Effect of Video-based Telemedicine on Transport Management of Simulated Newborns.

OBJECTIVE: Video-based telemedicine is a reliable tool to assess the severity of respiratory distress in children, increasing the appropriateness of triage and disposition for acutely ill children. Telemedicine simulations may identify patterns in regional transport management and influence attitudes toward telemedicine. METHODS: The objective was to determine the effect of videos on simulated neonatal transport care compared with telephone management. Participants received information about a newborn requiring respiratory support by an audio recording and made management decisions based on only that information. Four videos of varying respiratory distress on respiratory support were then shown. After each video, participants again rated patient stability and recommended management. RESULTS: Sixteen neonatologists completed the cases. Compared with the telephone call, there were significant differences in ratings of patient stability and confidence in their assessment after watching the videos. When given the same information, participants were less likely to recommend intubation after viewing an infant in mild respiratory distress than after the telephone call (P < .05). Most participants felt that viewing the videos was helpful in formulating their assessment and plan. CONCLUSION: Video-based telemedicine simulations influenced the perceived stability of neonates during transport. Viewing the patient increased provider confidence in their assessment and recommendations.

Extracorporeal cardiopulmonary resuscitation outcomes in term and premature neonates*.

OBJECTIVE: Extracorporeal cardiopulmonary resuscitation appears to improve survival in patients with acute refractory cardiopulmonary failure. This analysis was performed to determine survival outcomes and predictors of in-hospital mortality for term and preterm neonates who received extracorporeal cardiopulmonary resuscitation. DESIGN: Retrospective review of data from the Extracorporeal Life Support Organization international registry. SETTING: Pediatric and neonatal ICUs. PATIENTS: Infants less than or equal to 30 days. INTERVENTIONS: Extracorporeal cardiopulmonary resuscitation. MEASUREMENTS AND MAIN RESULTS: Demographic, clinical, and survival data from patients who received extracorporeal cardiopulmonary resuscitation between 1998 and 2010 were analyzed to determine factors that affect in-hospital mortality. Overall survival to hospital discharge for the 641 neonates who received extracorporeal cardiopulmonary resuscitation was 39%. In univariate analysis, gestational age correlated inversely with stroke (odds ratio, 0.84 [95% CI, 0.75-0.95]; p = 0.006) and death (odds ratio, 0.87 [95% CI, 0.78-0.96]; p = 0.005) as did corrected gestational age (odds ratio, 0.89 [95% CI, 0.81-0.97]; p = 0.006) and birth weight (odds ratio, 0.53 [95% CI, 0.38-0.74]; p < 0.001). Dysrhythmia as the primary diagnosis had significantly lower odds of death than single-ventricle cardiac disease (odds ratio, 0.24 [95% CI, 0.06-0.95]; p = 0.04). Higher pre-extracorporeal cardiopulmonary resuscitation oxygenation decreased the odds of death (odds ratio, 0.996 [95% CI, 0.994-0.999]; p = 0.01), whereas complications occurring on extracorporeal life support increased the odds of death. In the multivariate analysis, lower birth weight and pre-extracorporeal cardiopulmonary resuscitation oxygenation, as well as complications including CNS hemorrhage, pulmonary hemorrhage, acidosis, renal replacement therapy, and mechanical complications, increased the odds of death. CONCLUSIONS: Overall survival for neonates receiving extracorporeal cardiopulmonary resuscitation is similar to older pediatric patients but decreases with lower gestational age and weight. Despite this, many low-birth weight neonates survive to hospital discharge.

Surfactant and partial liquid ventilation via conventional and high-frequency techniques in an animal model of respiratory distress syndrome.

OBJECTIVE: To compare the physiologic and pathologic effects of conventional ventilation (CV) and high-frequency ventilation (HFV) during partial liquid ventilation (PLV) with perflubron after surfactant treatment with the results of HFV plus surfactant in an animal lung-injury model created by saline lavage. We also studied the dose effects of perflubron during HFV. DESIGN: Randomized experimental study. SETTING: Research animal laboratory. SUBJECTS: A total of 32 newborn piglets. INTERVENTIONS: After lung injury was induced, the animals were randomized to one of four groups: a) CV + surfactant + perflubron to functional residual capacity (FRC); b) HFV + surfactant + perflubron to FRC; c) HFV + surfactant + 10 mL/kg perflubron; and d) HFV + surfactant. All then received intratracheal surfactant. After 30 mins, perflubron was administered to the PLV groups. The animals underwent ventilation for 20 hrs. MEASUREMENTS AND MAIN RESULTS: Arterial blood gases and hemodynamic variables were continuously monitored. Pulmonary histologic and morphometric analyses were performed after death or euthanasia at 20 hrs. All animals had sustained improvements in arterial/alveolar oxygen ratios, and no differences were observed among groups. All HFV groups required higher mean airway pressures to maintain oxygenation (p <.05). Hemodynamics did not differ among groups. Pathologic analysis demonstrated decreased lung injury in both cranial-dorsal (nondependent) and caudal-ventral (dependent) lobes of all animals treated with PLV when compared with those treated with HFV + surfactant (p <.05). CONCLUSIONS: After surfactant treatment, physiologic support over 20 hrs was similar during HFV with or without perflubron and CV with perflubron. All PLV modalities improved lung pathologic factors uniformly to a greater degree than did HFV + surfactant. A lower treatment volume of perflubron during HFV produced physiologic and pathologic results similar to those produced by perflubron with respect to FRC during either CV or HFV.