Protocolized Sedation vs Usual Care in Pediatric Patients Mechanically Ventilated for Acute Respiratory Failure

Background: Sleep disruptions frequently occur in hospitalized patients, especially with critically ill, mechanically ventilated patients. Severely altered sleep architectures result in unclassifiable sleep stages as listed by the conventional Rechtschaffen and Kales (R&K) criteria, and a new classification for sleep scoring including atypical sleep (AS) and pathological wakefulness (PW) has recently been proposed. Objective: To demonstrate the feasibility of performing objective sleep qualification in patients receiving mechanical ventilation due to acute respiratory failure. Materials and Methods: In the present prospective cohort study, polysomnography was performed in 38 patients requiring invasive mechanical ventilation due to acute respiratory failure at the respiratory care unit (RCU) of Siriraj Hospital between February and December 2017. Their sleep stages were analyzed by conventional rules and the new classifications of AS and PW. The associations between the presence of AS or PW and the patients’ characteristics were analyzed. Correlations between sleep quality and clinical parameters were also determined. Results: Most of the patients had poor sleep quality with median sleep efficiency (IQR) of 35.9% (18.5, 62.3) and significantly decreased slowwave sleep [median (IQR) 0.4% (0.00, 5.70)] and REM [median (IQR) 1.3% (0.00, 6.43)]. According to the new classifications, 14 out of 38 (prevalence of 36.8%) mechanically ventilated patients had AS. The prevalence of PW and either AS or PW were 36.8% and 52.6%, respectively. A higher baseline respiratory rate was observed among patients who had either AS or PW at 24 versus 20 breaths/minute (p=0.02), while a longer duration of mechanical ventilator support was found in patients with PW at nine versus five (p=0.003). Patient-ventilator asynchrony was also noted in all patients. Conclusion: Sleep quality among critically ill and mechanically ventilated patients was severely disturbed. A higher prevalence of AS and PW were noted. The technical feasibility of sleep recording in Thai intensive care unit (ICU) settings was established. Keywords: Polysomnography, Atypical sleep, ICU

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Spinal Deformity Surgery in Pediatric Patients With Cerebral Palsy: A National-Level Analysis of Inpatient and Postdischarge Outcomes

Global Spine Journal ◽

10.1177/2192568220960075 ◽

2020 ◽

pp. 219256822096007

Author(s):

Nathan J. Lee ◽

Michael Fields ◽

Venkat Boddapati ◽

Justin Mathew ◽

Daniel Hong ◽

...

Keyword(s):

Cerebral Palsy ◽

Respiratory Failure ◽

Length Of Stay ◽

Acute Respiratory Failure ◽

Spinal Fusion ◽

Spinal Deformity ◽

Pediatric Patients ◽

National Level ◽

Spinal Deformity Surgery ◽

Tract Infections

Study Design: Retrospective cohort. Objective: To provide a national-level assessment of the short-term outcomes after spinal deformity surgery in pediatric patients with cerebral palsy. Methods: A national, prospectively collected database was queried to identify pediatric (≤18 years) patients with cerebral palsy, who underwent spinal fusion surgery from 2012 to 2017. Separate multivariate analyses were performed for the primary outcomes of interest including extended length of stay (>75th percentile, >8 days), and readmissions within 90 days after the index admission. Results: A total of 2856 patients were reviewed. The mean age ± standard deviation was 12.8 ± 2.9 years, and 49.4% of patients were female. The majority of patients underwent a posterior spinal fusion (97.0%) involving ≥8 levels (79.9%) at a teaching hospital (96.6%). Top medical complications (24.5%) included acute respiratory failure requiring mechanical ventilation (11.4%), paralytic ileus (8.2%), and urinary tract infections (4.6%). Top surgical complications (40.7%) included blood transfusion (35.6%), wound complication (4.9%), and mechanical complication (2.7%). The hospital cost for patients with a length of hospital stay >8 days ($113 669) was nearly double than that of those with a shorter length of stay ($68 411). The 90-day readmission rate was 17.6% (mean days to readmission: 30.2). The most common reason for readmission included wound dehiscence (21.1%), surgical site infection (19.1%), other infection (18.9%), dehydration (16.9%), feeding issues (14.5%), and acute respiratory failure (13.1%). Notable independent predictors for 90-day readmissions included preexisting pulmonary disease (odds ratio [OR] 1.5), obesity (OR 3.4), cachexia (OR 27), nonteaching hospital (OR 3.5), inpatient return to operating room (OR 1.9), and length of stay >8 days (OR 1.5). Conclusions: Efforts focused on optimizing the perioperative pulmonary, hematological, and nutritional status as well as reducing wound complications appear to be the most important for improving clinical outcomes.

