Follow-up assessment of pulmonary functions in mechanically ventilated children after discharge from pediatric intensive care unit: A developing country perspective

Background: There is a paucity of data on the pulmonary function tests (PFTs) in pediatric mechanically ventilated patients, especially in a developing country setting. Materials and Methods: This prospective study was carried out in the pediatric intensive care unit over 15 months. The PFTs were measured using spirometry at discharge, at 3 and 6 months. Results: Of 32 eligible children, 20 (mean age 9 ± 2.62 years) completed the 6-month follow-up. The most common indications for mechanical ventilation were respiratory (45%) and neurological (35%) causes. At the end of 6 months, 65% children had abnormal lung function (restrictive pattern). Patients with longer duration of ventilation, high peak pressures, and high fractional inhaled oxygen had a trend toward more abnormality in the lung function. Conclusions: Pediatric mechanically ventilated patients developed restrictive pulmonary defects after discharge that gradually improved over time. The majority was asymptomatic and reported no lifestyle limitations. There is a need for longer follow-up studies to assess the lung function and clinical condition postdischarge

Risk factors for extubation failure in mechanically ventilated children in pediatric intensive care unit

Background: Mechanical ventilation is lifesaving in children with respiratory failure. However, its unnecessary prolongation once a child is capable of sustaining spontaneous effective ventilation is associated with significant complications. Objective: To identify the factors that lead to higher chance of extubation failure in mechanically ventilated children. Materials and Methods: A prospective, observational study was conducted over a period of 1 year. Children admitted to pediatric intensive care unit of a tertiary care hospital of Northern India aged 1 month–17 years, needing mechanical ventilation were included in the study. Predefined criteria were used to decide the timing of extubation. Relevant details were recorded to study various patient-related parameters and their association with extubation outcome. Results: Mean age of the study group was 50 months with a male:female ratio of 3:1. Extubation failure rate was 14.5%. Extubation failure was significantly higher in patients ventilated for >7 days (p=0.01), those with the pediatric risk of mortality score >10 at admission (p=0.009), in addition to peak inspiratory pressure >16 cm H2O (p=0.009) and FiO2 ≥0.35 (p=0.01) before extubation. Accidental extubation was also associated with higher extubation failure (p<0.001). Conclusion: Our study demonstrates that even though sicker patients requiring ventilation for longer duration are more prone to failed extubations, protocol based, and planned extubations lead to better extubation success

Pulmonary Functions in Normal School Children in the Age Group of 6-15 Years in North India

Objective: Lung function tests have become an integral part of assessment of pulmonary disease. As few studies on pulmonary function tests have been carried out in young children in India, the study was carried out in normal urban and rural school children in Ludhiana district of North India to determine pulmonary functions in the age group 6-15 years and to find its correlation with regards to age, sex, height and weight. Methods: The study group included 600 normal children between 6-15 years age from different urban and rural schools in the region. A preformed questionnaire was interviewed and detailed general physical and systemic examination was done. Pulmonary function tests were measured by using Micromedical Gold standard fully computerized portable auto spirometer (Superspiro Cat No. SU 6000). Findings: The present study shows, all the three independent variables (age, weight and height) have linear positive correlation with lung function parameters, both for boys and girls. Lung function values in boys were significantly higher as compared to that of girls. Urban children had higher lung function parameters than rural children except IRV, FEF25%. Among all anthropometric parameters, height was the most independent variable with maximum coefficient of correlation. Conclusion: Equations derived from the present study for estimation of the expected values of lung function will help to interpret the observed lung function values in children of North India

A study of the prevalence and risk factors of asthma in urban schools of Ludhiana, Punjab

Background: Asthma is the most common chronic childhood disease being increasingly diagnosed in recent years. A review estimating the prevalence of bronchial asthma in the Indian children concluded the burden to be high than previously understood. There is paucity of data from Punjab, and no study from Ludhiana has estimated the true prevalence of asthma in urban area. Objective: To determine the prevalence and risk factors for childhood asthma using questionnaires and pulmonary function tests. Material and Methods: This was a questionnaire based cross-sectional study over a period of 1.5 year in the age group of 5-15 years studying in three schools of urban Ludhiana. The data were analyzed b STATA Software (version 16, college station Tx, USA). P < 0.05 was considered as significant. Results: The retrieval of questionnaire I was possible in 80% of the 2500 distributed. The prevalence of asthma was calculated as 7.5% (95% confidence interval, 5.2-10.5). The mean age of the children with asthma was 8.67 ΁ 2.62 years. The most common symptoms reported by the cases were wheezing and seasonal allergy. No predilection for sex, socioeconomic status, and pet at home was noted. The family history of asthma and allergy, family history of smoking were emerged as significant risk factors. Conclusions: The prevalence of asthma in the urban schools of Ludhiana was found to be 7.5% which was much higher than previously reported. Age groups 5-8 years were commonly affected. Family history of asthma or allergy, and smoking history were found to be significant risk factors for development of asthma

Online Learning and Residents' Acquisition of Mechanical Ventilation Knowledge:Sequencing Matters

OBJECTIVE: Rapid advancements in medicine and changing standards in medical education require new, efficient educational strategies. We investigated whether an online intervention could increase residents' knowledge and improve knowledge retention in mechanical ventilation when compared with a clinical rotation and whether the timing of intervention had an impact on overall knowledge gains. DESIGN: A prospective, interventional crossover study conducted from October 2015 to December 2017. SETTING: Multicenter study conducted in 33 PICUs across eight countries. SUBJECTS: Pediatric categorical residents rotating through the PICU for the first time. We allocated 483 residents into two arms based on rotation date to use an online intervention either before or after the clinical rotation. INTERVENTIONS: Residents completed an online virtual mechanical ventilation simulator either before or after a 1-month clinical rotation with a 2-month period between interventions. MEASUREMENTS AND MAIN RESULTS: Performance on case-based, multiple-choice question tests before and after each intervention was used to quantify knowledge gains and knowledge retention. Initial knowledge gains in residents who completed the online intervention (average knowledge gain, 6.9%; SD, 18.2) were noninferior compared with those who completed 1 month of a clinical rotation (average knowledge gain, 6.1%; SD, 18.9; difference, 0.8%; 95% CI, -5.05 to 6.47; p = 0.81). Knowledge retention was greater following completion of the online intervention when compared with the clinical rotation when controlling for time (difference, 7.6%; 95% CI, 0.7-14.5; p = 0.03). When the online intervention was sequenced before (average knowledge gain, 14.6%; SD, 15.4) rather than after (average knowledge gain, 7.0%; SD, 19.1) the clinical rotation, residents had superior overall knowledge acquisition (difference, 7.6%; 95% CI, 2.01-12.97;p = 0.008). CONCLUSIONS: Incorporating an interactive online educational intervention prior to a clinical rotation may offer a strategy to prime learners for the upcoming rotation, augmenting clinical learning in graduate medical education