Adding Continuous Vital Sign Information to Static Clinical Data Improves the Prediction of Length of Stay After Intubation: A Data-Driven Machine Learning Approach.

Background: Bedside monitors in the ICU routinely measure and collect patients' physiologic data in real time to continuously assess the health status of patients who are critically ill. With the advent of increased computational power and the ability to store and rapidly process big data sets in recent years, these physiologic data show promise in identifying specific outcomes and/or events during patients' ICU hospitalization.

Methods: We introduced a methodology designed to automatically extract information from continuous-in-time vital sign data collected from bedside monitors to predict if a patient will experience a prolonged stay (length of stay) on mechanical ventilation, defined as >4 d, in a pediatric ICU.

Distribution of Ventilation Measured by Electrical Impedance Tomography in Critically Ill Children.

Background: Electrical impedance tomography (EIT) is a noninvasive, portable lung imaging technique that provides functional distribution of ventilation. We aimed to describe the relationship between the distribution of ventilation by mode of ventilation and level of oxygenation impairment in children who are critically ill. We also aimed to describe the safety of EIT application.

Noninvasive Ventilation Is Interrupted Frequently and Mostly Used at Night in the Pediatric Intensive Care Unit.

Background: Noninvasive ventilation (NIV) is commonly used to support children with respiratory failure, but detailed patterns of real-world use are lacking. The aim of our study was to describe use patterns of NIV via electronic medical record (EMR) data.

Methods: We performed a retrospective electronic chart review in a tertiary care pediatric ICU in the United States.

Empirical Probability of Positive Response to PEEP Changes and Mechanical Ventilation Factors Associated With Improved Oxygenation During Pediatric Ventilation.

Background: PEEP is titrated to improve oxygenation during mechanical ventilation. It is clinically desirable to identify factors that are associated with a clinical improvement or deterioration following a PEEP change. However, these factors have not been adequately described in the literature.

Equilibration Time Required for Respiratory System Compliance and Oxygenation Response Following Changes in Positive End-Expiratory Pressure in Mechanically Ventilated Children.

Objectives: Increases in positive end-expiratory pressure are implemented to improve oxygenation through the recruitment and stabilization of collapsed alveoli. However, the time it takes for a positive end-expiratory pressure change to have maximum effect upon oxygenation and pulmonary compliance has not been adequately described in children. Therefore, we sought to quantify the time required for oxygenation and pulmonary system compliance changes in children requiring mechanical ventilation.

Daily Goals Formulation and Enhanced Visualization of Mechanical Ventilation Variance Improves Mechanical Ventilation Score.

Background: The systematic implementation of evidence-based practice through the use of guidelines, checklists, and protocols mitigates the risks associated with mechanical ventilation, yet variation in practice remains prevalent. Recent advances in software and hardware have allowed for the development and deployment of an enhanced visualization tool that identifies mechanical ventilation goal variance. Our aim was to assess the utility of daily goal establishment and a computer-aided visualization of variance.

Categorization in Mechanically Ventilated Pediatric Subjects: A Proposed Method to Improve Quality.

Background: Thousands of children require mechanical ventilation each year. Although mechanical ventilation is lifesaving, it is also associated with adverse events if not properly managed. The systematic implementation of evidence-based practice through the use of guidelines and protocols has been shown to mitigate risk, yet variation in care remains prevalent.

The effects of lung recruitment maneuvers on exhaled breath condensate pH.

Exhaled breath condensate (EBC) pH serves as a surrogate marker of airway lining fluid (ALF) pH and can be used to evaluate airway acidification (AA). AA is known to be present in acute respiratory distress syndrome (ARDS) and can be evaluated via continuous EBC pH measurement during mechanical ventilation. Lung recruitment maneuvers (LRMs) are utilized in the treatment of ARDS, however, their impact on EBC pH has never been explored.

High-Frequency Oscillatory Ventilation in Pediatric Acute Lung Injury: A Multicenter International Experience.

Objective: We aim to describe current clinical practice, the past decade of experience and factors related to improved outcomes for pediatric patients receiving high-frequency oscillatory ventilation. We have also modeled predictive factors that could help stratify mortality risk and guide future high-frequency oscillatory ventilation practice.

Design: Multicenter retrospective, observational questionnaire study.

Mechanical ventilation guided by electrical impedance tomography in experimental acute lung injury.

Objective: To utilize real-time electrical impedance tomography to guide lung protective ventilation in an animal model of acute respiratory distress syndrome.

Design: Prospective animal study.

Setting: Animal research center.

Interaction of dependent and non-dependent regions of the acutely injured lung during a stepwise recruitment manoeuvre.

