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Pediatric extubation readiness

Maja Pavcnik, Mojca Groselj Grenc
BACKGROUND: Light sedation is the prerequisite for weaning from mechanical ventilation. Our aim was to evaluate the technical feasibility and efficacy of sevoflurane delivered by anesthetic conserving device (ACD) for sedation of children during weaning from mechanical ventilation. METHODS: Prospective observational feasibility study in paediatric ICU. Patients who were identified as ready for weaning from mechanical ventilation and had Withdrawal-Assessment- Tool version 1 (WAT-1) score of ≥ 8 were switched from intravenous sedatives to sevoflurane sedation by ACD (AnaConDa) placed at the inspiratory limb of the ventilator (INSP group) or at Y-piece (Y group)...
March 12, 2019: Minerva Anestesiologica
Guillaume Mortamet, Nicolas Nardi, Véronique Groleau, Sandrine Essouri, Brigitte Fauroux, Philippe Jouvet, Guillaume Emeriaud
BACKGROUND: The present study aimed to characterize the behavior of 3 components of respiratory muscle function during mechanical ventilation weaning in children to better understand the respective impact of a spontaneous breathing trial on ventilatory mechanical action (esophageal pressure [Pes ], ventilatory demand (electrical activity of the diaphragm [EAdi ]), and oxygen consumption. METHODS: This was a prospective single-center study. All children ≥ 1 months and <18 y old who were intubated and on mechanical ventilation, and who were hospitalized in the pediatric ICU were eligible...
December 11, 2018: Respiratory Care
Samer Abu-Sultaneh, Acrista J Hole, Alvaro J Tori, Brian D Benneyworth, Riad Lutfi, Christopher W Mastropietro
OBJECTIVES: Establishing protocols to wean mechanical ventilation and assess readiness for extubation, with the goal of minimizing morbidity associated with extubation failure and prolonged mechanical ventilation, have become increasingly important in contemporary PICUs. The aim of this quality improvement initiative is to establish a respiratory therapist-led daily spontaneous breathing trial protocol to standardize extubation readiness assessment and documentation in our PICU. DESIGN: A quality improvement project...
October 2017: Pediatric Critical Care Medicine
Michele Luglio, Josiane de Carvalho Simas Maia, Werther Brunow de Carvalho, Flavia Krepel Foronda
No abstract text is available yet for this article.
March 2017: Critical Care Medicine
Edward Vincent S Faustino, Rainer Gedeit, Adam J Schwarz, Lisa A Asaro, David Wypij, Martha A Q Curley
OBJECTIVE: Identifying children ready for extubation is desirable to minimize morbidity and mortality associated with prolonged mechanical ventilation and extubation failure. We determined the accuracy of an extubation readiness test (Randomized Evaluation of Sedation Titration for Respiratory Failure extubation readiness test) in predicting successful extubation in children with acute respiratory failure from lower respiratory tract disease. DESIGN: Secondary analysis of data from the Randomized Evaluation of Sedation Titration for Respiratory Failure clinical trial, a pediatric multicenter cluster randomized trial of sedation...
January 2017: Critical Care Medicine
Robinder G Khemani, Justin Hotz, Rica Morzov, Rutger C Flink, Asvari Kamerkar, Marie LaFortune, Gerrard F Rafferty, Patrick A Ross, Christopher J L Newth
PURPOSE: Pressure support is often used for extubation readiness testing, to overcome perceived imposed work of breathing from endotracheal tubes. We sought to determine whether effort of breathing on continuous positive airway pressure (CPAP) of 5 cmH2O is higher than post-extubation effort, and if this is confounded by endotracheal tube size or post-extubation noninvasive respiratory support. METHODS: Prospective trial in intubated children. Using esophageal manometry we compared effort of breathing with pressure rate product under four conditions: pressure support 10/5 cmH2O, CPAP 5 cmH2O (CPAP), and spontaneous breathing 5 and 60 min post-extubation...
