FINAL PROGRAM CONGRESS CENTRE MONTREUX, SWITZERLAND MAY 25-28,

Transcription

1 FINAL PROGRAM CONGRESS CENTRE MONTREUX, SWITZERLAND MAY 25-28,

2 EPNV Notes 2

3 Table of content EPNV Conference Organization 4 Welcoming Words 5 Faculty and Workshop Leaders 6 Program at a Glance 8 Scientific and Educational Program 9 Table of Abstracts 22 Oral Presentations 28 E-Posters 41 Index of Authors 70 Sponsors & Exhibitors 76 Exhibition Plan 80 General Information 82 Social Program 84 General Conditions 85 About Montreux 87 Map of Montreux 90 3

4 EPNV Conference Organization The 13 th Conference on Pediatric and Neonatal Mechanical Ventilation (EPNV) offers a unique opportunity for delegates to learn about leading edge innovations from all over the world. The format of the program includes keynote speakers, oral and E-posters presentations from peer reviewed submitted abstracts. The social program offers the opportunity for networking and meeting the delegates. Scientific Program Committee Peter Rimensberger (Congress Chairman) Thomas Berger Jürg Hammer Martin Kneyber Laurent Storme Switzerland Switzerland Switzerland The Netherlands France Endorsed by: The European Society of Pediatric and Neonatal Intensive Care (ESPNIC) Educational Credits The EACCME (European Accreditation Council for Continuing Medical Education) has granted 21 European CME credits to the 13 th EPNV congress. The Swiss Society of Neonatology (SGI/SSMI) has granted 21 CME credits Administrative Secretariat Symposium & Conference Organizers Rue Rousseau 30, CH Geneva, Switzerland Tel: +41 (0) Fax: +41 (0) info@epnv-montreux.org 4

5 Welcoming Words EPNV Welcome to the 13 th European Conference on Pediatric and Neonatal Mechanical Ventilation Dear Colleagues and Friends, The 13 th European Conference on Pediatric and Neonatal Mechanical Ventilation will again be in Montreux (Switzerland), which will continue to provide the unique and ideal environment for our meeting. As in previous year, thematic sessions include lecturers by key experts and well known speakers on various topics related to ventilation and respiratory failure in new-borns and children. With the previous very positive and exciting experience integrating nursing in the educational program. We will continue to emphasize free paper and E-poster presentations offering young pediatricians, neonatologists, pediatric intensivists, pediatric anesthesists, a multidisciplinary forum where they can present their research and share their clinical experience with all participants. In addition, according to our strong commitment to education, we will offer again a series of precongress workshops that will focus on very practical bedside issues. We are inviting you to participate and to make this 13 th European Conference on Pediatric and Neonatal Mechanical Ventilation a high standard event and a tremendous success. We are looking forward to seeing you in Montreux in May. Peter C. Rimensberger Congress Chairman 5

6 EPNV Faculty & Workshop Leaders Olivier Baud Thomas Berger Risha Bhatia France Switzerland Australia Peter Dargaville Australia Heather Duncan United Kingdom Andreas Flemmer Germany Tom Goos The Netherlands Dean Hess USA Pierre-Henri Jarreau France Haresh Kirpalani USA Martin Kneyber The Netherlands Amir Kugelman Israel Lucas Liaudet Switzerland 6 Daniel Lichtenstein France

7 Faculty & Workshop Leaders EPNV Alberto Medina Vicent Modesto i Alapont Vincent Muehlethaler Spain Spain Switzerland Satoshi Nakagawa Japan Christopher Newth USA Christian Poets Germany Kyle Rehder USA Peter Rimensberger Switzerland Thomas Schaible Germany Barbara Schmidt USA Laurent Storme France David Tingay Australia Berndt Urlesberger Austria Nadya Yousef France 7

8 EPNV Program at a Glance Pre-Congress Workshops Wednesday, May 25, 08:00-10:00 Registration Opening 10:00-14:00 Workshop 1a - Room Miles VI-IX Workshop 2 - Room Miles V 14:00-15:00 Break 15:00-19:00 Workshop 1b - Room Miles VI-IX Workshop 3 - Room Miles V 19:00-20:00 ESPNIC General Assembly - Room Miles V Thursday, May 26, 08:00-12:00 Workshop 1c - Room Miles VI-IX Workshop 4 - Room Miles V Main Conference Thursday, May 26, 12:30-13:30 Industry Sponsored Lunch Symposium - Room Miles VI-IX 14:00-14:15 Opening Remarks - Room Miles V 14:15-15:00 Opening Lecture - Room Miles V 15:00-15:30 Coffee Break - Commercial exhibition 15:30-18:00 SESSION 1 - Room Miles V 18:00-20:00 Welcome Reception - Exhibition Area Friday, May 27, 08:00-08:45 Applied Physiology Lecture 1 - Room Miles V Applied Physiology Lecture 2 - Room Miles VI-IX 09:00-10:30 SESSION 2 - Room Miles V SESSION 3 - Room Miles VI-IX 10:30-11:00 Coffee Break - Commercial exhibition 11:00-12:00 ORAL PRESENTATIONS 1 Room Miles V E-Posters 12:00-13:45 Industry Sponsored Lunch Symposium - Room Miles VI-IX ORAL PRESENTATIONS 2 Room Miles VI-IX 13:45-15:15 SESSION 4 - Room Miles V SESSION 5 - Room Miles VI-IX 15:15-15:45 Coffee Break - Commercial exhibition 15:45-18:00 SESSION 6 - Room Miles V SESSION 7 - Room Miles VI-IX 19:00 Get Together Dinner Saturday, May 28, 08:30-09:15 Applied Physiology Lecture 3 - Room Miles V Applied Physiology Lecture 4 - Room Miles VI-IX 09:15-09:45 Coffee Break - Commercial exhibition 09:45-11:50 SESSION 8 - Room Miles V SESSION 9 - Room Miles VI-IX 11:50-12:30 Closing Lecture - Room Miles V 8

9 Scientific and Educational Program EPNV May 25-26, : Pre-Conference Workshops Wednesday (May 25): 10:00 19:00 Thursday (May 26): 08:00 12:00 May 26-28, : Main Conference Thursday (May 26): 12:30 18:00 Friday (May 27): 08:00 18:00 Saturday (May 28): 08:30 12:30 Wednesday Pre-Congress Workshops Wednesday, May 25, From 08:00 Registration Opening 10:00-14:00 Room Miles VI-IX Workshop 1a: Lung ultrasound in the neonatal and paediatric ICU Workshop-Leaders: Daniel Lichtenstein (France), Nadya Yousef (France) 10:00-14:00 Room Miles V Workshop 2: How to use HFOV in neonates, infants and children (with hands on stations) Industry sponsored (unrestricted) Workshop-Leaders: Amir Kugelman (Israel), Satoshi Nakagawa (Japan), Peter Rimensberger (Switzerland), Risha Bhatia (Australia) 1) Basic physiology and working principals of HFOV (Peter Rimensberger, Switzerland) 2) Assessing ventilation efficiency during HFOV: CO 2 monitoring (Amir Kugelman, Israel) 3) Neonatal HFOV clinical application (David Tingay, Australia) 4) Pediatric HFOV clinical application (Satoshi Nakagawa, Japan) 5) Hands-on group rotations Coffee break (20 minutes between 11:30 and 12:30) 9

10 EPNV Scientific and Educational Program Wednesday 15:00-19:00 Room Miles VI-IX Workshop 1b: Lung ultrasound in the neonatal and paediatric ICU Workshop-Leaders: Daniel Lichtenstein (France), Nadya Yousef (France) 15:00-19:00 Room Miles V Workshop 3: Understanding oxygenation and ventilation control concepts Industry sponsored (unrestricted) Workshop-Leaders: Tom Goos (The Netherlands), Andreas Flemmer (Germany), Christian Poets (Germany), Peter Rimensberger (Switzerland) 1) Closed-loop oxygen controllers: Concept and Clinical experience after 5 years (Christian Poets, Germany) 2) CO 2 monitoring and control (Tom Goos, The Netherlands) 3) Concepts of adaptive ventilation control (including volume targeting) (Andreas Flemmer, Germany & Peter Rimensberger, Switzerland) 4) Concepts of closed proportional assist (NAVA) (Peter Rimensberger, Switzerland) 5) Hands-on group rotations Coffee break (20 minutes between 16:30 and 17:30) 19:00-20:00 Room Miles V ESPNIC General Assembly 10

11 Scientific and Educational Program EPNV Thursday, May 26, 08:00-12:00 Room Miles VI-IX Workshop 1c: Lung ultrasound in the neonatal and paediatric ICU Workshop-Leaders: Daniel Lichtenstein (France), Nadya Yousef (France) 08:00-12:00 Room Miles V Workshop 4: Understanding ventilators, function principals, and specific clinical use Industry sponsored (unrestricted) Workshop-Leaders: Peter Rimensberger (Switzerland), Andreas Flemmer (Germany), Alberto Medina (Spain) 1) Patient characteristics and what is technically needed to control, support, or assist breathing (Peter C Rimensberger, Switzerland) 2) Various modes: what are they, how do they function, what do I have to set? (Andreas Flemmer, Germany) 3) Which mode may make sense in which condition (Alberto Medina, Spain) 4) Hands-on group rotations Thursday Coffee break (20 minutes between 09:30 and 10:30) 11

12 EPNV Scientific and Educational Program Thursday Main Conference Thursday, May 26, 12:30-13:30 Room Miles VI-IX Industry Sponsored Lunch Symposium Developing early warning systems for the neonatal and pediatric unit Symposium Leaders: Geoffrey Alms (USA), Heather Duncan (UK) 1) Predictive monitoring for early detection of sepsis in neonates (Geoffrey Alms, USA) 2) Anticipating life threatening events in the pediatrics unit (Heather Duncan, UK) 14:00-14:15 Room Miles V Opening Remarks Peter Rimensberger (Switzerland) 14:15-15:00 Room Miles V Opening lectures Oxygen: Bad or good Lucas Liaudet (Switzerland) 15:00-15:30 Coffee break 12 15:30-18:00 Room Miles V SESSION 1: Creating evidence in acute neonatal/pediatric respiratory failure: Today and Tomorrow Chairs: Peter Rimensberger (Switzerland) and Olivier Baud (France) 15:30-16:00 Evidence-based neonatology in the field of acute respiratory failure of the newborn: What is known? Haresh Kirpalani (USA)

13 Scientific and Educational Program EPNV 16:00-16:30 What are relevant outcomes in neonatal/pediatric respiratory trials? Thomas Berger (Switzerland) 16:30-17:00 Applied physiology at the bedside to individualize care Peter Dargaville (Australia) 17:00-17:30 Bayes' rule and Christi's data: Is HFNC really safe? Vicent Modesto i Alapont (Spain) Thursday - Friday 17:30-18:00 Research as a Standard of Care in the ICU Christopher Newth (USA) 18:00-20:00 Welcome Reception in the Exhibition Area Friday, May 27, 08:00-08:45 Room Miles V Applied Physiology Lecture 1: Respiratory mechanics in the mechanically ventilated patient: Beyond pressure and flow measures Dean Hess (USA) 08:00-08:45 Room Miles VI-IX Applied Physiology Lecture 2: Pathophysiology of apnoea in the preterm : It is not all about brain immaturity Christian Poets (Germany) 13

