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Francesco Cardona

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Posts posted by Francesco Cardona

    Hi,

    I think it also depends on which frequency you are using. I would refer to these publications:

    Sanchez-Luna M, Gonzalez-Pacheco N, Santos-Gonzalez M, Tendillo-Cortijo F. High-frequency Ventilation. Clin Perinatol. 2021;48(4):855-68. https://www.ncbi.nlm.nih.gov/pubmed/34774213

    grafik.png

    Also helpful in this aspect (Hibberd et al 2024): https://www.ncbi.nlm.nih.gov/pubmed/37726160

    grafik.png

    On I:E ratio:

    The I:E impacts both inspiratory and expiratory VT, with ratios of 1:2 (inspiratory time half as long as expiratory time at any given frequency) or 1:1 (inspiratory and expiratory time equal) most commonly used. At any given frequency, I:E of 1:2 will deliver a lower VT, and PAW, than an I:E of 1:1 and introduces a variable PAW drop of 2–4 cmH2O between the airway opening and the lung, which may enhance gas transport (online supplemental figure S2).52 Clinical data on the setting of I:E ratio are lacking, but preclinical and bench studies provide a rationale to use a ratio of 1:2 when gas trapping is present.

    IMHO I personally would not be to worried about more atelectasis solely because of IE-ratio if you are using volume-guarantee. But probably there are smarter people out there who know more about HFO and may be able to help better.

    • Thanks 4

    Hi Pontus,

    agree with all comments before.

    we have lots of experience with US-guided central lines, less with peripheral (but some) and arterial lines. It is only done by doctors at our department. We use both approaches: out-of-plane and in-plane.

    Regarding the canulas: we use both, most commonly we use the neoflon/venflon. but personally I think the one on the left is superior as it is a lot sharper and has less issues with not being able to puncture the skin or vessels adequately. Though my favourite is the Jelco iv. Once you use it you dont want to go back - especially in kids with thicker/tougher skin. Although it needs some practice as it does not have the "wings" of the neoflon which allows for a better grip.

    We have some experience with the guidewire, it comes in handy at times, but needs some practice to handle optimally.

    Although aimed at adults, I think this article has lots of good practical advice: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9886173/  or also here https://www.pocus101.com/ultrasound-guided-peripheral-iv-insertion-placement-and-access-made-easy/

    • Like 1

    Posted

    You might have come across this editorial in the Journal "Nature Medicine".

    Most countries have implemented newborn screening and with affordable genetic testing available, there have been studies looking into screening with genetic tests. But what should be tested for? How do we handle markers for diseases that occur later in life? How do we deal with the emotional aspects for parents, children and care givers? And how do we deal with requests from third parties?

    https://www.nature.com/articles/s41591-024-03227-9

     

    • Like 2

    Posted

    Please add any information or resources you have for transporting infants or pregnant women out of Ukraine. We have compiled lists of material for example.

    Here is a list of needed items for neonatal transport as recommended by Rosemarie Boland, Australian Neonatal Transport Nurse

    https://twitter.com/piatkat/status/1501482359748706305?s=20&t=RiFIoWIiu5ak4M6HUWYnhw

     

    https://docs.google.com/document/d/1vA1Ixm-j7LtbU5nrGULW5zZE5avklXLnRpv9ihsDBlk/edit?usp=sharing

    Equipment list for neonatal transport.pdf

    • Thanks 1

    11 hours ago, kalamazoo said:

    Many neonatal and pediatric travel nurses in the USA are available to help in any way possible

    What is the best way to contact travel nurses best?

    Very good topic.

    I agree with Stefan.

    CLAMP -> X-RAY (after a few hours) -> PULL

    I would probably adapt the time frame if it was recurrent or there is concern of recurrence or the child is otherwise unstable.

    We almost exclusively use pig tail drains at this point. In our opinion they are also more comfortable for the infant and they are placed easily.

    Our surgical patients though often have straight tubes.

    • Like 1
    • Thanks 1

    4 hours ago, Stefan Johansson said:

    Do you mean the BPD diagnosis  set by need of resp support at 36w?

    https://www.atsjournals.org/doi/10.1164/rccm.201812-2348OC

    The definition of bronchopulmonary dysplasia that best predicted early childhood morbidity categorized disease severity according to the mode of respiratory support administered at 36 weeks’ postmenstrual age, regardless of supplemental oxygen use.

    • Thanks 1