Pediatric Bag Research Articles

Component therapy.

The dramatic advances that have taken place in recent years in the care of sick and premature infants also have been matched by a similar increase in the use of blood transfusion therapy. Haematological features indicate that a newborn has a blood volume of 85-125 ml/kg the foetal haemoglobin is 60-85% and average Hb in full term infant is 18 gm/dl. By 2-3 months it falls to 11-12 g/dl the main cause of anemia are iron poor diet, weaning diets recurrent or chronic infections and hemolytic episodes in malarious areas. The red cells transfusions are usually top up transfusions, exchange transfusions, partial exchange transfusions. Top up- are for investigational losses and correction of mild degrees of anemias, upto to 5-15 ml/kg. They comprise 90% of all neonatal transfusions and are used in low birth babies in special care units for a maximum of 9-10 episodes. The walk in donor programs once popular are not much in vogue. The threshold for transfusion is 8-10 g/dl Hb for upto 5 weeks. Exchange transfusions are done for correction of anemia, removal of bilirubin, removal of antibodies and replacement of red cells. Ideally plasma reduced red cells that are not older than 5 days are used. It is prepared by removal of 120 ml of standard whole blood donation. The advantage of fresh cells is that hyperkalemia is avoided and good post transfusion survival acceptable red cell oxygen affinity. However it has to be screened for sickle cell disease and G6PD deficiency. Indications for exchange transfusion are kernicterus, neonatal hemolysis, G6PD deficiency, ARDS, neonatal sepsis, DIC and neonatal isoimmune thrombocytopaenia. Complications include over transfusion, perforation of major vessels, hypocalcaemia, citrate toxicity, hypothermia, hypoglycaemia, thrombocytopenia, necrotizing enterocolitis, GVHD, bacterial, viral infections. Partial exchange transfusions are done for symptomatic anemia, where Hb<10 g/dl, it is indicated in polycythemia and hyperviscosity syndromes. Exchange volume = Blood volume x (observed Hct-Desired HCt) divided observed Hct. Points to consider-there is weak expression of ABO antigens so particular care while grouping. Transfusing volumes should be 2-5 ml/kg/hour in paediatric bags of 50-100 ml with infusion devices. Platelet transfusion are indicated in neonatal throbocytopaenia, thrombocytopaenia due to sepsis, DIC, bacterial pathogens, CMV, TORCHS, Obstetric conditions such as pre eclampsia, intrauterine death abruption placenta birth injury hypoxia schock neonatal iso immune thrombocytopaenia and maternal ITP. Administration 1 RDE/pack per 2.5 kg single dose of fresh platelets less than 24hrs which contains 55 x 10(9) cells. This also contributes fresh plasma so is useful for coagulation defects also, though there is a risk of CMV and GVHD due to leucocyte contamination. Granulocyte concentrate; Gravity leucopheresis-1:8 ratio of 60 ml of 6% HES made to stand for 1hr.

In vitro characteristics of red blood cell concentrates prepared from under- and overcollected units of whole blood and from a paediatric blood bag system.

The problem of how to deal with red blood cell concentrates (RBCs) prepared from under- or overcollected units of whole blood (WB) and how to collect blood from underweight persons arises in the context of autologous predeposit. To determine the quality of RBCs stored in PAGGS-M additive solution prepared from under- and overcollected units of whole blood and of PAGGS-M RBCs prepared from a paediatric 250-mL top outlet blood bag system we measured blood picture, haemolysis, K+, pH, ATP and 2,3-DPG on days 0, 10, 20, 30, 40 and 49 of storage. The volume of WB collected ranged from 150 to 600 mL in 50-mL increments (4 units per volume). Haemolysis was under 0.8% on day 49 in all RBCs prepared from WB donations between 200 mL and 600 mL. However, the day 49 haemolysis level of standard RBCs prepared from 450 mL of WB (0.15 +/- 0.03%) was reached earlier in RBCs from under- and overcollected units of whole blood. 2,3-DPG levels decreased rapidly between days 10 and 20 in all RBCs studied. RBCs from 450-mL donations showed acceptable ATP maintenance after 49 days (70.4% of day 0 value), while all other RBC ATP levels were below 50% of the day 0 level on day 49. In vitro quality data of RBCs prepared from a 250-mL donation in the paediatric blood bag system after storage for about 25 days were comparable to those after 49 days of storage of standard RBCs. Our results suggest that it is feasible to transfuse PAGGS-M RBCs prepared from under- as well as overcollected units of WB in the autologous setting. However, we strongly recommend shortening the storage period of such RBCs to maintain the quality level of standard RBCs.

Effects of smaller tidal volumes during basic life support ventilation in patients with respiratory arrest: good ventilation, less risk?

