scholarly journals Influence of the Bed Head Positioning on the Current Expiratory Volume of Pediatric Patients in Mechanical Ventilation: A Pilot Clinical Controlled Trial

2021 ◽  
Vol 1 (1) ◽  
Author(s):  
Camila Gemin R. Locatelli ◽  
Valéria Cabral Neves ◽  
Adriana Koliski ◽  
José Eduardo Carreiro
Keyword(s):  
Blood Pressure ◽  
Mechanical Ventilation ◽  
Oxygen Saturation ◽  
Tidal Volume ◽  
Pediatric Patients ◽  
Controlled Trial ◽  
Progressive Increase ◽  
Head Position ◽  
Peripheral Oxygen Saturation ◽  
Head Positioning

he elevated bed head position is an important therapeutic intervention that can reduce respiratory complications associated with mechanical ventilation. The objective of this study was to evaluate the effects of elevation at the head of the bed on the tidal volume, pressure variables, hemodynamic data and peripheral oxygen saturation in pediatric patients on mechanical ventilation. Methods: In a before-and-after clinical trial, 52 patients of both sexes, with a chronological age of 28 days to 14 years old, were admitted to the pediatric intensive care unit for more than 24 hours. These were positioned at 0º, 30º, 45º and 60º of elevation of the head of the bed. For each position, the expiratory tidal volume, pressure variables, hemodynamic data and peripheral oxygen saturation were evaluated. Results: The patients presented an increase in the expired tidal volume, with the bed head angulation at 30º and 45º. Heart rate increased when the head was positioned at 60º. The peripheral oxygen saturation variable increased in the 30º and 45º positions. The systolic blood pressure variables and diastolic blood pressure showed a progressive increase in the 30º, 45º and 60º positions respectively. Significant effects on increasing the SatO2/FiO2 ratio were observed in the 30º and 45º positions. Conclusion: This study demonstrated a significant increase in expired tidal volume and an increase in the SatO2/FiO2 ratio with the patient positioned at 30º and 45º of elevation of the head of the bed. The peripheral oxygen saturation variable increased in the 30º and 45º positions. The elevated bed head position should be considered when monitoring children during mechanical ventilation.

Instillation of normal saline before suctioning in patients with pulmonary infections: a prospective randomized controlled trial

1998 ◽  
Vol 7 (4) ◽  
pp. 261-266 ◽  
Author(s):  
MH Ackerman ◽  
DJ Mick
Keyword(s):  
Blood Pressure ◽  
Adverse Effect ◽  
Heart Rate ◽  
Oxygen Saturation ◽  
Normal Saline ◽  
Pulmonary Infection ◽  
Controlled Trial ◽  
Pulmonary Infections ◽  
Randomized Controlled ◽  
Prospective Randomized Controlled Trial

OBJECTIVE: To determine the effect of instillation of normal saline before suctioning on oxygen saturation, heart rate, and blood pressure in patients with pulmonary infections. METHODS: A prospective randomized controlled trial was conducted in the surgical, medical, and burn/trauma ICUs of an academic medical center. Eighteen men and 11 women (mean age = 60 years) receiving mechanical ventilation who met the criteria for pulmonary infection were randomly assigned to 2 groups. One group had instillation of a 5-mL bolus of normal saline before suctioning; the other did not. Suctioning was done as needed during an 8-to 12-hour period. Oxygen saturation, heart rate, and blood pressure were measured noninvasively immediately before and after suctioning, at 1-minute intervals for 5 minutes after suctioning, and at 10 minutes after suctioning. RESULTS: Instillation of normal saline had an adverse effect on oxygen saturation, which worsened over time. Differences in saturation between the 2 groups were significant at 4, 5, and 10 minutes after suctioning. Differences in heart rate and blood pressure were not significant. CONCLUSION: Instillation of normal saline before suctioning has an adverse effect on oxygen saturation and should not be used routinely in patients receiving mechanical ventilation who have pulmonary infection.

scholarly journals Development and Validation of a Simplified Prehospital Triage Model Using Neural Network to Predict Mortality in Trauma Patients: The Ability to Follow Commands, Age, Pulse Rate, Systolic Blood Pressure and Peripheral Oxygen Saturation (CAPSO) Model

