The percentage success observed was similar to that published. In this sample, the failure of HFNC was only associated with an initial pCO2 ≥ 55mmHg. On there being no complications reported as regards it use, it is considered safe, although a randomised, controlled, multicentre study is required to compare and contrast these results.
Pediatric Intensive Care Units (PICUs) provide multidisciplinary care to critically ill children and their families. Grief is present throughout the trajectory of illness and can peak around the time of death or non-death losses. The objective of this study was to assess how PICUs around the world implement grief and bereavement care (GBC) as part of an integrated model of care. This is a multicenter cross-sectional, prospective survey study. Questionnaires with multiple-choice and open-ended questions focusing on unit infrastructure, personnel, policies, limited patient data, and practices related to GBC for families and health care professionals (HCPs) were completed by on-site researchers, who were HCPs on the direct care of patients. PICU fulfillment of GBC goals was evaluated using a custom scoring based on indicators developed by the Initiative for Pediatric Palliative Care (IPPC). We compared average total and individual items fulfillment scores according to the respective country's World Bank income. Patient characteristics and details of unit infrastructure were also evaluated as potential predictors of total GBC fulfillment scores. Statistical analysis included multilevel generalized linear models (GLM) with a Gaussian distribution adjusted by child age/gender and clustering by center, using high income countries (HICs) as the comparative reference. Additionally, we applied principals of content analysis to analyze and summarize open-ended answers to contextualize qualitative data. The study included 34 PICUs from 18 countries: high-income countries (HICs): 32.4%, upper middle-income countries (UMICs): 44.1%, low middle-income and low-income countries (LMI/LICs): 23.5%. All groups reported some compliance with GBC goals; no group reported perfect fulfillment. We found statistically significant differences in GBC fulfillment scores between HICs and UMICs (specifically, HCP grief support), and between HICs and LMICs (specifically, family grief support and HCP grief support). PICUs world-wide provide some GBC, independent of income, but barriers include lack of financial support, time, and training, overall unit culture, presence of a palliative care consultation service, and varying cultural perceptions of child death. Disparities in GBC for families and HCPs exist and were related to the native countries' income level. Identifying barriers to support families and HCPs, can lead to opportunities of improving GBC in PICUs world-wide.
Background: Non-invasive mechanical ventilation (NIMV) frequently involves the development of pressure ulcer (PU) secondary to face-masks. Its prevention considers the empirical use of protective patches between skin and mask, in order to reduce the pressure exerted by face-masks. Objectives: To evaluate the effect of protective patches on the pressure exerted by face-masks, and its impact on ventilatory parameters. Method: A simulated model of BiPAP using total face mask on a training phantom with a physiological airway model (ALS PRO+) in supine position was used. The pressure on the front, chin and cheek was measured using 3 types of patches commonly used versus a control group, using pressure sensors (Interlinks Electronics(R)). The values obtained with the model of mask-protective patches in the programmed variables (peak inspiratory flow (PIF), expired tidal volume (Vte) and inspiratory positive pressure (IPAP)) were evaluated with a Trilogy 100 ventilator, Respironics(R). The programming and recording of the variables were carried out in 8 opportunities in each group by independent operators. Results: Any decrease in facial pressure with the protective patches used was observed, compared to the control group. Moltopren(R) increased facial pressure at all support points (p < 0.001), increased leakage, decreased PIF, Vte and IPAP (p < 0.001). Hydrocolloid patches increased facial pressure only in the left cheek, increased leakage and decreased PIF. Polyurethane patches did not produce changes in facial pressure or ventilatory variables. Conclusion: The use of Moltopren(R), hydrocolloid and transparent polyurethane protective patches did not contribute to the decrease on facial pressure. A deleterious effect of Moltopren and hydrocolloid patches was observed on the administration of ventilatory variables, concluding that the non-use of the protective patches allowed a better administration of the programmed parameters.
La Cánula Nasal de Alto Flujo (CNAF) es una modalidad de soporte respiratorio no invasivo cada vez más difundida en la población pediátrica por sus beneficiosos efectos sobre la oxigenación, ventilación y confort del paciente. Sus mecanismos de acción han sido ampliamente estudiados, siendo la generación de presión positiva la que aún genera más controversia. Si bien aún existe poca solidez de la evidencia respecto a la eficacia y seguridad de la CNAF en la literatura, su facilidad de instalación, mantención y seguridad aparente ha determinado que en varios centros su uso se considere ya un estándar de cuidado “off- label”, factible de utilizar en unidades de menor complejidad, con la consiguiente descompresión de unidades críticas. Este artículo pretende realizar una puesta al día de la CNAF en cuanto a sus mecanismos de acción, evidencia referente a su utilidad en pediatría, potenciales indicaciones, así como su uso fuera de unidades críticas.
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