14 EPNV Scientific and Educational Program Friday 09:00-10:30 Room Miles V SESSION 2: Pediatric acute respiratory distress syndrome: Beyond conventional mechanical ventilation Chairs: Jürg Hammer and Peter Rimensberger (Switzerland) 09:00-09:30 Is HFOV still an option? Martin Kneyber (The Netherlands) 09:30-10:00 Respiratory ECMO: When and how? Kyle Rehder (USA) 10:00-10:15 OP-01: SF-ratio like predictive marker of the mortality rate in acute respiratory distress syndrome in pediatric intensive care unit Vicent Modesto i Alapont (Spain) 10:15-10:30 OP-02: Using transcutaneous electromyographic respiratory muscle recordings to introduce the neurosync index in the paediatric intensive care unit; is it feasible? Robert Blokpoel (The Netherlands) 09:00-10:30 Room Miles VI-IX SESSION 3: Respiratory Support in the Newborn Chairs: Andreas Flemmer (Germany), Thomas Berger (Switzerland) 09:00-09:25 HFNC versus CPAP in the newborn Peter Dargaville (Australia) 09:25-09:50 Non-invasive ventilation in the newborn: Where to go? Haresh Kirpalani (USA) 14 09:50-10:15 Continuous ETCO2 measures in the NICU: We have to learn on how to use it Amir Kugelman (Israel)

15 Scientific and Educational Program EPNV 10:30-11:00 Coffee break 10:15-10:30 OP-03: Impact of the synchronized nasal intermitent mandatory ventilation by neurally adjusted ventilatory assist (NAVA) in premature infants with respiratory failure. Celso Rebello (Brazil) Friday 11:00-12:00 Room Miles V Oral presentations 1 Chairs: Jürg Hammer (Switzerland), Haresh Kirpalani (USA) 11:00-11:15 OP-15: The use of inhaled Nitric Oxide (NO) in pediatric cardiac centers and NICU : A Franco-Belgian multicentre prospective survey from the POSITIVE study group Sylvie Laroche (France) 11:15-11:30 OP-05: An audit of humidification adequacy comparing single and double heated ventilator circuits in ventilated children in PICU: check your FACT(ory) S(ettings) first Mireia Garcia Cuscó (UK) 11:30-11:45 OP-06: Ultrasound for Diaphragmatic Dysfunction in Post-Operative Cardiac Children Hussam Hamadah (Saudi Arabia) 11:45-12:00 OP-07: Pressure and oscillation transmission with modern HFOV oscillators: bench comparison Daniele De Luca (France) 15

16 EPNV Scientific and Educational Program Friday 11:00-12:00 Room Miles VI-IX Oral presentations 2 Chairs: Olivier Baud (France), Martin Kneyber (The Netherlands) 11:00-11:15 OP-09: Optimal target range of closed-loop inspired oxygen support in preterm infants (OPTICLIO STUDY) Thomas Bachman (USA) 11:15-11:30 OP-10: Selecting the optimum target range or closed loop Fio2-Spo2 control: a synthesis of clinical trials Thomas Bachman (USA) 11:30-11:45 OP-08: Influence of gestational age on lung volume response to a sustained inflation at birth in preterm lambs David Tingay (Australia) 11:45-12:00 OP-11: Surfactant protein B gene polymorphism in neonates with respiratory distress syndrome Han Jeong-Ho (South Korea) 11:00-12:00 E-Posters Facilitators: Andreas Flemmer (Germany), Pierre-Henri Jarreau (France), Berndt Urlesberger (Austria), Amir Kugelman (Israel) 16 12:00-13:45 Room Miles VI-IX Industry Sponsored Lunch break: NAVA: Closed-loop ventilation mode or something more? 1) NAVA : beyond the best synchronization, Marco Piastra (Italy) 2) NIV and Intrinsic PEEP during severe bronchiolitis: benefits of NAVA, Florent Baudin (France) 3) Beyond mechanical ventilation: Monitoring of the EADi signal, Peter Rimensberger (Switzerland)

17 Scientific and Educational Program EPNV 13:45-15:15 Room Miles V SESSION 4: Ventilation, humidification and aerosols Chairs: Alberto Medina (Spain), Khyle Rheder (USA) 13:45-14:15 Aerosol therapy during non-invasive mechanical ventilation, CPAP and HFNC Dean Hess (USA) 14:15-14:45 Controlling and treating the asthma patient in the PICU Jürg Hammer (Switzerland) Friday 14:45-15:15 Humidification: passive or active? Martin Kneyber (The Netherlands) 13:45-15:15 Room Miles VI-IX SESSION 5: Oxygen targeting in the neonate: Do we know how? Chairs: Christian Poets (France), Amir Kugelman (Israel) 13:45-14:25 The oxygen discussion Barbara Schmidt (USA) 14:25-14:50 Targeting peripheral oxygen saturation versus cerebral oxygenation:does it matter? Berndt Urlesberger (Austria) 14:50-15:15 How should we design an optimal closed-loop oxygen controller? Peter Dargaville (Australia) 15:15-15:45 Coffee break 17

18 EPNV Scientific and Educational Program Friday 15:45-18:00 Room Miles V SESSION 6: Hot topics and controversies in cardiorespiratory support in newborns with CDH Chairs: Peter Dargaville (Australia), Peter Rimensberger (Switzerland) 15:45-16:30 The HFOV controversy: Pro-Con debate Pro: Satoshi Nakagawa (Japan) Con: Thomas Schaible (Germany) 16:30-17:15 Non-invasive hemodynamics for guiding cardiorespiratory support and treatment of PHT Laurent Storme (France) 17:15-17:45 Management of the surgical lung and long term outcome David Tingay (Australia) 17:45-18:00 OP-12: Ultrasound TAP Block for postoperative pain control in mechanical ventilated neonates Dario Galante (Italy) 15:45-17:45 Room Miles VI-IX SESSION 7: Bronchopulmonary dysplasia prevention and treatment reviewed Chairs: Olivier Baud (France), Haresh Kirpalani (USA) 15:45-16:15 Prevention: Can BPD be prevented and to which extend? Olivier Baud (France) 16:15-17:00 Treatment: Which drug when? Barbara Schmidt (USA) 18 17:00-17:30 Ventilation strategies to prevent, BPD and ventilation strategies to support the BDP patient Pierre-Henri Jarreau (France)

19 Scientific and Educational Program EPNV 17:30-17:45 OP-14: Neurally adjusted ventilatory assist (NAVA) in preterm newborn infants with respiratory distress syndrome - a randomized controlled trial Merja Kallio (Finland) 19:00 Departure for Congress Dinner Bus departure from the congress center Friday - Saturday Saturday, May 28, 08:30-09:15 Room Miles V Applied Physiology Lecture 3 ARDS scenario: Oxygenation physiology Alberto Medina (Spain) 08:30-09:15 Room Miles VI-IX Applied Physiology Lecture 4 Physiological effects of apnoea and how we can deal with them Peter Dargaville (Australia) 09:15-09:45 Coffee break 19

20 EPNV Scientific and Educational Program Saturday 09:45-11:45 Room Miles V SESSION 8: How to ventilate the child: Bridging between physiological reasoning, clinical expertise and evidence based guidelines (PEMVECC) Chair: Peter Rimensberger (Switzerland) 09:45-10:25 The patient with a normal lung: Physiological reasoning Jürg Hammer (Switzerland) Expert opinion Kyle Rehder (USA) PEMVECC recommendations Martin Kneyber (The Netherlands) 10:25-11:05 The patient with restrictive lung disease: Physiological reasoning Jürg Hammer (Switzerland) Expert opinion Peter Dargaville (Australia) PEMVECC recommendations Martin Kneyber (The Netherlands) 11:05-11:45 The patient with obstructuve lung disease: Physiological reasoning Jürg Hammer (Switzerland) Expert opinion Peter Dargaville (Australia) PEMVECC recommendations Martin Kneyber (The Netherlands) 20

21 Scientific and Educational Program EPNV 09:45-11:45 Room Miles VI-IX SESSION 9: Circulation and breathing interactions in the neonate Chairs: Berndt Urlesberger (Austria), Pierre-Henri Jarreau (France) 09:45-10:15 Transition of circulation and breathing after birth: Whatmeasures might facilitate normal physiologic transition? Laurent Storme (France) Saturday 10:15-10:45 Hemodynamics during spontaneous breathing, respiratory assist and controlled positive pressure ventilation in newborns Vincent Muehlethaler (Switzerland) 10:45-11:15 Mask CPAP during neonatal transition: too much of a good thing for term infants? Christian Poets ( Germany) 11:15-11:45 Supporting the preterm lung at birth: Sustained lung inflation or PEEP? David Tingay (Australia) 11:50-12:30 Closing Lecture Integration towards automation of ventilation Christopher Newth (USA) 21

22 EPNV Table of Abstracts Oral Presentations OP-01 OP-02 SF ratio like predictive marker of the mortality rate in acute respiratory distress syndrome in pediatric intensive care unit Vicent Modesto i Alapont (Spain) Using transcutaneous electromyographic respiratory muscle recordings to introduce the neurosync index in the paediatric intensive care unit; is it feasible? Robert Blokpoel (The Netherlands) OP-03 Impact of the synchronized nasal intermitent mandatory ventilation by neurally adjusted ventilatory assist (nava) in premature infants with respiratory failure Celso Rebello (Brazil) 30 OP-05 An audit of humidification adequacy comparing single and double heated ventilator circuits in ventilated children in PICU: check your FACT(ory) S(ettings) first Mireia Garcia Cuscó (United Kingdom) 31 OP-06 Ultrasound for Diaphragmatic Dysfunction in Post-Operative Cardiac Children Hussam Hamadah (Saudi Arabia) 32 OP-07 Pressure and oscillation transmission with modern HFOV oscillators: bench comparison Daniele De Luca (Switzerland) 33 OP-08 Influence of gestational age on lung volume response to a sustained inflation at birth in preterm lambs David Tingay (Australia) 34 22

23 Table of Abstracts EPNV OP-09 Optimal target range of closed-loop insired oxygen support in preterm infants (opticlio study) Thomas Bachman (United States of America) OP-10 Selecting the optimum target range for closed loop FIO2-SpO 2 control: a synthesis of clinical trials Thomas Bachman (United States of America) OP-11 Surfactant protein B gene polymorphism in neonates with respiratory distress syndrome Jeong-Ho Han (South Korea) 37 OP-12 Ultrasound TAP Block for postoperative pain control in mechanical ventilated neonates Dario Galante (Italy) 38 OP-14 Neurally adjusted ventilatory assist (nava) in preterm newborn infants with respiratory distress syndrome - a randomized controlled trial Merja Kallio (Finland) 39 OP-15 The use of inhaled Nitric Oxide (NO) in pediatric cardiac centers 40 and NICU : A Franco-Belgian multicentre prospective survey from the POSITIVE study group Sylvie Laroche (France) 23

