Parents' perspective on recovery at home following adenotonsillectomy: a prospective single-centre qualitative analysis.

Purpose: In North America, pediatric adenotonsillectomy (TA) is conducted as an ambulatory procedure, thus shifting the burden of postoperative care to parents. The purpose of this study was to describe this parental experience.

Methods: We conducted a prospective single-centre qualitative study, recruiting the families of children (n = 317) undergoing elective TA in 2018.

Automated prediction of extubation success in extremely preterm infants: the APEX multicenter study.

Background: Extremely preterm infants are frequently subjected to mechanical ventilation. Current prediction tools of extubation success lacks accuracy.

Methods: Multicenter study including infants with birth weight ≤1250 g undergoing their first extubation attempt.

Validation of the parent's postoperative pain measure with an age-appropriate reference pain scale for children 2-12 years old during a 14-day recovery after tonsillectomy: A prospective cohort study.

Background: Adenotonsillectomy is associated with severe postoperative pain. The parent's postoperative pain measure (PPPM), a 15-item instrument to measure a child's pain at home, has been validated with a seven-point faces scale in children 7-12 years and with the parents' global report of pain in children 2-6 years.

Aims: Our primary objective was to validate the PPPM with a recommended age-appropriate pain scale in children 2-12 years after adenotonsillectomy.

Parental Engagement of a Prototype Electronic Diary in an Ambulatory Setting Following Adenotonsillectomy in Children: A Prospective Cohort Study.

Adenotonsillectomy is performed in children on an outpatient basis, and pain is managed by parents. A pain diary would facilitate pain management in the ambulatory setting. Our objective was to evaluate the parental response rate and the compliance of a prototype electronic pain diary (e-diary) with cloud storage in children aged 2-12 years recovering from adenotonsillectomy and to compare the e-diary with a paper diary (p-diary).

Automatic unsupervised respiratory analysis of infant respiratory inductance plethysmography signals.

Infants are at risk for potentially life-threatening postoperative apnea (POA). We developed an Automated Unsupervised Respiratory Event Analysis (AUREA) to classify breathing patterns obtained with dual belt respiratory inductance plethysmography and a reference using Expectation Maximization (EM). This work describes AUREA and evaluates its performance.

Cardiorespiratory behavior of preterm infants receiving continuous positive airway pressure and high flow nasal cannula post extubation: randomized crossover study.

Background: Nasal continuous positive airway pressure (NCPAP) and high flow nasal cannula (HFNC) are modes of non-invasive respiratory support commonly used after extubation in extremely preterm infants. However, the cardiorespiratory physiology of these infants on each mode is unknown.

Methods: Prospective, randomized crossover study in infants with birth weight ≤1250 g undergoing their first extubation attempt.

Undersampling and Bagging of Decision Trees in the Analysis of Cardiorespiratory Behavior for the Prediction of Extubation Readiness in Extremely Preterm Infants.

Extremely preterm infants often require endotracheal intubation and mechanical ventilation during the first days of life. Due to the detrimental effects of prolonged invasive mechanical ventilation (IMV), clinicians aim to extubate infants as soon as they deem them ready.Unfortunately, existing strategies for prediction of extubation readiness vary across clinicians and institutions, and lead to high reintubation rates.

The anatomy of the pediatric airway: Has our knowledge changed in 120 years? A review of historic and recent investigations of the anatomy of the pediatric larynx.

Background: There is disagreement regarding the anatomy of the pediatric airway, particularly regarding the shape of the cricoid cartilage and the location of the narrowest portion of the larynx.

Aims: The aim of this review is to clarify the origin and the science behind these differing views.

Methods: We undertook a review of published literature, University Libraries, and authoritative textbooks with key search words and phrases.

A semi-Markov chain approach to modeling respiratory patterns prior to extubation in preterm infants.

After birth, extremely preterm infants often require specialized respiratory management in the form of invasive mechanical ventilation (IMV). Protracted IMV is associated with detrimental outcomes and morbidities. Premature extubation, on the other hand, would necessitate reintubation which is risky, technically challenging and could further lead to lung injury or disease.

Optimal Classification of Respiratory Patterns From Manual Analyses Using Expectation-Maximization.

Manual scoring (MS) of cardiorespiratory signals is the gold standard method for the analysis of respiratory data in sleep laboratories. In MS, trained, expert scorers characterize respiratory patterns by scrolling through a data record and visually identifying patterns. However, MS is limited by high intra- and inter-scorer variability and subjectivity.

Impact of Time Lapse on ASCP Board of Certification Medical Laboratory Scientist (MLS) and Medical Laboratory Technician (MLT) Examination Scores.

Background: Research in several professional fields has demonstrated that delays (time lapse) in taking certification examinations may result in poorer performance by examinees. Thirteen states and/or territories require licensure for laboratory personnel. A core component of licensure is passing a certification exam.

