BackgroundOptimal sedation and analgesia is a challenge in paediatric intensive care units (PICU) because of difficulties in scoring systems and specific metabolism inducing tolerance and withdrawal. Excessive sedation is associated with prolonged mechanical ventilation and hospitalisation. Adult and paediatric data suggest that goal-directed sedation algorithms reduce the duration of mechanical ventilation. We implemented a nurse-driven sedation protocol in a PICU and evaluated its impact.MethodsWe conducted a before and after protocol implementation study in a population of children aged 0–18 years who required mechanical ventilation for at least 24 h between January 2013 and March 2015. After the protocol implementation in January 2014, nurses managed analgesia and sedation following an algorithm that included the COMFORT behaviour scale (COMFORT-B). Duration of mechanical ventilation was the primary outcome; secondary outcomes were total doses and duration of medications, PICU length of stay, incidence of ventilator-associated pneumonia, and occurrence of withdrawal symptoms. Pre–post analysis followed with segmented regression analysis of interrupted time series was used to assess the effect of protocol.ResultsA total of 200 children were analysed, including 107 before implementation and 93 children after implementation of the protocol. After implementation of the protocol, the total number of COMFORT-B scores per day of mechanical ventilation significantly increased from 3.9 ± 2.5 times during the pre-implementation period to 6.6 ± 3.5 times during the post-implementation period (p < 10−3). Mean duration of mechanical ventilation tended to be lower in the post-implementation period (8.3 ± 7.3 vs 6.6 ± 5.6 days, p = 0.094), but changes in either the trend per trimester from pre-implementation to post-implementation (p = 0.933) or the immediate change after implementation (p = 0.923) were not significant with segmented regression analysis. No significant change between pre- and post-implementation was shown for total dose of sedatives, withdrawal symptoms, agitation episodes, or unplanned endotracheal extubations.ConclusionsThese results were promising and suggested that implementation of a nurse-driven sedation protocol in a PICU was feasible. Evaluation of sedation and analgesia was better after the protocol implementation; duration of mechanical ventilation and occurrence of withdrawal symptoms tended to be reduced.Electronic supplementary materialThe online version of this article (doi:10.1186/s13613-017-0256-7) contains supplementary material, which is available to authorized users.
ObjectiveAlveolar capillary dysplasia (ACD) is one of the causes of pulmonary hypertension. Its diagnosis is histological but new pathogenetic data have emerged. The aim of this study was to describe a French cohort of patients with ACD to improve the comprehension and the diagnosis of this pathology which is probably underdiagnosed.MethodsA retrospective observational study was conducted in French hospitals. Patients born between 2005 and 2017, whose biological samples were sent to the French genetic reference centres, were included. Clinical, histological and genetic data were retrospectively collected.ResultsWe presented a series of 21 patients. The mean of postmenstrual age at birth was 37.6 weeks. The first symptoms appeared on the median of 2.5 hours. Pulmonary hypertension was diagnosed in 20 patients out of 21. Two cases had prolonged survival (3.3 and 14 months). Histological analysis was done on lung tissue from autopsy (57.1% of cases) or from percutaneous biopsy (28.6%). FOXF1 was found abnormal in 15 patients (71.4%): 8 deletions and 7 point mutations. Two deletions were found by chromosomal microarray.ConclusionThis study is one of the largest clinically described series in literature. It seems crucial to integrate genetics early into diagnostic support. We propose a diagnostic algorithm for helping medical teams to improve diagnosis of this pathology.
Abstracts ventilation (r:0.3 p<0.01), treatment with fentanyl (r:0.23 p<0.05), remifentanyl (r:0.25 p<0.05), and absolute and proportional gastric residual volume (r:0.24 p<0.05 and r:0.3 p<0.01, respectively). A negative association with daily enteral feeding volume (r:-0.37 p<0.01) was observed. Treatment with epinephrine or norepinephrine was also associated with a delay in the first defecation (5.6 vs 2.8 days p<0.01). Conclusions Mean time to first defecation in critically ill children is 4 days. Constipation in critically ill children seems to be associated with severity of illness. Enteral nutrition could help bowel motility. Background and aims Parenteral support is indicated in short bowl syndrome (SBS) patients with intestinal failure to avoid metabolic imbalance, electrolyte and nutrient deficiencies, and to maintain adequate growth and function. Length, function and adaptation of residual bowel, promoted by e.g. luminal stimulation by nutrients determine the subsequent form of therapy. Colostrum contains putative stimulatory factors why, we hypothesise that supplementation could promote adaptation in children with SBS. Intestinal absorption of energy and wet weight was used to assess efficacy of colostrum and to define intestinal failure. Methods and materials Nine children with SBS were included in a double-blinded randomised cross-over trial. Twenty percent of their enteral nutrition was replaced with bovine colostrum and a milk-mixture for 4 weeks, separated by a 4 week wash-out period. Between baseline and end of study, children were clinical and biological assessed 4 times. Results Four HPN-patients had mean energy absorption of basal metabolic rate (BMR) of 81% and wet weight absorption of basal fluid need (BFN) of 6% at baseline compared to 5 non-HPN-patients with mean energy absorption of BMR of 196% and wet weight absorption of BFN at 76%, p=0.02, p=0.05. Colostrum did not improved energy or wet weight absorption compared to milk-mix, p=0.85, p=0.59. Urea increased during colostrum supplementation, p=0.04. Conclusion The degree of intestinal function and a distinction between intestinal insufficiency and failure can successfully be assessed by energy and wet weight balance studies. Bovine colostrum did not promote intestinal adaptation. A RANDOMIZED PLACEBO CONTROLLED TRIAL OF BOVINE COLOSTRUM FED TO CHILDREN WITH SHORT BOWEL SYNDROME EVALUATED BY METABOLIC BALANCE STUDIES
Background Neurally adjusted ventilatory assist (NAVA) is a ventilatory mode that delivers synchronized ventilation, proportional to the electrical activity of the diaphragm (EAdi). Although it has been proposed in infants with a congenital diaphragmatic hernia (CDH), the diaphragmatic defect and the surgical repair could alter the physiology of the diaphragm. Aim To evaluate, in a pilot study, the relationship between the respiratory drive (EAdi) and the respiratory effort in neonates with CDH during the postsurgical period under either NAVA ventilation or conventional ventilation (CV). Methods This prospective physiological study included eight neonates admitted to a neonatal intensive care unit with a diagnosis of CDH. EAdi, esophageal, gastric, and transdiaphragmatic pressure, as well as clinical parameters, were recorded during NAVA and CV (synchronized intermittent mandatory pressure ventilation) in the postsurgical period. Results EAdi was detectable and there was a correlation between the ΔEAdi (maximal − minimal values) and the transdiaphragmatic pressure (r = 0.26, 95% confidence interval [CI] [0.222; 0.299]). There was no significant difference in terms of clinical or physiological parameters during NAVA compared to CV, including work of breathing. Conclusion Respiratory drive and effort were correlated in infants with CDH and therefore NAVA is a suitable proportional mode in this population. EAdi can also be used to monitor the diaphragm for individualized 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.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.