Implementation of an Inhaled Nitric Oxide Weaning Protocol and Stewardship in a Level 4 NICU to Decrease Inappropriate Use.

Objective: Inhaled nitric oxide (iNO) is an effective but expensive treatment of pulmonary hypertension in newborns, with limited data regarding weaning. Our institution implemented a multidisciplinary iNO weaning protocol and stewardship to reduce inappropriate use of iNO. The objective of this study was to evaluate our institutional iNO usage before and after implementation.

Variability in expiratory flow requirements among oscillatory positive expiratory pressure.

Introduction: Oscillatory positive expiratory pressure (OPEP) devices facilitate secretion clearance by generating positive end expiratory pressure. However, different device designs may produce different levels of expiratory pressure with the same expiratory flow rate. We bench tested four devices to determine the relationship between expiratory flow and expiratory pressure in each.

Preparing for an Influenza Pandemic: Hospital Acceptance Study of Filtering Facepiece Respirator Decontamination Using Ultraviolet Germicidal Irradiation.

Objectives: Predictions estimate supplies of filtering facepiece respirators (FFRs) would be limited in the event of a severe influenza pandemic. Ultraviolet decontamination and reuse (UVDR) is a potential approach to mitigate an FFR shortage. A field study sought to understand healthcare workers' perspectives and potential logistics issues related to implementation of UVDR methods for FFRs in hospitals.

High-Flow Nasal Cannula and Aerosolized β Agonists for Rescue Therapy in Children With Bronchiolitis: A Case Series.

Asthma and bronchiolitis are episodic obstructive pulmonary diseases characterized by bronchoconstriction, airway wall inflammation, increased mucus production, and air-flow obstruction. We present the cases of 5 infants treated for acute bronchiolitis with respiratory distress using a combination of high-flow nasal cannula oxygen (HFNC) and an Aerogen nebulizer to deliver aerosolized β-agonist therapy. In all infants, we found that HFNC resulted in a greater heart rate increase than delivery via a facemask.

Use of heliox delivered via high-flow nasal cannula to treat an infant with coronavirus-related respiratory infection and severe acute air-flow obstruction.

Heliox, a helium-oxygen gas mixture, has been used for many decades to treat obstructive pulmonary disease. The lower density and higher viscosity of heliox relative to nitrogen-oxygen mixtures can significantly reduce airway resistance when an anatomic upper air-flow obstruction is present and gas flow is turbulent. Clinically, heliox can decrease airway resistance in acute asthma in adults and children and in COPD.

Direct comparison of the effects of nebulized nitroprusside versus inhaled nitric oxide on pulmonary and systemic hemodynamics during hypoxia-induced pulmonary hypertension in piglets.

Objective: To test the hypothesis that nebulized nitroprusside and inhaled nitric oxide would not differ in producing selective pulmonary vasodilation during hypoxia-induced pulmonary hypertension in piglets.

Setting: University laboratory.

Subjects: Five piglets.

Modeling the effect of progressive endotracheal tube occlusion on tidal volume in pressure-control mode.

Unlabelled: A recognized hazard of prolonged endotracheal intubation is progressive airway occlusion resulting from deposition of secretions on the inner surface of the endotracheal tube (ETT). When volume-controlled ventilation is used, progressive ETT occlusion may be detected by monitoring the difference between peak and plateau airway pressures. In pressure-controlled modes, however, inspiratory airway pressures are preset and thus cannot act as a warning indicator.

Modification of a critical care ventilator for use during magnetic resonance imaging.

Introduction: The unique electromagnetic environment of the magnetic resonance imaging (MRI) scanner presents particular problems for critically ill patients requiring mechanical ventilation during MRI. Most currently available MRI-compatible ventilators are limited in scope and function and thus may not be suitable for patients requiring high peak inspiratory pressure or flow.

Methods: To determine whether a standard critical care ventilator could be used under MRI conditions, we modified a Siemens Servo 900C by replacing the standard oxygen blender with an MRI-compatible blender.