55 research outputs found
Comparative performances analysis of neonatal ventilators
No full textBackground: Mechanical ventilation is a therapeutic action for newborns with respiratory diseases but may have side effects. Correct equipment knowledge and training may limit human errors. We aimed to test different neonatal mechanical ventilators' performances by an acquisition module (a commercial pressure sensor plus an isolated chamber and a dedicated software). Methods: The differences (ΔP) between peak pressure values and end-expiration pressure were investigated for each ventilator. We focused on discrepancies among measured and imposed pressure data. A statistical analysis was performed. Results: We investigated the measured/imposed ΔP relation. The ΔP do not reveal univocal trends related to ventilation setting parameters and the data distributions were non-Gaussian. Conclusions: Measured ΔP represent a significant parameter in newborns' ventilation, due to the typical small volumes. The investigated ventilators showed different tendencies. Therefore, a deep specific knowledge of the intensive care devices is mandatory for caregivers to correctly exploit their operating principles
A novel simulator for mechanical ventilation in newborns: MERESSINA
No full textRespiratory problems are among the main causes of mortality for preterm newborns with pulmonary diseases; mechanical ventilation provides standard care, but long-term complications are still largely reported. In this framework, continuous medical education is mandatory to correctly manage assistance devices. However, commercially available neonatal respiratory simulators are rarely suitable for representing anatomical and physiological conditions; a step toward high-fidelity simulation, therefore, is essential for nurses and neonatologists to acquire the practice needed without any risk. An innovative multi-compartmental infant respirator simulator based on a five-lobe model was developed to reproduce different physio-pathological conditions in infants and to simulate many different kinds of clinical scenarios. The work consisted of three phases: (1) a theoretical study and modeling phase, (2) a prototyping phase, and (3) testing of the simulation software during training courses. The neonatal pulmonary simulator produced allows the replication and evaluation of different mechanical ventilation modalities in infants suffering from many different kinds of respiratory physio-pathological conditions. In particular, the system provides variable compliances for each lobe in an independent manner and different resistance levels for the airway branches; moreover, it allows the trainer to simulate both autonomous and mechanically assisted respiratory cycles in newborns. The developed and tested simulator is a significant contribution to the field of medical simulation in neonatology, as it makes it possible to choose the best ventilation strategy and to perform fully aware management of ventilation parameters
MEchatronic REspiratory System SImulator for Neonatal Applications (MERESSINA) project: a novel bioengineering goal
No full textRosa T Scaramuzzo,1,2 Massimiliano Ciantelli,1 Ilaria Baldoli,3 Lisa Bellanti,3 Marzia Gentile,1 Francesca Cecchi,3 Emilio Sigali,1 Selene Tognarelli,3 Paolo Ghirri,1–4 Stefano Mazzoleni,3 Arianna Menciassi,3 Armando Cuttano,1 Antonio Boldrini,1–4 Cecilia Laschi,3 Paolo Dario3 1Centro di Formazione e Simulazione Neonatale "NINA," UO Neonatologia, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy; 2Istituto di Scienze della Vita, 3The BioRobotics Institute, Scuola Superiore Sant'Anna, Pisa, Italy; 4Università di Pisa, Pisa, Italy Abstract: Respiratory function is mandatory for extrauterine life, but is sometimes impaired in newborns due to prematurity, congenital malformations, or acquired pathologies. Mechanical ventilation is standard care, but long-term complications, such as bronchopulmonary dysplasia, are still largely reported. Therefore, continuous medical education is mandatory to correctly manage devices for assistance. Commercially available breathing function simulators are rarely suitable for the anatomical and physiological realities. The aim of this study is to develop a high-fidelity mechatronic simulator of neonatal airways and lungs for staff training and mechanical ventilator testing. The project is divided into three different phases: (1) a review study on respiratory physiology and pathophysiology and on already available single and multi-compartment models; (2) the prototyping phase; and (3) the on-field system validation. Keywords: simulation, lung, newborn, continuous medical education, respiratory syste