2021 ◽  
Vol 8 ◽  
Author(s):  
Yun Li ◽  
Lu Wang ◽  
Yuyan Liu ◽  
Yan Zhao ◽  
Yong Fan ◽  
...  
Keyword(s):  
Neural Network ◽  
Blood Pressure ◽  
Confidence Interval ◽  
Systolic Blood Pressure ◽  
Oxygen Saturation ◽  
Neural Network Model ◽  
Risk Groups ◽  
The Other ◽  
Peripheral Oxygen Saturation ◽  
Trauma Scores

Objective: Most trauma scoring systems with high accuracy are difficult to use quickly in field triage, especially in the case of mass casualty events. We aimed to develop a machine learning model for trauma mortality prediction using variables easy to obtain in the prehospital setting.Methods: This was a retrospective prognostic study using the National Trauma Data Bank (NTDB). Data from 2013 to 2016 were used for model training and internal testing, and data from 2017 were used for validation. A neural network model (NN-CAPSO) was developed using the ability to follow commands (whether GCS-motor was <6), age, pulse rate, systolic blood pressure (SBP) and peripheral oxygen saturation, and a new score (the CAPSO score) was developed based on logistic regression. To achieve further simplification, a neural network model with the SBP variable removed (NN-CAPO) was also developed. The discrimination ability of different models and scores was compared based on the area under the receiver operating characteristic curve (AUROC). Furthermore, a reclassification table with three defined risk groups was used to compare NN-CAPSO and other models or scores.Results: The NN-CAPSO had an AUROC of 0.911(95% confidence interval 0.909 to 0.913) in the validation set, which was higher than the other trauma scores available for prehospital settings (all p < 0.001). The NN-CAPO and CAPSO score both reached the AUROC of 0.904 (95% confidence interval 0.902 to 0.906), and were no worse than other prehospital trauma scores. Compared with the NN-CAPO, CAPSO score, and the other trauma scores in reclassification tables, NN-CAPSO was found to more accurately classify patients to the right risk groups.Conclusions: The newly developed CAPSO system simplifies the method of consciousness assessment and has the potential to accurately predict trauma patient mortality in the prehospital setting.

scholarly journals Immediate effects of manual hyperinflation on cardiorespiratory function and sputum clearance in mechanically ventilated pediatric patients: A randomized crossover trial

2021 ◽  
pp. 1-8
Author(s):  
Tawatchai Luadsri ◽  
Jaturon Boonpitak ◽  
Kultida Pongdech-Udom ◽  
Patnuch Sukpom ◽  
Weerapong Chidnok
Keyword(s):  
Blood Pressure ◽  
Mechanical Ventilation ◽  
Critical Care ◽  
Pediatric Patients ◽  
Physical Therapist ◽  
Peak Inspiratory Pressure ◽  
Lung Compliance ◽  
Post Intervention ◽  
Mechanically Ventilated ◽  
Arterial Blood

Background: In developing countries, lower respiratory tract infection is a major cause of death in children, with severely ill patients being admitted to the critical-care unit. While physical therapists commonly use the manual hyperinflation (MHI) technique for secretion mass clearance in critical-care patients, its efficacy has not been determined in pediatric patients. Objective:This study investigated the effects of MHI on secretion mass clearance and cardiorespiratory responses in pediatric patients undergoing mechanical ventilation. Methods:A total of 12 intubated and mechanically ventilated pediatric patients were included in this study. At the same time of the day, the patients received two randomly ordered physical therapy treatments (MHI with suction and suction alone) from a trained physical therapist, with a washout period of 4[Formula: see text]h provided between interventions. Results:The MHI treatment increased the tidal volume [[Formula: see text]; 1.2[Formula: see text]mL/kg (95% CI, 0.8–1.5)] and static lung compliance [[Formula: see text]; 3.7[Formula: see text]mL/cmH2O (95% CI, 2.6–4.8)] immediately post-intervention compared with the baseline ([Formula: see text]). Moreover, the MHI with suction induced higher [Formula: see text] [1.4[Formula: see text]mL/kg (95% CI, 0.8–2.1)] and [Formula: see text] [3.4[Formula: see text]mL/cmH2O (95% CI, 2.1–4.7)] compared with the suction-alone intervention. In addition, the secretion mass [0.7[Formula: see text]g (95% CI, 0.6–0.8)] was greater in MHI with suction compared with suction alone ([Formula: see text]). However, there was no difference in peak inspiratory pressure, mean airway pressure, respiratory rate, heart rate, blood pressure, mean arterial blood pressure or oxygen saturation ([Formula: see text]) between interventions. Conclusions:MHI can improve [Formula: see text], [Formula: see text] and secretion mass without inducing adverse hemodynamic effects upon the pediatric patients requiring mechanical ventilation.