24 EPNV Table of Abstracts E-Posters EP-01 EP-02 Extubation after spontaneous breathing trial with automatic tube compensation (ATC) vs pressure support (PS). David Arjona (Spain) Gaps between the evidence of clinical effectiveness and the patterns of use of automated FIO2 control in polish nicus Thomas Bachman (United States of America) EP-03 Evaluation of differences in relative effectiveness of automated FIO2 among sites in a multicenter trial Thomas Bachman (United States of America) 43 EP-04 Safety and Efficacy of Lung Recruitment Maneuvers in Pediatric Post-Operative Cardiac Patients Harjot Bassi (United States of America) 44 EP-05 Airflow obstruction in the postoperative pediatric patients with tetrology of fallot, pulmonary atresia and major aortopulmonary collaterals Harjot Bassi (United States of America) 45 EP-06 In-depths analysis of ventilatory parameters in infants ventilated with volume-guaranteed HFOV using computational data retrieval and processing Gusztav Belteki (United Kingdom) 46 EP-07 A novel technique for detailed computational analysis of neonatal ventilator modes, parameters and alarms Gusztav Belteki (United Kingdom) 47 24

25 Table of Abstracts EPNV EP-08 EP-09 Less invasive surfactant administration in the nordic countries Lars Björklund (Sweden) Outcome of INSURE in Preterm Infants with Respiratory Distress Syndrome : a single center experience Mihye Bae (South Korea) EP-10 Use of Heated, Humidified High-Flow Nasal Cannula in Neonatal Intensive Care Unit: A Taiwan Survey Ke-Yun Chao (Taiwan) 50 EP-11 Instillation of DNAse via flexible fibreoptic bronchoscopy in newborn infants with severe respiratory disease Theodore Dassios (United Kingdom) 51 EP-12 Feasibility of longitudinal assessment of quantified oxygenation impairment in bronchopulmonary dysplasia in infancy Theodore Dassios (United Kingdom) 52 EP-13 Rescue Noninvasive high frequency ventilation (NHFOV) feasibility and safety for BPD-developing babies with pending intubation: pilot prospective study Valentina Giovanna Dell Orto (France) 53 EP-14 Bronhoalveolar lavage in severe neonatal respiratory distress Mihaela Demetrian (Romania) 54 EP-15 The role of circulating progenitor cells in neonatal lung injury Vasiliki Soubasi-Griva (Greece) 55 25

26 EPNV Table of Abstracts EP-16 EP-17 Correlation of the inflammatory mediator, the oxidative stress marker and the transpulmonary pressure as the lung stress Ririe Fachrina Malisie (Indonesia) Analyze the parameters of respiratory mechanics based on the parameter settings of mechanical ventilation Boudhar Kamel (Algeria) EP-18 Low-Invasive-Surfactant-Administration A New Beginning Crivceanscaia Larisa (Moldova) 58 EP-19 Effective Tidal Volume in Very Low Birth Weight Infants with High Frequency Oscillatory Ventilation Soonmin Lee (South Korea) 59 EP-20 Regional ventilation using muti-plane and patient tailored eit approach in an infant with congenital regional hyperinflation David G Tingay (Australia) 60 EP-21 Infection from Virus A-H2N1 and pneumonia from Candida Albicans: treatment with early NIV,apheresis and capsofungin. Leonardo Milella (Italy) 61 EP-22 Ethical dilemma and challenges in resuscitation/management of newborn with harlequin ichthyosis Aesha Mohammedi (United Kingdom) 62 EP-23 Non-invasive positive pressure ventilation (nippv) using ram cannula interface in management of respiratory failure in a children s hospital picu Luke Noronha (United States of America) 63 26

27 Table of Abstracts EPNV EP-24 EP-25 Bronchial selective intubation in a preterm with interstitial pulmonary emphysema Flavia Petrillo (Italy) NAVA in a child with Miller-Fisher Syndrome: repetita iuvat Emanuele Rossetti (Italy) EP-26 Spontaneous breathing during high frequency oscillatory ventilation Sjoerdtje Slager (The Netherlands) 66 EP-27 Treatment of cepacia syndrome with nebulized meropenem & amikacin & intravenous methylprednisolone in a patient with infective exacerbation of bronchiectasis Herng Lee Tan (Singapore) 67 EP-28 A case of rhizomelic chondrodyslasia punctata in newborn Hatice Tatar Aksoy (Turkey) 68 EP-29 Minor Differences in Dead Space Ratios after Palliation of Hypoplastic Left Heart Syndrome are Not Correlated with Changes in Clinical Outcomes Brigham Willis (United States of America) 69 27

28 EPNV Oral Presentations Oral Presentations Friday, May 27, 09:00 10:30 OP-01: SF RATIO LIKE PREDICTIVE MARKER OF THE MORTALITY RATE IN ACUTE RESPIRATORY DISTRESS SYNDROME IN PEDIATRIC INTENSIVE CARE UNIT Vicent Modesto i Alapont (Spain), Alberto Medina, Pablo del Villar Guerra, Juan Mayordomo, Jorge López OBJECTIVES: Based on clinical experience NIV is used as an initial ventilatory support in pediatric acute respiratory distress syndrome(pards). But its utility is unclear. Evidence in adult studies shows that persistence in NIV of those who do not improve may delay intubation and lead to adverse outcomes. We sougth to determine the utility of SF ratio as a NIV outcome predictor in the mortality rate in PARDS. METHODS: In this prospective cohort study, we included all consecutive children over a 1-year period who fulfilled criteria for ARDS(Berlin definition) and were initially managed with NIV. Clinical variables were collected at baseline and at one hour intervals. Failure criterion was the need for endotracheal intubation. Logistic Regression models were adjusted(based on AIC) and ROC curve analysis was done based on standard analysis(auc computed with De Long method). RESULTS: A total of 28 patients were included in the cohort. NIV failure was seen in 13/28(46.43%; 95%CI=27.51 to 66.13). Overall intensive care unit mortality was 12/28(42.86%; 95%CI=24.46 to 62.82%). In the multivariable analysis SF ratio at 1h>175 and HR at 2hs were independent predictors of mortality:auc=0.8698(95%ci= to 1). The model predicted well what children could be rescued with NIV. CONCLUSIONS: NIV may be useful in selected patients with mild ARDS but should be used with great caution in moderate and severe ARDS, as failure risk is high. Non-invasive measurements like the SF ratio at 1h low than 175 and the HF at 2hs seem to be predictive markers of PARDS mortality that can aid in decision making. 28

29 Oral Presentations EPNV Oral Presentations Friday, May 27, 09:00 10:30 OP-02: USING TRANSCUTANEOUS ELECTROMYOGRAPHIC RESPIRATORY MUSCLE RECORDINGS TO INTRODUCE THE NEUROSYNC INDEX IN THE PAEDIATRIC INTENSIVE CARE UNIT; IS IT FEASIBLE? Robert Blokpoel (The Netherlands), Alette Koopman, Sandra Dijkstra, Martin Kneyber OBJECTIVES: Patient-ventilator asynchrony (PVA) is associated with poor clinical outcome in mechanically ventilated adults. By measuring the electrical activity of the diaphragm (EAdi) and comparing them with the ventilator pressure waveforms Sinderby et al. developed a method (NeuroSync) to depict real-time the amount of PVA. This technique seems promising however it may not be suited for paediatrics. Our study aim was to introduce the NeuroSync method in paediatrics by measuring EAdi transcutaneously (teadi). METHODS: The onset and decline of 5-minute recordings of both teadi (NAON and NAOFF) and ventilator pressurization (MVON and MVOFF) were manually marked by two investigators and automatically detected by in-house developed software. The NA and MV timings were compared to calculate per-breath trigger and cycle-off errors and the transcutaneous NeuroSync (tneurosync). Breaths were classified as dyssynchronous when values >33%, and asynchronous when NA was not related to MV. RESULTS: Of the 24 included patients rates of synchronous, dyssynchronous, asynchronous breaths were 11.0% ( %), 46.6% ( %), 29.7% ( %). Rates of complete dissociations were 4.9% ( %) multiple MV with NA, 3.0% ( %) multiple NA with MV, 1.7% (0-12.8%) MV without NA and 0.7% (0-2.6%) for NA without MV. The intra-class correlation coefficient (ICC) between manually and automatically obtained tneurosync was Inter-expert and inter-method agreement were reflected by ICCs of 0.92 and 0.91 for trigger errors, and 0.94 and 0.95 for cycle-off errors. CONCLUSIONS: The tneurosync method is a reliable method for real-time PVA detection and could be a step to determine the effects of PVA in paediatrics. 29

30 EPNV Oral Presentations Oral Presentations Friday, May 27, 09:00 10:30 OP-03: IMPACT OF THE SYNCHRONIZED NASAL INTERMITENT MANDATORY VENTILATION BY NEURALLY ADJUSTED VENTILATORY ASSIST (NAVA) IN PREMATURE INFANTS WITH RESPIRATORY FAILURE Celso Rebello (Brazil), Ana Cristina Yagui, Jucille Meneses, Bianca Zolio, Gabriela Brito, Luciana Fagundes OBJECTIVES: To evaluate, in very low birth weight infants (VLBW - birth weight 1500g) with respiratory failure treated with noninvasive ventilatory support, the impact of SNIPPV with neural adjustment (NAVA) on the success of ventilation and the need for endotracheal intubation, compared to CPAP. METHODS: An open, prospective, randomized clinical trial, was conducted in the NICU of the Hospital Israelita Albert Einstein (São Paulo, Brazil) and the Integrative Medicine Institute Prof. Fernandes Figueira - IMIP (Recife, Brazil), including VLBW infants with respiratory failure treated with noninvasive ventilatory support. Two groups were formed: NAVA (SNIPPV) and CPAP. The main variable was the need for tracheal intubation within 72 hours after birth (FiO in CPAP= 7cmH2O to maintain SpO %) or recurrent apneas. Secondary variables were defined as the time of CPAP use; time for intubation; the incidence of pneumothorax and other major complications of prematurity. RESULTS: 84 infants were randomized, (NAVA=39; CPAP=42; 3 excluded). No differences were observed regarding to cesarean delivery, birth weight, gestational age, use of antenatal corticosteroids, 5 min Apgar score and SNAPPE II. The need for intubation was similar in the NAVA and CPAP groups 5 (12.8%) vs 6 (14.3%), p=0.895; the rate of surfactant treatment 10 (25.6%) vs 9 (21.4%), p=0.854; the mechanical ventilation time (hours) 24.2±21.4 vs 119.3±48.0, p=0.200 and the time of CPAP use (hours) 116.4±115.1 vs 152.4±203.2, p=0.967 also were similar. CONCLUSIONS: In VLBW preterm infants SNIPPV by NAVA did not reduce the need for endotracheal intubation, compared to traditional CPAP. 30

31 Oral Presentations EPNV Oral Presentations Friday, May 27, 11:00 12:00 OP-05: AN AUDIT OF HUMIDIFICATION ADEQUACY COMPARING SINGLE AND DOUBLE HEATED VENTILATOR CIRCUITS IN VENTILATED CHILDREN IN PICU: CHECK YOUR FACT(ORY) S(ETTINGS) FIRST Mireia Garcia Cuscó (United Kingdom), Balazs Fule, Rachel Hancock, Siobhan Burke, Reinout Mildner OBJECTIVES: Comparison of humidification adequacy between single-heated (SHVC) and double-heated ventilator circuits (DHVC) in invasively ventilated children in a paediatric intensive care unit (PICU). METHODS: We assessed Fisher&Paykel MR850 humidifier settings, temperature probe position (TPP), adequacy of VC humidification and cost through opportunistic sampling on invasively ventilated patients in a 31 bed tertiary PICU before and after changeover from custom-made SHVCs with water trap (Intersurgical) to DHVCs (Fisher&Paykel Evaqua). RESULTS: Over a four week period, 268 observations on SHVC showed correct TPP in 29%. At the VC Y-piece, standing water was present in 38%, and droplets in 44% of observations. During changeover, we found a third of humidifiers in default factory setting (FACTS) whereby automatic humidity compensation function in response to ambient temperature above 26oC was activated. This function was subsequently deactivated. After changeover, 115 observations were obtained with correct TPP in 95%. At the VC Y-piece, 11% showed standing water and 34% showed droplets. Overall we found 66% improvement in TPP, and 27% and 10% absolute reduction in standing water and droplets respectively at the VC Y-piece (p<0.01). Changeover to DHVC cost 3% more compared to SHVC. CONCLUSIONS: Changeover to DHVCs and correction of default FACTS resulted in significant improvement in adequacy of humidification at low additional cost. We speculate that this is related to significant improvement in TPP, improved humidification performance with DHVC, and/or change in FACTS, as activation of automatic humidity compensation function at ambient temperatures below 26oC may cause increased VC condensation. 31

