Publications by authors named "Andreas Schibler"

Renal chloride metabolism is currently poorly understood but may serve as both a diagnostic and a treatment approach for acute kidney injury. We investigated whether plasma chloride, ammonia and glutamine as well as urinary chloride, ammonium and glutamine concentrations may serve as markers for acute kidney injury in paediatric patients. We conducted a prospective observational trial in a tertiary care paediatric intensive care unit.

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  • - The study explored the effectiveness of nasal high-flow oxygen versus standard oxygen therapy during tubeless upper airway surgeries in children, to see if it could reduce the need for rescue oxygen interventions.
  • - Conducted in five Australian hospitals, the trial involved 581 procedures with children aged 0-16 years, and aimed to determine whether high-flow oxygen could maintain uninterrupted surgical anesthesia.
  • - Results from the trial, which included ten secondary outcomes like hypoxia events and was registered under a clinical trials registry, indicated a comprehensive assessment of safety and effectiveness.
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  • The study investigates the clinical use of nasal high-flow therapy for infants with bronchiolitis in Australian hospitals, focusing on the choice of initial oxygen therapy and the severity of the disease prior to treatment.
  • Among 235 infants, those receiving high-flow therapy showed more severe respiratory symptoms and a longer hospital stay (0.6 days), with a higher rate of transfers to intensive care compared to those on standard oxygen therapy.
  • The findings suggest that infants with greater disease severity are more likely to be treated with high-flow therapy, leading to more escalated care despite similar severity levels in both treatment groups.
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  • A pilot trial compared nasal high-flow (NHF) therapy with standard oxygen therapy (SOT) in children with acute respiratory failure to evaluate therapy escalation and hospital stay length.
  • The study used a decision tree model to analyze cost-effectiveness from a healthcare perspective, focusing on incremental costs per length of stay avoided across different patient types.
  • Results indicated NHF may be cost-effective for non-obstructive patients needing escalated care, but generally, it is unlikely to be more cost-effective than SOT for most other groups.
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Background: Hypoxaemia occurs in approximately 30% of children during anaesthesia for flexible bronchoscopy. High-flow nasal oxygen (HFNO) can prolong safe apnoea time and be used in children with abnormal airways. During flexible bronchoscopy, there is limited evidence if HFNO confers advantages over current standard practice in avoiding hypoxaemia.

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The NITric oxide during cardiopulmonary bypass (CPB) to improve Recovery in Infants with Congenital heart defects (NITRIC) trial, a 1320-patient, multicentre, randomised controlled trial, is aiming to improve survival free of ventilation after CPB by using nitric oxide delivered into the oxygenator of the CPB. To provide a statistical analysis plan before completion of patient recruitment and data monitoring. Final analyses for this study will adhere to this statistical analysis plan, which details all key pre-planned analyses.

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Objective: There is a need for evidence on the best sedative agents in children undergoing open heart surgery for congenital heart disease. This study aimed to evaluate the feasibility and safety of dexmedetomidine in this group compared with midazolam.

Design: Double blinded, pilot randomized controlled trial.

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  • This study investigated the oral RSV fusion protein inhibitor AK0529 for treating infant patients hospitalized with respiratory syncytial virus (RSV) infection, as current therapies are ineffective.
  • In a Phase 2 trial, infants were given AK0529 or a placebo, with no significant safety issues reported and promising results showing reduced viral load and respiratory symptoms with the higher dose of AK0529.
  • Overall, AK0529 was well-tolerated and indicated a potential for effective treatment in reducing RSV-related morbidity in young children.
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The placement of an endotracheal tube for children with acute or critical illness is a low-frequency and high-risk procedure, associated with high rates of first-attempt failure and adverse events, including hypoxaemia. To reduce the frequency of these adverse events, the provision of oxygen to the patient during the apnoeic phase of intubation has been proposed as a method to prolong the time available for the operator to insert the endotracheal tube, prior to the onset of hypoxaemia. However, there are limited data from randomised controlled trials to validate the efficacy of this technique in children.

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Background: Extracorporeal membrane oxygenation (ECMO) provides support for the pulmonary or cardiovascular function of children in whom the predicted mortality risk remains very high. The inevitable host inflammatory response and activation of the coagulation cascade due to the extracorporeal circuit contribute to additional morbidity and mortality in these patients. Mixing nitric oxide (NO) into the sweep gas of ECMO circuits may reduce the inflammatory and coagulation cascade activation during ECMO support.

