European journal of pediatrics
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Randomized Controlled Trial
Tracheal intubation of pediatric manikins during ongoing chest compressions. Does Glidescope® videolaryngoscope improve pediatric residents' performance?
Our objective was to test the ability of pediatric residents to intubate the trachea of infant and child manikins during continuous chest compressions (CC) by means of indirect videolaryngoscopy with Glidescope® versus standard direct laryngoscopy. A randomized crossover simulation trial was designed. Twenty-three residents trained to intubate child and infant manikins were eligible for the study. They were asked to perform tracheal intubation in manikins assisted by both standard laryngoscopy and Glidescope® while a colleague delivered uninterrupted chest compressions. In the infant cardiac arrest scenario, the median (IQR) total time for intubation was significantly shorter with the Miller laryngoscope [28.2 s (20.4-34.4)] than with Glidescope® [38.0 s (25.3-50.5)] (p = 0.021). The number of participants who needed more than 30 s to intubate the manikin was also significantly higher with Glidescope® (n = 13) than with the Miller laryngoscope (n = 7, p = 0.01). In the child scenario, the total time for intubation and number of intubation failures were similar with Macintosh and Glidescope® laryngoscopes. The participants' subjective difficulty of the procedure was similar for direct and videolaryngoscopy. ⋯ In simulated infant and child cardiac arrest scenarios, pediatric residents are able to intubate the trachea during CC. The videolaryngoscope Glidescope® does not improve performance in this setting.
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Both disposable and non-disposable T-piece resuscitator (TPR) devices are used. Accuracy of the disposable and non-disposable infant TPR was compared. Peak inspiratory pressures (PIP) and positive end-expiratory pressures (PEEP) were measured during ventilation of a test lung. Measured PIP ±1 cmH2O and PEEP ±0.5 cmH2O of the desired pressures were considered acceptable. We tested the following: (A) Accuracy of setting pressures using built-in manometers of three disposable TPRs, (B) Minimal and maximal PIP and PEEP levels for the non-disposable and disposable TPR were measured using different gas flow rates, and (C) Accuracy of 25 caregivers setting pressures (PIP 25 cmH2O and PEEP 5 cmH2O). The results of the tests performed were as follows: (A) With pressures set: PIP 20, 25, 30, and 40 cmH2O and PEEP 5-8 cmH2O with 1 cmH2O stepwise increment, measured PIPs and PEEPs were in acceptable range. (B) At gas flow rates 5, 8, 10, and 15 L/min (disposable vs. non-disposable), min-max PIP were 4.0-43.2 vs. 2.9-77.1 cmH2O and min-max PEEP were 0.3-22.3 and 0.6-59.7 cmH2O. (C) Set PIP (cmH2O) by participants using disposable vs. non-disposable TPR was 25.8 (0.8) vs. 25.9 (1.3) (ns). PEEP was 5.4(0.5) vs. 4.7(0.5); p < 0.001. ⋯ The accuracy of the disposable TPR is comparable to that of the non-disposable TPR.
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The objective of the current study is to compare the use of a nasal continuous positive airway pressure (nCPAP) to a high-flow humidified nasal cannula (HFNC) in infants with acute bronchiolitis, who were admitted to a pediatric intensive care unit (PICU) during two consecutive seasons. We retrospectively reviewed the medical records of all infants admitted to a PICU at a tertiary care French hospital during the bronchiolitis seasons of 2010/11 and 2011/12. Infants admitted to the PICU, who required noninvasive respiratory support, were included. The first noninvasive respiratory support modality was nCPAP during the 2010/11 season, while HFNC was used during the 2011/2012 season. We compared the length of stay (LOS) in the PICU; the daily measure of PCO2 and pH; and the mean of the five higher values of heart rate (HR), respiratory rate (RR), FiO2, and SpO2 each day, during the first 5 days. Thirty-four children met the inclusion criteria: 19 during the first period (nCPAP group) and 15 during the second period (HFNC group). Parameters such as LOS in PICU and oxygenation were similar in the two groups. Oxygen weaning occurred during the same time for the two groups. There were no differences between the two groups for RR, HR, FiO2, and CO2 evolution. HFNC therapy failed in three patients, two of whom required invasive mechanical ventilation, versus one in the nCPAP group. ⋯ We did not find a difference between HFNC and nCPAP in the management of severe bronchiolitis in our PICU. Larger prospective studies are required to confirm these findings.
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Adenosine deaminase 2 (ADA2) deficiency due to CECR1 mutations is a recently defined disorder that involves systemic inflammation and vasculopathy often associated with polyarteritis nodosa. We report on a 5-year-old girl with a severe vasculopathy who carried two novel mutations in CECR1. ⋯ Identification of CECR1 mutations in patients with vasculopathy may lead to earlier diagnosis of ADA2 deficiency.