European journal of pediatrics
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Randomized Controlled Trial
Effect of metronome guidance on infant cardiopulmonary resuscitation.
This study was conducted to investigate the effect of metronome guidance on the performance of infant cardiopulmonary resuscitation (CPR). A total of 36 medical doctors conducted a 2-min single rescuer CPR with the two-finger technique (TFT) or two-thumb encircling hands technique (TT) on an infant manikin without metronome guidance (baseline test). After completing the baseline test, the participants were assigned to either a "guidance group" or "non-guidance group." The guidance group performed CPR with a high-pitched sound at 110 beats/min from a metronome (test 2), while the non-guidance group performed 2-min CPR without metronome guidance (test 1). ⋯ Conclusion: Metronome guidance improves the adequacy of chest compression rate during infant CPR without affecting chest compression depth in both the TFT and TT. Trial registration: Clinical Research Information Service, KCT0002735 What is Known: • The rate of chest compressions can be optimized by the use of metronome guidance in pediatric cardiopulmonary resuscitation (CPR). • An adverse effect of deteriorating chest compression depth was found while using a metronome guidance during adult CPR simulations. What is New: • The metronome guidance improved the adequacy of the chest compression rate during infant CPR without affecting other parameters including average depth and the ratio of adequate depth in both the two-finger chest compression technique and two-thumb encircling hand technique.
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Randomized Controlled Trial Observational Study
Comparison of blind intubation with different supraglottic airway devices by inexperienced physicians in several airway scenarios: a manikin study.
Endotracheal intubation is the gold standard for airway management. Supraglottic airway devices (SADs) are useful in airway abnormalities. SAD blind intubation enables airway management with better ventilation and a reduced risk of gastric content aspiration. ⋯ Conclusion: Our manikin study demonstrated that iGEL was the most effective device for blind intubation by inexperienced physicians in different pediatric airway scenarios. What is Known: • For pediatric resuscitation, bag-mask ventilation is the first-line method for airway control and ventilation. • Endotracheal intubation is considered by many scientific societies the gold standard for airway management. • Supraglottic airway devices are particularly useful when bag-mask ventilation is difficult or impossible but can be also used for blind intubation. What is New: • The iGEL laryngeal mask turns out the most effective device for blind intubation by inexperienced physicians in different pediatric airway scenarios. • It may be a reasonable first emergency blind intubation technique for inexperienced physicians in pediatric patients in normal airway with and without continuous chest compressions, as well as in difficult airway with continuous chest compressions.
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Situation awareness (SA) is an important human factor and necessary for effective teamwork and patient safety. Human patient simulation (HPS) with video feedback allows for a safe environment where health care professionals can develop both technical and teamwork skills. It is, however, very difficult to observe and measure SA directly. ⋯ However, the assessment of pediatric team performance in these clinical situations has been traditionally difficult. • The Situation Awareness Global Assessment Technique (SAGAT) is a method of objectively and directly measuring SA during a team simulation using "freezes" at predetermined points in time with participants reporting on "what is going on" from their perspective on the situation. What is new? • We assessed SA, and its relationship with team effectiveness, in multidisciplinary pediatric teams performing simulated critical events in critically ill children on the medical ward using the SAGAT model, outside the emergency room setting. • In all three scenarios, consensus on the primary problem (shared mental model) leads to faster achievement of predefined goals. Consensus on leadership was overall low, without a significant impact on goal achievement.
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Randomized Controlled Trial
Relaxation-guided imagery reduces perioperative anxiety and pain in children: a randomized study.
Several studies have shown the efficacy of psychological interventions in reducing preoperative anxiety in children undergoing surgery. This study aims to investigate the effectiveness of a specific non-pharmacological technique, the relaxation-guided imagery, in reducing both preoperative anxiety and postoperative pain in a sample of 60 children (6-12 years old) undergoing minor surgery who were randomly assigned to the experimental group (N = 30) or the control group (N = 30). The first group received the relaxation-guided imagery, before the induction of general anesthesia; the second group received standard care. ⋯ Future studies should focus on developing protocols and studying the eventual reduction of administered drugs for anesthesia and pain. What is Known: • Literature suggests the usefulness of relaxation-guided imagery in reducing anxiety and pain in the perioperative period. • Stronger evidences are needed to support the application of relaxation-guided imagery as routine care in pediatric surgery. What is New: • To our knowledge, this is the first randomized study to investigate the efficacy of relaxation-guided imagery in reducing preoperative anxiety and postoperative pain within a single pediatric sample. • The present study provides stronger evidence in an area that is lacking in research.
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Lung auscultation is an important part of a physical examination. However, its biggest drawback is its subjectivity. The results depend on the experience and ability of the doctor to perceive and distinguish pathologies in sounds heard via a stethoscope. ⋯ What is Known: • Auscultation performance of average physician is very low. AI solutions presented in scientific literature are based on small data bases with isolated pathological sounds (which are far from real recordings) and mainly on leave-one-out validation method thus they are not reliable. What is New: • AI learning process was based on thousands of signals from real patients and a reliable description of recordings was based on multiple validation by physicians and acoustician resulting in practical and statistical prove of AI high performance.