32 EPNV Oral Presentations Oral Presentations Friday, May 27, 11:00 12:00 OP-06: ULTRASOUND FOR DIAPHRAGMATIC DYSFUNCTION IN POST- OPERATIVE CARDIAC CHILDREN Hussam Hamadah (Saudi Arabia), King AbdulAziz Medical City, Mahmoud Elbarbary, Omar Hijazi, Ghassan Shaath, Sameh Ismail, Mohamed Kabbani INTRODUCTION: Diaphragmatic Dysfunction is a common cause of failed extubation and prolonged mechanical ventilation after pediatric cardiac surgery in up to 14%. This study aims to evaluate the role of critical care bedside Ultrasound performed by intensivist to diagnose diaphragmatic dysfunction and the need for plication after pediatric cardiac surgery. METHODS: Retrospective cohort study on prospectively collected data for postoperative children admitted to PCICU during Diaphragmatic dysfunction was suspected based on difficulties in weaning from positive pressure ventilation or Chest X-Ray findings. Ultrasound studies were performed by PCICU intensivist and confirmed by qualified radiologist. RESULTS: Out of 344 post-operative patients, 32 needed diaphragm ultrasound for suspected dysfunction. Ultrasound confirmed diaphragmatic dysfunction in17/32 (53%) patients with an average age and weight of (10.8±3.8) months and (6±1) Kg respectively. The incidence rate of diaphragmatic dysfunction was (4.9%) in relation to the whole population. Diaphragmatic plication was needed in 9/17 cases (53%), with rate of 2.6% in post-operative cardiac children. Mean plication day was (15.1±1.3) after surgery. All patients who underwent plication were under 4 months of age. Post plication they were discharged with mean Pediatric CICU and hospital stay of (19±3.5) and (42±8) days respectively. CONCLUSIONS: Critical care ultrasound assessment of diaphragmatic movement is a useful and practical bedside tool that can be performed by a trained pediatric (CICU) intensivist. It may help in early detection and management of diaphragmatic dysfunction post pediatric cardiac surgery which may have potential positive effect on morbidity and outcome. 32

33 Oral Presentations EPNV Oral Presentations Friday, May 27, 11:00 12:00 OP-07: PRESSURE AND OSCILLATION TRANSMISSION WITH MODERN HFOV OSCILLATORS: BENCH COMPARISON Daniele De Luca (Switzerland), Charlotte Boussard, Agathe Debray, Valentina Dell Orto, Shivani Shankar-Aguilera BACKGROUND: Various modern oscillators are available on the market since a few years. They are supposed to provide a true HFOV based on a piston/ membrane displacement. Few data exist about their comparative performances. We sought to compare them on a bench model of neonatal lung carrying different mechanical properties. METHODS: Four different oscillators were connected to a lung model mimicking three different conditions (no lung disease: compliance 1 ml/cmh 2 O, Resistance 50 cmh 2 O/L/sec; restrictive: compliance 0.3 ml/cmh 2 O, Resistance 50 cmh 2 O/L/sec; mixed: compliance 0.3 ml/cmh 2 O, Resistance 150 cmh 2 O/L/sec). A neonatal respiratory function monitors (FLORIAN, Switzerland) has been used to measure pressure at the airway opening (Pao) and at lung (Plung). Mean airway pressure (Paw) and P have been changed in different permutations and experiments were performed in duplicate. Experiments with changing Paw and P were used to study Paw and oscillation transmission, respectively. This latter was evaluated using oscillatory pressure ratio at the lung (OPRd). RESULTS: Paw is always well correlated with Pao and Plung with all devices (R2 always >0.97). Pressure transmission is better provided by SM3100A (Plung -0.3, -0.6, -1 cmh 2 O respective to the set Paw, for the three models, respectively; p always <0.0001); the other ventilators always provided a slightly higher Plung (1.5 cmh 2 O on average). In terms of oscillation transmission at the lung Fabian- III+ reaches the best performance: (OPRd 0.25, 0.15, 0.1 cmh 2 O, for the three models, respectively; p always <0.0001). CONCLUSIONS: There are significant differences in pressure delivery and oscillation transmission between oscillators. These performances should be considered by the caregivers. 33

34 EPNV Oral Presentations Oral Presentations Friday, May 27, 11:00 12:00 OP-08: INFLUENCE OF GESTATIONAL AGE ON LUNG VOLUME RESPONSE TO A SUSTAINED INFLATION AT BIRTH IN PRETERM LAMBS David Tingay (Australia), McCall Karen, Andreas Waldmann, Stephan Bohm, Raffaele Dellaca, Peter Dargaville BACKGROUND: In preterm lambs time to aeration during a sustained inflation (SI) is variable and determined by the intrinsic mechanical state of the lung. Gestational age (GA) influences mechanics and regional volume behaviour. Thus, a standardised SI time may not optimise lung aeration across different GA groups. OBJECTIVE: To investigate the relationship between GA and time to reach lung volume stability (T stable ) within the lung during a SI at birth. DESIGN/METHODS: A 40 cmh 2 O SI was delivered to 49 lambs in five GA groups (Term~142d). Real-time changes in lung volume were displayed at the bedside using a new electrical impedance tomography system (Swisstom Pioneer Set). The SI was applied until 10s after visual volume stability, or a maximum 180s. T stable within the whole lung, gravity-dependent and non-gravity-dependent hemithoraces were determined from exponential modelling of the SI volumetime relationship. RESULTS: T stable was inversely proportional to GA and significantly higher in all regions in lambs 125d; from a mean (SD) of 257 [103]s (118d) and 276 [81]s (125d) to 53 [13]d at term (p<0.01, one-way ANOVA). Global lung volume (V SI ) at T stable increased with GA from 20 [17] ml/kg at 118d to 55 [13] ml/kg at term (p<0.01). The dependent regions received 63% of aeration in all GA groups, but T stable did not differ between the hemithoraces. CONCLUSIONS: Time to lung volume stability during a SI is significantly longer and more variable in extremely preterm lambs. Individualised SI approaches should be considered in the development of clinical SI protocols. 34

35 Oral Presentations EPNV Oral Presentations Friday, May 27, 11:00 12:00 OP-09: OPTIMAL TARGET RANGE OF CLOSED-LOOP INSIRED OXYGEN SUPPORT IN PRETERM INFANTS (OPTICLIO STUDY) Thomas Bachman (United States of America), Maria van den Heuvel, Arjan te Pas, Wes Onland, Anton van Kaam, Henriette van Zanten OBJECTIVE: Automated FiO 2 control (A-FiO 2 ) improves the proportion of time spent within the target range (TR) and reduces the time in SpO 2 extremes, compared to manual control in preterm infants. However, it is unknown to what extent narrowing the TR during A-FiO 2 results in tighter control of the SpO 2. Our aim was to compare the efficacy of A-FiO 2 using three different SpO 2 TRs with the same midpoint. METHODS: Preterm infants receiving non-invasive ventilator support with FiO 2 >0.21 were randomized to three SpO 2 TRs (86-94%, 88-92%, 89-91%) for 24 hours each. The 3 A-FiO 2 periods were separated by two 24-hour periods of manual adjustment using the standard TR of 86-94%. RESULTS: Forty-one preterm infants were studied. The proportions of time using A-FiO 2 within our intended SpO 2 TR were high, (74%, 73% and 70% respectively, P=ns). Narrowed TR resulted in less time with SpO 2 of <86%% (15% vs. 10% vs. 10%, P=<0.05), and <80% (3.4% vs 1.9% vs 1.7%, P<0.01). Whereas time with SpO 2 >94% increased slightly (16% vs. 22% vs. 19%, P=NS). Time with SpO 2 >98% was not different among the 3 ranges. There were no differences between the two tighter TRs. Use during all three A-FiO 2 ranges reflected significantly better control than during manual adjustment (P<0.001). CONCLUSION: Tighter A-FiO 2 control ranges led to reduced time with lower SpO 2 and no significant increased exposure to higher SpO 2. 35

36 EPNV Oral Presentations Oral Presentations Friday, May 27, 11:00 12:00 OP-10: SELECTING THE OPTIMUM TARGET RANGE FOR CLOSED LOOP FIO2-SPO2 CONTROL: A SYNTHESIS OF CLINICAL TRIALS Thomas Bachman (United States of America), Maria van den Heuvel, Wes Onland, Anton van Kaam, Maria Wilinska OBJECTIVE: Large trials have demonstrated marked impact in outcomes associated with changes in SpO 2 management. Much of the uncertainty about optimum target ranges (TR) revolves around the challenges of manual FiO 2 - titration. Automated control (Auto-FiO 2 ) is becoming available. Four systems have been clinically evaluated with a variety of SpO 2 TRs. Our aim was to determine factors relating to selection of the optimum TR for Auto-FiO 2. METHODS: All trials investigating Auto-FiO 2 were reviewed. Those including a comparison between set TRs were selected. TR characteristics (width, midpoint) and effectiveness parameters (SpO 2 : median/distribution, time in TR and extremes) were prospectively defined. RESULTS: Three studies from 9 centers met the criteria, including 273 days of Auto-FiO 2 control in 143 preterm infants. Seven target ranges were evaluated, all within an envelop of 86%-95%. TRs included four SpO 2 widths (2, 3, 4, 6, 8) and four midpoints (90%, 91.5%, 92%, 93%). There were no clinically relevant differences in time within the TR. The midpoint of the TR had the most impact on the distribution of SpO 2. However, there was an interaction between the midpoint and the width, with clinically relevant differences at SpO 2 extremes associated primarily with the high or low control points. CONCLUSION: When using Auto-FiO 2 oxygen exposure is affected by the midpoint and width of the set TR. This exposure differs from that expected during manual control, and must be considered when selecting the optimal TR for automated control. 36

