PEEP GENERATED BY HIGHFLOW NASAL CANNULA IN A PEDIATRIC MODEL
Ejiofor BD, Carroll RW, Bortcosh W, Kacmarek RM. Respiratory Care. 2019;64(10):1240-1249.
The authors of this study relate the current knowledge of high-flow nasal cannula (HFNC) generates positive end-expiratory pressure (PEEP) in neonatal and adult populations at lower flows (2-8 L/min) and higher flows (>=60 L/min); however, there are limited data on ssessing PEEP delivered by moderate flows (8-50 L/min), which is the commonly used flows in pediatric patients. The aim of this study was to quantify the effect of the Comfort Flo HFNC on airway pressures in simulated spontaneously breathing lung models using various flow ranges that would be indicated for pediatric patients.
The researchers created 5 different nares to simulate different pediatric upper airway using a 3-dimensional printer and connected to a lung simulator. Using the 5 different nares, age-specific flows were delivered: infant, 8 L/min; pediatric, 20 L/min; small adult, 35 L/min; and large adult, 50 L/min. Pressure was measured with HFNC flows of 6 to 60 L/min with 25%, 50%, and 75% air leak to simulate open-mouth breathing. Positive end-expiratory pressures of 1.2 to 36 cm H2O were generated with the HFNC flows of 6 to 60 L/min. The researchers found that by increasing the flow and decreasing the air leak higher levels of PEEP were delivered (P < .001 and >10% difference). Making adjustments to simulate different patient ages helped to establish different levels of PEEP. The researchers concluded that increasing the flow and decreasing leak resulted in a greater PEEP.
PAIN ASSESSMENT PRACTICES IN THE PEDIATRIC INTENSIVE CARE UNIT
Laures E, LaFond C, Hanrahan K, Pierce N, Min H, McCarthy AM. J Pediatr Nurs. 2019 Sep-Oct;48:55-62.
In this cross-sectional, multisite, descriptive study, researchers sought to describe current pain assessment practices in US pediatric intensive care units from a previous related study. Researchers did a retrospective chart analysis for a designated 24-hour period (n = 220 children across 15 units). Neonatal intensive care units and intermediate care units were excluded from this study. Ages for the children ranged from younger than 1 month to 21 years, with 51% being 2 years or younger.
The average number of pain assessments per child during the 24-hour time period was 11.5 (SD, 5.8; range, 1-28). A total of 12 pain scales were used and included 7 behavioral and 5 self-reported. The most commonly used scales were the numeric self-reported (12 hospitals) and FLACC scale (10 hospitals). Also included when no pain scale was included was "assume pain present," or a sedation scale was used. Location of pain was documented in 23 of 220 children (11%) for a total of 65 of 2448 assessments. The researchers found that 69% of the children required some type of ventilatory assistance. The researchers also found that of 74 children who could communicate effectively about their pain, fewer than half had a self-reported pain scale used.
The researchers found that nurses may benefit from tools to assist them in choosing the most appropriate pain scale. Also, education and site-specific quality improvement projects could help address the differences in sedation scales and pain scales and when to use them appropriately.