catheter and laryngeal mask endotracheal surfactant therapy the calmest approach as a novel mist technique

AbstractPurpose: Neonatal respiratory distress syndrome (RDS) is a major cause of mortality and morbidity among preterm infants. Although the INSURE (INtubation, SURfactant administration, Estubation) technique for surfactant replacement therapy is so far the gold standard method, over the last years new approaches have been studied, i.e. less invasive surfactant administration (LISA) or minimally invasive surfactant therapy (MIST). Here we propose an originally modified MIST, called CALMEST (Catheter And Laryngeal Mask Endotracheal Surfactant Therapy), using a particular laryngeal mask as a guide for a thin catheter to deliver surfactant directly in the trachea.Materials and methods: We performed a preliminary study on a mannequin and a subsequent in vivo pilot trial.Results and conclusions: This novel procedure is quick, effective and well tolerated and might represent an improvement in reducing neonatal stress. Ultimately, CALMEST offers an alternative approach that could be extremely useful for medica..

Errors in Neonatology

Introduction: Danger and errors are inherent in human activities. In medical practice errors can lean to adverse events for patients. Mass media echo the whole scenario. Methods: We reviewed recent published papers in PubMed database to focus on the evidence and management of errors in medical practice in general and in Neonatology in particular. We compared the results of the literature with our specific experience in Nina Simulation Centre (Pisa, Italy). Results: In Neonatology the main error domains are: medication and total parenteral nutrition, resuscitation and respiratory care, invasive procedures, nosocomial infections, patient identification, diagnostics. Risk factors include patients’ size, prematurity, vulnerability and underlying disease conditions but also multidisciplinary teams, working conditions providing fatigue, a large variety of treatment and investigative modalities needed. Discussion and Conclusions: In our opinion, it is hardly possible to change the human beings but it is likely possible to change the conditions under they work. Voluntary errors report systems can help in preventing adverse events. Education and re-training by means of simulation can be an effective strategy too. In Pisa (Italy) Nina (ceNtro di FormazIone e SimulazioNe NeonAtale) is a simulation center that offers the possibility of a continuous retraining for technical and non-technical skills to optimize neonatological care strategies. Furthermore, we have been working on a novel skill trainer for mechanical ventilation (MEchatronic REspiratory System SImulator for Neonatal Applications, MERESSINA). Finally, in our opinion national health policy indirectly influences risk for errors.   Proceedings of the 9th International Workshop on Neonatology · Cagliari (Italy) · October 23rd-26th, 2013 · Learned lessons, changing practice and cutting-edge researc

High-fidelity simulation in Neonatology and the Italian experience of Nina

The modern methodology of simulation was born in the aeronautical field. In medicine, anesthetists showed great attention for technological advances and simulation, closely followed by surgeons with minimally invasive surgery. In Neonatology training in simulation is actually useful in order to face unexpected dramatic events, to minimize clinical risk preventing errors and to optimize team work. Critical issues in simulation are: teachers-learners relationship, focus on technical and non-technical skills, training coordination, adequate scenarios, effective debriefing. Therefore, the quality of a simulation training center is multi-factorial and is not only related to the mannequin equipment. High-fidelity simulation is the most effective method in education. In Italy simulation for education in Medicine has been used for a few years only. In Pisa we founded Nina (that is the acronymous for the Italian name of the Center, CeNtro di FormazIone e SimulazioNe NeonAtale), the first neonatal simulation center dedicated but integrated within a Hospital Unit in Italy. This paper describes how we manage education in Nina Center, in order to offer a model for other similar experiences

An active simulator for neonatal intubation: Design, development and assessment

This study describes the technical realization and the pre-clinical validation of a instrumented neonatal intubation skill trainer able to provide objective feedback for the improvement of clinical competences required for such a delicate procedure. The Laerdal® Neonatal Intubation Trainer was modified by applying pressure sensors on areas that are mainly subject to stress and potential injuries. Punctual Force Sensing Resistors (FSRs) were characterized and fixed on the external side of the airway structure on the dental arches and epiglottis. A custom silicone tongue was designed and developed to integrate a matrix textile sensor for mapping the pressure applied on its whole surface. The assessment of the developed tool was performed by nine clinical experts who were asked to practice three intubation procedures apiece. Median and maximum forces, over threshold events (i.e. 2 N for gingival arch sensors and 7 N for epiglottis and tongue sensors respectively) and execution time were measured for each trainee. Data analysis from training sessions revealed that the epiglottis is the point mainly stressed during an intubation procedure (maximum value: 16.69 N, median value: 3.11 N), while the analysis carried out on the pressure distribution on the instrumented tongue provided information on both force values and distribution, according to clinicians’ performance. The debriefing phase was used to enhance the clinicians’ awareness of applied force and gestures performed, confirming that the present study is an adequate starting point for achieving and optimizing neonatal intubation skills for both residents and expert clinicians