37 Oral Presentations EPNV Oral Presentations Friday, May 27, 11:00 12:00 OP-11: SURFACTANT PROTEIN B GENE POLYMORPHISM IN NEONATES WITH RESPIRATORY DISTRESS SYNDROME Jeong-Ho Han (South Korea) BACKGROUND: The etiology of respiratory distress syndrome (RDS) is multifactorial and multigenic. Polymorphisms of surfactant protein B have been previously described to be a risk factor for respiratory distress syndrome (RDS). The objectives of this study were to determine and compare the frequencies of SP-B gene polymorphisms in Korean neonates with and without RDS. METHODS: We studied 82 neonates: 50 late preterm babies without RDS, 18 with RDS, and 8 term babies without RDS, 6 with RDS. The following four SP-B gene polymorphisms were analyzed: A/C at 5, C/A at 198, C/T at 392, and A/C at 892. The polymorphisms were detected by PCR amplification of genomic DNA and genotyping. The genotypes were determined using PCR-based converted restriction fragment length polymorphisms. RESULTS: The RDS group consisted of 15 (53%) girls and 13 (47%) boys. Weight ranged from 1390 to 3260 g and mean gestational age (GA) was 34+5 weeks (range: 32+2 to 40+3 weeks). The Non-RDS group consisted of 27 (43%) girls and 31 (57%) boys. Weight ranged from 1480 to 3410 g and mean GA was 35+3 weeks (range: 32+4 to 40+1 weeks). The A/C polymorphism at position 5 of the SP-B gene showed was 46% in RDS group, 48% in non-rds group. For the C/A polymorphism at 198, 75% in RDS group, 81% in non-rds group, and for the C/T polymorphism at 392, 58% in RDS group, 81% in non-rds group were showen without significant difference. There was also no difference between RDS group and non-rds group for A/C polymorphism at 892. In subgroup analysis for the full term infants, we did not detect differences in the frequencies of the polymorphisms between the RDS and non-rds group. CONCLUSIONS: In Korean neonate, surfactant protein B polymorphism is no significant risk factor for RDS. Further studies are needed. 37

38 EPNV Oral Presentations Oral Presentations Friday, May 27, 15:45 18:00 OP-12: ULTRASOUND TAP BLOCK FOR POSTOPERATIVE PAIN CONTROL IN MECHANICAL VENTILATED NEONATES Dario Galante (Italy) BACKGROUND: Ultrasound transversus abdominis plane (TAP) block has been suggested to be useful for postoperative pain control in pediatric neonatal surgery. In our department of anesthesia we use ultrasound TAP block in neonates after abdominal surgery that need mechanical ventilation and for whom pain control allows optimum adjustment to the mechanical ventilator. METHODS: A retrospective analysis was performed in 58 male patients aged 0-30 days old undergoing abdominal surgery were randomly allocated to receive ultrasound-guided TAP block (Group B, n=29) or balanced anesthesia with no block (Group NB, n=29). Both groups were induced with AIR/O2/ sevoflurane and maintained with 3% sevoflurane. Mechanical ventilation with endotracheal intubation was maintained during surgery. Group B received ultrasound TAP block with 0.25% levobupivacaine (0.3 ml/kg). No opioids were administered in Group B, fentanyl 2 mcg/kg in Group NB. Postoperative pain and sedation level were evaluated at 4 time points: 0, 0.5, 1, and 4 h after the end of the anesthesia. If patients developed pain after surgery, rescue doses of opioids were administered. RESULTS: The mean FE/FI ratio of sevoflurane in Group B was significantly lower than in Group NB (P < ) and the average postoperative pain evaluation scores were lower in Group B. 7 patients of Group NB required rescue doses of opioids. CONCLUSIONS: Ultrasound TAP block for postoperative pain control in mechanical ventilated neonates allowed the use of a significantly lower amount of sevoflurane and opioids and provided more effective postoperative and intraoperative analgesia reducing the administration of opioids with a best mechanical ventilation. 38

39 Oral Presentations EPNV Oral Presentations Friday, May 27, 15:45 18:00 OP-14: NEURALLY ADJUSTED VENTILATORY ASSIST (NAVA) IN PRETERM NEWBORN INFANTS WITH RESPIRATORY DISTRESS SYNDROME - A RANDOMIZED CONTROLLED TRIAL Merja Kallio (Finland), Ulla Koskela, Outi Peltoniemi, Tytti Pokka, Maria Suo- Palosaari, Timo Saarela OBJECTIVES: The aim of this trial was to compare NAVA with current standard ventilation in preterm infants requiring invasive ventilation due to neonatal respiratory distress syndrome (RDS). We hypothesized that the use of NAVA would reduce the duration of mechanical ventilation. METHODS: Sixty infants born between 28+0 and 36+6 weeks of gestation were randomized to conventional ventilation or NAVA. The patients were enrolled at the neonatal and pediatric intensive care units of Oulu University Hospital, Finland, from July 2010 to May RESULTS: The median durations of invasive ventilation were 34.7 hours (IQR h) and 25.8 h ( h) in NAVA and control groups, respectively (p=0.21). Lower PIPs were achieved with NAVA (P=0.015), while other ventilatory or vital parameters did not differ between the groups. Similar small amounts of opiates (0.1±0.2 mg/kg morphine equivalents) and sedative agents were used in both groups (P=0.45). CONCLUSIONS: NAVA did not reduce the duration of invasive ventilation or the amount of sedatives used. It was a safe and feasible ventilation mode for the majority of preterm infants suffering from RDS, and led to lower PIPs. Larger randomized controlled trials on NAVA in neonatal intensive care are clearly needed, but comprehensive clinical experience with NAVA along with clinically applicable extubation criteria are prerequisites to reliably accomplishing future trials. 39

40 EPNV Oral Presentations Oral Presentations Friday, May 27, 11:00 12:00 OP-15: THE USE OF INHALED NITRIC OXIDE (INO) IN PEDIATRIC CARDIAC CENTERS AND NICU: A FRANCO-BELGIAN MULTICENTRE PROSPECTIVE SURVEY FROM THE POSITIVE STUDY GROUP Sylvie Laroche (France), Philippe Mauriat, Pierre-Louis Leger, Jean Michel Liet, Ziad Assaf, Gilles Cambonie, Gauthier Loron, Laurent Lecourt, Claudio Barbanti, Philippe Pouard INTRODUCTION: Inhaled Nitric Oxide (ino) is commonly used in Europe since 20 years but few study really described the daily ICU practice. The objective of this study was to evaluate the usage of ino and determine the gap between guidelines and real life. METHODS: Multicenter, prospective, non-interventional study on ino administered through an integrated delivery and monitoring device in 7 centers. The following parameters were observed: dose, treatment duration, ventilation modes, monitoring procedures, weaning procedures and occurrence of a rebound effect. Concomitant treatments and safety data were collected. RESULTS: 119 patients with pulmonary arterial hypertension (36 neonates with PPHN, 81 children with PAH post cardiac surgery for congenital heart disease) were enrolled within one year. Starting doses were similar in PPHN and PAH with [ ] ppm and 20 [18-20] ppm, respectively. The highest doses used were identical for both groups (20 ppm). Median treatment duration was 3 days [ ] in PPHN, and 3.9 days [ ] in PAH, respectively. ino was delivered at identical doses during invasive (including HFO) or non invasive ventilation (spontaneous ventilation, high flow nasal ventilation). Treatment was considered to be efficient in 84% of PPHN and 95% of PAH patients. Adverse advents occurred in 15.1 % of the patients (for PPHN 13 (34;2%) and PAH 5 ( 6.2% )) including a rebound effect in 2.6%, and 1.2%, respectively. Methemoglobinemia levels higher than 2.5% were observed in 7.9% of the neonatal but in none of the pediatric patients. Other pulmonary vasodilators were concomitantly used in 23.7% of the neonatal, and 95 % of the pediatric cases. 40 CONCLUSION: This survey confirms that ino is safe and efficient in lowering pulmonary arterial pressures in these study populations. Last generation devices and appropriate staff training allow for good compliance with actual recommendations.

41 E-Posters EPNV EP-01: EXTUBATION AFTER SPONTANEOUS BREATHING TRIAL WITH AUTOMATIC TUBE COMPENSATION (ATC) VS PRESSURE SUPPORT (PS) David Arjona (Spain), Raul Borrego, Paula Santos, María Herrera, María Gutierrez, Carmen Martin OBJECTIVES: To assess if spontaneous breathing trail (SBT) with ATC is as effective as PS in predicting extubation success in pediatric patients. MATERIALS AND METHODS: randomized unmasked control trial. Inclusion criteria: mechanically ventilated children (< 14 years) for more than 24 hours that meet criteria for SBT. 1-Hour SBT is done: CPAP of 5 cm water and ATC or CPAP of 5 cm water and PS of 8cm H 2 O. Patients who passed the SBT were immediately extubated. The primary outcome was the ability to breathe without assistance within 48 hours after extubation. The frequency/tidal volume/kilo ratio, the P.01 and maximum inspiratory force was also measured as predictors of success. RESULTS: 56 patients (55%males with median age: 14 months) were studied, 28 with ATC and 28 with PS. SBT was discontinued in 5 patients (8%). Extubation failed in eight of the 51 remaining subjects (4 in ATC group (16%) and 4 in PS group (15.4%), (p=0.95). The main rapid shallow breathing index (RSBI) in patients who had successful weaning was 3.6, compares with 5.8 in those who failed (mean difference 2.2;CL95%:0.4 to 4.1;p =.018). We found no statistical differences in the values of P.01, maximum inspiratory force nor frequency/tidal volume ratio between the two types of support. CONCLUSIONS: A SBT with ATC is useful for extubation, being as effective in predicting extubation success as SBT with Pressure Support. RSBI might be a helpful index for weaning 41

42 EPNV E-Posters EP-02: GAPS BETWEEN THE EVIDENCE OF CLINICAL EFFECTIVENESS AND THE PATTERNS OF USE OF AUTOMATED FIO2 CONTROL IN POLISH NICUS Thomas Bachman (United States of America), Maria Wilinska OBJECTIVE: Many studies have demonstrated the importance of careful management of neonatal oxygen. Neonatal ventilators with closed-loop control of FiO 2 (AUTO-FiO 2 ) have become widely available in Poland s tertiary care neonatal units. In 2013 a web-based registry of their use was introduced, capturing objective and subjective data. We sought to identify gaps between published evidence of AUTO-FiO 2 effectiveness and its routine use in Poland. METHODS: We reviewed all the published studies of the use of AUTO-FiO 2. We extracted information reported, including the target range, study population (EGA, weight, age and indication for use), metrics of safety (extreme SpO 2 levels) and effectiveness (maintenance of a desired target range, reduction of operator adjustments). We extracted from the registry database corresponding descriptive data about our actual routine use and outcome. RESULTS: AUTO-FiO 2 was used in 283 infants at 7 centers. Clinician assessment of the effectiveness of AUTO-FiO 2 was consistent with the clinical study experience. The target ranges and alarms used were also consistent with those studied. Several of the other contrasts were, however, stark. The clinical study populations were exclusively extreme preterms, several weeks of age, studied for 1 day or less, and often exhibiting frequent desaturations. In our clinical use AUTO-FiO 2 usually started in the first day or two of life with the goal of automating routine FiO 2 adjustment, rather than intervening in difficult infants. Use continued for much longer periods. This routine use also included a significant proportion of near term infants. CONCLUSION: Areas needing additional education and clinical research were identified. 42