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Comparison of Simultaneous Capillary Blood Gases and End-Tidal Carbon Dioxide in Mechanically Ventilated Pediatric Patients with Acute Respiratory Failure

Journal of Pediatric Intensive Care ◽

10.1055/s-0040-1714096 ◽

2020 ◽

Author(s):

Capan Konca ◽

Mehmet Tekin ◽

Fatih Uckardes ◽

Samet Benli ◽

Ahmet Kucuk

Keyword(s):

Carbon Dioxide ◽

Respiratory Failure ◽

Pediatric Patients ◽

Blood Gases ◽

Blood Gas Analysis ◽

Gas Analysis ◽

Mechanically Ventilated ◽

End Tidal Carbon Dioxide ◽

End Tidal

AbstractIn the follow-up of ventilation, invasive blood gas analysis and noninvasive monitoring of end-tidal carbon dioxide (ETCO2) are used. We aimed to investigate the relationship between capillary partial pressure of carbon dioxide (PcCO2) levels and ETCO2 and also to investigate ETCO2's predictive feature of PcCO2 levels. This study included 28 female and 30 male pediatric patients; 28 patients were type-1 respiratory failure (RF), 16 patients were acute respiratory distress syndrome, and 14 patients were type-2 RF. Our results showed a significant correlation between ETCO2 and PcCO2. Although the strength of the correlation was weak throughout the measurements, the strength of this correlation increased significantly in type-2 RF.

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Out-of-Hospital Continuous Positive Airway Pressure Ventilation Versus Usual Care in Acute Respiratory Failure: A Randomized Controlled Trial

Annals of Emergency Medicine ◽

10.1016/j.annemergmed.2008.01.006 ◽

2008 ◽

Vol 52 (3) ◽

pp. 232-241.e1 ◽

Cited By ~ 44

Author(s):

James Thompson ◽

David A. Petrie ◽

Stacy Ackroyd-Stolarz ◽

Darrell J. Bardua

Keyword(s):

Randomized Controlled Trial ◽

Respiratory Failure ◽

Continuous Positive Airway Pressure ◽

Acute Respiratory Failure ◽

Usual Care ◽

Airway Pressure ◽

Positive Airway Pressure ◽

Controlled Trial ◽

Randomized Controlled ◽

Positive Airway Pressure Ventilation

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O038 / #728: AN EXPLORATORY INVESTIGATION OF THE INFLAMMATORY AND COAGULANT RESPONSE AFTER ACUTE RESPIRATORY FAILURE IN OVERWEIGHT, OBESE AND APPROPRIATE WEIGHT PEDIATRIC PATIENTS

Pediatric Critical Care Medicine ◽

10.1097/01.pcc.0000738256.80411.30 ◽

2021 ◽

Vol 22 (Supplement 1 3S) ◽

pp. 22-23

Author(s):

S. Ward ◽

M. Dahmer ◽

H. Weeks ◽

A. Sapru ◽

M. Quasney ◽

...

Keyword(s):

Respiratory Failure ◽

Acute Respiratory Failure ◽

Pediatric Patients ◽

Exploratory Investigation

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Association of weaning preparedness with extubation outcome of mechanically ventilated patients in medical intensive care units: a retrospective analysis

PeerJ ◽

10.7717/peerj.8973 ◽

2020 ◽

Vol 8 ◽

pp. e8973

Author(s):

Feng-Ching Lin ◽

Yao-Wen Kuo ◽

Jih-Shuin Jerng ◽

Huey-Dong Wu

Keyword(s):

Intensive Care ◽

Respiratory Failure ◽

Acute Respiratory Failure ◽

Intensive Care Units ◽

Extubation Failure ◽

Mechanically Ventilated ◽

Mechanically Ventilated Patients ◽

Failure Group ◽

Medical Intensive Care ◽

Ventilated Patients

Background Assessment of preparedness of weaning has been recommended before extubation for mechanically ventilated patients. We aimed to understand the association of a structured assessment of weaning preparedness with successful liberation. Methods We retrospectively investigated patients with acute respiratory failure who experienced an extubation trial at the medical intensive care units of a medical center and compared the demographic and clinical characteristics between those patients with successful and failed extubation. A composite score to assess the preparedness of weaning, the WEANSNOW score, was generated consisting of eight components, including Weaning parameters, Endotracheal tube, Arterial blood gas analysis, Nutrition, Secretions, Neuromuscular-affecting agents, Obstructive airway problems and Wakefulness. The prognostic ability of the WEANSNOW score for extubation was then analyzed. Results Of the 205 patients included, 138 (67.3%) patients had successful extubation. Compared with the failure group, the success group had a significantly shorter duration of MV before the weaning attempt (11.2 ± 11.6 vs. 31.7 ± 26.2 days, p < 0.001), more with congestive heart failure (42.0% vs. 25.4%, p = 0.020), and had different distribution of the types of acute respiratory failure (p = 0.037). The failure group also had a higher WEANSNOW score (1.22 ± 0.85 vs. 0.51 ± 0.71, p < 0.001) and worse Rapid Shallow Breathing Index (93.9 ± 63.8 vs. 56.3 ± 35.1, p < 0.001). Multivariate logistic regression analysis showed that a WEANSNOW Score = 1 or higher (OR = 2.880 (95% CI [1.291–6.426]), p = 0.010) and intubation duration >21 days (OR = 7.752 (95% CI [3.560–16.879]), p < 0.001) were independently associated with an increased probability of extubation failure. Conclusion Assessing the pre-extubation status of intubated patients in a checklist-based approach using the WEANSNOW score might provide valuable insights into extubation failure in patients in a medical ICU for acute respiratory failure. Further prospective studies are warranted to elucidate the practice of assessing weaning preparedness.

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