Simulation of childbirth improves clinical management capacity and self-confidence in medical students

Background The learning process of physiological mechanisms of childbirth and its management are important elements in the education of medical students. In this study, we verify how the use of a high-fidelity simulator of childbirth improves competence of students in this regard. Methods A total of 132 medical students were recruited for the study in order to attend a physiological childbirth in a no-hospital environment after being assigned to two groups. The control group received only a normal cycle of lectures, while the simulation (SIM) group followed a specific training session on the simulator. Subsequently, both groups were assessed for their technical and non-technical skills in a simulated childbirth. Also, a self-assessment test regarding their self-confidence was administrated before and after simulation, and repeated after 8 weeks. Results The SIM group showed better performance in all the domains with a better comprehension of the mechanisms of childbirth, managing and assistance of labour and delivery. In addition, compared to the control group, they presented a better self-related awareness and self-assurance regarding the possibility of facing a birth by themselves. Conclusion The present study demonstrated that the use of a high-fidelity simulator for medical students allows a significant improvement in the acquisition of theoretical and technical expertise to assist a physiological birth

Micro extraction by packed sorbent coupled to liquid chromatography-tandem mass spectrometry for the analysis of prostanoids and isoprostanoids in dried blood spots of preterm newborns suffering from patent ductus arteriosus

An innovative UHPLC-ESI-MS/MS method for the analysis of prostaglandin-E2, 8-iso-prostaglandin-F2α and 8-iso-prostaglandin-E2 in dried blood spots is proposed. The non-invasive and painless monitoring of these inflammation and oxidative stress mediators in preterm newborns suffering from Patent Ductus Arteriosus could assess their potential role as predictors of response to therapy. Analytes were extracted from dried blood spot (50 µL) with 70:30 v/v methanol:water mixture. The extracts were purified by a semi-automated micro-extraction by packed sorbent (MEPS) before injection in the UHPLC-MS/MS instrument. Analytes were separated by a reversed-phase Polaris-C18 column and a gradient elution with aqueous formic acid (0.1%) and 50:50 v/v methanol:acetonitrile mixture. Triple quadrupole mass spectrometer operated in ESI(-) and MRM mode. The fast and easy sample clean-up by MEPS guaranteed a high reproducibility (RSD < 5%) and extraction yield (90-105%) in less than ten minutes, and limited the required volume of both solvents (30-100 µL) and sample (100 µL), with respect to conventional solid phase extraction. Limits of detection below 20 pg/mL, linearity (R2 > 0.99) over three orders of magnitude and satisfactory overall intra- and inter-day precisions (RSD < 10%) were obtained. The deuterated internal standard was successfully laid on the filter paper instead of the common addition to the extraction solvent, in order to control both storage and extraction steps. Particular attention was paid to stability issues. To the best of our knowledge, this is the first analytical method combining a fast and reproducible MEPS procedure and a highly sensitive and selective UHPLC-ESI-MS/MS analysis for the determination of prostaglandin-E2, 8-iso-prostaglandin-F2α and 8-iso-prostaglandin-E2 in dried blood spots. The method resulted suitable for the monitoring of preterm newborns (<32 weeks' gestation) with Patent Ductus Arteriosus

Comparative performances analysis of neonatal ventilators

Background: Mechanical ventilation is a therapeutic action for newborns with respiratory diseases but may have side effects. Correct equipment knowledge and training may limit human errors. We aimed to test different neonatal mechanical ventilators' performances by an acquisition module (a commercial pressure sensor plus an isolated chamber and a dedicated software). Methods: The differences (ΔP) between peak pressure values and end-expiration pressure were investigated for each ventilator. We focused on discrepancies among measured and imposed pressure data. A statistical analysis was performed. Results: We investigated the measured/imposed ΔP relation. The ΔP do not reveal univocal trends related to ventilation setting parameters and the data distributions were non-Gaussian. Conclusions: Measured ΔP represent a significant parameter in newborns' ventilation, due to the typical small volumes. The investigated ventilators showed different tendencies. Therefore, a deep specific knowledge of the intensive care devices is mandatory for caregivers to correctly exploit their operating principles

Additional file 2: Table S2. of Technical realization of a sensorized neonatal intubation skill trainer for operators’ retraining and a pilot study for its validation

Mean times of operators scheduled for attempts in two session. (DOCX 12 kb

Additional file 3: Table S3. of Technical realization of a sensorized neonatal intubation skill trainer for operators’ retraining and a pilot study for its validation

Mean pressure values scheduled for attempts in two session. We considered data with outliers exclusion. (DOCX 13 kb