Paediatric anaesthesia
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Paediatric anaesthesia · Feb 2022
ReviewUnderstanding pediatric ventilation in the operative setting. Part I: Physical principles of monitoring in the modern anesthesia workstation.
The modern anesthesia workstation provides a wealth of information some of which is of particular interest when it comes to optimizing ventilation settings. This knowledge gains even more importance in the therapy of pediatric patients. ⋯ The purpose of this review is to outline the clinical impact, technological background, and reliability of the most relevant information measured and calculated by a modern anesthesia workstation. It aims at translating the technical knowledge into a more competent and vigilant application in the clinical setting.
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Paediatric anaesthesia · Feb 2022
ReviewVentilatory management of critically ill children in the emergency setting, during transport and retrieval.
Critical illness in children is uncommon. The acute stabilization and resuscitation of critically ill children remains challenging to even the most experienced operator. ⋯ The consideration of pathophysiological implications of disease and the equipment available during transport and retrieval from the roadside or nonspecialist setting to pediatric intensive care allows the clinician involved in resuscitation, stabilization, and establishment of ventilation to employ targeted strategies to optimize ventilatory success. This review focuses on the types of ventilatory challenges that must be addressed when managing critically ill children in the local settings in which they present, and the resources available to optimize the outcome prior to and during transfer to a higher level of care.
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Paediatric anaesthesia · Feb 2022
ReviewVentilation through small-bore airways in children by implementing active expiration.
Management of narrowed airways can be challenging, especially in the smallest patients. This educational review focusses on active expiration through small-bore airways with the Ventrain (Ventinova Medical, Eindhoven, The Netherlands). Manual ventilation with the Ventrain establishes inspiratory and expiratory flow control: By setting an appropriate flow, the volume of gas insufflated over time can be controlled and expiration through a small-bore airway is expedited by jet-flow generated suction, coined "expiratory ventilation assistance" (EVA). ⋯ Active expiration by EVA has been clinically introduced to turn a "straw in the airway" into a lifesaver allowing not only for quick and reliable reoxygenation but also adequate ventilation. As well as managing airway emergencies, ventilating through small-bore airways by applying EVA implements new options for pediatric airway management in elective interventional procedures. Safe application of EVA demands a thorough understanding of the required equipment, the principle and function of the Ventrain, technical prerequisites, clinical safety measures, and, most importantly, appropriate training.