AIM To characterize the clinical course and outcomes of nasal intermittent mandatory ventilation(NIMV) use in acute pediatric respiratory failure.METHODS We identified all patients treated with NIMV in the pediatric i...AIM To characterize the clinical course and outcomes of nasal intermittent mandatory ventilation(NIMV) use in acute pediatric respiratory failure.METHODS We identified all patients treated with NIMV in the pediatric intensive care unit(PICU) or inpatient general pediatrics between January 2013 and December 2015 at two academic centers.Patients who utilized NIMV with other modes of noninvasive ventilation during the same admission were included.Data included demographics,vital signs on admission and prior to initiation of NIMV,pediatric risk of mortality Ⅲ(PRIsM-Ⅲ) scores,complications,respiratory support characteristics,PICU and hospital length of stays,duration of respiratory support,and complications.Patients who did not require escalation to mechanical ventilation were defined as NIMV responders;those who required escalation to mechanical ventilation(MV) were defined as NIMV nonresponders.NIMV responders were compared to NIMV non-responders.RESULTS Forty-two patients met study criteria.six(14%) failed treatment and required MV.The majority of the patients(74%) had a primary diagnosis of bronchiolitis.The median age of these 42 patients was 4 mo(range 0.5-28.1 mo,IQR 7,P = 0.69).No significant difference was measured in other baseline demographics and vitals on initiation of NIMV;these included age,temperature,respiratory rate,O2 saturation,heart rate,systolic blood pressure,diastolic blood pressure,and PRIsM-Ⅲ scores.The duration of NIMV was shorter in the NIMV nonresponder vs NIMV responder group(6.5 h vs 65 h,P < 0.0005).Otherwise,NIMV failure was not associated with significant differences in PICU length of stay(LOs),hospital LOs,or total duration of respiratory support.No patients had aspiration pneumonia,pneumothorax,or skin breakdown.CONCLUSION Most of our patients responded to NIMV.NIMV failure is not associated with differences in hospital LOs,PICU LOs,or duration of respiratory support.展开更多
Acute viral bronchiolitis is a leading cause of admission to pediatric intensive care units, but research on the care of these critically ill infants has been limited. Pathology of viral bronchiolitis revealed respira...Acute viral bronchiolitis is a leading cause of admission to pediatric intensive care units, but research on the care of these critically ill infants has been limited. Pathology of viral bronchiolitis revealed respiratory obstruction due to intraluminal debris and edema of the airways and vasculature. This and clinical evidence suggest that airway clearance interventions such as hypertonic saline nebulizers and pulmonary toilet devices may be of benefit, particularly in situations of atelectasis associated with bronchiolitis. Research to distinguish an underlying asthma predisposition in wheezing infants with viral bronchiolitis may one day lead to guidance on when to trial bronchodilator therapy. Considering the paucity of critical care research in pediatric viral bronchiolitis, intensive care practitioners must substantially rely on individualization of therapies based on bedside clinical assessments. However, with the introduction of new diagnostic and respiratory technologies, our ability to support critically ill infants with acute viral bronchiolitis will continue to advance.展开更多
BACKGROUND Critically ill neonates and pediatric patients commonly require multiple low flow infusions.Volume limitations are imposed by small body habitus and comorbidities like cardiopulmonary disease,renal failure,...BACKGROUND Critically ill neonates and pediatric patients commonly require multiple low flow infusions.Volume limitations are imposed by small body habitus and comorbidities like cardiopulmonary disease,renal failure,or fluid overload.Vascular access is limited by diminutive veins.Maintenance fluids or parenteral nutrition in conjunction with actively titrated infusions such as insulin,fentanyl,prostaglandins,inotropes and vasopressors may necessitate simultaneous infusions using a single lumen to maintain vascular catheter patency.This requirement for multiple titratable infusions requires concentrated medications at low flows,rather than more dilute drugs at higher flows that in combination may volume overload small infants.AIM To determine whether carrier fluid reduces variability that variability of low flow drug infusions is proportional to syringe size in pediatric critical care.METHODS We assessed concentrations of orange“drug”in a 0.2 mL/h low flow clinical model with blue dyed carrier fluid at 5 mL/h,using 3-,10-,or 60-mL syringes.A graduated volumetric pipette was used to measure total flow.Mean time to target concentration was 30,21,and 46 min in 3-,10-,and 60-mL syringes,respectively(P=0.42).After achieving target concentration,more dilute drug was delivered by 60-mL(P<0.001)and 10-mL syringes(P=0.04)compared to 3-mL syringes.Drug overdoses were observed during the initial 45 min of infusion in 10-and 60-mL syringes.Total volumes infused after target concentration were less in the 60-mL condition compared to 3-mL(P<0.01)and 10-mL(P<0.001)syringes.RESULTS Linear mixed effects models demonstrated lesser delivered drug concentrations in the initial 30 min by 3-mL compared to 10-and 60-mL syringes(P=0.005 and P<0.001,respectively)but greater drug concentrations and total infused drug in the subsequent 30-60 and 60-90 min intervals with the 3-and 10-mL compared to 60-mL syringes.CONCLUSION With carrier fluid,larger syringes were associated with significantly less drug delivery,less total volume delivered,and other flow problems in our low flow drug model.Carrier fluid should not be used to compensate for inappropriately large syringes in critical low flow drug infusions.展开更多
