Current trends in paediatric and neonatal ventilatory care – a nationwide survey

Ålander, Merja; Peltoniemi, Outi; Saarela, Timo; Anttila, Eija; Pokka, Tytti; Kontiokari, Tero

doi:10.1111/j.1651-2227.2012.02830.x

Cited by 15 publications

(17 citation statements)

References 25 publications

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“…The time spent on the ventilator did not differ between the groups. Patients recovering from surgery and needing ventilatory support for only a short time formed the main part of the series, representing a typical PICU population . This is seen in the Kaplan–Meier curves, where nearly half of the patients were extubated within a few hours and the curves remain close together.…”

Section: Discussionmentioning

confidence: 99%

Neurally adjusted ventilatory assist (NAVA) in pediatric intensive care—A randomized controlled trial

Kallio

Peltoniemi

Anttila

et al. 2014

Pediatric Pulmonology

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Section: Discussionmentioning

confidence: 99%

Neurally adjusted ventilatory assist (NAVA) in pediatric intensive care—A randomized controlled trial

Kallio

Peltoniemi

Anttila

et al. 2014

Pediatric Pulmonology

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“…(2, 3) To alleviate these discomforts and facilitate gas exchange during mechanical ventilation, children and adults routinely receive sedatives and analgesics. (4, 5) However, routine administration of analgesics in premature infants receiving mechanical ventilation may be associated with harm. (6–11)…”

mentioning

confidence: 99%

Sedation, Analgesia, and Paralysis during Mechanical Ventilation of Premature Infants

Zimmerman

Smith

Benjamin

et al. 2017

The Journal of Pediatrics

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Objective To characterize administration of sedatives, analgesics, and paralytics in a large cohort of mechanically ventilated, premature infants. Study design Retrospective cohort study including all infants <1500 g birth weight and <32 weeks gestational age mechanically ventilated at 348 Pediatrix Medical Group neonatal intensive care units (NICU) from 1997–2012. The primary outcome is the proportion of mechanically ventilated days in which infants were administered drugs of interest. Multivariable logistic regression was used to evaluate the predictors of administration of drugs of interest. Results We identified 85,911 mechanically ventilated infants. Infants received a drug of interest (opioids, benzodiazepines, other sedatives, and paralytics) on 433,587/1,305,413 (33%) of mechanically ventilated infant-days. The administration of opioids increased during the study period from 5% of infant-days in 1997 to 32% in 2012. The administration of benzodiazepines increased during the study period from 5% of infant-days in 1997 to 24% in 2012. Use of paralytics and other drugs remained ≤1% throughout the study period. Predictors of drug administration included younger gestational age, small for gestational age status, male sex, major congenital anomaly, older postnatal age at intubation, exposure to high frequency ventilation, exposure to inotropes, more recent year of discharge, and NICU site. Conclusion Administration of opioids and benzodiazepines in mechanically ventilated premature infants increased over time. Because infant characteristics were unchanged, site-specific differences in practice likely explain our observations. Increased administration over time is concerning given limited evidence of benefit and potential for harm.

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“…Practices relating to infant positioning (supine vs. prone) or the ability to do kangaroo care during MV are also nurse or clinician dependent. Most importantly, the use of sedation during MV is so controversial that it has led to very changeable practices; some clinicians always provide opiates and/or sedatives to intubated patients, while others sometimes or never use it [14,15].…”

Section: Invasive Mechanical Ventilationmentioning

confidence: 99%

“…There are currently over 10 different MV modes available, including assist control (pressure or volume controlled), intermittent mandatory ventilation (with or without synchronization, with or without pressure support), HFOV (with or without volume control), high-frequency jet ventilation and neurally adjusted ventilatory assist (NAVA). Use of all these ventilators and modalities is rarely guided by patient disease or best evidence, but rather by availability, familiarity and personal preferences [11][12][13][14][15][16].…”

Section: Invasive Mechanical Ventilationmentioning

confidence: 99%

Respiratory Care Protocols in Neonatal Intensive Care

Shalish¹,

Anna²

2016

Respiratory Management of Newborns

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Neonatal respiratory care involves physicians with variable backgrounds treating multiple respiratory problems and populations with a number of invasive and noninvasive devices and strategies. Unfortunately, there is a lack of strong evidence to guide the most adequate management for several specific situations. Altogether, this complexity leads to significant practice variability that can affect patient and health care outcomes. Respiratory care protocols, guided by evidence and/or consensus, are an attractive solution to promote standardization of care and reduction of unnecessary practice variations. Indeed, despite the limited evidence supporting the use of respiratory protocols in neonates, a significant number of units have already developed and implemented them into clinical practice. Respiratory care protocols appear to promote evidence-based practices, discourage outdated approaches and ultimately improve patient safety.

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Current trends in paediatric and neonatal ventilatory care – a nationwide survey

Abstract: Most of the principles of lung-protective ventilation have been well accepted by clinicians. More attention should be paid to achieving normocapnia and normoxia and to the correct use of sedatives, especially in units that only occasionally provide paediatric ventilation.

Cited by 15 publications

References 25 publications

Neurally adjusted ventilatory assist (NAVA) in pediatric intensive care—A randomized controlled trial

Neurally adjusted ventilatory assist (NAVA) in pediatric intensive care—A randomized controlled trial

Sedation, Analgesia, and Paralysis during Mechanical Ventilation of Premature Infants

Respiratory Care Protocols in Neonatal Intensive Care

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