measuring-inspiratory-effort-in-mechanically-ventilated-children

Measuring Inspiratory Effort In Mechanically Ventilated Children

An accurate assessment of inspiratory effort in mechanically ventilated children is essential for optimizing ventilator support and avoiding lung- and ...

The Hospital for Sick Children

At SickKids it is a perennial challenge for clinical leads and preceptors to ensure that student respiratory therapists (SRTs) acquire the entire scope of the paediatric skill set as set out by the 2016 National Competency Profile. As such, simulation has historically been used to supplement the clinical experience for SRTs at Sick Kids; however, the extent to which simulation-based education can replace clinical experience is not clearly established in the literature. At SickKids, we have created an alternative paediatric rotation where the percentage of time spent in the simulation environment is greater than in the traditional, clinical-based rotation. We hypothesize that there should be comparable levels of performance in a simulated setting between students in clinical and simulation-based rotations, as well as comparable measures of self-reported values for cognitive load, self-appraisal, and self-efficacy. Thus far, we have enrolled 59 students, with 54 completing postclinical rotation testing. Follow-up retention testing has been complicated by geographical factors. Following data analysis, we will publish our findings.

Simulation use in paediatric student respiratory therapy training.

Pediatric mechanical ventilation practice guidelines are not well established; therefore, the European Society for Paediatric and Neonatal Intensive Care (ESPNIC) developed consensus recommendations on pediatric mechanical ventilation management in 2017. However, the guideline's applicability in different health care settings is unknown. This study aimed to determine the consensus on pediatric mechanical ventilation practices from Canadian respiratory therapists' (RTs) perspectives and consensually validate aspects of the ESPNIC guideline.

A Delphi Survey of Canadian Respiratory Therapists' Practice Statements on Pediatric Mechanical Ventilation.

The use of volatile anesthetic agents in the paediatric intensive care unit (PICU) is experiencing increased interest since the availability of the miniature vapourizing device. However, the effectiveness of scavenging systems in the presence of humidifiers in the ventilator circuit is unknown.

Volatile gas scavenging in the paediatric intensive care unit: Occupational health and safety assessment.

Extubation failure (EF) in neonates recovering from congenital cardiac surgery is associated with morbidity and mortality. Adding continuous physiologic monitoring data and risk analytics algorithms to clinical factors has the potential to assist clinicians in identifying those neonates at high risk for EF. We aimed to evaluate the association of two physiologic risk analytics algorithms evaluating the probability of inadequate delivery of oxygen index (ID o2 ) and inadequate ventilation of carbon dioxide index (IV co2 ) with EF in neonates receiving mechanical ventilation (MV) after cardiac surgery. A secondary aim was to evaluate the clinical factors associated with EF.

Extubation Failure in Neonates Following Congenital Cardiac Surgery: Multicenter Retrospective Cohort, 2017-2020.

 Assessment tools for health professionals providing airway management and team support during airway events are essential to facilitate learning and document competence. We aimed to evaluate the validity of evidence of the Pediatric Airway Management and Intubation Support (PAMIS) tool for use in assessing the competency of respiratory therapists (RTs) assisting with pediatric intubation in a simulated environment.  The PAMIS tool, developed based on task deconstruction, comprises 10 items assessing 3 core competency domains (manual ventilation, intubation preparation and assistance, and interprofessional team collaboration) and a global rating of performance. Novice and intermediate RT trainees and experienced registered RTs performed a simulated airway management scenario that was assessed independently by 2 live raters and 2 blinded video-based raters using the PAMIS tool. Fifteen videos were also re-evaluated by blinded raters 3 months later. Validity evidence for the tool was generated following Messick's validity framework, including evidence of content, response process, internal structure, and relations with other variables.  We analyzed assessments for 51 participants (15 novice, 21 intermediate, and 15 experienced participants) completed by 10 assessors. Internal consistency was acceptable (α = 0.75), with item-total correlations ranging from 0.17 to 0.74. Inter-rater reliability was high for both live (intraclass correlation coefficient [ICC] = 0.97) and video-based assessments (ICC = 0.85), with strong agreement between the 2 assessment modalities (ICC = 0.94). Test-retest reliability was excellent (ICC = 0.92). PAMIS scores differed significantly based on experience level ( < .001) and correlated highly with a global assessment of performance ratings ( = 0.89,  < .001). Both live and video-based ratings were perceived as user-friendly, with live assessments perceived as easier to use.  The PAMIS tool demonstrated strong validity evidence for use as a formative assessment of competence for RTs providing pediatric airway management and intubation assistance within a simulated setting. This study presents a validated assessment tool designed to support competency-based RT education and practice.