Two Moroccan sisters presenting with a severe salt-wasting form of congenital adrenal hyperplasia but normal female genitalia
No full textWe report the case of 2 sisters (46,XX) born from consanguineous Moroccan parents. Both sisters had normal female genitalia, but within 2 weeks after birth, they presented with a severe salt-wasting crisis. Hormonal investigations suggested the diagnosis of congenital adrenal hyperplasia, which was confirmed by subsequent molecular analysis to be caused by 3β-hydroxysteroid dehydrogenase type 2 deficiency. Here, we discuss the main features like onset, possible complications, genetics, and replacement therapy of this rare disease
Incidence and Determinants of Acute Kidney Injury after Prone Positioning in Severe COVID-19 Acute Respiratory Distress Syndrome
No full text1) Background: Acute kidney injury (AKI) is common among critically ill COVID-19 patients, but its temporal association with prone positioning (PP) is still unknown, and no data exist on the possibility of predicting PP-associated AKI from bedside clinical variables. (2) Methods: We analyzed data from 93 COVID-19-related ARDS patients who underwent invasive mechanical ventilation (IMV) and at least one PP cycle. We collected hemodynamic variables, respiratory mechanics, and circulating biomarkers before, during, and after the first PP cycle. PP-associated AKI (PP-AKI) was defined as AKI diagnosed any time from the start of PP to 48 h after returning to the supine position. A t-test for independent samples was used to test for the differences between groups, while binomial logistical regression was performed to assess variables independently associated with PP-associated AKI. (3) Results: A total of 48/93 (52%) patients developed PP-AKI, with a median onset at 24 [13.5–44.5] hours after starting PP. No significant differences in demographic characteristics between groups were found. Before starting the first PP cycle, patients who developed PP-AKI had a significantly lower cumulative fluid balance (CFB), even when normalized for body weight (p = 0.006). Central venous pressure (CVP) values, measured before the first PP (OR 0.803, 95% CI [0.684–0.942], p = 0.007), as well as BMI (OR 1.153, 95% CI = [1.013–1.313], p = 0.031), were independently associated with the development of PP-AKI. In the multivariable regression analysis, a lower CVP before the first PP cycle was independently associated with ventilator-free days (OR 0.271, 95% CI [0.123–0.936], p = 0.011) and with ICU mortality (OR:0.831, 95% CI [0.699–0.989], p = 0.037). (4) Conclusions: Acute kidney injury occurs frequently in invasively ventilated severe COVID-19 ARDS patients undergoing their first prone positioning cycle. Higher BMI and lower CVP before PP are independently associated with the occurrence of AKI during prone positioning
Micro extraction by packed sorbent coupled to liquid chromatography-tandem mass spectrometry for the analysis of prostanoids and isoprostanoids in dried blood spots of preterm newborns suffering from patent ductus arteriosus
No full textAn innovative UHPLC-ESI-MS/MS method for the analysis of prostaglandin-E2, 8-iso-prostaglandin-F2α and 8-iso-prostaglandin-E2 in dried blood spots is proposed. The non-invasive and painless monitoring of these inflammation and oxidative stress mediators in preterm newborns suffering from Patent Ductus Arteriosus could assess their potential role as predictors of response to therapy.
Analytes were extracted from dried blood spot (50 μL) with 70:30 v/v methanol:water mixture. The extracts were purified by a semi-automated micro-extraction by packed sorbent (MEPS) before injection in the UHPLC-MS/MS instrument. Analytes were separated by a reversed-phase Polaris-C18 column and a gradient elution with aqueous formic acid (0.1%) and 50:50 v/v methanol:acetonitrile mixture. Triple quadrupole mass spectrometer operated in ESI(-) and MRM mode. The fast and easy sample clean-up by MEPS guaranteed a high reproducibility (RSD < 5%) and extraction yield (90-105%) in less than ten minutes, and limited the required volume of both solvents (30-100 μL) and sample (100 μL), with respect to conventional solid phase extraction. Limits of detection below 20 pg/mL, linearity (R2 > 0.99) over three orders of magnitude and satisfactory overall intra- and inter-day precisions (RSD < 10%) were obtained. The deuterated internal standard was successfully laid on the filter paper instead of the common addition to the extraction solvent, in order to control both storage and extraction steps. Particular attention was paid to stability issues.
