Physiologic Effects of 3 Different Neonatal Volume-Targeted Ventilation Modes in Surfactant-Deficient Juvenile Rabbits.

Background: Different brands of volume-targeted modes may vary the location of tidal volume (V) monitoring and whether peak inspiratory pressure is adjusted based on inspiratory, expiratory or leak-compensated V. These variables may result in different levels of support provided to patients, especially when an endotracheal tube (ETT) leak is present. We hypothesized that there would be no differences in gas exchange, triggering, or work of breathing between volume-targeted modes of 3 different brands of equipment in a surfactant-deficient, spontaneously breathing animal model with and without an ETT leak.

Bronchodilator delivery during simulated pediatric noninvasive ventilation.

Background: Noninvasive ventilation (NIV) is usually applied using bi-level positive airway pressure devices, and many of these devices use a single-limb patient circuit with an integrated leak port to purge the circuit of exhaled carbon dioxide. Sometimes bronchodilator therapy is indicated in pediatric patients, but there have been no studies of the optimal nebulizer position, with respect to leak, during pediatric NIV. We hypothesized that there would be no differences in albuterol delivery with a vibrating-mesh nebulizer between 3 different positions/exhalation leak valve combinations in the patient circuit during simulated pediatric NIV.

Use of a lung model to assess mechanical in-exsufflator therapy in infants with tracheostomy.

Background: The mechanical in-exsufflator (MIE) is commonly used to augment cough in patients with neuromuscular disease from infancy to adulthood. Little is known about the alveolar pressures, lung volumes, and expiratory flow rates generated by the MIE when used via tracheostomy tube in infants and children.

Methods: A high-fidelity mechanical lung model was programmed to simulate infants with tracheostomy tubes.

Therapeutic bilateral lung lavage in a child with pulmonary alveolar proteinosis.

Objective: Pulmonary alveolar proteinosis is a rare condition that can cause life-threatening respiratory failure attributable to excessive alveolar accumulation of surfactant proteins. The standard treatment for removing these secretions is through therapeutic bilateral lung lavage. Descriptions of procedures for performing therapeutic bilateral lung lavage and methods used to evaluate the overall effectiveness of this invasive procedure in children with pulmonary alveolar proteinosis have not been adequately described in the medical literature.

The impact of imposed expiratory resistance in neonatal mechanical ventilation: a laboratory evaluation.

Background: Small endotracheal tubes (ETTs) and neonatal ventilators can impact gas exchange, work of breathing, and lung-mechanics measurements in infants, by increasing the expiratory resistance (R(E)) to gas flow.

Methods: We tested two each of the Babylog 8000plus, Avea, Carestation, and Servo-i ventilators. In the first phase of the study we evaluated (1) the imposed R(E) of an ETT and ventilator system during simulated passive breathing at various tidal volume (V(T)), positive end-expiratory pressure (PEEP), and frequency settings, and (2) the intrinsic PEEP at various ventilator settings.

The conversion to metered-dose inhaler with valved holding chamber to administer inhaled albuterol: a pediatric hospital experience.

Background: Metered-dose inhalers with valved holding chambers (MDI-VHCs) have been shown to be equivalent to small-volume nebulizers (SVNs) for the delivery of bronchodilators in children. At Seattle Children's Hospital and Regional Medical Center we sought to implement the conversion from SVN to MDI-delivered albuterol in nonintubated patients receiving intermittent treatments.

Methods: There were 4 distinct interventions used to plan and implement this conversion program: (1) literature review, (2) product selection, (3) policy and operational changes, and (4) staff training.

Neonatal and pediatric pulse oximetry.

The pulse oximeter has become a vital instrument in the care of infants and children with cardiopulmonary disease. Recent advances in pulse oximetry technology have improved some aspects of pulse oximeter performance. However, the reliability, accuracy, and clinical utility of pulse oximetry remain problematic in some types of patients under certain conditions.

A survey of albuterol administration practices in intubated patients in the neonatal intensive care unit.

Introduction: Aerosolized albuterol is commonly used in the treatment of neonatal respiratory illnesses. Clinical and in vitro studies have identified numerous factors that affect aerosol drug delivery during neonatal mechanical ventilation, including the choice of metered-dose inhaler (MDI) or nebulizer, the use of a holding chamber, time between actuations, the volume of nebulized solution, and the position and placement of the nebulizer or MDI. Because there is no consensus on the optimal method of administration, there is probably substantial variability among institutions in how aerosolized albuterol is administered to mechanically ventilated infants in the neonatal intensive care unit (NICU).