Pediatric Airway Management and Intubation Support Competency Assessment Tool.

The use of risk analytics indices alongside clinical factors has potential to assist clinicians in identifying children at high risk for extubation failure (EF). We investigated the association of two physiologic risk analytics indices with EF in children receiving mechanical ventilation (MV) after cardiac surgery: the probability of inadequate oxygen delivery (ID o2 ) and inadequate ventilation of carbon dioxide index (IV co2 ). A secondary aim was to evaluate clinical factors associated with EF.

Clinical and Risk Analytics Associations With Extubation Failure in Children Following Congenital Cardiac Surgery: A Multicenter Retrospective Cohort Study, 2017-2020.

The use of post-extubation respiratory support in single-ventricle neonates undergoing the Norwood procedure is poorly described. We investigated the patterns of respiratory support following extubation as well as factors associated with prolonged exposure to post-extubation noninvasive respiratory support (NRS), defined as greater than or equal to 72 hours, in neonates recovering from the Norwood procedure.

Associations With Prolonged Post-Extubation Noninvasive Respiratory Support in Neonates Following the Norwood Procedure: A Two-Center Retrospective Cohort Study, 2019-2023.

BackgroundFlexible bronchoscopy (FB) has become an essential diagnostic and therapeutic tool in pediatric intensive care units (PICUs). Despite increasing adoption, comprehensive data on FB's current use, clinical impact and safety in critically ill children, particularly those supported by extracorporeal membrane oxygenation (ECMO), remain limited. We aimed to describe the utilization, findings, microbiological yield and complications of FB in critically ill pediatric patients, including its diagnostic and therapeutic applications and associated physiologic effects.MethodsThis retrospective cohort study included all children aged 0-18 years who underwent FB in a quaternary PICU between January 2019 and December 2024. Data were abstracted from the electronic medical record and analyzed descriptively. Physiologic variables before and after bronchoscopy were compared using paired differences (Δ = post - pre).ResultsA total of 179 patients underwent 246 bronchoscopies. The median age was 61 months (IQR 17-172), and the median time from PICU admission to bronchoscopy was 4 days (IQR 1-11). All patients were mechanically ventilated, and 26% were supported with ECMO. The most frequent indications were evaluation of infection (30.3%), focal imaging abnormalities (25.0%), and surveillance bronchoscopy (15.4%). Increased airway secretions were observed in 50% of procedures. Airway plug removal (22.8%), bronchoalveolar lavage (20.7%), and Dornase alfa instillation (7.7%) were the most common interventions. Multiple findings and interventions often occurred during a single procedure. Concordance between bronchoscopic and non-bronchoscopic lavage cultures was moderate, with highest agreement for  (67%) and  (100%). Complications were infrequent: minor bleeding (4.9%) and transient desaturation (4.5%) were most common; no pneumothorax or mortality occurred. Physiologic parameters showed minimal change post-procedure.ConclusionsFlexible bronchoscopy is a safe and versatile diagnostic and therapeutic procedure in the PICU, including among ECMO-supported patients. The stable physiologic profile and low complication rate support its continued integration into multidisciplinary critical care practice.

Article	Year
Simulation use in paediatric student respiratory therapy training. Canadian journal of respiratory therapy : CJRT = Revue canadienne de la therapie respiratoire : RCTR\| PubMed ID: 30996635	2017
A Delphi Survey of Canadian Respiratory Therapists' Practice Statements on Pediatric Mechanical Ventilation. Respiratory care\| PubMed ID: 35922069	2022
Volatile gas scavenging in the paediatric intensive care unit: Occupational health and safety assessment. Canadian journal of respiratory therapy : CJRT = Revue canadienne de la therapie respiratoire : RCTR\| PubMed ID: 38903540	2024
Extubation Failure in Neonates Following Congenital Cardiac Surgery: Multicenter Retrospective Cohort, 2017-2020. Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies\| PubMed ID: 39927824	2025
Pediatric Airway Management and Intubation Support Competency Assessment Tool. Respiratory care\| PubMed ID: 40354174	2025
Clinical and Risk Analytics Associations With Extubation Failure in Children Following Congenital Cardiac Surgery: A Multicenter Retrospective Cohort Study, 2017-2020. Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies\| PubMed ID: 40736342	2025
Associations With Prolonged Post-Extubation Noninvasive Respiratory Support in Neonates Following the Norwood Procedure: A Two-Center Retrospective Cohort Study, 2019-2023. Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies\| PubMed ID: 41705886	2026
Characterizing Bronchoscopy in Pediatric Critical Care: A Cohort Analysis of Practice and Outcomes. Journal of intensive care medicine\| PubMed ID: 41954489	2026

Katherine Reise

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