scholarly journals Premedication with intranasal dexmedetomidine decreases barbiturate requirement in pediatric patients sedated for magnetic resonance imaging: a retrospective study

2018 ◽  
Author(s):  
Panu Uusalo ◽  
Mirjam Lehtinen ◽  
Eliisa Löyttyniemi ◽  
Tuula Manner ◽  
Mika Scheinin ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Oxygen Saturation ◽  
Pediatric Patients ◽  
Supplemental Oxygen ◽  
Procedural Sedation ◽  
Resonance Imaging ◽  
Peripheral Oxygen Saturation ◽  
Adrenoceptor Agonist ◽  
Magnetic Resonance Imaging Mri

Abstract Background: Barbiturates are commonly used in ambulatory sedation of pediatric patients. However, use of barbiturates involve risks of respiratory complications. Dexmedetomidine, a highly selective α2-adrenoceptor agonist, is increasingly used for pediatric sedation. Premedication with intranasal (IN) dexmedetomidine offers a non-invasive and efficient possibility to sedate pediatric patients undergoing magnetic resonance imaging (MRI). Our hypothesis was that dexmedetomidine would reduce barbiturate requirements in procedural sedation. Methods: We included 200 consecutive pediatric patients undergoing MRI, and analyzed their hospital records retrospectively. Half of the patients received 3 μg/kg of IN dexmedetomidine (DEX group) 45-60 min before MRI while the rest received only thiopental (THIO group) for procedural sedation. Sedation was maintained with further intravenous thiopental dosing as needed. Thiopental consumption, heart rate (HR) and peripheral oxygen saturation were recorded. Results: The cumulative thiopental requirement during MRI was (median and interquartile range [IQR]) 4.4 (2.7-6.0) mg/kg/h in the DEX group and 12.4 (9.8-14.8) mg/kg/h in the THIO group (difference 7.9 mg/kg/h, 95% CI 6.8–8.8, P < 0.001). Lowest measured peripheral oxygen saturation remained slightly higher in the DEX group compared to the THIO group (median nadirs and IQR: 97 (95-97) % and 96 (94-97) %, P < 0.001). Supplemental oxygen was delivered to 33 % of the patients in the THIO group compared to 2 % in the DEX group (P < 0.001). The lowest measured HR (mean and SD) was lower (78 (16) bpm) in the DEX group compared to the THIO group (92 (12) bpm) (P < 0.001). Conclusion: Premedication with IN dexmedetomidine (3 μg/kg) was associated with markedly reduced thiopental dosage needed for efficient procedural sedation for pediatric MRI.

scholarly journals Premedication with intranasal dexmedetomidine decreases barbiturate requirement in pediatric patients sedated for magnetic resonance imaging: a retrospective study

2018 ◽  
Author(s):  
Panu Uusalo ◽  
Mirjam Lehtinen ◽  
Eliisa Löyttyniemi ◽  
Tuula Manner ◽  
Mika Scheinin ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Oxygen Saturation ◽  
Pediatric Patients ◽  
Supplemental Oxygen ◽  
Procedural Sedation ◽  
Resonance Imaging ◽  
Peripheral Oxygen Saturation ◽  
Adrenoceptor Agonist ◽  
Magnetic Resonance Imaging Mri

Abstract Background: Barbiturates are commonly used in ambulatory sedation of pediatric patients. However, use of barbiturates involve risks of respiratory complications. Dexmedetomidine, a highly selective α2-adrenoceptor agonist, is increasingly used for pediatric sedation. Premedication with intranasal (IN) dexmedetomidine offers a non-invasive and efficient possibility to sedate pediatric patients undergoing magnetic resonance imaging (MRI). Our hypothesis was that dexmedetomidine would reduce barbiturate requirements in procedural sedation. Methods: We included 200 consecutive pediatric patients undergoing MRI, and analyzed their hospital records retrospectively. Half of the patients received 3 μg/kg of IN dexmedetomidine (DEX group) 45-60 min before MRI while the rest received only thiopental (THIO group) for procedural sedation. Sedation was maintained with further intravenous thiopental dosing as needed. Thiopental consumption, heart rate (HR) and peripheral oxygen saturation were recorded. Results: The cumulative thiopental requirement during MRI was (median and interquartile range [IQR]) 4.4 (2.7-6.0) mg/kg/h in the DEX group and 12.4 (9.8-14.8) mg/kg/h in the THIO group (difference 7.9 mg/kg/h, 95% CI 6.8–8.8, P < 0.001). Lowest measured peripheral oxygen saturation remained slightly higher in the DEX group compared to the THIO group (median nadirs and IQR: 97 (95-97) % and 96 (94-97) %, P < 0.001). Supplemental oxygen was delivered to 33 % of the patients in the THIO group compared to 2 % in the DEX group (P < 0.001). The lowest measured HR (mean and SD) was lower (78 (16) bpm) in the DEX group compared to the THIO group (92 (12) bpm) (P < 0.001). Conclusion: Premedication with IN dexmedetomidine (3 μg/kg) was associated with markedly reduced thiopental dosage needed for efficient procedural sedation for pediatric MRI.