43 E-Posters EPNV EP-03: EVALUATION OF DIFFERENCES IN RELATIVE EFFECTIVENESS OF AUTOMATED FIO2 AMONG SITES IN A MULTICENTER TRIAL Thomas Bachman (United States of America) OBJECTIVE: Many studies have demonstrated potential for automated FiO 2 adjustment (Auto-FiO 2 ) to improve SpO 2 control in preterm infants. Auto-FiO 2 systems are becoming widely available. Since an important part of the evidence was derived in multicenter trials, problems at individual sites could be masked in the pooled analyses displayed in the published studies. Only one of these studies has reported differences among the centers. Identification of potential site adoption problems might be important. We chose, therefore, to determine the differences among sites in our multicenter study and to evaluate their causes. METHODS: We used the prospectively defined primary endpoint from our study (proportion of time with SpO 2 in: target range, <80% and >98%) as the outcomes. For this analysis we prospectively identified time in the target range during routine control and the frequency of desaturations <80% as factors relating to patient characteristics and median SpO 2 during routine control as a marker of effective manual control. We calculated 95% confidence intervals in the outcomes, patient factors and manual control factors. RESULTS: Analyses showed differences among centers [Absolute Improvement SpO 2 : target range ( %), <80% ( %), >98% ( %)]. There were differences in subject stability among centers [routine SpO 2 target range (45%-76%), desaturations/hour ( )]. The differences in effectiveness were consistent with differences in the subject stability, and not differences in adequacy of manual control. CONCLUSIONS: There were no center specific aberrant results, suggesting the adequacy of the training and the general system adoptability. 43

44 EPNV E-Posters EP-04: SAFETY AND EFFICACY OF LUNG RECRUITMENT MANEUVERS IN PEDIATRIC POST-OPERATIVE CARDIAC PATIENTS Harjot Bassi (United States of America), Tiffany Morandi, Kristi Richardson, John J. Nigro, Christine Tenaglia, Brigham Willis INTRODUCTION: Recruitment maneuvers (RM) are a dynamic process of an intentional transient increase in transpulmonary pressure aimed at opening unstable airless alveoli. Due to concerns regarding the hemodynamic consequences of recruitment maneuvers in children with heart disease, these maneuvers have not been widely utilized in this population. The objective of this study was to demonstrate the safety and efficacy of lung RMs in postoperative pediatric cardiac patients. METHODS: A retrospective chart review was performed on a sample of postoperative cardiac surgical patients who received RMs and those who did not. RESULTS: Sixty-one patients had open heart surgery with a total of four hundred thirty five lung recruitment maneuvers performed. Assessment of hemodynamic tolerability demonstrated no change in mean arterial pressure and heart rate during or after the maneuvers, while there was significant yet transient rise in central venous pressure during recruitment (p <.01, 95% CI). There was an increase in dynamic compliance (Cdyn) following RMs of 0.14mL/ cmh20/kg (p <.0001, 95% CI). All 61 patients had an immediate increase in Cdyn. Clinical outcomes demonstrated no significant difference between the RM group and control group in length of mechanic ventilation (p =.16), length of hospital stay (p = 0.28), mortality (p =.99) or difference in occurrence of pneumothorax (p =.44) and pneumonia (p =.06). CONCLUSION: Lung RMs were well tolerated in post-operative pediatric cardiac surgical patients. These findings suggest RM protocols could be investigated in a prospective study to further determine safety and efficacy. 44

45 E-Posters EPNV EP-05: AIRFLOW OBSTRUCTION IN THE POSTOPERATIVE PEDIATRIC PATIENTS WITH TETROLOGY OF FALLOT, PULMONARY ATRESIA AND MAJOR AORTOPULMONARY COLLATERALS Harjot Bassi (United States of America), Ritu Asija INTRODUCTION: The postoperative course of patients with Tetrology of Fallot with pulmonary atresia and major aortopulmonary collaterals (TOF, PA, MACPAs) can be complicated with severe airflow obstruction (AO). Our goal is to determine risk factors that predict the development of AO following unifocalization. We hypothesize that patients with previous history of asthma, airway abnormalities and extensive intraoperative dissection are more likely to develop AO. METHODS: A restrospective chart review was performed on 23 pateints with TOF, PA, MAPCAs following unifocalization between March 2011 and June Patient history was reviewed for asthma, airway abnormalities, Qp:Qs, the number of pulmonary artery branches intervened upon and presence of 22q11 deletion. We diagnosed patients with postoperative AO based on clinical exam. RESULTS: A total of 23 patients underwent 23 procedures over the study period. Only one patient had history of asthma. Eleven patients demonstrated AO and all were treated with bronchodilators. Five patients had history of airway abnormalities in which four of them demonstrated AO. There was no difference in the number of interventions on PA branches between the two groups (p=0.29). No difference in preoperative Qp:Qs was seen with AO (p=0.20). AO was seen in 45% of patients with 22q11 deletion. There was no difference in duration of mechanical ventilation, ICU stay, and hospitalization stay. CONCLUSIONS: This small retrospective study shows that patients are at risk of developing AO after unifocalization surgery even without underlying airway abnormalities, preexisiting asthma, high preoperative Qp:Qs, extensive disection and presence of 22q11 deletion. 45

46 EPNV E-Posters EP-06: IN-DEPTHS ANALYSIS OF VENTILATORY PARAMETERS IN INFANTS VENTILATED WITH VOLUME-GUARANTEED HFOV USING COMPUTATIONAL DATA RETRIEVAL AND PROCESSING Gusztav Belteki (United Kingdom), Colin Morley OBJECTIVES: High frequency oscillatory ventilation (HFOV) is an alternative to conventional mechanical ventilation in neonates that offers short and long term benefits in some situations. Some of the newer ventilators allow volume targeting of oscillations also known as volume guarantee (HFOV-VG). We wanted to analyse the ventilatory parameters in neonates ventilated with HFOV-VG with high sampling frequency and over long periods. METHODS: As part of a service evaluation project we studied the ventilatory parameters and their variability of 7 infants ventilated with HFOV-VG. We used the DataGrabber software (Draeger) to download data with 1Hz frequency from the Babylog VN500 ventilator. Each recording period was longer than 20 hours. Using the Python computer language we developed a data analysis workflow to analyse and interpret these large datasets. RESULTS: Over the whole recording periods, the mean tidal volume (Vthf) was between 1.31 ml/kg and 3.26 ml/kg in the 7 cases of HFOV-VG, with a standard deviation between 0.19 and 0.7 ml/kg. This variability was significantly less (p=0.038) than the variability of two cases ventilated with HFOV only. Approximately half of the variability was due to short-term (within 1 minute) changes in Vthf. The amplitude pressure varied more during HFOV-VG than during HFOV. Mean airway pressure was not affected by changes in amplitude pressure. CONCLUSIONS: Adding volume guarantee to HFOV results in a tighter control of the tidal and minute volumes and more variability in amplitude pressure. Babies with different severity of lung disease require significantly different tidal volumes to achieve normocapnia. 46

47 E-Posters EPNV EP-07: A NOVEL TECHNIQUE FOR DETAILED COMPUTATIONAL ANALYSIS OF NEONATAL VENTILATOR MODES, PARAMETERS AND ALARMS Gusztav Belteki (United Kingdom), Colin Morley OBJECTIVES: Obtaining detailed data about how a mechanical ventilator is working is important for assessing its effectiveness and how it interacts with the patient. We set out to develop a novel technique for recording, analysing and displaying data retrieved from the Dräger Babylog VN500 neonatal ventilator with high sampling frequency and over long periods. METHODS: Ventilation data were obtained as part of a service evaluation project on 30 ventilated neonates. Data were exported in plain text format from a VN500 using the DataGrabber software, retrieving airway pressure and flow data at 100Hz, and over 40 other variables at 1Hz, including ventilatory parameters, settings and alarm data. All data are time-stamped with microsecond precision. We performed continuous data recording for more than 24 hours in each case producing over 85,000 data points per day for each 1Hz parameter and over 8.5 million per day data points for the 100Hz parameters. RESULTS: We developed data analysis workflows to manipulate, analyse, display, and interpret the data using the Python computer language and its add-on packages to help clinicians. We describe a workflow to analyse the variability of ventilatory parameters both in the short term and the long term. We also report a workflow that generates a detailed report and statistics about alarm activity. Finally, we demonstrate how ventilation waveforms down to individual breaths are rebuilt and analysed from the stored data. CONCLUSIONS: This data retrieval and analysis method will provide easy access to efficiently stored ventilation data for research, audit and medicolegal purposes. 47

48 EPNV E-Posters EP-08: LESS INVASIVE SURFACTANT ADMINISTRATION IN THE NORDIC COUNTRIES Lars J Björklund (Sweden), Christian Heiring, Baldvin Jonsson, Sture Andersson OBJECTIVES: Less invasive surfactant administration (LISA), i.e. surfactant therapy during spontaneous breathing without tracheal intubation, is increasingly used in preterm infants as an alternative to INSURE. We report the present use of the new technique in the Nordic countries. METHODS: In autumn 2015, a web-based survey of surfactant administration was ed to the directors of all neonatal units in the Nordic Region, except that in Finland, where care of very preterm infants is highly centralized, the survey was sent only to the 5 university-based units. Respondents were told that answers should reflect practice of the unit and not personal preferences. RESULTS: 73 units (83%) responded, and 23 (32%) reported using LISA (Denmark 11%, Finland 60%, Iceland 100%, Norway 82%, and Sweden 9%). LISA was used in 62% of level 3 units, but only in 14% of level 2 units, and most commonly in babies with GA 26 weeks. Premedication was used, always or sometimes, by 78% of responding units. The drug most often used was fentanyl, either alone or in combination with atropine. The main reasons for not using LISA were unfamiliar with technique (61%), no benefit over other methods (22%), and concerns about discomfort (26%). CONCLUSIONS: The reasons for the slow and uneven spreading of LISA in the Nordic countries and the higher use of premedication than previously reported may be the dominance of INSURE in this region (used by 82%), incomplete evidence for the superiority of LISA, and concerns about discomfort for the infants. 48

49 E-Posters EPNV EP-09: OUTCOME OF INSURE IN PRETERM INFANTS WITH RESPIRATORY DISTRESS SYNDROME : A SINGLE CENTER EXPERIENCE Shinyun Byun (South Korea), Mihye Bae, Narae Lee, Youngmi Han, Kyounghee Park Administration of endotracheal surfactant is the main treatment for preterm infants(pi) suffering from RDS with mechanical ventilation(mv). Complications may develop as consequence of MV. INSURE (Intubation, Surfactant and Rapid Extubation) is a new management for RDS. Objective is to assess outcome of INSURE combined with early ncpap in managing preterm infants with RDS. We retrospectively reviewed the medical records of 88 PI (< 35 weeks) from 2011 to PI were enrolled after obtaining informed parental consent. We excluded congenital anomaly. They were divided into INSURE(40) and MV group(48). All infants received 200 mg/kg poractant alpha. The comparison included duration of MV and oxygen therapy, IVH, PDA, pneumothorax, BPD and mortality rate. 35 PI in INSURE group (87.5 %) succeeded. Median birth weight and gestational age in INSURE and MV groups were 1,806g, 32.5 weeks and 1,605g, 30.2 weeks(p=0.015, p=0.023). The need for MV in 5th day of admission was 63% decreased in INSURE group. The incidences of IVH, PDA, pneumothorax, BPD and mortality rates were not significantly different among two groups. The causes of INSURE treatment failure were pneumothorax, tachypnea and distress. But, there were no significant differences in the need for MV in 5th day and the duration of oxygen therapy among two groups by multivariate analysis according to birth weight and gestational age (P=0.18, P=0.13). It seems rationale to perform INSURE as the initial treatment for PI with RDS. We need large randomised controlled trials to prove the safety and efficacy in our settings. 49

