22-25 weeks of gestational age
- 2021
-
Ingår i: Pediatric Pulmonology. - : John Wiley & Sons. - 8755-6863 .- 1099-0496. ; 56:5, s. 1000-1007
-
Tidskriftsartikel (refereegranskat)abstract
- BackgroundEarly hypocapnia in preterm infants is associated with intraventricular hemorrhage (IVH) and bronchopulmonary dysplasia (BPD). Volume targeted ventilation (VTV) has been shown to reduce hypocapnia in preterm infants. Less is known of VTV in infants born at <26 weeks gestational age (GA).ObjectivesOur aim was to investigate the short- and long-term effects of early VTV as compared to pressure limited ventilation (PLV) in extremely preterm infants on the incidence of hypocapnia, days on ventilatory support, IVH, and BPD.Study DesignA retrospective observational study of 104 infants born at 22–25 weeks GA (mean ± SD; 24+0 ± 1+1 GA; birth weight 619 ± 146 g), ventilated with either VTV (n = 44) or PLV (n = 60) on their first day of life. Ventilatory data and blood gases were collected at admission and every fourth hour during the first day of life, together with perinatal characteristics and outcomes.ResultsPeak inflation pressure (PIP) was lower in the VTV-group than in the PLV-group during the first 20 h of life (p < .05), without any difference in respiratory rate or FiO2. Incidence of hypocapnia (PaCO2 < 4.5 kPa) was lower with VTV than PLV during the first day of life (32% vs. 62%; p < .01). Infants in the VTV-group were more frequently extubated at 24 h (30% vs. 13%; p < .05). IVH Grade ≥3, BPD, and time on mechanical ventilation did not differ between the groups.ConclusionsVTV is safe to apply in infants born at <26 GA and was observed to result in a lower incidence of hypocapnia compared to infants ventilated by PLV, without any differences in outcomes.
|
|
| 11. |
|
|
| 12. |
- Wallström, Linda, 1973-
(författare)
-
Optimizing mechanical ventilation in extremely preterm infants
- 2021
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Extremely low gestational age newborns (ELGANs) i.e. infants born before 28 weeks of gestational age (GA), require respiratory support during their hospital stay, and a majority needs mechanical ventilation (MV) at some time point. The duration of mechanical ventilation is related to morbidity and mortality, and respiratory support needs to be approached with the aim of minimizing both short and long term effects.In this thesis the overall aim was to explore lung mechanics and the effect of different ventilatory settings and modes during MV in ELGANs.In Paper I and II, bedside forced oscillation technique (FOT) was combined with a positive end-expiratory pressure (PEEP)-titration trial. In Paper I, FOT measurements on day 1 showed dependence of reactance (Xrs) on PEEP. FOT-parameters correlated with days on MV, and together with radiography and GA predicted respiratory outcomes. In Paper II, FOT was studied on day 1, 3 and 7, and Xrs was used to find the optimal lung recruiting PEEP. The optimal PEEP was lower than the clinically set PEEP, and especially during the first day of life. Xrs indicated that the lung was easily over extended with small increases in PEEP.In Paper III, we compared retrospectively early application of volume targeted ventilation (VTV) to pressure limited ventilation (PLV) in infants born at 22+0-25+6 weeks GA. Infants that received VTV had lower peak inflation pressures, less frequent hypocapnia and were earlier extubated to CPAP compared to infants receiving PLV.In Paper IV, we investigated the respiratory activity in animals by measurements of phrenic nerve activity (PNA), and in infants by measuring electrical activity of the diaphragm (EAdi) during the transition from PLV to proportional assist ventilation (PAV), a proportionally adjusted ventilatory mode. PNA and EAdi increased during PAV as compared to PLV with similar tidal volumes, thus promoting increased respiratory activity and weaning. In conclusion, we found that FOT was feasible bedside in ELGANs and FOT-parameters were correlated to PEEP and respiratory outcomes; VTV was safely applied during the first day of life; increased breathing activity during PAV suggests this to be a suitable mode in weaning from MV to non-invasive ventilation, when optimized support is needed during this transition.
|
|
| 13. |
- Wallström, Linda, 1973-, et al.
(författare)
-
Respiratory activity in the transition from assist control to proportional assist ventilation or CPAP in cats and preterm infants.
-
Annan publikation (övrigt vetenskapligt/konstnärligt)abstract
- Background: Phrenic nerve activity (PNA) has been studied in animal models to evaluate respiratory activity during different ventilatory modes and lung conditions. Bedside measurements of esophageal circumferential electrical activity of the diaphragm (EAdi) allows us to interpret the respiratory activity in relation to the applied ventilatory support. During proportional assist ventilation (PAV) the applied airway pressure is proportional to the breathing effort, allowing the patient to control amplitude and timing of tidal breathing.Objective: To study respiratory activity, measured as PNA and EAdi, in the transition from assist control ventilation (A/C) to PAV in a study comparing cats and premature infants. Our hypothesis was that PAV is associated with increased respiratory activity compared to A/C whereby weaning might be promoted.Methods: Intubated study objects (five cats and three infants) were exposed to A/C and PAV (60-70% elastic unloading) with interposed periods of CPAP and fixed end-expiratory pressures (cats: 2 cm H20; infants: 5-6 cm H20). Respiratory activity was assessed by PNA in cats and Edi in infants.Results: Higher PNA amplitudes were observed in cats during PAV than during A/C (0.41±0.13 vs 0.22±0.06AU; p=0.03). Higher maximum EAdi were detected in infants during PAV than during A/C (10.0±2.5µV vs 5.1±1.2 µ V; p<0.01). Similar tidal volumes and respiratory rates were observed with PAV and A/C in both cats and infants, but at markedly lower peak pressures during PAV (4.42±0.62 vs 7.01±0.52 cmH2O, p<0.001; 20.3±1.8 vs 23.4±1.3cm H2O, p<0.01).Conclusion: PAV stimulates higher respiratory activity than A/C in both cats and infants with reciprocally increased PNA and EAdi, suggesting that PAV might be an optimal mode of weaning from A/C to CPAP.
|
|
