scholarly journals Elaboration of neonatal and pediatric mechanical lungs

2021 ◽  
Author(s):  
Anna Esther de Souza Lopes Palagar ◽  
Katrine de Souza Guimarães ◽  
Gabriela Motta Vasconcelos ◽  
Karla Duarte Barreto Xavier ◽  
Luciano Matos Chicayban
Keyword(s):  
Neonatal Intensive Care ◽  
Pediatric Patients ◽  
Life Support ◽  
Physical Therapists ◽  
Invasive Mechanical Ventilation ◽  
Life Support Care ◽  
Mechanical Lung ◽  
Orotracheal Tube ◽  
Two Stages ◽  
And Training

Pediatric patients or newborns admitted to Neonatal Intensive Care Units (NICU) receive life support care due to various conditions and pathologies. The physiotherapist controls and applies medicinal gases, institutes and monitors invasive and non-invasive mechanical ventilation, as well as performs weaning, among others. Learning ventilatory management must be appropriate for the age and, therefore, consider different lungs for the proper simulations of compliance and resistance. Although the insertion of physical therapists is relatively recent, there are several postgraduate courses and training in this area. The creation of a mechanical lungthat covers, separately, neonatal and pediatric patients will be a fundamental tool for the learning and training of future professionals who will work in the area. To develop two neonatal and pediatric mechanical lungs, as well as to simulate different elastic and resistive behaviors inherent in clinical practice. Experimental study, bench, divided into two stages: creation of mechanical lungs and evaluation of mechanical characteristics. The lungs will be made on a two-story metallic base: on the upper floor, the pediatric lung and the lower floor, the neonatal. In the second stage, the mechanical lung will be connected to a mechanical ventilator, using its own ventilatory parameters used in both types of patients. For the neonatal, respiratory rate of 35rpm, inspiratory time of 0.45 and endotracheal tube of 3.0 mm. The pediatric lung will be ventilated with a volume between 100-120mL, 20-25 compliance and a 4.5mm orotracheal tube. The construction of the neonatal and pediatric mechanical lung will strongly add the teaching of the Neonatal and Pediatric Intensive Physical Therapy specialty in the Undergraduate and Graduate settings, adding value to the teaching and training of professionals.

scholarly journals Ethical Issues around Death and Withdrawal of Life Support in Neonatal Intensive Care

2021 ◽  
Author(s):  
Stuti Pant
Keyword(s):  
Intensive Care ◽  
Neonatal Intensive Care ◽  
Life Support ◽  
Ethical Issues ◽  
Ethical Dilemmas ◽  
Human Life ◽  
Traumatic Experiences ◽  
National Guidelines ◽  
Brain Injured ◽  
Discharge Against Medical Advice

AbstractAmongst all the traumatic experiences in a human life, death of child is considered the most painful, and has profound and lasting impact on the life of parents. The experience is even more complex when the death occurs within a neonatal intensive care unit, particularly in situations where there have been conflicts associated with decisions regarding the redirection of life-sustaining treatments. In the absence of national guidelines and legal backing, clinicians are faced with a dilemma of whether to prolong life-sustaining therapy even in the most brain-injured infants or allow a discharge against medical advice. Societal customs, vagaries, and lack of bereavement support further complicate the experience for parents belonging to lower socio-economic classes. The present review explores the ethical dilemmas around neonatal death faced by professionals in India, and suggests some ways forward.

283 DO NOT RESUSCITATE ORDERS AND WITHDRAWAL OF LIFE SUPPORT IN DYING PEDIATRIC PATIENTS

2005 ◽  
Vol 53 (1) ◽  
pp. S128.1-S128
Author(s):  
B. J. Baker ◽  
J. C. Partridge ◽  
S. A. Sehring ◽  
R. F. Kramer ◽  
B. A. Cooper ◽  
...  
Keyword(s):  
Pediatric Patients ◽  
Life Support ◽  
Do Not Resuscitate ◽  
Do Not Resuscitate Orders

Extracorporeal membrane oxygenation outcomes in children with hemophagocytic lymphohistiocytosis