50 EPNV E-Posters EP-10: USE OF HEATED, HUMIDIFIED HIGH-FLOW NASAL CANNULA IN NEONATAL INTENSIVE CARE UNIT: A TAIWAN SURVEY Ke-Yun Chao (Taiwan), Yi-Ling Chen, Li-Yi Tsai, Yu-Hsuan Chien, Shu-Chi Mu INTRODUCTION: Recently, Heated humidified high-flow nasal cannula (HHHFNC) have been introduced and widely applied as non-invasive respiratory support (NRS) in neonates. The use of HHHFNC is getting popular and widespread over the worldwide. Surveys of USA, UK, and Australia reported the using rate of HHHFNC in neonatal and pediatric associated unit were 69%, 77% and 63% respectively. The aim of this survey was to determine, by phone interviewed, current practices of HHHFNC in Taiwanese NICUs. METHOD: This is a telephone survey to 17 neonatal training program directors (PD) from regional teaching hospital or medical center in Taiwan. RESULTS: There were 15 medical center and 2 regional teaching hospital that completed the survey. 11(65%) hospitals using HHHFNC as respiratory support while 6 (35%) hospitals did not used HHHFNC. Most of the PD thought HHHFNC was a safe device for neonates (88%), and mentioned that they were using HHHFNC without any protocol or guideline (82%). All of hospital applied HHHFNC as a step-down therapy for weaning NCPAP, only one hospital practiced in initial therapy; No one applied immediately after extubation. CONCLUSIONS: Although the using rate of HHHFNC is 65% in Taiwanese NICUs, we still working on how to use, when to use, and who need to use. In our study, the use of HHHFNC in neonates is optimism, and it seems like to be a friendly device for everyone. 50

51 E-Posters EPNV EP-11: INSTILLATION OF DNASE VIA FLEXIBLE FIBREOPTIC BRONCHOSCOPY IN NEWBORN INFANTS WITH SEVERE RESPIRATORY DISEASE Theodore Dassios, Cara Bossley, Ann Hickey, Olie Chowdhury (United Kingdom) BACKGROUND AND AIM: The use of bronchoscopy in the neonatal setting has been described in the literature but it is not a technique in common use. We describe the experience from a tertiary level neonatal unit of cases in which flexible fibreoptic bronchoscopy (FFB) with instillation of DNAse was used to assist the respiratory management of newborn infants with severe respiratory disease. METHODS: Cases of neonatal inpatients undergoing bronchoscopy were identified from the paediatric respiratory database. For the period January 2010 to January, 5 such cases were identified. Data was collected from review of case notes and analysed. RESULTS: Five infants, with a median gestation at birth of 27 weeks and a median birth weight of 880 grams, underwent bronchoscopy at a median postnatal age of 123 days. All FFBs were performed by a consultant paediatric respiratory physician using a 28mm bronchoscope. No adverse incidents were reported. Median (range) FiO 2 requirement before FFB was 0.42 ( ) and 24 hours after the FFB 0.31 ( ). Median (range) mean airway pressure before FFB was 14 (13-18) cmh 2 0 and 24 hours after FFB was 11 (11-17) cmh 2 O. CONCLUSIONS: In centres with access to a paediatric respiratory service, Instillation of DNAse via FFB may be considered as a safe adjunct in the management of severe respiratory disease on neonatal units. The low volume of cases generated in our busy tertiary unit based in a large teaching hospital suggests that neonatal teams will remain reliant on paediatric respiratory physicians to provide this service. 51

52 EPNV E-Posters EP-12: FEASIBILITY OF LONGITUDINAL ASSESSMENT OF QUANTIFIED OXYGENATION IMPAIRMENT IN BRONCHOPULMONARY DYSPLASIA IN INFANCY Theodore Dassios, Leo Thanikkel, Anna Curley, Colin Morley, Robert Ross- Russell (United Kingdom) BACKGROUND: Bronchopulmonary dysplasia (BPD) is associated with significant respiratory morbidity in infancy. To quantify the evolution of oxygenation impairment in infants with BPD, we non-invasively measured the ventilation/perfusion (V/Q) ratio and the degree of right to left shunt over the first year of life. MEASURES: We studied 8 infants receiving respiratory support with BPD (defined as receiving oxygen at 28 days), in a tertiary UK Neonatal Unit at diagnosis and at follow up during the first year of life. The follow up measurements were conducted in clinic or while the infants were still inpatient. Fraction of inspired oxygen (FiO 2 ) was altered to vary transcutaneous oxygen saturation (SpO 2 ) between 88% and 96%. Shunt and V/Q ratio were derived using a computer algorithm by plotting and analysing at least three pairs of FiO 2 and SpO 2 for each infant. RESULTS: Median (IQR) gestational age was 26 (24 27) weeks; postnatal age at initial measurement was 48 (30-68) days and age at follow up 256 ( ) days. Initial V/Q and shunt were 0.46 ( ) and 9 (2-15) respectively. V/Q and shunt at follow up were 0.51( ) and 3(0-15) respectively Two infants demonstrated a relative decrease of V/Q at follow up while the remaining six demonstrated increased V/Q at follow up. Shunt decreased in seven of eight infants. CONCLUSIONS: Evolution of BPD can be monitored in infancy with measurements of shunt and V/Q ratio. These indices tend to normalise over the first year of life in the majority of infants with BPD reflecting disease resolution. 52

53 E-Posters EPNV EP-13: RESCUE NONINVASIVE HIGH FREQUENCY VENTILATION (NHFOV) FEASIBILITY AND SAFETY FOR BPD-DEVELOPING BABIES WITH PENDING INTUBATION: PILOT PROSPECTIVE STUDY Valentina Giovanna Dell Orto (France), Rafik Ben Ammar, Shivani Shankar- Aguilera, Nadya Youssef, Daniele de Luca BACKGROUND: NHFOV is a novel technique that might spare intubation and invasive ventilation.to date NHFOV is known to efficaciously reduce CO 2,but there aren t clear data about safety and its effect on oxygenation.our primary aim is to evaluate the safety and feasibility of NHFOV in critically ill preterm neonates with pending intubation.secondary aim is to evaluate NHFOV effect on oxygenation. METHODS: This was a pilot prospective cohort study enrolling preterm neonates7d,ventilated under biphasic positive pressure ventilation (BiPAP) with respiratory failure at risk for intubation for the following criteria:ph 7.20 and FiO 2 >40%.These babies were switched to NHFOV or noninvasive positive pressure ventilation(nippv) according to ventilator availability.we collected physiologic parameters (heart rate(hr),respiratory rate(rr),mean blood pressure(bp),numbers of spells and apneas) and respiratory data (SatO 2,FiO 2,main airway pressure,ptcco 2,PtcO 2 ) as change(δ) over 2h before and after the onset of NIPPV and HFOV.Data were analyzed with repeated measures-anova:nippv or NHFOV was inserted as covariate. RESULTS: 6 and 7 neonates were recruited in the NIPPV and NHFOV groups,respectively.groups were comparable for basic data.δ in HR, RR, BP and SatO 2 weren t different between groups (p=0.193; 0.125; 0.18; 0.453, respectively),as well as number of spells(p=0.711) and apnoeas(p=0.636).in the NIPPV group mean oxygenation index decreases from 6.9(1.9) to 6.4(1.3) and in NHFOV from 11.1(3.5) to 9.1(3.5):between subjects comparison is at the border of significance(p=0.09).no technical problems were reported during NHFO CONCLUSIONS: Preliminary data of this pilot study suggest that NHFOV is as feasible and safe as NIPPV for BPD-developing preterm babies with pending intubation.enrolment must be continued to clarify NHFOV effect on oxygenation. 53

54 EPNV E-Posters EP-14: BRONHOALVEOLAR LAVAGE IN SEVERE NEONATAL RESPIRATORY DISTRESS Mihaela Demetrian (Romania), Ioana Angelescu, Georgeta Grecu, Andra Pirnuta, Andreea Vidru, Alina Mantea OBJECTIVES: Improving lung function in severe respiratory distress by applying an alternative therapy: surfactant bronchoalveolar lavage. METHOD: Bronchoalveolar lavage via an endotracheal tube with a solution containing 30 ml/kgc surfactant diluted to a 5 mg/ml concentration. RESULTS: We present three cases of severe respiratory distress with different etiologies, which benefited from the above-mentioned therapy. The first case is that of a newborn at term, female, born spontaneously with meconium aspiration and refractory hypoxemia, where we practiced bronchoalveolar lavage at 20 hours from birth, after the failure of HFOV and ino therapy. The second case is that of a premature baby (GA= 29 weeks), female, from a multiple pregnancy (triplets,) who received surfactant lavage at 36 hours from birth for massive pulmonary hemorrhage. The third case is that of a term newborn, male, extracted by cesarean section, transferred to our clinic at 50 hours of life, where we practiced BAL prior to initiating therapy with ino. In all 3 cases we observed an obvious improvement in respiratory function in the first hour after lavage. In the first two cases the evolution was constantly favorable, which allowed their extubation after 5 or 6 days. For the third case although we originally obtained an increase in oxygenation for more than 6 hours, a period of steady decline in respiratory function followed soon after, death occurring in the 6th day of life. CONCLUSIONS: Bronchoalveolar lavage with surfactant may be a life saving method in cases where other therapies have failed. 54

55 E-Posters EPNV EP-15: THE ROLE OF CIRCULATING PROGENITOR CELLS IN NEONATAL LUNG INJURY Nikos Efstathiou, George Koliakos, George Kyriazis, Katerina Kantziou, Vasiliki Drossou, Vasiliki Soubasi-Griva (Greece) INTRODUCTION: Circulating progenitor cells(cpcs) aim to collaborate in organogenesis and regeneration after tissue injury. Impairment of endothelial progenitor cells has been shown to contribute to the development of bronchopulmonary dysplasia(bpd), however data is limited and the role of CPCs in association to lung injury is not well established. PURPOSE: To study the mobilization of endogenous CPCs in neonates with RDS and BPD from the 1st-45th day of life, and to investigate whether there is a correlation with the severity of lung injury. MATERIAL AND METHODS: 47 preterm neonates(ga:29,1±2,6w) were enrolled. Circulating Haematopoietic Stem Cells(HSCs) and Very Small Embryonic-Like Stem Cells(VSELs) were determined using flow cytometry on the 1 st,3 rd,9 th,18 th and 45 th day of life. RESULTS: Neonates were divided in 3groups according to the development of respiratory distress syndrome(rds) Group 1: 14neonates(GA:28.2±2.9w) with mild RDS, Group 2: 10neonates(GA:27.7±2.1w) with severe RDS, Group 3: 22neonates(GA:30.2±2.1w) without RDS (controls). 10/47 neonates developed BPD. VSELs or HSCs levels were not correlated with GA. HSCs were not found to correlate with RDS or BPD. Lower levels of VSELs were observed during the study in group2 compared to group1 or controls. The difference reached SS on day18 for group2 compared to group1(p<0.05) or controls(p=0.062). Neonates with BPD showed lower VSELs on the same day(p<0.05). CONCLUSIONS: VSELs are known to contribute in tissue organogenesis during embryonic period. Lower levels in preterms with severe RDS and BPD is probably related to the pathophysiology of the disease. Exogenous administration of progenitor cells might counterbalance the endogenous inadequate mobilization and ameliorate the grade of lung injury. 55

