The goal was to define reference ranges for pulse oxygen saturation (Spo(2)) values in the first 10 minutes after birth for infants who received no medical intervention in the delivery room.
Infants ...were eligible if a member of the research team was available to record Spo(2) immediately after birth. Infants were excluded if they received supplemental oxygen or any type of assisted ventilation. Spo(2) was measured with a sensor applied to the right hand or wrist as soon as possible after birth; data were collected every 2 seconds.
We studied 468 infants and recorded 61650 Spo(2) data points. The infants had a mean + or - SD gestational age of 38 + or - 4 weeks and birth weight of 2970 + or - 918 g. For all 468 infants, the 3rd, 10th, 50th, 90th, and 97th percentile values at 1 minute were 29%, 39%, 66%, 87%, and 92%, respectively, those at 2 minutes were 34%, 46%, 73%, 91%, and 95%, and those at 5 minutes were 59%, 73%, 89%, 97%, and 98%. It took a median of 7.9 minutes (interquartile range: 5.0-10 minutes) to reach a Spo(2) value of >90%. Spo(2) values for preterm infants increased more slowly than those for term infants. We present percentile charts for all infants, term infants of > or = 37 weeks, preterm infants of 32 to 36 weeks, and extremely preterm infants of <32 weeks.
These data represent reference ranges for Spo(2) in the first 10 minutes after birth for preterm and term infants.
The present guidelines are the most recent data on postoperative nausea and vomiting (PONV) and an update on the 2 previous sets of guidelines published in 2003 and 2007. These guidelines were ...compiled by a multidisciplinary international panel of individuals with interest and expertise in PONV under the auspices of the Society for Ambulatory Anesthesia. The panel members critically and systematically evaluated the current medical literature on PONV to provide an evidence-based reference tool for the management of adults and children who are undergoing surgery and are at increased risk for PONV. These guidelines identify patients at risk for PONV in adults and children; recommend approaches for reducing baseline risks for PONV; identify the most effective antiemetic single therapy and combination therapy regimens for PONV prophylaxis, including nonpharmacologic approaches; recommend strategies for treatment of PONV when it occurs; provide an algorithm for the management of individuals at increased risk for PONV as well as steps to ensure PONV prevention and treatment are implemented in the clinical setting.
Objectives To identify variables that predict extubation success in extremely preterm infants born <28 weeks gestational age (GA), and to compare outcomes between those who had successful or failed ...extubation. Study design A secondary analysis of data from a randomized trial of postextubation respiratory support that included 174 extremely preterm infants. “Extubation success” was defined as not requiring reintubation within 7 days, and “extubation failure” the converse. Predictive variables that were different between groups were included in a multivariable logistic regression model. Results Sixty-eight percent of infants were successfully extubated. Compared with those infants who had extubation failure, they had a higher GA and birth weight, were extubated earlier, were more often exposed to prolonged ruptured membranes, more often avoided intubation in the delivery room, had a higher pre-extubation pH, and had lower mean pre-extubation fraction of inspired oxygen and partial pressure of carbon dioxide (PCO2 ). Only GA and PCO2 remained significant in the multivariable analysis (area under a receiver operating characteristic curve = 0.81). Extubation failure was associated with death, bronchopulmonary dysplasia, severe retinopathy of prematurity, patent ductus arteriosus ligation, and longer durations of respiratory support, oxygen supplementation, and hospitalization. When adjusted for allocated treatment in the randomized trial, GA, and birth weight z-score, extubation failure remained associated with death before discharge and prolonged respiratory support and hospitalization. Conclusions In extremely preterm infants, higher GA and lower pre-extubation PCO2 predicted extubation success. Infants in whom extubation failed were more likely to die and have prolonged respiratory support and hospitalization. Trial registration Australian New Zealand Clinical Trials Network: ACTRN12610000166077.
Moral Distress in Neonatology Prentice, Trisha M; Janvier, Annie; Gillam, Lynn ...
Pediatrics (Evanston),
08/2021, Letnik:
148, Številka:
2
Journal Article
Recenzirano
To longitudinally examine the nature of moral distress (MoD) experienced by clinicians caring for extremely low gestational age neonates.
Neonatologists, medical trainees, and nurses were surveyed at ...regular intervals on their experience of MoD and their preferred level of care in relation to 99 neonates born <28 weeks' gestational age managed from birth until discharge or death in 2 tertiary NICUs. Clinicians reporting significant distress (≥6 of 10 on Wocial's Moral Distress Thermometer) were asked to provide open-ended responses on why they experienced MoD. Descriptive statistics were used to analyze frequency and intensity of MoD across different clinician characteristics. Open-ended responses were analyzed by using mixed methods.
Over 18 months, 4593 of 5332 surveys (86% response rate) were collected. MoD was reported on 687 (15%) survey occasions; 91% of neonates elicited MoD during their hospitalization. In their open-ended answers, clinicians invoked 5 main themes to explain their distress: (1) infant-centered reasons (83%), including illness severity, predicted outcomes, and disproportionate care; (2) management plans (26%); (3) family-centered reasons (19%); (4) parental decision-making (16%); and (5) provider-centered reasons (15%). MoD was strongly associated with the perception of "parents wanting too much." Neonatologists experienced less distress and were more likely than nurses and trainees to align preferred levels of care with family wishes.
