Background

Lung ultrasound (LUS) is becoming an important point-of-care technique in intensive care units. Several semi-quantitative lung ultrasound scores, based on simple LUS signs are available and are used to describe lung aeration and guide respiratory care and interventions. There are currently few data on the relationship between lung mechanics and LUS scores.

Objectives

We aimed to study this relationship to gain an understanding of when a semi-quantitative evaluation of lung aeration may be reliable and useful in clinical practice.

Methods

This is a prospective observational cohort study enrolling NICU-admitted neonates subdivided into three groups:preterm babies with RDS needing intubation and surfactant administration (restrictive pattern group);preterm neonates with developing BPD needing invasive ventilation (mixed pattern group);neonates with no lung disease(control group).LUS was performed by a skilled ultrasonographer and a LUS score was calculated as previously published before surfactant administration, if any.Within 30’ from the LUS examination,respiratory mechanics were evaluated by measuring dynamic compliance(Cdyn) and resistances(Raw).

Results

Sixteen,eleven and eighteen neonates were enrolled in the restrictive,mixed and control groups,respectively.There is a highly significant correlation between LUS and Cdyn for the restrictive pattern group(r= -0.6; p=0.016),but not for either of the other two groups(mixed: r= -0.39; p=0.228; control: r= -0.37; p=0.130).There is no correlation between LUS and Raw for any of the groups(restrictive:r= 0.2; p=0.635; mixed:r= -0.28; p=0.594; control:r= 0.21; p=0.653).

Conclusion

There is an inverse and significant correlation between Cdyn and LUS scores exclusively for patients with a restrictive pattern.The LUS score may be better adapted to evaluate lung mechanics and aeration in restrictive respiratory failure.

Background

It is not yet consensual whether parents should accompany their child during interfacility transport and during primary transport to the hospital. However new guidelines have been recently published for neonatal transport encouraging this policy.

Our emergency transport team has accepted to ride with parents in our ambulances for more than ten years, with various results.

Objectives

The aim of this study was to assess the perception of this policy by the members of our team.

Methods

An anonymous survey was sent via an internet link to all driving, nursing and medical staff. Through 4 closed questions, they were asked to assess their perception of parental presence during retrieval. They could also underline the potential advantages and challenges of such policy.

Results

Thirty members (out of 31) of the team answered the survey. Parental presence during retrieval was perceived as “an opportunity” to ease the retrieval for 50% of the staff, compared to 3% considering parental presence as a “burden”. Twenty five percent thought that parental presence had “no influence”.

The most dreadful event (among 7 proposals) which may occur during the ride was an inappropriate parental behavior. The staff's expectation was that parents reassure their child during transfer.

Conclusion

As both medical, nursing and driving staff are ready to allow parental presence during retrieval, it should be included in the routine policy. A further study is needed to check if it doesn’t increase risks during retrieval.

Background

Parental presence during critical care was a major concern a few years ago. The problem is now solved, but there is little evidence about it during interfacility transport and primary intervention.

Objectives

We decided to conduct a study to assess and understand our current policy.

Methods

The prospective monocentric study was conducted from April 2018 to October 2018. Nursing staff was asked to state and rate the parents’ presence during retrieval by means of a standardized questionnaire. We used one answer only questions from a larger survey: “Have you transported one of the parents?” They had to choose one answer out of four: Yes, on their request, Yes on our demand, No they declined, No it wasn’t an option.

Results

Staff questionnaire was returned for 333/709 of the retrievals (47% response rate)

There was a major difference between neonates and older children accompaniment.

Forty percent of the newborns’ parents and 12% of the older children’s parents were not even asked to come with the ambulance. Respectively 17% and 77% of the parents accompanied the ride but 80% and 20% of those who were asked to accompany declined the proposal.

Conclusion

The difference of parental presence during neotate’s or older children’s retrieval is a concern even if the mother’s absence could be partially explained by the fact they needed medical attention after birth. It could be interesting to perform the same type of study in different countries in order to have the advice of caregivers.