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Long-term outcomes after early anaesthesia - The effect of pharmacologic sedation on neurodevelopment
VIRAL FILTER PLACEMENT IN A BUBBLE CPAP CIRCUIT: A BENCHTOP STUDY OF SAFETY AND EFFICACY.
Abstract
Abstract Body
Introduction
COVID-19 in newborns is rare. Bubble CPAP (B-CPAP) is used in infants with possible viral disease. Health workers are at increased risk of COVID-19. B-CPAP with a viral filter may reduce this. Aim: To assess safety and efficacy of B-CPAP with an electrostatic viral filter (EVF).
Methods
A B-CPAP system was connected to a simulation lung via ‘Hudson’ prongs. Flow was set at 6 L/min and pressure 7 cmH2O. A neonatal EVF was placed on the CPAP probe (Cp), water inlet (Wi) and compared to a control (Nf) over 18 h (Figure 1). Each position was tested thrice. Mean pressure (P) was analyzed. Filter position ‘failure’ was defined as P>10 cmH20 for 60 min. At these points, the P (cmH2O) were compared by t-test.
Figure 1. a) Nf b) CP, c) Wi
Results
Mean failure point (min) and associated P are summarized in table 1. P for each filter position over time is expressed in figure 2
| Mean Failure Point (min) | P Cp Failure point (cmH2O) | P Wi Failure Point (cmH2O) | |
|---|---|---|---|
| Cp | 363.5 | 16.0 (3.0) * | 18.4 (1.3) * |
| Wi | 582.5 | 8.7 (2.5) | 9.2 (2.5) * |
| Nf | 5.0 (1.6) | 5.21 (1.2) |
mean (SD); *p<0.05 compared to Wi and Nf; n=3/group
Table1.
Figure 2. Mean (SD) pressure of filter positions over time
Conclusion
Viral filter placement in B-CPAP affects pressure delivery. A filter on the Cp should be avoided. The Wi may cautiously accommodate a viral filter but with pressure monitoring. Further testing of CPAP with a viral filter is required.
COMPLICATIONS RELATED TO INTERFACES IN CRITICALLY ILL CHILDREN WITH NON-INVASIVE VENTILATION
Abstract
Abstract Body
Background and aims: Non-invasive ventilation (NIV) has evolved with the appearance of new interfaces. The objective of this study is to compare its complications according to the different interfaces.
Methods: Retrospective, observational and single-center study with patients admitted to a Pediatric Intensive Care Unit under NIV in 2 periods (2014 and 2019). Demographic data, reason for admission, type of interfaces and complications have been collected.
Results: 143 patients (55.9% boys) with a median (interquartile range) of 7 months (2-46.2 months) were included. The most commonly used NIV mode was bilevel pressure (91.6%) with nasal cannulas in 72.7% of patients. In 2014, the endotracheal tube (ETT) at nasopharyngeal position was more used than in 2019 when it was replaced with total face mask (p <0.05). 15.4% of the patients had complications, with hypoventilation (venous PCO2> 60 mmHg) as the most frequent (6.3%). NIV failed in 32 patients (22.4%).
Nasal / oronasal masks showed an increased risk of skin sores (OR 16.375 95%CI 2.034-131.848) and hypoventilation (OR 9.071 95%CI 1.876-44.088). No statistical differences were found with the other interfaces. A higher percentage of NIV failure was observed in children with nasopharyngeal ETT (54,5% vs 19,7% p=0,017) and lower in those with nasal cannulas (16,5% vs 38,4% p=0,005).
Conclusions: NIV has a low percentage of complications, most of them non-severe ones. During this time, the nasopharyngeal ETT, with the highest percentage of NIV failure, has been replaced by total face masks. Nasal cannula has shown a lower percentage of complications and NIV failures.