The benefit of treating acute lung injury with recruitment manoeuvres is controversial. An impediment to settling this debate is the difficulty in visualizing how distinct lung regions respond to the manoeuvre. Here, regional lung mechanics were studied by electrical impedance tomography (EIT) during a stepwise recruitment manoeuvre in a porcine model with acute lung injury.

Comparison of 2 lung recruitment strategies in children with acute lung injury.

Background: Lung recruitment maneuvers are frequently used in the treatment of children with lung injury. Here we describe a pilot study to compare the acute effects of 2 commonly used lung recruitment maneuvers on lung volume, gas exchange, and hemodynamic profiles in children with acute lung injury.

Methods: In a prospective, non-randomized, crossover pilot study, 10 intubated pediatric subjects with lung injury sequentially underwent: a period of observation; a sustained inflation (SI) maneuver of 40 cm H2O for 40 seconds and open-lung ventilation; a staircase recruitment strategy (SRS) (which utilized 5 cm H2O increments in airway pressure, from a starting plateau pressure of 30 cm H2O and PEEP of 15 cm H2O); a downwards PEEP titration; and a 1 hour period of observation with PEEP set 2 cm H2O above closing PEEP.

Reversal of dependent lung collapse predicts response to lung recruitment in children with early acute lung injury.

Objective: To describe the resolution of regional atelectasis and the development of regional lung overdistension during a lung-recruitment protocol in children with acute lung injury.

Design: Prospective interventional trial.

Setting: Pediatric intensive care unit.

Whither lung EIT: where are we, where do we want to go and what do we need to get there?

Breathing moves volumes of electrically insulating air into and out of the lungs, producing conductivity changes which can be seen by electrical impedance tomography (EIT). It has thus been apparent, since the early days of EIT research, that imaging of ventilation could become a key clinical application of EIT. In this paper, we review the current state and future prospects for lung EIT, by a synthesis of the presentations of the authors at the 'special lung sessions' of the annual biomedical EIT conferences in 2009-2011.

Isoflurane for life-threatening bronchospasm: a 15-year single-center experience.

Background: Children with severe bronchospasm requiring mechanical ventilation may become refractory to conventional therapy. In these critically ill patients, isoflurane is an inhaled anesthetic agent available in some centers to treat bronchospasm. We hypothesized that isoflurane is safe and would lead to improved gas exchange in children with life-threatening bronchospasm refractory to conventional therapy.

A unified approach for EIT imaging of regional overdistension and atelectasis in acute lung injury.

Patients with acute lung injury or acute respiratory distress syndrome (ALI/ARDS) are vulnerable to ventilator-induced lung injury. Although this syndrome affects the lung heterogeneously, mechanical ventilation is not guided by regional indicators of potential lung injury. We used electrical impedance tomography (EIT) to estimate the extent of regional lung overdistension and atelectasis during mechanical ventilation.

Quality of life of pediatric cardiac patients who previously required extracorporeal membrane oxygenation.

Objectives: We sought to assess quality of life of pediatric cardiac extracorporeal membrane oxygenation survivors. We hypothesized that these patients would have decreased quality of life when compared to that of a general U.S.

A spontaneous breathing trial with pressure support overestimates readiness for extubation in children.

Objective: To evaluate the performance of an extubation readiness test based on a spontaneous breathing trial using pressure support.

Design: Retrospective chart review.

Setting: Pediatric intensive care unit.

Pediatric respiratory diseases: 2011 update for the Rogers' Textbook of Pediatric Intensive Care.

Objectives: To review articles relevant to the field of pediatric respiratory disease that were published after the 2008 Rogers' Textbook of Pediatric Intensive Care.

Data Sources: The authors searched the PubMed database (http://www.ncbi.

Electrocardiographic guidance for the placement of gastric feeding tubes: a pediatric case series.

Background: The placement of nasal or oral gastric tubes is one of the most frequently performed procedures in critically ill children; tube malposition, particularly in the trachea, is an important complication. Neurally adjusted ventilatory assist (NAVA) ventilation (available only on the Servo-i ventilator, Maquet Critical Care, Solna, Sweden) requires a proprietary-design catheter (Maquet Critical Care, Solna, Sweden) with embedded electrodes that detect the electrical activity of the diaphragm (EA(di)). The EA(di) catheter has the potential benefit of confirming proper positioning of a gastric catheter, based on and the EA(di) waveforms.

Electrical activity of the diaphragm during extubation readiness testing in critically ill children.

Objectives: To investigate the electrical activity of the diaphragm during extubation readiness testing.

Design: Prospective observational trial.

Setting: A 29-bed medical-surgical pediatric intensive care unit.