Author Of 2 Presentations
A LOOK INTO TRACHEOSTOMY PRACTICE IN PAEDAITRIC CRITICAL CARE
Abstract
Background
Tracheostomy is commonly indicated in intensive care (ICU) patients requiring prolonged intubation. Adult ICU data demonstrates early tracheostomies (within 10 days post-intubation) can reduce mortality rate, duration of mechanical ventilation (MV) and length of stay (LOS).
Objectives
To review tracheostomy practice in a UK Paediatric Critical Care Unit (PCCU) and compare outcomes between early tracheostomy (ET) and late tracheostomy (LT) in mechanically ventilated patients.
Methods
Medical records of PCCU patients who underwent tracheostomies from 2014 to 2018 were reviewed. Indications for tracheostomies were identified. Patients were divided into ET group (tracheostomy by 10 days post-intubation), and LT group (beyond 10 days). Clinical parameters between ET and LT groups were analysed.
Results
Twenty eight patients were identified; 18 male (64%) and 10 female (36%), with a mean age of 4.3 years. Indications for tracheostomies included; organic airway pathology (42.8%), access for ventilator dependence (28.6%), and airway protection following traumatic/neurological insult (28.6%). The ET group consists of 10 patients (36%); the LT group 18 patients (64%). No mortality was recorded in either group 30 days post-tracheostomy. 50% of the ET group was successfully weaned off MV compared to 39% from the LT group. The median LOS of the ET group was 21 days versus 52 days for the LT group.
Conclusion
Early tracheostomy contributed to higher rates of successful weaning off mechanical ventilation and reduced length of stay in PCCU. It does not affect mortality rate. However, due to small sample size, the results should be interpreted with care.
AIRWAY PRESSURE RELEASE VENTILATION AS A RESCUE THERAPY IN PAEDIATRIC ARDS
Abstract
Background
Airway pressure release ventilation (APRV) is an inverse-ratio mode of ventilation which aims to maintain high mean airway pressures whilst minimising ventilator induced lung injury. APRV has been reported to be safe, well tolerated and in many cases improve haemodynamics.
Objectives
We aimed to identify if APRV has a role as a rescue therapy in paediatric ARDS to prevent escalation to HFOV.
Methods
Retrospective analysis of children with refractory hypoxaemia to conventional ventilation transitioned to APRV during period May 2014 - August 2018 at Nottingham Children’s Hospital, UK. Demographics, diagnosis, indication, PaO2/FiO2 (P/F ratio), mean duration of time on APRV, complications and outcomes were analysed.
Results
15 patients were identified; 4 were excluded. The mean age was 6.4 years (4 months – 17 years). On implementation of APRV, mean PaCO2 was 8.36 kPA and mean P/F ratio was 68, where a P/F ratio of <100 indicates severe ARDS. 72% of patients remained on APRV for <1 hour. One patient received nitric oxide whilst on APRV. Only 10% de-escalated from APRV due to improvement in clinical status. 63% escalated to HFOV or ECMO. No complications were reported.
Conclusion
Our results only identified one patient in our sample who improved when APRV was used as a rescue therapy. However, as there were no complications observed whilst utilising APRV, we suggest it is a safe mode of ventilation to trial in paediatric patients with severe ARDS.
Presenter of 1 Presentation
A LOOK INTO TRACHEOSTOMY PRACTICE IN PAEDAITRIC CRITICAL CARE
Abstract
Background
Tracheostomy is commonly indicated in intensive care (ICU) patients requiring prolonged intubation. Adult ICU data demonstrates early tracheostomies (within 10 days post-intubation) can reduce mortality rate, duration of mechanical ventilation (MV) and length of stay (LOS).
Objectives
To review tracheostomy practice in a UK Paediatric Critical Care Unit (PCCU) and compare outcomes between early tracheostomy (ET) and late tracheostomy (LT) in mechanically ventilated patients.
Methods
Medical records of PCCU patients who underwent tracheostomies from 2014 to 2018 were reviewed. Indications for tracheostomies were identified. Patients were divided into ET group (tracheostomy by 10 days post-intubation), and LT group (beyond 10 days). Clinical parameters between ET and LT groups were analysed.
Results
Twenty eight patients were identified; 18 male (64%) and 10 female (36%), with a mean age of 4.3 years. Indications for tracheostomies included; organic airway pathology (42.8%), access for ventilator dependence (28.6%), and airway protection following traumatic/neurological insult (28.6%). The ET group consists of 10 patients (36%); the LT group 18 patients (64%). No mortality was recorded in either group 30 days post-tracheostomy. 50% of the ET group was successfully weaned off MV compared to 39% from the LT group. The median LOS of the ET group was 21 days versus 52 days for the LT group.
Conclusion
Early tracheostomy contributed to higher rates of successful weaning off mechanical ventilation and reduced length of stay in PCCU. It does not affect mortality rate. However, due to small sample size, the results should be interpreted with care.