Publications by authors named "Jefta van Dijk"
Background: The underlying pathophysiological pathways how reverse triggering is being caused are not fully understood. Respiratory entrainment may be one of these mechanisms, but both terms are used interchangeably. We sought to characterize reverse triggering and the relationship with respiratory entrainment among mechanically ventilated children with and without acute lung injury.
View Article and Find Full Text PDFBackground: The patient's neuro-respiratory drive, measured as electrical activity of the diaphragm (EAdi), quantifies the mechanical load on the respiratory muscles. It correlates with respiratory effort but requires a dedicated esophageal catheter. Transcutaneous (surface) monitoring of respiratory muscle electromyographic (sEMG) signals may be considered a suitable alternative to EAdi because of its non-invasive character, with the additional benefit that it allows for simultaneously monitoring of other respiratory muscles.
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- The study investigates the effectiveness of two ventilation methods, pressure controlled assist/control (PC-A/C) and continuous spontaneous ventilation (CSV), in weaning children under 5 years from ventilators due to respiratory failure.
- Researchers measured patient effort using techniques like inspiratory work of breathing and pressure-rate-product in 36 children, finding no significant differences in effort between the two ventilation modes.
- A reduction in pressure support during ventilation did lead to a significant increase in patient effort, although the changes were clinically noticeable rather than statistically significant.
Article Synopsis
- The study aims to analyze practices for safely transitioning pediatric patients in respiratory failure from mechanical ventilation to independent breathing, using established evidence synthesis standards.
- Data was collected from multiple medical databases and trial registers, focusing on research articles in English that included diverse patient populations from infants to older children.
- Findings emphasize the importance of daily assessments, specifically spontaneous breathing trials, to determine if a patient is ready for extubation, suggesting that a structured approach can help shorten the duration of mechanical ventilation.
Background: Allowing the ventilated adult patient to breathe spontaneously may improve tidal volume (V) distribution toward the dependent lung regions, reduce shunt fraction, and decrease dead space. It has not been studied if these effects under various levels of ventilatory support also occur in children. We sought to explore the effect of level of ventilatory support on V distribution and end-expiratory lung volume (EELV) in spontaneously breathing ventilated children in the recovery phase of their acute respiratory failure.
View Article and Find Full Text PDFBackground: For years, paediatric critical care practitioners used the adult American European Consensus Conference (AECC) and revised Berlin Definition (BD) for acute respiratory distress syndrome (ARDS) to study the epidemiology of paediatric ARDS (PARDS). In 2015, the paediatric specific definition, Paediatric Acute Lung Injury Consensus Conference (PALICC) was developed. The use of non-invasive metrics of oxygenation to stratify disease severity were introduced in this definition, although this potentially may lead to a confounding effect of disease severity since it is more common to place indwelling arterial lines in sicker patients.
View Article and Find Full Text PDFBackground: Patient-ventilator asynchrony is associated with increased morbidity and mortality. A direct causative relationship between Patient-ventilator asynchrony and adverse clinical outcome have yet to be demonstrated. It is hypothesized that during trigger errors excessive pleural pressure swings are generated, contributing to increased work-of-breathing and self-inflicted lung injury.
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- The study investigates the relationship between mechanical energy (ME) delivered by ventilators and lung injury in mechanically ventilated children, focusing on how tidal volume normalized to body weight correlates with lung pathology.
- Researchers analyzed data from 312 pediatric patients, finding that ME, rather than mechanical power (MP), was more strongly associated with underlying lung conditions and the duration of ventilation.
- The results indicate that a significant portion of ventilator-generated energy is transferred to the lungs, influenced by factors like lung compliance and airway resistance.
Article Synopsis
- The study aimed to measure the "imposed work of breathing" in pediatric endotracheal tubes, comparing various sizes and configurations in a lab setting.
- Researchers used a model to simulate spontaneous breathing and examined different tidal volumes while calculating the work of breathing across different age groups from newborns to adolescents.
- Findings revealed that shorter endotracheal tubes reduced the work of breathing significantly, with the most noticeable effects in small children, while the presence of an intraluminal catheter increased the work of breathing across all age groups.
Article Synopsis
- Pediatric critical care practitioners often use pressure support (PS) to reduce the imposed work of breathing (WOBimp) during extubation readiness tests (ERT), but there's a lack of pediatric data on its necessity.
- A study with 112 ventilated children showed that WOBimp was significantly higher without PS (0.27 J/L) compared to with PS (0.00 J/L), indicating a notable difference in breathing effort.
- Despite measurable changes in breathing rate and other factors when PS was not used, these did not have a clinically relevant impact on patient comfort, suggesting that PS may not be essential during ERT regardless of endotracheal tube size.