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  • The study aims to compare the accuracy of quantitative EEG (QEEG) interpretations by pediatric ICU nurses against standard cEEG assessments by neurologists, focusing on seizure detection and its related confounding factors.
  • The study will be conducted at a single pediatric ICU, involving trained nurses who will evaluate QEEG while neurologists analyze cEEG, with ethical approval already granted for the research.
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Importance: Nasal high-flow oxygen therapy in infants with bronchiolitis and hypoxia has been shown to reduce the requirement to escalate care. The efficacy of high-flow oxygen therapy in children aged 1 to 4 years with acute hypoxemic respiratory failure without bronchiolitis is unknown.

Objective: To determine the effect of early high-flow oxygen therapy vs standard oxygen therapy in children with acute hypoxemic respiratory failure.

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Importance: Most children admitted to pediatric intensive care units (PICUs) receive intravenous fluids. A recent systematic review suggested mortality benefit in critically ill adults treated with balanced solutions compared with sodium chloride, 0.9% (saline).

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Objectives: To evaluate in a preplanned secondary analysis of our parent randomized controlled trial predictors of intensive care unit (ICU) admission in infants with bronchiolitis and analyze if these predictors are equally robust for children receiving high-flow or standard-oxygen.

Study Design: A secondary analysis of a multicenter, randomized trial of infants aged <12 months with bronchiolitis and an oxygen requirement was performed using admission and outcome data of all 1472 enrolled infants. The primary outcome was ICU admission.

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Objective: This review assesses the effect of apnoeic oxygenation during paediatric intubation on rates of hypoxaemia, successful intubation on the first attempt and other adverse events.

Data Sources: The databases searched included PubMed, Medline, CINAHL, EMBASE and The Cochrane Library. An electronic search for unpublished studies was also performed.

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Background: Intravenous fluid therapy represents the most common intervention critically ill patients are exposed to. Hyperchloremia and metabolic acidosis associated with 0.9% sodium chloride have been observed to lead to worse outcomes, including mortality.

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  • Acute kidney injury (AKI) is a significant health issue in critically ill children, with about 9.2% of pediatric ICU patients developing it according to KDIGO criteria.
  • The study found that the majority of AKI cases were classified as stage 1, and about 70.4% of affected patients recovered within 7 days.
  • Comparatively, the other AKI classification criteria (pRIFLE and pROCK) were less sensitive than KDIGO, and those meeting all three criteria experienced a high mortality rate of 35%.
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  • - The study aimed to evaluate the feasibility of a randomized controlled trial examining the effects of normal saline instillation (NSI) and recruitment maneuvers (RM) during endotracheal suction in mechanically ventilated children in a pediatric intensive care unit.
  • - Despite successfully meeting some feasibility criteria, the study faced challenges with eligibility and protocol adherence, leading to a low enrollment rate of 58 participants out of 818 eligible patients.
  • - Results indicated that while NSI may reduce the incidence of ventilator-associated pneumonia (VAP), this wasn't statistically significant, but it did improve oxygen saturation levels; RMs offered short-term benefits in lung volume and compliance but not in VAP incidence reduction.
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Continuous capnography has been recognised as an essential monitoring device in all anesthetized patients, despite which airway device is in use, regardless of their location, as a measure to improve patient safety. Capnography is the non-invasive measurement of a sample of the exhaled carbon dioxide which has multiple clinical uses including as a method to confirm placement of a tracheal tube and/or to assess ventilation, perfusion and metabolism. Notably, capnography is used during routine paediatric anesthesia to assess ventilation and as a surrogate measure for arterial carbon dioxide pressure.

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  • High-flow oxygen therapy is being increasingly used for children with acute hypoxaemic respiratory failure (AHRF), but evidence on its effectiveness is limited; this study aimed to evaluate its feasibility compared to standard oxygen therapy.
  • In a pilot study involving 563 children aged 0-16, those receiving high-flow oxygen had a lower treatment failure rate (11.7%) compared to standard oxygen (18.1%), particularly in those with obstructive airway disease.
  • Despite no significant differences in ICU admissions or hospital stay duration, the findings suggest that high-flow oxygen is a viable option for treating AHRF in children outside of the ICU, paving the way for larger trials.
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