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- 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. |
- 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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| 4. |
- 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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| 8. |
- Vanhorebeek, I, et al.
(författare)
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The authors reply
- 2014
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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. ; 15:8, s. 793-794
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)
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