Perfusion ◽  
2016 ◽  
Vol 32 (2) ◽  
pp. 151-156 ◽  
Author(s):  
Katherine Cashen ◽  
Roland L Chu ◽  
Justin Klein ◽  
Peter T Rycus ◽  
John M Costello
Keyword(s):  
Risk Factors ◽  
Extracorporeal Membrane Oxygenation ◽  
Cardiac Failure ◽  
Hemophagocytic Lymphohistiocytosis ◽  
Pediatric Patients ◽  
Life Support ◽  
Extracorporeal Life Support ◽  
Hemorrhagic Complication ◽  
Membrane Oxygenation ◽  
Va Ecmo

Introduction: Pediatric patients with hemophagocytic lymphohistiocytosis (HLH) may develop refractory respiratory or cardiac failure that warrants consideration for extracorporeal membrane oxygenation (ECMO) support. The purposes of this study were to describe the use and outcomes of ECMO in pediatric HLH patients, to identify risk factors for hospital mortality and to compare their ECMO use and outcomes to the ECMO population as a whole. Methods: Pediatric patients (⩽ 18 years) with a diagnosis of HLH in the Extracorporeal Life Support Organization (ELSO) Registry were included. Results: Between 1983 and 2014, data for 30 children with HLH were available in the ELSO registry and all were included in this study. All cases occurred in the last decade. Of the 30 HLH patients, 24 (80%) had a respiratory indication for ECMO and six (20%) had a cardiac indication (of which 4 were E-CPR and 2 cardiac failure). Of the 24 respiratory ECMO patients, 63% were placed on VA ECMO. Compared with all pediatric patients in the ELSO registry during the study period (n=17,007), HLH patients had worse hospital survival (non-HLH 59% vs HLH 30%, p=0.001). In pediatric HLH patients, no pre-ECMO risk factors for mortality were identified. The development of a hemorrhagic complication on ECMO was associated with decreased mortality (p=0.01). Comparing HLH patients with respiratory failure to patients with other immune compromised conditions, the overall survival rate is similar (HLH 38% vs. non-HLH immune compromised 31%, p=0.64). Conclusions: HLH is an uncommon indication for ECMO and these patients have increased mortality compared to the overall pediatric ECMO population. These data should be factored into decision-making when considering ECMO for pediatric HLH patients.

Resuscitation and Withdrawal of Therapy in Pediatric Intensive Care

PEDIATRICS ◽  
1992 ◽  
Vol 89 (5) ◽  
pp. 961-963
Author(s):  
RICHARD B. MINK ◽  
MURRAY M. POLLACK
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Neonatal Intensive Care ◽  
Life Support ◽  
Pediatric Intensive Care ◽  
New Haven ◽  
Hammersmith Hospital ◽  
Hospital Deaths ◽  
Withdrawal Of Therapy ◽  
Haven Hospital

Although issues concerning withdrawal and limitation of life support are commonly discussed,1-6 actual practices in pediatrics are largely unknown and are limited to neonatal intensive care unit (ICU) studies. In the neonatal ICUs at Yale-New Haven Hospital and at Hammersmith Hospital, 14% and 30%, respectively, of all deaths followed withdrawal of care.7,8 In adult ICUs, limitation and/or withdrawal of therapy is common,9 and in one investigation, resuscitation was not attempted immediately before ICU death in nearly two-thirds of cases.10 Nonetheless, many physicians believe that most hospital deaths occur only after all resuscitative attempts have failed,6,11,12 and others believe that resuscitative efforts neither are indicated nor desirable in many cases.1,13

The Subjectivity of Attitudes Toward Life Support Care

2007 ◽  
Vol 37 (7) ◽  
pp. 1166
Author(s):  
Jieun Choi ◽  
Yun Jung ◽  
Boon Han Kim ◽  
Hye Won Jeon ◽  
Yoon Sook Kim
Keyword(s):  
Life Support ◽  
Life Support Care

scholarly journals It's Not Just a Needlestick: Exploring Phlebotomists' Knowledge, Training, and Use of Comfort Measures in Pediatric Care to Improve the Patient Experience

2019 ◽  
Vol 3 (5) ◽  
pp. 847-856
Author(s):  
Julie Piazza ◽  
Sandra Merkel ◽  
Harry Neusius ◽  
Susan Murphy ◽  
Joan Gargaro ◽  
...  
Keyword(s):  
Child Development ◽  
Patient Experience ◽  
Pediatric Patients ◽  
Child Life ◽  
Patient Comfort ◽  
Pediatric Care ◽  
Training Methods ◽  
Hospital System ◽  
Topical Anesthetics ◽  
And Training