Physiological Responses to Passive Exercise in Adults Receiving Mechanical Ventilation

2013 ◽  
Vol 22 (4) ◽  
pp. 337-348 ◽  
Author(s):  
Christina Amidei ◽  
Mary Lou Sole
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Mechanical Ventilation ◽  
Oxygen Saturation ◽  
Interleukin 6 ◽  
Repeated Measures ◽  
Physiological Responses ◽  
Interleukin 10 ◽  
Mean Blood Pressure ◽  
Cytokine Levels

Background Critical illness may weaken muscles, with long-term consequences. Objective To assess physiological responses to an early standardized passive exercise protocol to prevent muscle weakness in adults receiving mechanical ventilation. Methods A quasi-experimental within-subjects repeated-measures design was used. Within 72 hours of intubation, 30 patients had 20 minutes of bilateral passive leg movement delivered by continuous-passive-motion machines at a standardized rate and flexion-extension. Heart rate, mean blood pressure, oxygen saturation, and cytokine levels were measured before, during, and after the intervention. The Behavioral Pain Scale was used to measure patients’ comfort. Repeated-measures analysis of variance was used to analyze the effect of the exercise on independent variables. Results Patients were mostly white men with a mean age of 56.5 years (SD, 16.9) with moderate mortality risk and illness severity. Heart rate, mean blood pressure, and oxygen saturation did not differ from baseline at any time measured. Pain scores were significantly reduced (F2.43,70.42 = 4.08; P = .02) 5 and 10 minutes after exercise started and remained reduced at the end of exercise and 1 hour later. Interleukin 6 levels were significantly reduced (F1.60,43.1 = 4.35; P = .03) at the end of exercise but not after the final rest period. Interleukin 10 levels did not differ significantly. Ratios of interleukin 6 to interleukin 10 decreased significantly (F1.61,43.38 = 3.42; P = .05) at the end of exercise and again after 60 minutes’ rest. Conclusion The exercise was well tolerated, and comfort improved during and after the intervention. Cytokine levels provided physiological rationale for benefits of early exercise.

PREGNANCY, POOR P/F RATIOS,PRONE VENTILATION: POSITIVE OUTCOMES IN COVID 19 INFECTION

2021 ◽  
pp. 58-59
Author(s):  
Rupali Battu ◽  
Jaspreet kaur ◽  
Ritu Baloda ◽  
Kumar Saurabh ◽  
Sahil Rohilla
Keyword(s):  
Mechanical Ventilation ◽  
Pregnant Woman ◽  
Severe Acute Respiratory Syndrome ◽  
Respiratory Distress ◽  
Oxygen Saturation ◽  
Reverse Transcription ◽  
Nasopharyngeal Swab ◽  
Positive Outcomes ◽  
Peripheral Oxygen Saturation ◽  
Reverse Transcription Pcr

A 22 year old pregnant woman was hospitalised with fever, cough, myalgia and dyspnoea at 12 weeks of gestation. Worsening respiratory distress and lack of improvement in peripheral oxygen saturation mandated the need for mechanical ventilation and ICU admission. A nasopharyngeal swab proved positive for severe acute respiratory syndrome coronavirus 2 by reverse transcription-PCR. In view of poor P/F ratios patient was ventilated intermittently in prone position for approximately 14-16 hours/day. With this strategy, patient was ventilated for 5 days and successfully extubated. Regular foetal assessments revealed that the fetus was unharmed by the intervention. Thus, we recommend timely prone ventilation in pregnant patients with severe covid 19 infection for better outcomes

Sign in / Sign up

Export Citation Format

Share Document