Aims & Objectives

Randomized non-inferiority trial between High Flow Oxygen Nasal Canula (HFNC) and Continuous Positive Airway Pressure (CPAP) in children with hypoxic respiratory failure. Primary objective was to assess improvement in oxygenation in first 24 hours, while intubation rates, ventilator days, mortality were the secondary objectives.

Methods

266 children (one month till 18-years age) with acute hypoxemic respiratory failure (PaO₂/FiO₂ ratio < 300 or SpO₂/FiO₂ ratio <260) of any cause, were randomized into CPAP (n=132) and HFNC (n = 134 ) groups.

Results

Oxygenation (PF Ratio) improved significantly in 24 hours within HFNC group (p value < 0.001) and CPAP group (p value < 0.001). Efficacy of improvement of oxygenation was similar in HFNC and CPAP groups (p=0.61). Mortality rates were similar in both groups (p value 0.39). Intubation rate and mean sedation dose were higher in CPAP group (p value 0.046 , p value <0.01 respectively). PICU stay, ventilator-days and 28-days ventilator-free days were similar in both groups. 9 children in CPAP group sustained facial pressure-sores while none in HFNC group. In subgroup of children with ARDS, Asthma and Bronchiolitis, HFNC and CPAP, achieved significant (p<0.005) improvement in oxygenation, while intubation rates, PICU stay, ventilator-days and 28 days ventilator-free days were similar in HFNC or CPAP groups amongst the three subgroups.

Conclusions

HFNC needs less complicated setup and skills compared to CPAP. We found HFNC a useful alternative to CPAP for respiratory support of children with hypoxic respiratory failure of any cause. This is particularly important for resource limited situations.

Clinical Trial registry (ctri.nic.in) : CTRI/2018/04/013165

Aims & Objectives

To compare the effects of chest physiotherapy (CPT) with endotracheal suction on ventilation distribution and gas exchange in ventilated children.

Methods

Design: Secondary analysis of data collected within a prospective randomised controlled trial investigating the effect of recruitment manoeuvres on ventilated children following endotracheal suction. Setting and Participants: Participants included sixty children <16 years receiving care within a tertiary Paediatric Intensive Care Unit (PICU) and requiring mechanical ventilation. Intervention: Children receiving CPT for intensive airway clearance were compared to children receiving suction only. Outcome measures: Ventilation distribution and gas exchange measures.

Results

Ventilation distribution and end expiratory lung volume (EELV) were measured using electrical impedance tomography (EIT) in sixty children.

Seventeen participants (28%) received CPT (28.7 ± 49.3 months) and forty-three participants (72%) received no CPT (47.8 ± 55.8 months) (p=0.22). Gas exchange (arterial blood gases and oxygen saturation) and physiological variables (heart rate and respiratory rate) were also recorded. In the CPT group, there was a significantly higher EELV (p<0.001) and global inhomogeneity index (p=0.017) indicating more ventilation inhomogeneity, and lower geometric centre (p=0.005) reflecting a relatively more posterior (dependent) centre of ventilation. There were no differences in amplitude, gas exchange or physiological measures between the CPT and no CPT groups (p>0.05).

Conclusions

EIT can detect regional changes in ventilation distribution following CPT in ventilated children making it a potential clinical tool to measure effects of CPT. Changes suggestive of improved ventilation distribution were demonstrated in the CPT group.

Aims & Objectives

High-flow oxygen-therapy is increasingly used in children with acute hypoxic respiratory failure (AHRF), despite limited high-quality evidence of efficacy outside intensive care units.

Methods

An open labelled RCT feasibility design was used in emergency departments and general wards of two tertiary children’s hospitals. Over a period of 1-year, children aged 0-16 years with AHRF were randomised (1:1) to either high-flow or standard-oxygen. Children on the standard-oxygen could receive rescue high-flow in the general wards if their conditions met treatment failure criteria. The primary efficiency-endpoints were feasibility, recruitment rates and safety followed by the efficacy-endpoints measuring the proportion escalation of care. We measured the duration of hospital stay, duration of oxygen therapy and rates of ICU admission.

Results

Of 563 randomised, 283 received high-flow and 280 standard-oxygen with no adverse events. The proportion of children receiving escalation of care was 11.7% (32/283 children) on the high-flow and 18.1% (50/280 infants) on standard-oxygen (risk difference -6.4 percentage points; 95% CI -12.4%, -0.5%; p=0.04). In children with obstructive airway disease 9.7% on high-flow and 17.4% on standard-oxygen required escalation (risk difference -7.7% percentage points; 95% CI -14.3%, -1.1%; p=0.03), whereas in children with non-obstructive disease no difference was observed. No difference in length of hospital stay was observed. 60% of children who failed standard-oxygen responded to rescue high-flow.

Conclusions

High-flow outside ICU appears to be safe in children with AHRF and the required proportion of escalation was lower compared to standard-oxygen. The trial design can be applied in a future large RCT.

Aims & Objectives

AIMS AND OBJECTIVES: Ventilator-associated pneumonia increases hospital stay time, cost, morbidity and mortality in PICU and is directly related to care protocols.

Preventive practice bundle have been shown to reduce the incidence rates of VAP.

Our objective was to know the relationship between the implementation and monitoring of the ventilator bundle and the incidence of ventilator associated pneumonia in the area of ​​pediatric intensive care.

Methods

METHODOLOGY.

Observational, descriptive, prospective, longitudinal study, which included a reference sample of 280 patients, from 1 month to 18 years of age, hospitalized in the PICU and under mechanical ventilation for more than 48 hours.

The medical staff of the PICU were trained to implement the actions of the PREVENT-NAVV (Practice hand washing-Remember to use protective barriers-Elevate head to 30º-Vigilance condensation of the MV circuit-Exhaustive oral hygiene and avoid bronchial lavage, Nebulize wisely, deep vein Thrombosis profilaxis -Nutrition-Antiacids-sedation Vacations-Value extubation daily) bundle in the course of their care work.

The annual NAV rate was reduced from 6.6 to 3.2 / 1000 days of ventilation (P = 0.05).

Results

The annual NAV rate was reduced from 6.6 to 3.2 / 1000 days of ventilation (P = 0.05).

Conclusions

CONCLUSIONS: PREVENT-NAVV was created from articles made in adult patients with little evidence in the pediatric population. The decision to integrate them into the bundle was taken considering that their practice did not imply an additional risk for the patient. Therefore, the PREVENT- NAVV is a bundle that has decreased the annual incidence rate of the VAP.