Abstract Background Blood draws are a routine element of the pediatric patient experience. They are also associated with the greatest fear and pain for a child. Because of the limited literature regarding phlebotomists' knowledge, experience, training, or stress related to their use of comfort techniques during pediatric blood draws, this study explored current practices and training methods. Phlebotomist training tends to focus on clinical technique rather than pediatric or patient comfort support. The study includes aims to develop a measurement for phlebotomists' use of comfort techniques for pediatric blood draws. Method Focus groups of parent advocates (n = 24) and pediatric phlebotomists (n = 11) reviewed the survey questionnaire, and it was revised before being e-mailed to hospital system phlebotomists (n = 128). Results Almost half of the sample group lacked training in child development. The most frequently used comfort measures were words of explanation and reassurance, positioning of the child, and distraction. Requesting child life specialist support and using pain management devices or topical anesthetics were used less often. Primary challenges to performing pediatric blood draws were anxious patients and parents. Conclusion Phlebotomists' use of available comfort measures occurs infrequently. Including child development and comfort techniques in training programs is essential to providing pediatric patients with a more satisfactory experience.

scholarly journals Optical Recognition of Handwritten Logic Formulas Using Neural Networks

Electronics ◽  
2021 ◽  
Vol 10 (22) ◽  
pp. 2761
Author(s):  
Vaios Ampelakiotis ◽  
Isidoros Perikos ◽  
Ioannis Hatzilygeroudis ◽  
George Tsihrintzis
Keyword(s):  
Neural Networks ◽  
Character Recognition ◽  
Gradient Descent ◽  
Feedforward Neural Networks ◽  
Stochastic Gradient ◽  
Stochastic Gradient Descent ◽  
Training Algorithms ◽  
Gradient Descent Algorithm ◽  
Two Stages ◽  
And Training

In this paper, we present a handwritten character recognition (HCR) system that aims to recognize first-order logic handwritten formulas and create editable text files of the recognized formulas. Dense feedforward neural networks (NNs) are utilized, and their performance is examined under various training conditions and methods. More specifically, after three training algorithms (backpropagation, resilient propagation and stochastic gradient descent) had been tested, we created and trained an NN with the stochastic gradient descent algorithm, optimized by the Adam update rule, which was proved to be the best, using a trainset of 16,750 handwritten image samples of 28 × 28 each and a testset of 7947 samples. The final accuracy achieved is 90.13%. The general methodology followed consists of two stages: the image processing and the NN design and training. Finally, an application has been created that implements the methodology and automatically recognizes handwritten logic formulas. An interesting feature of the application is that it allows for creating new, user-oriented training sets and parameter settings, and thus new NN models.

scholarly journals Determinants of preterm infants’ deaths at the Neonatal Intensive Care Units in the Northeast Countryside in Brazil

2020 ◽  
Vol 20 (2) ◽  
pp. 535-544
Author(s):  
Raquel Gomes Lima ◽  
Verônica Cheles Vieira ◽  
Danielle Souto de Medeiros
Keyword(s):  
Mechanical Ventilation ◽  
Preterm Infants ◽  
Neonatal Intensive Care ◽  
Distress Syndrome ◽  
Neonatal Period ◽  
Invasive Mechanical Ventilation ◽  
Pulmonary Hemorrhage ◽  
Neonatal Intensive Care Units ◽  
Early Weaning ◽  
Neonatal Icu

Abstract Objectives: to assess preterm infants’ characteristics, health conditions and neonatal care effect on their death at the neonatal ICU. Methods: this was a non-concurrent cohort study, including preterm infants from three neonatal ICUs from January 1st to December 31st, 2016, followed during the neonatal period and deaths registered during the entire hospitalization. Multivariate analysis was performed using Poisson regression. Results: of the 181 preterm infants, 18.8% died during hospitalization. Associated with the outcome: a gestational age between 28 and 32 weeks (RR= 5.66; CI95%= 2.08-15.40), and less than 28 weeks (RR=9.24; CI95%=3.27-26.12), Apgar score of 5th minutes less than 7 (RR: 1.82; CI95%=1.08-3.08), use of invasive mechanical ventilation up to 3 days (RR= 4.44; CI95%= 1.66-11.87) and 4 days and more (RR=6.87; CI95%=2.58-18.27). Besides the late sepsis (RR: 3.72, CI95%=1.77-7.83), acute respiratory distress syndrome (RR=2.86, CI95%=1.49-5.46), pulmonary hemorrhage (RR=1.97; CI95%=1.40-2.77), and necrotizing enterocolitis (RR= 3.41; CI95%=1.70-6.83). Conclusions: the results suggest the importance of using strategies to improve care during childbirth, conditions for extremely premature infants, early weaning from a mechanical ventilation and prevention on nosocomial infection.