To the best of our knowledge, this is the first analytical method combining a fast and reproducible MEPS procedure and a highly sensitive and selective UHPLC-ESI-MS/MS analysis for the determination of prostaglandin-E2, 8-iso-prostaglandin-F2α and 8-iso-prostaglandin-E2 in dried blood spots. The method resulted suitable for the monitoring of preterm newborns (<32 weeks' gestation) with Patent Ductus Arteriosus
NEO-SAFE: a clinical model for patients and healthcare personnel safety in primary level hospitals
No full textPatient safety is a major concern in medicine. Approximately, 4 million infants die each year worldwide and 23% of these deaths are caused by perinatal asphyxia. To prevent the long-term damage of asphyxia, the resuscitation flowchart must be perfectly and promptly performed. However, high effectiveness in performing resuscitation can only be achieved and maintained if the algorithm is frequently executed. Therefore, maintaining a high level of patient care is difficult in some remote centres. The aim of this study was to evaluate the effectiveness of a new organizational model of care-network between Hub & Spoke hospitals to improve both the safety of the newborns in hospitals with a low number of births and the well-being of operators. Our project, NEO-SAFE (NEOnatal SAFety and training Elba), began in 2017 and involved the neonatal intensive care unit and the NINA Center of the Pisa University Hospital (hub) and the Hospital of Elba Island (spoke). It consisted of a continuous training program, both with 'classic' training course and 'on-job tutoring' (on side and remotely), of the health workers at spoke (i.e. nurses, midwives, and paediatricians). All four milestones of the study design were achieved. During the project, NINA Center instructors organized training courses for the staff in Portoferraio. These courses were based on learning technical and non-technical skills in a training course of increasing difficulty. Staff training needs were also monitored during the project by means of periodic questionnaires, sentinel events, and specific requests. The curve described by the rate of newborns transfer to the Pisa neonatal intensive care unit (hub) shows a monotonous decreasing trend line. On the other hand, this project allowed operators to develop greater self-confidence and greater safety in managing emergency situations, reducing stress for them and improving patient safety. The project allowed the creation of a safe, effective, low-cost, and reproducible organizational model for centres with a low number of births. Moreover, the tele-medicine approach is an important improvement in the assistance and is a window on the future
Errors in Neonatology
No full textIntroduction: Danger and errors are inherent in human activities. In medical practice errors can lean to adverse events for patients. Mass media echo the whole scenario.
Methods: We reviewed recent published papers in PubMed database to focus on the evidence and management of errors in medical practice in general and in Neonatology in particular. We compared the results of the literature with our specific experience in Nina Simulation Centre (Pisa, Italy).
Results: In Neonatology the main error domains are: medication and total parenteral nutrition, resuscitation and respiratory care, invasive procedures, nosocomial infections, patient identification, diagnostics. Risk factors include patients’ size, prematurity, vulnerability and underlying disease conditions but also multidisciplinary teams, working conditions providing fatigue, a large variety of treatment and investigative modalities needed.
Discussion and Conclusions: In our opinion, it is hardly possible to change the human beings but it is likely possible to change the conditions under they work. Voluntary errors report systems can help in preventing adverse events. Education and re-training by means of simulation can be an effective strategy too. In Pisa (Italy) Nina (ceNtro di FormazIone e SimulazioNe NeonAtale) is a simulation center that offers the possibility of a continuous retraining for technical and non-technical skills to optimize neonatological care strategies. Furthermore, we have been working on a novel skill trainer for mechanical ventilation (MEchatronic REspiratory System SImulator for Neonatal Applications, MERESSINA). Finally, in our opinion national health policy indirectly influences risk for errors.
Proceedings of the 9th International Workshop on Neonatology · Cagliari (Italy) · October 23rd-26th, 2013 · Learned lessons, changing practice and cutting-edge researc
An active one-lobe pulmonary simulator with compliance control for medical training in neonatal mechanical ventilation.
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