Scoring Tools for the Analysis of Infant Respiratory Inductive Plethysmography Signals.

Infants recovering from anesthesia are at risk of life threatening Postoperative Apnea (POA). POA events are rare, and so the study of POA requires the analysis of long cardiorespiratory records. Manual scoring is the preferred method of analysis for these data, but it is limited by low intra- and inter-scorer repeatability.

Automated analysis of respiratory behavior for the prediction of apnea in infants following general anesthesia.

Infants recovering from general anesthesia are at risk of postoperative apnea (POA), a potentially life threatening event. There is no accurate way to identify which infants will experience POA, and thus all infants with postmenstrual age <; 60 weeks are monitored for apnea in hospital postoperatively. Using a comprehensive, automated analysis of the postoperative breathing patterns, we identified the occurrence of respiratory pauses in 24 infants at age risk for POA.

A new movement artifact detector for photoplethysmographic signals.

Oximeters are commonly used in abbreviated cardiorespiratory studies (ACS) to monitor blood oxygen saturation and heart rate using the photoplethysmography (PPG) signal. These data are prone to movement artifacts, especially in infants who move or need to be handled often. Therefore segments of PPG data contaminated by movement artifact must be detected as a first stage of analysis.

Novel measurements of the length of the subglottic airway in infants and young children.

Background: To date, the lengths of the subglottic and tracheal airway segments have been measured from autopsy specimens. Images of the head and neck obtained from computerized tomography (CT) provide an alternate method. Our objective in this study was to identify anatomic landmarks from CT scans in infants and young children to estimate the lengths of the subglottic and tracheal airway segments and to correlate these lengths with age.

Detection of breathing segments in respiratory signals.

The typical approach for analysis of respiratory records consists of detection of respiratory pauses and elimination of segments corrupted by movement artifacts. This is motivated by established rules used for manual scoring of respiratory events, which focus on pause segmentation and do not define criteria to identify breathing segments. With this strategy, breathing segments can only be inferred indirectly from the absence of abnormalities, yielding an unclear and ambiguous definition.

Prediction of extubation readiness in extreme preterm infants based on measures of cardiorespiratory variability.

The majority of extreme preterm infants require endotracheal intubation and mechanical ventilation (ETT-MV) during the first days of life to survive. Unfortunately this therapy is associated with adverse clinical outcomes and consequently, it is desirable to remove ETT-MV as quickly as possible. However, about 25% of extubated infants will fail and require re-intubation which is also associated with a 5-fold increase in mortality and a longer stay in the intensive care unit.

Does employee safety influence customer satisfaction? Evidence from the electric utility industry.

Problem: Research on workplace safety has not examined implications for business performance outcomes such as customer satisfaction.

Method: In a U.S.

Home noninvasive ventilation: what does the anesthesiologist need to know?

Treatment of chronic respiratory failure with noninvasive ventilation (NIV) is standard pediatric practice, and NIV systems are commonly used in the home setting. Although practice guidelines on the perioperative management of children supported with home NIV systems have yet to be published, increasingly these patients are referred for consultation regarding perioperative management. Just as knowledge of pharmacology underlies the safe prescription of medication, so too knowledge of biomedical design is necessary for the safe prescription of NIV therapy.

Automated unsupervised respiratory event analysis.

We recently presented a comprehensive automated off-line method for supervised respiratory event classification from uncalibrated respiratory inductive plethysmography signals. This method required training with a sample of clinical measurements classified by an expert. This human intervention is labor intensive and involves subjective judgments that may introduce bias to the automated classification.

Outcome, risk, and error and the child with obstructive sleep apnea.

Adenotonsillectomy is the mainstay of treatment for pediatric obstructive sleep apnea syndrome (OSAS). However, there is evidence that the child with severe OSAS is at increased risk of respiratory compromise. The most difficult risk factor to assess is the severity of OSAS, and these difficulties are reviewed.

Automated off-line respiratory event detection for the study of postoperative apnea in infants.

Previously, we presented automated methods for thoraco-abdominal asynchrony estimation and movement artifact detection in respiratory inductance plethysmography (RIP) signals. This paper combines and improves these methods to give a method for the automated, off-line detection of pause, movement artifact, and asynchrony. Simulation studies demonstrated that the new combined method is accurate and robust in the presence of noise.

An anesthetic management protocol to decrease respiratory complications after adenotonsillectomy in children with severe sleep apnea.

Background: A high incidence of respiratory morbidity after adenotonsillectomy is reported in children with obstructive sleep apnea syndrome (OSAS). In an effort to decrease this morbidity, we implemented perioperative guidelines recommending an adjustment in the administration of opioids, dexamethasone, and atropine in children with OSAS who demonstrated recurrent episodes of profound hypoxemia during the perioperative sleep study.

Methods: We performed a retrospective review and compared results with historic data from 2001.