scholarly journals Extracorporeal Membrane Oxygenation: The First 10 Years Experience of a Portuguese Pediatric Intensive Care Unit

2021 ◽  
Vol 34 (6) ◽  
pp. 435
Author(s):  
Daniel Meireles ◽  
Francisco Abecasis ◽  
Leonor Boto ◽  
Cristina Camilo ◽  
Miguel Abecasis ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Overall Survival ◽  
Intensive Care ◽  
Pediatric Intensive Care Unit ◽  
Pediatric Patients ◽  
Life Support ◽  
Extracorporeal Life Support ◽  
Pediatric Intensive Care ◽  
Overall Survival Rate ◽  
Clinical Complications

Introduction: In Portugal, extracorporeal membrane oxygenation (ECMO) is used in pediatric patients since 2010. The aim of this study was to describe the clinical characteristics of patients, indications, complications and mortality associated with the use of ECMO during the first 10-years of experience in the Pediatric Intensive Care Unit located in Centro Hospitalar Universitário Lisboa Norte.Material and Methods: Retrospective observational cohort study of all patients supported with ECMO in a Pediatric Intensive Care Unit, from the 1st of May 2010 up to 31st December 2019.Results: Sixty-five patients were included: 37 neonatal (≤ 28 days of age) and 28 pediatric patients (> 28 days). In neonatal cases, congenital diaphragmatic hernia was the main reason for ECMO (40% of neonatal patients and 23% of total). Among pediatric patients, respiratory distress was the leading indication for ECMO (47% of total). The median length of ECMO support was 12 days. Clinical complications were more frequent than mechanical complications (65% vs 35%). Among clinical complications, access site bleeding was the most prevalent with 38% of cases. The overall patient survival was 68% at the time of discharge (65% for neonatal and 71% for pediatric cases), while the overall survival rate in Extracorporeal Life Support Organization registry was 61%. The number of ECMO runs has been increasing since 2011, even though in a non-linear way (three cases in 2010 to 11 cases in 2019).Discussion: In the first 10 years we received patients from all over the country. Despite continuous technological developments, circuitrelated complications have a significant impact. The overall survival rate in the Pediatric Intensive Care Unit was not inferior to the one reported by the Extracorporeal Life Support Organization.Conclusion: The overall survival of our Pediatric Intensive Care Unit is not inferior to one reported by other international centers. Our experience showed the efficacy of the ECMO technique in a Portuguese centre.

scholarly journals An innovative cardiopulmonary resuscitation mannequin for common people

MEDISAINS ◽  
2020 ◽  
Vol 18 (1) ◽  
pp. 35
Author(s):  
Runi Pramesti Putri ◽  
Endiyono Endiyono
Keyword(s):  
Cardiopulmonary Resuscitation ◽  
Basic Life Support ◽  
Life Support ◽  
First Aid ◽  
Ordinary People ◽  
Common People ◽  
The Individual ◽  
Led Lights ◽  
And Training

Background: The success of basic life support is determined by the role of the individual(s) who first encountered a patient with a heart attack, and he will be a helper in the situation. Lack of socialization and training for laypeople makes them unable to implement a right first aid in cases of cardiac arrest. There is a need for innovations in cardiac, pulmonary resuscitation for ordinary people to facilitate them in practicing compression measures.Technique: CPR mannequin is made of a plywood material in the shape of the human body; it is 34 cm long, 34 cm wide, and 6.5 cm high. There are 2 LED lights to detect the accuracy of the compression depth.Conclusion: CPR mannequin can facilitate and improve the skills of laypeople in performing cardiopulmonary resuscitation

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