Elevated Diaphragmatic Tonic Activity in PICU Patients: Age-Specific Definitions, Prevalence, and Associations.

OBJECTIVES: Tonic diaphragmatic activity (tonic Edi, i.e., sustained diaphragm activation throughout expiration) reflects diaphragmatic effort to defend end-expiratory lung volumes. Detection of such elevated tonic Edi may be useful in identifying patients who need increased positive end-expiratory pressure. We aimed to: 1) identify age-specific definitions for elevated tonic Edi in ventilated PICU patients and 2) describe the prevalence and factors associated with sustained episodes of high tonic Edi. DESIGN: Retrospective study using a high-resolution database. SETTING: Single-center tertiary PICU. PATIENTS: Four hundred thirty-one children admitted between 2015 and 2020 with continuous Edi monitoring. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: We characterized our definition of tonic Edi using data from the recovery phase of respiratory illness (i.e., final 3 hr of Edi monitoring, excluding patients with significant persistent disease or with diaphragm pathology). High tonic Edi was defined as population data exceeding the 97.5th percentile, which for infants younger than 1 year was greater than 3.2 µV and for older children as greater than 1.9 µV. These thresholds were then used to identify patients with episodes of sustained elevated tonic Edi in the first 48 hours of ventilation (acute phase). Overall, 62 of 200 (31%) of intubated patients and 138 of 222 (62%) of patients on noninvasive ventilation (NIV) had at least one episode of high tonic Edi. These episodes were independently associated with the diagnosis of bronchiolitis (intubated patients: adjusted odds [aOR], 2.79 [95% CI, 1.12-7.11]); NIV patients: aOR, 2.71 [1.24-6.0]). There was also an association with tachypnea and, in NIV patients, more severe hypoxemia. CONCLUSIONS: Our proposed definition of elevated tonic Edi quantifies abnormal diaphragmatic activity during expiration. Such a definition may help clinicians to identify those patients using abnormal effort to defend end-expiratory lung volume. In our experience, high tonic Edi episodes are frequent, especially during NIV and in patients with bronchiolitis.

French-Canadian Translation and Cultural Adaptation of the Clinical Opiate Withdrawal Scale: The COWS-FC.

OBJECTIVE: The main objective of the present study was to develop a French-Canadian translation and adaptation of the COWS (i.e., the COWS-FC) for the assessment of opioid withdrawal symptoms in clinical and research settings. METHODS: The French-Canadian translation and cultural adaptation of the COWS was performed following guidelines for the translation and cross-cultural adaptation of self-report measures. The steps consisted of (1) initial translation from English to French, (2) synthesis of the translation, (3) back-translation from French to English, (4) expert committee meeting, (5) test of the prefinal version among healthcare professionals and (6) review of final version by the expert committee. The expert committee considered four major areas where the French-Canadian version should achieve equivalence with the original English-version of the COWS. These areas were (1) semantic equivalence; (2) idiomatic equivalence; (3) experiential equivalence and (4) conceptual equivalence. RESULTS: Rigorous steps based on the guidelines for the translation and cultural adaptation of assessment tools were followed, which led to a semantically equivalent version of the COWS. After a pretest among healthcare professionals, members from the expert committee agreed upon slight modifications to the French-Canadian version of the COWS to yield a final COWS-FC version. CONCLUSIONS: A French-Canadian translation and adaptation of the COWS (i.e., the COWS-FC) was developed. The COWS-FC could be used for the assessment of opioid withdrawal symptoms in clinical and research settings.

French-Canadian translation of a self-report questionnaire to monitor opioid therapy for chronic pain: The Opioid Compliance Checklist (OCC-FC).

Context: Chronic noncancer pain (CNCP) is a frequent condition among Canadians. The psychosocial and economic costs of CNCP for individuals, their families, and society are substantial. Though opioid therapy is often used to manage CNCP, it is also associated with risks of misuse. The Opioid Compliance Checklist (OCC) was developed to monitor opioid misuse in patients taking opioids for CNCP. The objective of the present study was to provide a French-Canadian translation of the eight-item OCC, the OCC-FC. Methods: The eight-item OCC was translated for use in Québec using published guidelines for the translation and adaptation of self-report measures, including an expert committee and a double forward-backward translation process. A pretest of the adapted eight-item OCC was also conducted among 30 patients with CNCP. Results: A French-Canadian version of the OCC was generated. When ambiguity in the items was detected during expert committee consultation or pretest administration, modifications made were kept to a strict minimum to facilitate future comparisons across studies using the original English and translated French-Canadian version. Discussion: This study provides a culturally adapted tool that will contribute to identifying French-Canadian patients with CNCP who misuse opioids over the course of opioid therapy. This translation of the OCC has the strong potential to be useful in research and clinical settings.

Contexte: La douleur chronique non cancéreuse est une affection fréquente chez les Canadiens. Les coûts psychosociaux et économiques de la douleur chronique non cancéreuse pour les individus, leurs familles et la société sont considérables. Si le traitement opioïde est souvent utilisé pour la prise en charge de la douleur chronique non cancéreuse, il est également associé à des risques de mauvais usage. La liste de vérification de l'observance du traitement opioïde (OCC) a été élaborée pour surveiller le mauvais usage des opioïdes chez les patients prenant des opioïdes pour la douleur chronique non cancéreuse. L'objectif de la présente étude était de fournir une traduction canadienne-française de l'OCC en 8 points, le OCC-FC.Méthodes: L'OCC en 8 points a été traduit pour être utilisé au Québec selon les lignes directrices publiées pour la traduction et l'adaptation des mesures autorapportées, y compris un comité d'experts et un double processus de traduction - rétrotraduction. Un prétest de l'OCC en 8 points adapté a également été réalisé auprès de trente patients atteints de douleur chronique non cancéreuse.Résultats: Une version canadienne française de l'OCC a été produite. Lorsqu'une ambiguïté dans les énoncés a été détectée par 'lors de la consultation avec le comité d'experts ou de l'administration du prétest, les modifications apportées ont été maintenues au strict minimum afin de faciliter les comparaisons futures entre les études utilisant la version originale anglaise et la version canadienne-française traduite.Discussion: Cette étude fournit un outil culturellement adapté qui contribuera à répertorier les patients canadiens français atteints de douleur chronique non cancéreuse qui font un mauvais usage des opioïdes au cours de leur traitement. Cette traduction de l'OCC présente un grand potentiel d'utilité dans la recherche et les milieux cliniques.