AARC Clinical Practice Guidelines: Artificial Airway Suctioning.
Respiratory care
Artificial airway suctioning is a key component of airway management and a core skill for clinicians charged with assuring airway patency. Suctioning of the artificial airway is a common procedure performed worldwide on a daily basis. As such, it is imperative that clinicians are familiar with the most-effective and efficient methods to perform the procedure. We conducted a systematic review to assist in the development of evidence-based recommendations that pertain to the care of patients with artificial airways. From our systematic review, we developed guidelines and recommendations that addressed questions related to the indications, complications, timing, duration, and methods of artificial airway suctioning. By using a modified version of the RAND/UCLA Appropriateness Method, the following recommendations for suctioning were developed for neonatal, pediatric, and adult patients with an artificial airway: (1) breath sounds, visual secretions in the artificial airway, and a sawtooth pattern on the ventilator waveform are indicators for suctioning pediatric and adult patients, and an acute increase in airway resistance may be an indicator for suctioning in neonates; (2) as-needed only, rather than scheduled, suctioning is sufficient for neonatal and pediatric patients; (3) both closed and open suction systems may be used to safely and effectively remove secretions from the artificial airway of adult patients; (4) preoxygenation should be performed before suctioning in pediatric and adult patients; (5) the use of normal saline solution should generally be avoided during suctioning; (6) during open suctioning, sterile technique should be used; (7) suction catheters should occlude < 70% of the endotracheal tube lumen in neonates and < 50% in pediatric and adult patients, and suction pressure should be kept below -120 mm Hg in neonatal and pediatric patients and -200 mm Hg in adult patients; (8) suction should be applied for a maximum of 15 s per suctioning procedure; (9) deep suctioning should only be used when shallow suctioning is ineffective; (10) routine bronchoscopy for secretion removal is not recommended; and (11) devices used to clear endotracheal tubes may be used when airway resistance is increased due to secretion accumulation.
10.4187/respcare.09548
Uncertainty and perinatal post-traumatic stress disorder in the neonatal intensive care unit.
Research in nursing & health
Parents of infants in the neonatal intensive care unit (NICU) are at increased risk of developing perinatal post-traumatic stress disorder (PPTSD), a mental health condition known to interfere with healthy parental and infant attachment. Feelings of uncertainty about illness have been theorized as an antecedent to post-traumatic stress, however the relationship has not been explored in parents of infants requiring care in the NICU. The purpose of this prospective study was to explore parental uncertainty during and after NICU discharge and the relationship between uncertainty and PPTSD. The sample consisted of 319 parents during NICU hospitalization and 245 parents at 3 months postdischarge. Parents who screened positive for PPTSD 3 months after hospital discharge reported more uncertainty both while in the NICU and 3 months after hospital discharge (p < 0.001). In parents with a personal or family history of mental illness, the moderated/mediating structural probit analysis showed no direct or indirect effect of uncertainty during hospitalization or at 3 months after hospital discharge on screening positive for PPTSD. In parents who did not report personal or family history of mental illness, uncertainty at 3 months after hospital discharge had a direct effect (b = 0.678, p < 0.001) and indirect mediating effect (b = 0.276, p < 0.001) on screening positive for PPTSD. The results provide actionable implications for mental health and NICU providers: (1) routine screening for uncertainty and risk factors including previous personal and family history of mental illness, and (2) the development of NICU follow-up support services to mitigate risk for PPTSD.
10.1002/nur.22261
Implementing video cases in clinical paediatric teaching increases medical students' self-assessed confidence.
Malon Michelle,Cortes Dina,Andersen Jesper,Jensen Maria Anna Bruunsgaard,Mortensen Henrik Bindesbøll,Nygaard Ulrikka,Poulsen Anja,Sørensen Jette Led,Greisen Gorm
Danish medical journal
INTRODUCTION:Use of video cases in clinical education is rarely used systematically. MATERIAL AND METHODS:Medical students (n = 127) reported by questionnaire whether they had or had not seen a bedside case of each of 22 specific clinical conditions during their five-week clinical course in paediatrics in seven centres. A video case library showing children with common clinical conditions was established, and a short video was added to the oral examination. We evaluated students' and internal and external examiners' perceptions by questionnaires. RESULTS:A total of 81% of the students reported having seen a child with asthma in the daily clinic. In contrast, respiratory syncytial virus infection was only seen by 20%. Students' self-reported confidence in the assessment of paediatric patients increased after the video case library was made available: Before the intervention, 41% (57/138) of the students reported confidence at a score of 5-7 on a seven-point Likert scale. This increased to 64% (186/289) (p < 0.0001) after the introduction of the video case library. Before, 84% (116/138) of the students judged the impact of video cases to be high (score 5-7 on a seven-point Likert scale) and after the intervention, this share was 75% (218/289) (p = 0.06). Furthermore, internal as well as external examiners found video cases valuable, but the use of videos did not change the average examination grade. CONCLUSION:A video case supplement to teaching in clinical paediatrics was considered to be of value for teaching. We were successful in establishing an educational resource that students considered useful. Internal and external examiners found that a short video case was a valuable supplementary tool during the oral examination. FUNDING:The University of Copenhagen funded the study. TRIAL REGISTRATION:not relevant.
Individualized video recommendation modulates functional connectivity between large scale networks.
Su Conghui,Zhou Hui,Wang Chunjie,Geng Fengji,Hu Yuzheng
Human brain mapping
With the emergence of AI-powered recommender systems and their extensive use in the video streaming service, questions and concerns also arise. Why can recommended video content continuously capture users' attention? What is the impact of long-term exposure to personalized video content on one's behaviors and brain functions? To address these questions, we designed an fMRI experiment presenting participants with personally recommended videos and generally recommended ones. To examine how large-scale networks were modulated by personalized video content, graph theory analysis was applied to investigate the interaction between seven networks, including the ventral and dorsal attention networks (VAN, DAN), frontal-parietal network (FPN), salience network (SN), and three subnetworks of default mode network (dorsal medial prefrontal (dMPFC), Core, and medial temporal lobe (MTL)). Our results showed that viewing nonpersonalized video content mainly enhanced the connectivity in the DAN-FPN-Core pathway, whereas viewing personalized ones increased not only the connectivity in this pathway but also the DAN-VAN-dMPFC pathway. In addition, both personalized and nonpersonalized short videos decreased the couplings between SN and VAN as well as between two DMN subsystems, Core and MTL. Collectively, these findings uncovered distinct patterns of network interactions in response to short videos and provided insights into potential neural mechanisms by which human behaviors are biased by personally recommended content.
10.1002/hbm.25616