To evaluate the ability of radiography to detect malpositioned umbilical venous catheters in the left atrium and to determine the frequency of associated complications, we retrospectively compared radiographs and echocardiograms of 31 infants who had malpositioned catheters in the left atrium by echocardiography (cases) and 31 infants who had properly positioned catheters (controls). The case and control infants were of similar gestational age and birthweight (gestational age, 32 +/- 5 weeks; birthweight, 1672 +/- 899 g for cases; gestational age, 31 +/- 5 weeks; birthweight, 1666 +/- 958 g for controls). Malposition was defined as the catheter tip above the seventh thoracic vertebra by radiography. Radiography had sensitivity of 45%, specificity of 87%, positive predictive value of 77%, negative predictive value of 61%, accuracy of 66%, and prevalence of 50%. Thrombus formation in the heart was detected in 8 of 31 (26%) of cases and in 1 of 31 (3%) of controls (p = 0.03). The incidence of complications, such as necrotizing enterocolitis, culture-positive sepsis, total number of sepsis cases, thrombocytopenia, embolism to extremities, and hematuria were similar in both groups (difference not significant). These results suggest that radiography is unreliable in determining incorrect catheter placement. Catheters malpositioned in the left atrium were associated with thrombus formation. There was no significant increase in systemic complications in the infants with a malpositioned catheter.
OBJECTIVE
To compare work of breathing (WOB) indices between two nCPAP settings and two levels of HFNC in a crossover study.
STUDY DESIGN
Infants with a CGA 28–40 weeks, baseline of HFNC 3–5 lpm or nCPAP 5–6 cmH2O and fraction of inspired oxygen ≤40% were eligible. WOB was analyzed using respiratory inductive plethysmography (RIP) for each of the four modalities: HFNC 3 and 5 lpm, nCPAP 5 and 6 cmH2O. N = 20; Study weight 1516 g (±40 g).
RESULT
Approximately 12 000 breaths were analyzed indicating a high degree of asynchronous breathing and elevated WOB indices at all four levels of support. Phase angle values (means) (P<0.01): HFNC 3 lpm (114.7°), HFNC 5 lpm (96.7°), nCPAP 5 cmH2O (87.2°), nCPAP 6 cmH2O (80.5°). The mean phase relation of total breath (PhRTB) (means) (P<0.01): HFNC 3 lpm (63.2%), HFNC 5 lpm (55.3%), nCPAP 5 cmH2O (49.3%), nCPAP 6 cmH2O (48.0%). The relative labored breathing index (LBI) (means) (P≤0.001): HFNC 3 lpm (1.39), HFNC 5 lpm (1.31), nCPAP 5 cmH2O (1.29), nCPAP 6 cmH2O (1.26). Eighty-two percent of the study subjects—respiratory mode combinations displayed clustering, in which a proportion of breaths either occurred predominantly out-of-phase (relative asynchrony) or in-phase (relative synchrony).
CONCLUSION
In this study, WOB indices were statistically different, yet clinically similar in that they were elevated with respect to normal values. These infants with mild-to-moderate respiratory insufficiency demonstrate a meaningful elevation in WOB indices and continue to require non-invasive respiratory support. Patient variability exists with regard to biphasic clustered breathing patterns and the level of supplemental fraction of inspired oxygen ≤40% alone does not provide guidance to the optimal matching of WOB indices and non-invasive respiratory support.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.