Mean% standard bag usage has increased from 14.5% in 2016 to 29.5% in 2020 (figure 2)There is minimal change in wastage (figure 3) but wastage varied widely between different specialities (surgery: 2.2%, oncology and haematology: 3.6% and Paediatric Intensive Care (PICU) 7.3%).
We have a dedicated LISA guideline which provides guidance on surfactant administration to babies on the Neonatal Unit, with surfactant deficiency who are self ventilating on non-invasive ventilation with nCPAP, optiflow or vapotherm.Eligibility criteria are as follow:. Babies 27 weeks and above (singletons) . or 28 weeks and above of multiple births, who do not require invasive ventilation/transfer to tertiary centre, with surfactant deficiency are eligible for LISA. . Babies 27 to 28 weeks gestation in >3o% oxygen and rising at age 2 hours on nCPAP. . Babies 29weeks gestation and above in > 30% oxygen and rising at age 6 hours on . CPAP are likely to benefit from surfactant as they are at risk of CPAP failure. LISA can be considered.
A 4-week-old female patient presented with severe respiratory distress, hypoxia and apnoeic episodes on a background of a few-day history of coryza and cough. There was significantly reduced air entry on the left side and a displacement of the apex beat to the right of the chest. The examination findings with oxygen desaturations and a right-sided mediastinal shift on chest X-ray led to a diagnosis of tension pneumothorax following which a needle thoracentesis was undertaken. This appeared to worsen the patient’s clinical condition; hence, a chest drain was inserted with unsatisfactory clinical improvement. In view of the presentation and lack of clinical improvement after chest drain insertion, the case was transferred to the paediatric respiratory team in a tertiary centre where the diagnosis was revised to congenital lobar emphysema based on chest computer tomography findings. She subsequently benefited from a left upper lobectomy and lingulectomy and was discharged home 4 days after surgery.
This keeps young people safe, informs the level of support/supervision they require and is crucial to de-escalate crises. This process starts in PED but practice is widely variable in our single-centre studya level of inconsistency we would not tolerate in the assessment of physical symptoms. We plan to undertake regular multi-disciplinary training led by CAMHS to encourage standardised and robust assessments. We hope to improve the productivity and accuracy of discussions between PED and CAMHS and improve the patient journey for young people. We plan to repeat the vignettes following this intervention.
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