5 results
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.
Bacterial Adhesion to Nanomodified Surfaces: Dynamic Flow Effects on S. aureus and P. aeruginosa
- Mary C. Machado, Keiko M. Tarquinio, Thomas J. Webster
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- Journal:
- MRS Online Proceedings Library Archive / Volume 1498 / 2013
- Published online by Cambridge University Press:
- 27 February 2013, pp. 79-84
- Print publication:
- 2013
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Ventilator associated pneumonia (VAP) is a serious and costly clinical problem. Specifically, receiving mechanical ventilation over 24 hours increases the risk of VAP and is associated with high morbidity, mortality and medical costs. Cost effective endotracheal tubes (ETTs) that are resistant to bacterial infection would help to prevent this problem. The objective of this study was to determine differences in bacterial growth on nanomodified and unmodified ETTs under dynamic airway conditions. A bench top model based upon the general design of Hartmann et al. (1999) was constructed to test of the effectiveness of nanomodified ETTs under the airflow conditions present in the airway. Twenty-four hour studies performed in a dynamic flow chamber showed a marked difference in the biofilm formation on different areas of unmodified tubes. Areas where tubes were curved, such as at the entrance to the mouth and the connection between the oropharynx and the larynx, seemed to collect the largest amount of biofilm.
The biofilm formation on ETTs in the airflow system after 24 hours showed a large difference depending upon where tubes were oriented within the apparatus. This illustrates the importance of dynamic flow on biofilm formation in pediatric ETTs. It is of particular interest that increased biofilm density on both unmodified and nanomodified tubes appeared to occur at curves in the tube where changes in flow pattern occurred. This emphasizes the need for more accurate models of airflow within pediatric ETTs, suggesting that not only does flow affect pressure gradients along the tube, but in fact, determines the composition of the film itself. More testing is needed to determine the effects of biofilm formation on the efficiency of ETT under airflow, however this study provides significant evidence for nanomodification alone (without the use of antibiotics) to decrease bacteria function.
Nanomodified Endotracheal Tubes: Spatial Analysis of Reduced Bacterial Colonization in a Bench Top Airway Model
- Mary C. Machado, Keiko M. Tarquinio, Thomas J. Webster
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- Journal:
- MRS Online Proceedings Library Archive / Volume 1418 / 2012
- Published online by Cambridge University Press:
- 30 March 2012, mrsf11-1418-mm11-12
- Print publication:
- 2012
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Ventilator associated pneumonia (VAP) is a serious and costly clinical problem. Specifically, receiving mechanical ventilation for over 24 hours increases the risk of VAP and is associated with high morbidity, mortality and medical costs. Cost effective endotracheal tubes (ETTs) that are resistant to bacterial infection could help prevent this problem. The objective of this study was to determine differences in the growth of Staphylococcus aureus (S. aureus) on nanomodified and unmodified polyvinyl chloride (PVC) ETTs under dynamic airway conditions. PVC ETTs were modified to have nanometer surface features by soaking them in Rhizopus arrhisus, a fungal lipase. Twenty-four hour experiments (supported by computational models) showed that air flow conditions within the ETT influenced both the location and concentration of bacterial growth on the ETTs especially within areas of tube curvature. More importantly, experiments revealed a 1.5 log reduction in the total number of S. aureus on the novel nanomodified ETTs compared to the conventional ETTs after 24 hours of air flow. This dynamic study showed that lipase etching can create nano-rough surface features on PVC ETTs that suppress S. aureus growth and, thus, may provide clinicians with an effective and inexpensive tool to combat VAP.