Objective: When ventilating an unintubated patient in cardiac or respiratory arrest, smaller tidal volumes of 500 ml instead of 800–1200 ml may be beneficial to decrease peak airway pressure, and to minimise stomach inflation. The purpose was to determine the effects of small (∼500 ml) versus large (∼1000 ml) tidal volumes given with paediatric versus adult self-inflatable bags and ∼50% oxygen on respiratory parameters in patients during simulated basic life support ventilation. Methods: While undergoing induction of anaesthesia, patients were randomised to three minutes of ventilation with either an adult ( n=40) or paediatric ( n=40) self-inflatable bag. Results: When compared with an adult self-inflatable bag, the paediatric bag resulted in significantly lower mean (±standard deviation) exhaled tidal volume (365±55 versus 779±122 ml; P<0.0001), peak airway pressure (20±2 versus 25±5 cm H 2O; P<0.0001), but comparable oxygen saturation (97±1% versus 98±1%; NS (nonsignificant)). Stomach inflation occurred in five of 40 patients ventilated with an adult self-inflatable bag, but in no patients who were ventilated with a paediatric self-inflatable bag ( P=0.054). Conclusion: Administering smaller tidal volumes with a paediatric instead of an adult self-inflatable bag in unintubated adult patients with respiratory arrest maintains good oxygenation and carbon dioxide elimination while decreasing peak airway pressure, which makes stomach inflation less likely.

Influence of tidal volume on the distribution of gas between the lungs and stomach in the nonintubated patient receiving positive-pressure ventilation.

When ventilating a nonintubated patient in cardiac arrest, the European Resuscitation Council has recently recommended a decrease in the tidal volume from 0.8 to 1.2 L to 0.5 L, partly in an effort to decrease peak flow rate, and therefore, to minimize stomach inflation. The purpose of the present study was to examine the validity of the European Resuscitation Council's recommendation in terms of gas distribution between lungs and stomach in a bench model that simulates ventilation of a nonintubated patient with a self-inflatable bag representing tidal volumes of 0.5 and 0.75 L. A bench model of a patient with a nonintubated airway was used consisting of face mask, manikin head, training lung (lung compliance, 50 mL/cm H2O; airway resistance, 5 cm H2O/L/sec), adjustable lower esophageal sphincter pressure (LESP) and simulated stomach. University hospital laboratory. Thirty healthcare professionals. Healthcare professionals performed 1-min bag-mask ventilation at each LESP level of 5, 10, and 15 cm H2O at a rate of 12 breaths/min, using an adult and pediatric self-inflating bag, respectively. Volunteers were blinded to the LESP, which was randomly varied. Both types of self-inflating bags induced stomach inflation, with higher stomach and lower lung tidal volumes when the LESP was decreased. Lung tidal volume with the pediatric bag was significantly (p < .05) lower at all LESP levels when compared with the adult bag, and ranged between 240 mL at an LESP of 15 cm H2O and 120 mL at an LESP of 5 cm H2O. Stomach tidal volume with the adult bag ranged between 250 mL at an LESP of 15 cm H2O and increased to 550 mL at an LESP of 5 cm H2O. Stomach tidal volume with the pediatric bag was significantly lower (p < .05) at all LESP levels when compared with the adult bag and ranged between 70 mL at an LESP of 15 cm H2O and 300 mL at an LESP of 5 cm H2O. Our data support the recommendation of the European Resuscitation Council to decrease tidal volumes to 0.5 L when ventilating a cardiac arrest victim with an unprotected airway. A small tidal volume may be a better trade-off in the basic life support phase, as this may provide reasonable ventilation while avoiding massive stomach inflation.

PERFORMANCE OF PEDIATRIC RESUSCITATION BAGS ASSESSED WITH AN INFANT LUNG SIMULATOR

Many pediatric self-inflating bags are equipped with pressure relief (pop-off) valves to prevent barotrauma. We participated in a resuscitation in which a valve malfunction briefly caused inadequate ventilation. The pop-off valve was seated in an intermediate position between open and closed settings. To investigate this problem, we assessed the performance of several commonly used pediatric self-inflating bags using an infant lung simulator (D, B & M, Redlands, CA). Bags were deflated using a range of inspiratory times (TI), delivered tidal volumes, peak proximal airway pressure (Pp), and peak distal pressure (lung pressure, Pd). When the pop-off valve was set in the open position, Pp ranged from 42 cm to 105 cm H2O, although P(d) never exceeded 45 cm H2O. The mean difference between Pp and P(d) decreased from 14.2 +/- 1.1 cm H2O at TI = 0.2 s to 6.1 +/- 0.5 cm H2O at TI = 1 s. Inflation of all DMR (disposable) and PMR (nondisposable) bags in the intermediate valve position produced marked air leakage through the valve, with delivered tidal volumes of only 92 +/- 13 mL (DMR) for TI 0.6 s. A wide range of delivered tidal volumes was observed among all bags examined. We conclude that both DMR and PMR bags can be placed inadvertently in an intermediate valve position that can produce disastrous hypoventilation during resuscitation.(ABSTRACT TRUNCATED AT 250 WORDS)