August 2016: Intensive Care Medicine
Stacey Peterson-Carmichael, Paul C Seddon, Ira M Cheifetz, Inéz Frerichs, Graham L Hall, Jürg Hammer, Zoltán Hantos, Anton H van Kaam, Cindy T McEvoy, Christopher J L Newth, J Jane Pillow, Gerrard F Rafferty, Margaret Rosenfeld, Janet Stocks, Sarath C Ranganathan
Ready access to physiologic measures, including respiratory mechanics, lung volumes, and ventilation/perfusion inhomogeneity, could optimize the clinical management of the critically ill pediatric or neonatal patient and minimize lung injury. There are many techniques for measuring respiratory function in infants and children but very limited information on the technical ease and applicability of these tests in the pediatric and neonatal intensive care unit (PICU, NICU) environments. This report summarizes the proceedings of a 2011 American Thoracic Society Workshop critically reviewing techniques available for ventilated and spontaneously breathing infants and children in the ICU...
February 2016: Annals of the American Thoracic Society
Michael Gaies, Sarah Tabbutt, Steven M Schwartz, Geoffrey L Bird, Jeffrey A Alten, Lara S Shekerdemian, Darren Klugman, Ravi R Thiagarajan, J William Gaynor, Jeffrey P Jacobs, Susan C Nicolson, Janet E Donohue, Sunkyung Yu, Sara K Pasquali, David S Cooper
OBJECTIVE: To describe the clinical epidemiology of extubation failure in a multicenter cohort of patients treated in pediatric cardiac ICUs. DESIGN: Retrospective cohort study using prospectively collected clinical registry data. SETTING: Pediatric Cardiac Critical Care Consortium registry. PATIENTS: All patients admitted to the CICU at Pediatric Cardiac Critical Care Consortium hospitals. INTERVENTIONS: None...
November 2015: Pediatric Critical Care Medicine
Martha A Q Curley, David Wypij, R Scott Watson, Mary Jo C Grant, Lisa A Asaro, Ira M Cheifetz, Brenda L Dodson, Linda S Franck, Rainer G Gedeit, Derek C Angus, Michael A Matthay
IMPORTANCE: Protocolized sedation improves clinical outcomes in critically ill adults, but its effect in children is unknown. OBJECTIVE: To determine whether critically ill children managed with a nurse-implemented, goal-directed sedation protocol experience fewer days of mechanical ventilation than patients receiving usual care. DESIGN, SETTING, AND PARTICIPANTS: Cluster randomized trial conducted in 31 US pediatric intensive care units (PICUs)...
January 27, 2015: JAMA: the Journal of the American Medical Association
Kimberly White
Quality & Clinical Improvement Posters IISESSION TYPE: Original Investigation PosterPRESENTED ON: Wednesday, October 29, 2014 at 01:30 PM - 02:30 PMPURPOSE: Intubation and mechanical ventilation is often lifesaving, but can be associated with several complications. Prolonged use of an artificial airway can increase these complications; therefore, early extubation is an essential step in a patient's successful recovery. Having a reliable method of determining extubation readiness in the pediatric population is crucial to ensuring faster recovery times, improved patient outcomes, and decreased length of stay...
October 1, 2014: Chest
Susan Bankhead, Kolea Chong, Sally Kamai
The objective of this project was to reduce the number of failed extubations in the pediatric intensive care unit. This article describes extubation failures in the pediatric intensive care unit and the development and implementation of an extubation readiness protocol using the Iowa Model for Evidence-based Practice as a guideline. The Iowa Model consists of processes for implementing evidence into practice, such as critiquing and synthesizing the literature, identifying stakeholders, and recognizing triggers...
September 2014: Nursing Clinics of North America
Brian M Cummings, Natan Noviski
No abstract text is available yet for this article.
March 2014: Respiratory Care
Ayşe Belin Özer, Ömer Lütfi Erhan
A circumcision was planned for a four-month-old infant under local anesthesia. After the application of lidocaine, the infant stopped crying, and then generalized tonic-clonic convulsions and a diffuse erythematous rash developed. The patient was immediately monitored, ventilation was provided, and 1 mg midazolam was given intramuscularly. After insertion of a cannula, sodium thiopental 50 mg was given intravenously, the patient's convulsions were controlled, and endotracheal intubation was performed. The patient was extubated 30 minutes later...