Reduced Resistance to Air Flow from Nanomodified Endotracheal Tubes
- Mary C. Machado, Keiko M. Tarquinio, Thomas J. Webster
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- Journal:
- MRS Online Proceedings Library Archive / Volume 1316 / 2011
- Published online by Cambridge University Press:
- 23 May 2011, mrsf10-1316-qq06-08
- Print publication:
- 2011
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Ventilator associated pneumonia (VAP) is a serious and costly clinical problem. Specifically, receiving mechanical ventilation over 24 hours increases the risk of VAP and is associated with high morbidity, mortality and medical costs. Cost effective endotracheal tubes (ETTs) that are resistant to bacterial infection would help to prevent this problem. The objective of this study was to determine differences in bacterial growth on nanomodified and unmodified ETTs under dynamic airway conditions, a bench top model based upon the general design of Hartmann et al. (1999) was constructed to test of the effectiveness of nanomodified ETTs under the airflow conditions present in the airway. Twenty-four hour studies performed in a dynamic flow chamber showed a marked difference in the biofilm formation on different areas of unmodified tubes. Areas where tubes were curved, such as at the entrance to the mouth and the connection between the oropharynx and the larynx, seemed to collect the largest amount of biofilm. On the nanomodified tubes biofilm formation was markedly different occurring on smaller pieces.
The biofilm formation on ETTs in the airflow system after 24 hours showed a large difference depending upon where tubes were oriented within the apparatus. This illustrates the importance of dynamic flow on biofilm formation in pediatric ETTs. It is of particular interest that increased biofilm density on both unmodified and nanomodified tubes appeared to occur at curves in the tube where changes in flow pattern occured. This emphasizes the need for more accurate models of airflow within pediatric ETTs, suggesting that not only does flow affect pressure gradients along the tube, but in fact, determines the composition of the film itself. More testing is needed to determine the effects of biofilm formation on the efficiency of ETT under airflow, however this study provides significant evidence for nanomodification alone (without the use of antibiotics) to decrease bacteria function.
Assessment of Nanomodified Endotracheal Tubes in a Bench Top Airway Model
- Mary C. Machado, Daniel Chang, Thomas J Webster, Keiko M Tarquinio
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- Journal:
- MRS Online Proceedings Library Archive / Volume 1209 / 2009
- Published online by Cambridge University Press:
- 31 January 2011, 1209-YY08-06
- Print publication:
- 2009
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Ventilator associated pneumonia (VAP) is a serious and costly clinical problem. Specifically, receiving mechanical ventilation over 24 hours increases the risk of VAP and is associated with high morbidity, mortality and medical costs. This complication is especially hard to diagnose in children because of non-specific clinical signs and lack of established diagnostic methods. Cost effective endotracheal tubes (ETTs) that are resistant to bacterial infection would be essential tools for the prevention of VAP. In addition to their bacterial resistance, ETT with magnetic nanoparticles could aid in the diagnosis of VAP allowing physicians to locate infections with greater accuracy. The objective of this study was twofold, first to develop strategies to decrease bacterial adhesion on nano-rough ETT and secondly to develop better methods to assess in vitro bacterial adhesion or biofilm formation on ETT. In preliminary tests, nanomodified polyvinyl chloride (PVC) ETTs has been shown to be effective at reducing bacterial colonization. This study also sought to evaluate the bacterial resistance of these ETTs more effectively by creating a bench top airway model, which can create a similar environment to the flow system that ETTs are exposed to in vivo. The airway model designed to test ETTs has two Plexiglas chambers representing the oropharynx and the lungs, a tube representing the trachea and finally an intricate pumping system to the oropharynx with bacteria flow and to the lung with simulated compliance and resistance. ETTs were connected to a ventilator and passing the oropharynx into the trachea and observed under the mechanical ventilation and continuous bacterial flow system. In addition, the study examined dual gas flow conditions and their effect on bacterial growth of ETT. In no less than three separate trials in the airway chamber, each ETT will be tested for its effectiveness at the reduction of bacterial growth within the airway by sampling from both lung and oropharynx chambers during continuous operation. Special attention will be given to the long-term effects on the ETT by including a study that lasts longer than ten days. Both the bacterial proliferation in the two chambers and on the ETT itself will be carefully analyzed. This specialized testing should yield valuable information on the efficacy of nanomodified ETT in airway conditions and will provide further evidence to determine if nanomodified ETTs are a valid solution to VAP.