基金supported by NIH National Center for Advancing Translational Science,No.UL1TR001881
文摘AIM To characterize the clinical course and outcomes of nasal intermittent mandatory ventilation(NIMV) use in acute pediatric respiratory failure.METHODS We identified all patients treated with NIMV in the pediatric intensive care unit(PICU) or inpatient general pediatrics between January 2013 and December 2015 at two academic centers.Patients who utilized NIMV with other modes of noninvasive ventilation during the same admission were included.Data included demographics,vital signs on admission and prior to initiation of NIMV,pediatric risk of mortality Ⅲ(PRIsM-Ⅲ) scores,complications,respiratory support characteristics,PICU and hospital length of stays,duration of respiratory support,and complications.Patients who did not require escalation to mechanical ventilation were defined as NIMV responders;those who required escalation to mechanical ventilation(MV) were defined as NIMV nonresponders.NIMV responders were compared to NIMV non-responders.RESULTS Forty-two patients met study criteria.six(14%) failed treatment and required MV.The majority of the patients(74%) had a primary diagnosis of bronchiolitis.The median age of these 42 patients was 4 mo(range 0.5-28.1 mo,IQR 7,P = 0.69).No significant difference was measured in other baseline demographics and vitals on initiation of NIMV;these included age,temperature,respiratory rate,O2 saturation,heart rate,systolic blood pressure,diastolic blood pressure,and PRIsM-Ⅲ scores.The duration of NIMV was shorter in the NIMV nonresponder vs NIMV responder group(6.5 h vs 65 h,P < 0.0005).Otherwise,NIMV failure was not associated with significant differences in PICU length of stay(LOs),hospital LOs,or total duration of respiratory support.No patients had aspiration pneumonia,pneumothorax,or skin breakdown.CONCLUSION Most of our patients responded to NIMV.NIMV failure is not associated with differences in hospital LOs,PICU LOs,or duration of respiratory support.
文摘Acute viral bronchiolitis is a leading cause of admission to pediatric intensive care units, but research on the care of these critically ill infants has been limited. Pathology of viral bronchiolitis revealed respiratory obstruction due to intraluminal debris and edema of the airways and vasculature. This and clinical evidence suggest that airway clearance interventions such as hypertonic saline nebulizers and pulmonary toilet devices may be of benefit, particularly in situations of atelectasis associated with bronchiolitis. Research to distinguish an underlying asthma predisposition in wheezing infants with viral bronchiolitis may one day lead to guidance on when to trial bronchodilator therapy. Considering the paucity of critical care research in pediatric viral bronchiolitis, intensive care practitioners must substantially rely on individualization of therapies based on bedside clinical assessments. However, with the introduction of new diagnostic and respiratory technologies, our ability to support critically ill infants with acute viral bronchiolitis will continue to advance.
基金Supported by NIH National Center for Advancing Translational Sciences(NCATS)UCLA CTSI,No.UL1TR001881.
文摘BACKGROUND Critically ill neonates and pediatric patients commonly require multiple low flow infusions.Volume limitations are imposed by small body habitus and comorbidities like cardiopulmonary disease,renal failure,or fluid overload.Vascular access is limited by diminutive veins.Maintenance fluids or parenteral nutrition in conjunction with actively titrated infusions such as insulin,fentanyl,prostaglandins,inotropes and vasopressors may necessitate simultaneous infusions using a single lumen to maintain vascular catheter patency.This requirement for multiple titratable infusions requires concentrated medications at low flows,rather than more dilute drugs at higher flows that in combination may volume overload small infants.AIM To determine whether carrier fluid reduces variability that variability of low flow drug infusions is proportional to syringe size in pediatric critical care.METHODS We assessed concentrations of orange“drug”in a 0.2 mL/h low flow clinical model with blue dyed carrier fluid at 5 mL/h,using 3-,10-,or 60-mL syringes.A graduated volumetric pipette was used to measure total flow.Mean time to target concentration was 30,21,and 46 min in 3-,10-,and 60-mL syringes,respectively(P=0.42).After achieving target concentration,more dilute drug was delivered by 60-mL(P<0.001)and 10-mL syringes(P=0.04)compared to 3-mL syringes.Drug overdoses were observed during the initial 45 min of infusion in 10-and 60-mL syringes.Total volumes infused after target concentration were less in the 60-mL condition compared to 3-mL(P<0.01)and 10-mL(P<0.001)syringes.RESULTS Linear mixed effects models demonstrated lesser delivered drug concentrations in the initial 30 min by 3-mL compared to 10-and 60-mL syringes(P=0.005 and P<0.001,respectively)but greater drug concentrations and total infused drug in the subsequent 30-60 and 60-90 min intervals with the 3-and 10-mL compared to 60-mL syringes.CONCLUSION With carrier fluid,larger syringes were associated with significantly less drug delivery,less total volume delivered,and other flow problems in our low flow drug model.Carrier fluid should not be used to compensate for inappropriately large syringes in critical low flow drug infusions.
