Respiratory care
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Review
AARC Clinical Practice Guidelines: Capillary Blood Gas Sampling for Neonatal and Pediatric Patients.
In the absence of an indwelling arterial catheter, capillary blood gas sampling may be used to evaluate the acid/base and ventilation status of neonatal and pediatric patients with cardiorespiratory conditions. These guidelines were developed from a comprehensive review of the literature to provide guidance for the collection, handling, and interpretation of blood obtained from an arterialized capillary sample. Capillary and venous blood gas measurements are a useful alternative to arterial blood gas measurements for neonatal and pediatric patients who do not require close monitoring of [Formula: see text] In the presence of alterations in body temperature, blood pressure, or peripheral perfusion, agreement between a capillary blood gas with an arterial sample is recommended to determine whether changes in these physiologic conditions reduce reliability. ⋯ To reduce the cumulative pain effect and risk of complications, the capillary puncture procedure should be minimized when possible. Non-pharmacologic interventions should be used to reduce pain associated with capillary blood gas sampling. Automatic lancets are preferred to puncture the skin for capillary blood gas collection.
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Randomized Controlled Trial
Arterial Cannulation Simulation Training in Novice Ultrasound Users.
Arterial cannulation is an important procedure for hemodynamic monitoring and blood sampling. Traditional radial artery cannulation is performed by using anatomical knowledge and pulse palpation as a guide. Arterial cannulation using ultrasound (US) requires specific training, especially for new US users. We hypothesized that even for new US users, US guidance would facilitate the successful puncture by lower attempts before successful intraluminal cannulation of a simulation model of the radial artery. ⋯ US technique was more successful than traditional palpation technique for novice US users performing arterial cannulations for the first time. A study in the clinical practice is needed to confirm these results.
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Multicenter Study
Noninvasive Ventilation Exposure Prior to Intubation in Pediatric Hematopoietic Cell Transplant Recipients.
Noninvasive ventilation (NIV) has become more studied in immunocompromised patients. However, it has not been studied in hematopoietic cell transplantation (HCT) recipients, who have higher mortality and higher pulmonary complication rates than other immunocompromised patients. This population may be prone to negative effects from this treatment modality. The aim of this study was to determine whether NIV use is associated with worse outcomes in this vulnerable patient population. ⋯ In this cohort of children post-HCT, NIV use prior to intubation was associated with worse outcomes. The benefits and risks of NIV in this patient population should be carefully evaluated prior to its use, and careful patient selection is crucial for its optimal utilization.
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Blunt pulmonary contusions are associated with severe chest injuries and are independently associated with worse outcomes. Previous preclinical studies suggest that contusion progression precipitates poor pulmonary function; however, there are few current clinical data to corroborate this hypothesis. We examined pulmonary dynamics and oxygenation in subjects with pulmonary contusions to evaluate for impaired respiratory function. ⋯ Pulmonary contusions played an important role in the course of subjects who were acutely injured and required mechanical ventilation. Contusions were associated with hypoxemia not fully characterized by [Formula: see text]: [Formula: see text], and severe contusions had durable elevations in the oxygenation index despite confounders.