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Paediatric Respiratory Support: Clinical Update

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A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Emergency Medicine".

Deadline for manuscript submissions: closed (15 May 2022) | Viewed by 6539

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Special Issue Editor

Dr. Alberto Medina

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Guest Editor

Department of PICU, University of Oviedo, Oviedo, Spain
Interests: mechanical power; high frequency ventilation; high flow nasal canulae; non-invasive ventilation; children; weaning; spO2/FiO2 ratio; hypoxaemia; hypoxic pulmonary vasoconstriction reflex; acute respiratory distress syndrome (ARDS); asthma

Special Issue Information

Dear Colleagues,

Some of the most important topics in the paediatric intensive care currently are (1) the ventilatory support and (2) the best way to monitor the respiratory status of the patient. Recently new technolgies and strategies have expanded around the world and some of them without robust evidence based on randomised control trials. Even more, the economical impact of some of these different technologies involved in the respiratory support is considerable. The aim of this clinical update is to provide a updated overview of the most important topics regarding the respiratory support and monitoring in critically ill paediatric patients.

The most important topics which will be included in this issue are:

The bedside use of the spO2/FiO2 ratio.
The importance of hypoxia and its management in a clinical situation.
HFNC in paediatrics. Evidence and economical analysis.
Ventilatory support in low income countries. What is the best choice?
NIV-an overview in paediatrics
MV in ARDS paediatric patients.
MV in obstructive patients. A physiological approach .
HFV in paediatrics. Evidence and economical analysis.
ELSO in paediatrics. Evidence and economical analysis.
Mechanical power in paeditrics.
New monitoring technologies in paediatrics: volumetric capnography, Electrical impedance tomography, etc.
Taxonomy of the ventilatory modes applied to neonatal and paediatric ventilators
New modes in neonatal and paediatric (NAVA, PAV, HFOV + VG, etc): are they really cost-effective?

Dr. Alberto Medina
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

mechanical power
high frequency ventilation
high flow nasal canulae
non-invasive ventilation
children
weaning
spO2/FiO2 ratio
hypoxaemia
hypoxic pulmonary vasoconstriction reflex
acute respiratory distress syndrome (ARDS)
asthma

Published Papers (3 papers)

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Research

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14 pages, 1907 KiB

Open AccessArticle

Changes in Ventilation Practices for Bronchiolitis in the Hospital Ward and Need for ICU Transfer over the Last Decade

by Ruth Solana-Gracia, Vicent Modesto i Alapont, Leticia Bueso-Inchausti, María Luna-Arana, Ariadna Möller-Díez, Alberto Medina and Begoña Pérez-Moneo

J. Clin. Med. 2022, 11(6), 1622; https://doi.org/10.3390/jcm11061622 - 15 Mar 2022

Cited by 5 | Viewed by 1592

Abstract

There is limited evidence of the potential benefits of the use of high-flow nasal cannula (HFNC) for the management of bronchiolitis in the ward. Our aim is to describe the ventilation trends for bronchiolitis in our hospital along with the introduction of an HFNC ward protocol and to determine the need for respiratory support escalation and transfer to an intensive care unit (ICU). A retrospective analytical observational study of children < 12 months old requiring admission for a first RSV bronchiolitis episode in a single centre from January 2009 to December 2018. The sample was divided into four groups according to the type of respiratory support that would ensure the clinical stability of the infants on admission. A total of 502 infants were recruited. The total number and percentage of patients admitted in the ward grew progressively over time. Simultaneously, there was an increase in HFNC and, paradoxically, an increase in ICU transfers. The risk of failure was higher for those who required HFNC or CPAP for clinical stabilisation in the first 12 h after admission. Moreover, the risk of failure was also higher in children with standard oxygen therapy promptly escalated to HFNC, especially if they had atelectasis/viral pneumonia, coinfections or a history of prematurity. Despite the limitations of a retrospective analysis, our study reflects usual clinical practice and no correlation was found between the usage of HFNC and a shorter length of hospital stay or less time spent on oxygen therapy. Full article

(This article belongs to the Special Issue Paediatric Respiratory Support: Clinical Update)

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7 pages, 555 KiB

Open AccessArticle

Tidal Volume in Pediatric Ventilation: Do You Get What You See?

by Erik Koomen, Joppe Nijman, Ben Nieuwenstein and Teus Kappen

J. Clin. Med. 2022, 11(1), 98; https://doi.org/10.3390/jcm11010098 - 24 Dec 2021

Cited by 2 | Viewed by 3115

Abstract

Mechanical ventilators are increasingly evolving into computer-driven devices. These technical advancements have impact on clinical decisions in pediatric intensive care units (PICUs). A good understanding of the design of mechanical ventilators can improve clinical care. Tidal volume (TV) is one of the corner stones of ventilation: multiple technical factors influence the TV and, thus, influence clinical decision making. Ventilator manufacturers make various design choices regarding the phase, site and conditions of TV measurement as well as algorithmic processing choices. Such choice may impact the measurement and subsequent display of TV. A software change of the TV measuring algorithm of the SERVO-i^® (Getinge, Solna, Sweden) at the PICU of the University Medical Centre Utrecht was studied in a prospective cohort. It showed, as example, a clinically significant impact of 8% difference in reported TV. Design choices in both the hardware and software of mechanical ventilators can have a clinically relevant impact on the measurement of tidal volume. In our search for the optimal TV for lung-protective ventilation, such choices should be taken into account. Full article

(This article belongs to the Special Issue Paediatric Respiratory Support: Clinical Update)

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Review

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9 pages, 603 KiB

Open AccessReview

Neurally-Adjusted Ventilatory Assist (NAVA) versus Pneumatically Synchronized Ventilation Modes in Children Admitted to PICU

by Pravin Sugunan, Osama Hosheh, Mireia Garcia Cusco and Reinout Mildner

J. Clin. Med. 2021, 10(15), 3393; https://doi.org/10.3390/jcm10153393 - 30 Jul 2021

Cited by 2 | Viewed by 2315

Abstract

Traditionally, invasively ventilated children in the paediatric intensive care unit (PICU) are weaned using pneumatically-triggered ventilation modes with a fixed level of assist. The best weaning mode is currently not known. Neurally adjusted ventilatory assist (NAVA), a newer weaning mode, uses the electrical activity of the diaphragm (Edi) to synchronise ventilator support proportionally to the patient’s respiratory drive. We aimed to perform a systematic literature review to assess the effect of NAVA on clinical outcomes in invasively ventilated children with non-neonatal lung disease. Three studies (n = 285) were included for analysis. One randomised controlled trial (RCT) of all comers showed a significant reduction in PICU length of stay and sedative use. A cohort study of acute respiratory distress syndrome (ARDS) patients (n = 30) showed a significantly shorter duration of ventilation and improved sedation with the use of NAVA. A cohort study of children recovering from cardiac surgery (n = 75) showed significantly higher extubation success, shorter duration of ventilation and PICU length of stay, and a reduction in sedative use. Our systematic review presents weak evidence that NAVA may shorten the duration of ventilation and PICU length of stay, and reduce the requirement of sedatives. However, further RCTs are required to more fully assess the effect of NAVA on clinical outcomes and treatment costs in ventilated children. Full article

(This article belongs to the Special Issue Paediatric Respiratory Support: Clinical Update)

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