Paediatric Critical Care Research Group

South Brisbane, Australia

Paediatric Critical Care Research Group

South Brisbane, Australia

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Hough J.L.,Paediatric Critical Care Research Group | Hough J.L.,Australian Catholic University | Johnston L.,Materials Medical Research Institute | Johnston L.,University of Queensland | And 5 more authors.
Pediatric Critical Care Medicine | Year: 2012

RATIONALE: Although continuous positive airway pressure is used extensively in neonatal intensive care units, and despite the belief that positioning is considered vital to the maintenance of good lung ventilation, no data exist on regional ventilation distribution in infants on continuous positive airway pressure ventilatory support. OBJECTIVES: To investigate the effect of body position on regional ventilation in preterm infants on continuous positive airway pressure ventilatory support using electrical impedance tomography. DESIGN: Randomized crossover study design. SETTING: Neonatal intensive care unit. PATIENTS: Twenty-four preterm infants on continuous positive airway pressure were compared to six spontaneously breathing preterm infants. INTERVENTIONS: Random assignment of the order of the positions supine, prone, and quarter prone. MEASUREMENTS AND RESULTS: Changes in global and regional lung volume were measured with electrical impedance tomography. Although there were no differences between positions, regional tidal volume was increased in the posterior compared with the anterior lung (p < .01) and in the right compared with the left lung (p < .03) in both the spontaneously breathing infants and in the infants on continuous positive airway pressure. The posterior lung filled earlier than the anterior lung in the spontaneously breathing infants (p < .02), whereas in the infants on continuous positive airway pressure the right lung filled before the left lung (p < .01). There was more ventilation inhomogeneity in the infants on continuous positive airway pressure than in the healthy infants (p < .01). CONCLUSIONS: This study presents the first results on regional ventilation distribution in preterm infants on continuous positive airway pressure using electrical impedance tomography. Gravity had little impact on regional ventilation distribution in preterm infants on continuous positive airway pressure or in spontaneously breathing infants in the supine or prone position, indicating that ventilation distribution in preterm infants is not gravity-dependent but follows an anatomical pattern. AUSTRALIA NEW ZEALAND CLINICAL TRIALS REGISTRY: ACTRN12606000210572. Copyright © 2012 by the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies.


Schibler A.,Paediatric Critical Care Research Group | Pham T.M.T.,Paediatric Critical Care Research Group | Dunster K.R.,Paediatric Critical Care Research Group | Foster K.,Paediatric Intensive Care Unit | And 3 more authors.
Intensive Care Medicine | Year: 2011

To describe the change in ventilatory practice in a tertiary paediatric intensive care unit (PICU) in the 5-year period after the introduction of high-flow nasal prong (HFNP) therapy in infants <24 months of age. Additionally, to identify the patient subgroups on HFNP requiring escalation of therapy to either other non-invasive or invasive ventilation, and to identify any adverse events associated with HFNP therapy. The study was a retrospective chart review of infants <24 months of age admitted to our PICU for HFNP therapy. Data was also extracted from both the local database and the Australian New Zealand paediatric intensive care (ANZPIC) registry for all infants admitted with bronchiolitis. Between January 2005 and December 2009, a total of 298 infants <24 months of age received HFNP therapy. Overall, 36 infants (12%) required escalation to invasive ventilation. In the subgroup with a primary diagnosis of viral bronchiolitis (n = 167, 56%), only 6 (4%) required escalation to invasive ventilation. The rate of intubation in infants with viral bronchiolitis reduced from 37% to 7% over the observation period corresponding with an increase in the use of HFNP therapy. No adverse events were identified with the use of HFNP therapy. HFNP therapy has dramatically changed ventilatory practice in infants <24 months of age in our institution, and appears to reduce the need for intubation in infants with viral bronchiolitis. © 2011 Copyright jointly held by Springer and ESICM.


PubMed | Paediatric Critical Care Research Group
Type: Journal Article | Journal: Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies | Year: 2012

Although continuous positive airway pressure is used extensively in neonatal intensive care units, and despite the belief that positioning is considered vital to the maintenance of good lung ventilation, no data exist on regional ventilation distribution in infants on continuous positive airway pressure ventilatory support.To investigate the effect of body position on regional ventilation in preterm infants on continuous positive airway pressure ventilatory support using electrical impedance tomography.Randomized crossover study design.Neonatal intensive care unit.Twenty-four preterm infants on continuous positive airway pressure were compared to six spontaneously breathing preterm infants.Random assignment of the order of the positions supine, prone, and quarter prone.Changes in global and regional lung volume were measured with electrical impedance tomography. Although there were no differences between positions, regional tidal volume was increased in the posterior compared with the anterior lung (p < .01) and in the right compared with the left lung (p < .03) in both the spontaneously breathing infants and in the infants on continuous positive airway pressure. The posterior lung filled earlier than the anterior lung in the spontaneously breathing infants (p < .02), whereas in the infants on continuous positive airway pressure the right lung filled before the left lung (p < .01). There was more ventilation inhomogeneity in the infants on continuous positive airway pressure than in the healthy infants (p < .01).This study presents the first results on regional ventilation distribution in preterm infants on continuous positive airway pressure using electrical impedance tomography. Gravity had little impact on regional ventilation distribution in preterm infants on continuous positive airway pressure or in spontaneously breathing infants in the supine or prone position, indicating that ventilation distribution in preterm infants is not gravity-dependent but follows an anatomical pattern. AUSTRALIA NEW ZEALAND CLINICAL TRIALS REGISTRY:: ACTRN12606000210572.

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