2014: Journal of the Turkish Society of Algology
Hans Fuchs, Thomas Nicolai, Manuel B Schmid, Marcus Krüger
Timely weaning from invasive ventilation is of major importance to limit time of invasive ventilation and improve outcomes. However, in pediatrics only limited knowledge on the optimal weaning approach is available. In this review evidence from recent trials on weaning in pediatrics is summarized. Standardized daily evaluation of weaning readiness, daily interruption of sedation, use of pediatric sedation protocols, application of noninvasive ventilation and prophylactic treatment with steroids of patients with high risk for post-extubation upper airway obstruction have been shown to decrease duration of invasive ventilation or to decrease the risk of extubation failure...
October 2013: Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie: AINS
Maroun J Mhanna, Ingrid M Anderson, Narayan P Iyer, Amy Baumann
BACKGROUND: The pediatric literature addressing extubation readiness parameters and strategies to wean from mechanical ventilation is limited. METHODS: We designed a survey to assess the use of extubation readiness parameters among pediatric critical care physicians at academic centers in the United States. RESULTS: The overall response rate was 44.1% (417/945). The majority of respondents check for air leak and the amount of tracheal secretions...
March 2014: Respiratory Care
Cortney B Foster, Michael C Spaeder, Robert J McCarter, Yao I Cheng, John T Berger
OBJECTIVES: To determine whether the measurement of cerebral and somatic regional oxygen saturation during an extubation readiness trial predicts extubation failure in postoperative cardiac patients. DESIGN: Prospective observational study. SETTING: Tertiary care center cardiac ICU. PATIENTS: Pediatric patients 1 day to 21 years old following cardiac surgery for congenital heart disease. Patients were included if they were intubated for greater than 12 hours and were undergoing an extubation readiness trial...
July 2013: Pediatric Critical Care Medicine
James L Laham, Patrick J Breheny, Amanda Rush
CONTEXT: There is absence of evidence-based guidelines to determine extubation readiness in the pediatric intensive care unit (PICU). OBJECTIVE: Evaluate our practice of determining extubation readiness based on physician judgment of preextubation ventilator settings, blood gas analysis, and other factors potentially affecting extubation outcome. DESIGN: Prospective cohort study from August 2010 to April 2012. SETTING: Academic, multidisciplinary PICU...
February 2015: Journal of Intensive Care Medicine
Bronagh Blackwood, Carol Junk, Jeremy David Morrell Lyons, Danny F McAuley, Louise Rose
BACKGROUND: Organizational processes affect the duration of mechanical ventilation in adult and pediatric intensive care units, but surprisingly little is known about role responsibilities for mechanical ventilation and weaning and related contextual factors that may influence timely liberation from mechanical ventilation. OBJECTIVE: To determine the professional group and seniority of clinicians responsible for key decisions regarding ventilation and weaning; use of ventilation protocols and automated closed loop systems; and provision of education on mechanical ventilation...
May 2013: American Journal of Critical Care: An Official Publication, American Association of Critical-Care Nurses
Laurence Ducharme-Crevier, Geneviève Du Pont-Thibodeau, Guillaume Emeriaud
The monitoring of electrical activity of the diaphragm (EAdi) is a new minimally invasive bedside technology that was developed for the neurally adjusted ventilatory assist (NAVA) mode of ventilation. In addition to its role in NAVA ventilation, this technology provides the clinician with previously unavailable and essential information on diaphragm activity. In this paper, we review the clinical interests of EAdi in the pediatric intensive care setting. Firstly, the monitoring of EAdi allows the clinician to tailor the ventilatory settings on an individual basis, avoiding frequent overassistance leading potentially to diaphragmatic atrophy...
2013: Critical Care Research and Practice
Flávia K Foronda, Eduardo J Troster, Julio A Farias, Carmen S Barbas, Alexandre A Ferraro, Lucília S Faria, Albert Bousso, Flávia F Panico, Artur F Delgado
OBJECTIVES: To assess whether the combination of daily evaluation and use of a spontaneous breathing test could shorten the duration of mechanical ventilation as compared with weaning based on our standard of care. Secondary outcome measures included extubation failure rate and the need for noninvasive ventilation. DESIGN: A prospective, randomized controlled trial. SETTING: Two pediatric intensive care units at university hospitals in Brazil...
November 2011: Critical Care Medicine
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