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Safety of tracheal intubation in the presence of cardiac disease in paediatric ICUs
- Eleanor A. Gradidge, Adnan Bakar, David Tellez, Michael Ruppe, Sarah Tallent, Geoffrey Bird, Natasha Lavin, Anthony Lee, Vinay Nadkarni, Michelle Adu-Darko, Jesse Bain, Katherine Biagas, Aline Branca, Ryan K. Breuer, Calvin Brown III, Kris Bysani, Guillaume Emeriaud, Sandeep Gangadharan, John S. Giuliano, Jr, Joy D. Howell, Conrad Krawiec, Jan Hau Lee, Simon Li, Keith Meyer, Michael Miksa, Natalie Napolitano, Sholeen Nett, Gabrielle Nuthall, Alberto Orioles, Erin B. Owen, Margaret M. Parker, Simon Parsons, Lee A. Polikoff, Kyle Rehder, Osamu Saito, Ron C. Sanders, Jr, Asha Shenoi, Dennis W. Simon, Peter W. Skippen, Keiko Tarquinio, Anne Thompson, Iris Toedt-Pingel, Karen Walson, Akira Nishisaki, For National Emergency Airway Registry for Children (NEARKIDS) Investigators and Pediatric Acute Lung Injury and Sepsis Investigators (PALISI)
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- Journal:
- Cardiology in the Young / Volume 28 / Issue 7 / July 2018
- Published online by Cambridge University Press:
- 25 April 2018, pp. 928-937
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Introduction
Children with CHD and acquired heart disease have unique, high-risk physiology. They may have a higher risk of adverse tracheal-intubation-associated events, as compared with children with non-cardiac disease.
Materials and methodsWe sought to evaluate the occurrence of adverse tracheal-intubation-associated events in children with cardiac disease compared to children with non-cardiac disease. A retrospective analysis of tracheal intubations from 38 international paediatric ICUs was performed using the National Emergency Airway Registry for Children (NEAR4KIDS) quality improvement registry. The primary outcome was the occurrence of any tracheal-intubation-associated event. Secondary outcomes included the occurrence of severe tracheal-intubation-associated events, multiple intubation attempts, and oxygen desaturation.
ResultsA total of 8851 intubations were reported between July, 2012 and March, 2016. Cardiac patients were younger, more likely to have haemodynamic instability, and less likely to have respiratory failure as an indication. The overall frequency of tracheal-intubation-associated events was not different (cardiac: 17% versus non-cardiac: 16%, p=0.13), nor was the rate of severe tracheal-intubation-associated events (cardiac: 7% versus non-cardiac: 6%, p=0.11). Tracheal-intubation-associated cardiac arrest occurred more often in cardiac patients (2.80 versus 1.28%; p<0.001), even after adjusting for patient and provider differences (adjusted odds ratio 1.79; p=0.03). Multiple intubation attempts occurred less often in cardiac patients (p=0.04), and oxygen desaturations occurred more often, even after excluding patients with cyanotic heart disease.
ConclusionsThe overall incidence of adverse tracheal-intubation-associated events in cardiac patients was not different from that in non-cardiac patients. However, the presence of a cardiac diagnosis was associated with a higher occurrence of both tracheal-intubation-associated cardiac arrest and oxygen desaturation.
Global scattering functions: a tool for grazing incidence small angle X-ray scattering (GISAXS) data analysis of low correlated lateral structures
- S. Lenz, M. Bonini, S. K. Nett, M. C. Lechmann, S. G.J. Emmerling, R. S. Kappes, M. Memesa, A. Timmann, S. V. Roth, J. S. Gutmann
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- Journal:
- The European Physical Journal - Applied Physics / Volume 51 / Issue 1 / July 2010
- Published online by Cambridge University Press:
- 17 June 2010, 10601
- Print publication:
- July 2010
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- Article
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In this article we discuss the applicability of global scattering functions for structure analysis of Grazing Incidence Small Angle X-ray Scattering (GISAXS) data. Contrary to rigorous analysis of the full 2-D detector image, which can be performed with complex simulation models, the global scattering functions described here will be used to model transverse detector scans in the $q_{\parallel}$ reciprocal scattering planes. In contrast to a full GISAXS analysis, this procedure cannot explain structural features perpendicular to the sample plane. The discussed method is useful for the analysis of weakly correlated films. These films are e.g. found in polymer inorganic composite materials based on commercially available nanoparticles. In hybrid material systems polydisperse structures, including particle aggregates without precisely defined shape are formed. The pictured approach, which models scattering in terms of structural levels, has been previously applied with success in conventional transmission SAXS geometry. It is based on conventional exponential and power laws. Hence, data analysis becomes less complex compared to simulation approaches. Here we examine if this unified fitting model can be used to model diffuse, non specular scattering resulting from GISAXS. In this context the applicability and limit of its application to diffuse scattering in the GISAXS geometry is discussed. Furthermore diffuse $q_{\parallel}$ scattering from different ideal particle types is simulated and compared with fitted results. To verify our approach, fit results from experimental GISAXS curves obtained for real samples are compared with results from Scanning Probe Microscopy and Scanning Electron Microscopy studies. The samples investigated range from evaporated Au films to hybrid TiO2/polymer films and demonstrate the usefulness in the structural analysis of complex films.