The majority of preterm infants will generate some MoD; however, it is rarely shared and of a sustained nature. The main constraint reported by clinicians was "parents wanting too much," leading to disproportionate care.
Abstract
The circulation of the Arctic Ocean has traditionally been studied as a two-layer system, with a wind-driven anticyclonic gyre in the surface layer and a cyclonic boundary current in the ...Atlantic Water (AW) layer, primarily forced remotely through inflow and outflow to the basin. Here, an idealized numerical model is used to investigate the interplay between the dynamics of the two layers and to explore the response of the circulation in each of the layers to a change in the forcing in either layer. In the model, the intensity of the circulation in the surface and AW layers is primarily set by the ocean surface stress curl intensity and the inflow to the basin, respectively. Additionally, the surface layer circulation can strongly modulate the intensity of the intermediate layer by constraining the lateral extent of the AW current on the slope. In contrast, a change in the AW current strength has little effect on the surface layer circulation. The intensity of the circulation in the surface layer adjusts over a decade, on a time scale consistent with a balance between Ekman pumping and an eddy-induced volume flux toward the boundary, while the circulation in the AW layer adjusts quickly to any change of forcing (~1 month) through the propagation of boundary-trapped waves. As the two layers have different adjustment processes and time scales, and are subject to forcing that varies on all time scales, the interplay between the dynamics of the two layers is complex, and more simultaneous observations of the circulation within the two layers are required to fully understand it.
Managing risks and uncertainty are terms that are used interchangeably by project teams. Research on project procurement shows unexpected events in project delivery are often distinguished by these ...terms. This raises questions concerning how collaboration and coping ability help deal with inherent uncertainty and ambiguity. Using Weick's sense-making process of reflection and re-analysis a novel methodological approach was developed. A project database and contemporary literature was mined using the perspective of Snowden's Cynefin ambiguity framework. Two industry sourced examples provided support to the arguments made. The findings suggest that collaboration may lead to reduced people and process ambiguities and where ambiguity is revealed in projects it is often unrecognised, residing in a disordered zone. Observing ambiguity in this way provides a better understanding of ambiguity and advanced coping strategies. Having these perspectives is useful for identifying ambiguity where it may otherwise be missed or subsumed into risk and uncertainty.
•Research into project procurement is centred on managing risks.•Unexpected events in projects are distinguished by uncertainty and ambiguity.•Collaboration may lead to reduced people and process ambiguity.•Investigating ambiguity provides an understanding of coping strategies.•Failing to identify ambiguity allows it to subsumed into risk and uncertainty.
Thwaites Glacier is one of the fastest-changing ice-ocean systems in Antarctica
. Much of the ice sheet within the catchment of Thwaites Glacier is grounded below sea level on bedrock that deepens ...inland
, making it susceptible to rapid and irreversible ice loss that could raise the global sea level by more than half a metre
. The rate and extent of ice loss, and whether it proceeds irreversibly, are set by the ocean conditions and basal melting within the grounding-zone region where Thwaites Glacier first goes afloat
, both of which are largely unknown. Here we show-using observations from a hot-water-drilled access hole-that the grounding zone of Thwaites Eastern Ice Shelf (TEIS) is characterized by a warm and highly stable water column with temperatures substantially higher than the in situ freezing point. Despite these warm conditions, low current speeds and strong density stratification in the ice-ocean boundary layer actively restrict the vertical mixing of heat towards the ice base
, resulting in strongly suppressed basal melting. Our results demonstrate that the canonical model of ice-shelf basal melting used to generate sea-level projections cannot reproduce observed melt rates beneath this critically important glacier, and that rapid and possibly unstable grounding-line retreat may be associated with relatively modest basal melt rates.
The analysis of volatile sulfur compounds using headspace solid-phase microextraction (HS-SPME) is heavily influenced by matrix effects. The effects of a wine matrix, both non-volatile and volatile ...components (other than ethanol) were studied on the analysis of several common sulfur volatiles found in wine, including hydrogen sulfide (H
S), methanethiol (MeSH), dimethyl sulfide (DMS), dimethyl disulfide (DMDS), dimethyl trisulfide (DMTS), diethyl disulfide (DEDS), methyl thioacetate (MeSOAc), and ethyl thioacetate (EtSOAc). Varying levels of devolatilized wine and common wine volatiles (acids, esters, alcohols) were added to synthetic wine samples to act as matrices. Sulfur standards were added and analyzed using gas chromatography with pulsed-flame photometric detection (GC-PFPD). Five internal standards were used to find best representatives of each compound despite matrix effects. Sensitivity remained stable with the addition of devolatilized wine, while addition of volatile components decreased sensitivity. DMS was found to be best measured against EMS; DMDS and the thioacetates were best measured against DES; H
S, MeSH, DEDS, and DMTS were best measured against DIDS. The method was used to quantitate the volatile sulfur compounds in 21 wines with various ethanol contents and volatile profiles.
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