56 EPNV E-Posters EP-16: CORRELATION OF THE INFLAMMATORY MEDIATOR, THE OXIDATIVE STRESS MARKER AND THE TRANSPULMONARY PRESSURE AS THE LUNG STRESS Ririe Fachrina Malisie (Indonesia), Antonius H Pudjiadi, Sri Widya Djusman OBJECTIVES: The correlation of the lung pressure stress with the inflammatory mediator induced the endogen reactive oxygen species still unclear. METHODS: In piglets with normal saline lung lavage, we calculated the endinspiratory of transpulmonary pressure. The intervention group (n=5) had splinted the chest, but the control group (n=4) did not received. Each piglet was studied lung recruitment maneuver and measured oxidative stress marker (MDA, GSH, GSH/GSSG ratio) and TNF-α from plasma and bronchoalveolar lavage (BAL) fluids. RESULTS: The value of end-inspiratory transpulmonary pressure ( Ptp plateau) before (1,80±2,28 cmh 2 O) and after recruitment (11,0±5,83 cmh 2 O) of the intervention group was significant increase as compare with the control group before (1,25±3,68 cmh 2 O) and after (3,25±1,18 cmh 2 O) recruitment, with p value 0,049 respectively. Ptp plateau in the intervention group have strong correlated with lung compliance (p value 0,05; r 0,8). The levels of MDA plasma and GSH from BAL fluid (p value 0,017;r 0,944) were significantly increased after maneuver recruitment in the intervention group. TNF-α plasma level increased but did not significantly different between intervention and control group. CONCLUSIONS: TNF- α and oxidative stress marker were increased both of the groups prior to and after lung recruitment maneuvre and the level of GSH in BAL fluids was correlated with the lung stress. 56

57 E-Posters EPNV EP-17: ANALYZE THE PARAMETERS OF RESPIRATORY MECHANICS BASED ON THE PARAMETER SETTINGS OF MECHANICAL VENTILATION Boudhar Kamel (Algeria) INTRODUCTION: The adjustment of ventilation parameters is based on a set of clinical, radiological and essentially gasometric signs. This setting can be optimized by an evaluation of the respiratory mechanic s parameters by quantitative as well as by qualitative analysis of the various curves and loops. OBJECTIVES: Our study was proposed to analyze the variability of these parameters depending on the ventilator setting. METHODS: A comparative and mono centric study with a prospective recruiting was conducted over a period of two years ( ), in which were included all newborns requiring conventional mechanical ventilation hospitalized at the neonatal intensive care unit of the Central Hospital of Army Algeries. 2 models of respirators were used : SLE 5000 and the Stephanie III. 238 patients were included. RESULTS: The gestational age and the birth weight were the most determinant elements in the variability of the 4 parameters of the respiratory mechanics (p < 0.05). The ventilation mode has mainly intervened in the variability of the minute volume (p < 0.001). The model of respirator was decisive in the variability of the dynamic compliance and the resistance. The diameter of the endotracheal tube has played an important role in the variability of the resistance (p < ). CONCLUSIONS: The results, especially those concerning the tidal volume and dynamic compliance, have confirmed their actual contribution in the adaptation of ventilatory parameters. In addition, they allowed us to know how to appreciate the effectiveness of the ventilatoty support, to choose the perfect time to weaning and extubation. 57

58 EPNV E-Posters EP-18: LOW-INVASIVE-SURFACTANT-ADMINISTRATION A NEW BEGINNING Crivceanscaia Larisa (Moldova) BACKGROUND: To outline the clinical outcome of newborns with respiratory distress syndrome treated by LISA (Low-Invasive-Surfactant-Administration). MATERIAL AND METHODS: This study includes 34 newborns with RDS born between February 2015 and January in the Mother and Child Care Institute from Chişinău, Republic of Moldova. Studied parameters: gestational age, birth weight, antenatal corticoid administration, neonatal resuscitation methods, the moment of surfactant administration, subsequent respiratory support, oxigen therapy duration, associated conditions, hospitalization term. RESULTS: The mean gestational age of the enrolled newborns was 29.1 (± 1,6 SD) weeks, with maximum values of32 weeks and minimums of26 weeks. The birth weight had a mean value of1265 grams, with minimum values of 840 grams and maximum values of 1960 grams. The newborns received antenatal corticoids in 76.5% of cases. The initiation of breathing was performed by T-piece resuscitator with positive end-expiratory pressure in 94.12% of cases and by bag and mask ventilation without PEEP in 5.88% of cases % received prophylactic surfactant and 11.76%received late curative administration. We used poractant in 52.94% and beractant in 47.06% of cases. In all cases, subsequent respiratory support was performed through CPAP, there were no cases of newborns who required intubation and mechanical ventilation. The respiratory comorbidities or complications we encountered were: bronchopneumonia (85.3%) and apnea of prematurity (29.4%). Our lot had a mean of4.45 days of respiratory support and a mean of 39.4 days of hospital stay. CONCLUSIONS: LISA represents a good method to consider for surfactant administration if the clinical status of the newborn allow it. 58

59 E-Posters EPNV EP-19: EFFECTIVE TIDAL VOLUME IN VERY LOW BIRTH WEIGHT INFANTS WITH HIGH FREQUENCY OSCILLATORY VENTILATION Joo Hee Lim (South Korea), Soonmin Lee, Ho Sun Eun, Min Soo Park, Kook In Park, Ran Namgung INTRODUCTION: Removal of CO 2 (DCO 2 ) is much more efficient during high frequency ventilation, and determined by the frequency and tidal volume. DCO 2 value has much individual variance, appropriate DCO 2 and tidal volume is not yet established. AIM: The aim of this study is to analyze the DCO 2 value, tidal volume, minute volume delivered with Dräger VN500 and correlate with serum pco 2. METHODS: Twelve very low birth weight infants, admitted to the NICU from March 2015 to February, and treated with Dräger VN500 (Drägerwerk Ag & Co., Lübeck, Germany) in high-frequency oscillation ventilator (HFOV) mode, were included. Data for a range of ventilator settings and respiratory parameters were extracted from the ventilator daily. Total 301 sets of blood gas result were analyzed. RESULTS: Twelve patients (GA 28.3 ± 2.1 wk, BW 1050 ± 250 g) were treated with HFOV. Measured VT/kg in normocapnia range showed 2.12 ± 0.50 ml/kg, DCO 2 value showed 68.4 ± when the patient showed the hypercapnia state, measured VT/kg showed 1.58 ± 0.25 ml/kg, DCO 2 value showed 32.4 ± DCO 2 value were significantly correlated with pco 2 (p=0.024). CONCLUSION: In VLBW infant treated with HFOV, 2.1 ml/kg of tidal volume and 70 of DCO 2 are recommended for maintaining normocapnia state. Further large scaled study is needed. 59

60 EPNV E-Posters EP-20: REGIONAL VENTILATION USING MUTI-PLANE AND PATIENT TAILORED EIT APPROACH IN AN INFANT WITH CONGENITAL REGIONAL HYPERINFLATION Martijn Miedema, Andreas D Waldmann (Australia), Karen E McCall, Stephan H Böhm, Anton H van Kaam, David G Tingay OBJECTIVES: To evaluate regional ventilation using a new textile EIT interface at different planes and a patient-tailored chest model in a term infant with a congenital hyperinflated left upper lung lobe. METHODS: A previously well male term infant presented with progressive tachypnoea and oxygen requirement on Day 10 of life. Chest X-ray and highresolution CT-scan showed a congenital hyperinflated left upper lobe with significant mediastinal shift of anatomic structures to the right. EIT recordings, using a new non-sticky textile electrode infant belt (Swisstom, Switzerland) were performed to compare regional dynamic volume behaviour with the anatomical CT. Scans were performed at three cross-sections (7th intercostal space, nipple and just below armpit) corresponding to different mediastinal shift and hyperinflation. Regional tidal ventilation was determined using a standard and a customized 3D thorax model derived from CT generating EIT images tailored directly to the infants chest shape and location of anatomical contents. RESULTS: On all reconstructions, EIT was able to show the regional differences in ventilation consistent with the known pathology. The patient-tailored EIT images better accounted for mediastinal shift and provided more accurate assessment of the restricted right upper and left middle region ventilation expected from the hyperinflated lung lesion. CONCLUSION: This case report shows that in complex pulmonary conditions, EIT is capable of visualizing regional redistribution of ventilation using a multi plane and an optimized chest shape approach. 60

61 E-Posters EPNV EP-21: INFECTION FROM VIRUS A-H2N1 AND PNEUMONIA FROM CANDIDA ALBICANS: TREATMENT WITH EARLY NIV,APHERESIS AND CAPSOFUNGIN Leonardo Milella (Italy) Ten years girl, 34 Kg, with Dravet Syndrome, with diagnosys " convulsive state ARDS, lung plural infective processus", intubated, CMV hipoxyc normocapnic hyperpiretic, oliguric, HR 145 bpm, BP of 70/45. She presented convulsant crisis. The chest x-rays showed plural bilateral pulmonary focuses, diffuse air trapping zones. Receiving ceftriaxon and amikacin. Tests presented leucopenia, thrombocytopenia, anemia,pcr 33, procalcitonin of 1,07. We begun antibiotic and immunostimulating therapy: The inflammatory indexes continued to rise up The chest x-ray did not change. Hyperpiretic and hypoxic. We found positivity for virus A-H2N1. She begun immediatly plasmapheretic theraphy for five days. We saw an immediate and progressive improvement of phlogosis indexes, leucopenia and thrombocytopenia return to normality. In fifth day there was positivity to bronchial swab at Candida Albicans. The improvement of chest x-ray and EAB permited, on fifth day, to start a weaning with use of CPAP/PS 3 days of CPAP wather valve, latex bag and Gregory s plate. Extubated on eighth day followed from helmet CPAP.Negativization of all coltural exams, improvement of chest x-ray and EAB analyses in spontaneous breathing and O2 therapy, normalization of emochrome, apiretic in 3 days. The patient was transferred in good conditions with the following theraphy: meropenem, amikacina, capsofungin 30 mgx2, sideral, tamiflu. The administration of antibiotics was discontinued at 15 th day, capsofungin at 22 th day. Home discharged in 27 th day. The follow-up was done for 30th days with normalization of x-ray and haematic exams 61

62 EPNV E-Posters EP-22: ETHICAL DILEMMA AND CHALLENGES IN RESUSCITATION/ MANAGEMENT OF NEWBORN WITH HARLEQUIN ICHTHYOSIS Aesha Mohammedi (United Kingdom), Sheila Clarke, David Gibson BACKGROUND: Harlequin Ichthyosis(HI) is an extremely severe, rare autosomal recessive form of congenital Ichthyosis. Survival has improved but mortality is still reported to be approximately 50% in the neonatal period. The justification for aggressive resuscitation in neonatal period in the event of a life threatening secondary complications can pose ethical challenges for the medical team. We report a HI baby who posed similar ethical challenges. METHODOLOGY: A 32 weeker, 1.64kg baby boy born to first degree, consanguineous, asian parents with severe, generalised hyperkeratotic ichthyosis, widespread deep fissuring associated with severe ectropion, eclabian, bilateral occlusion of nostrils and ear canals, joint and digits contractures and malformation. Mom, 31yrs old had an unremarkable antenatal follow-up. Complete keratinous nasal occlusion prompted need for emergency intubation which was successful at third attempt. Transient nasopharyngeal airway were placed for nostril patency and one-way extubation done successfully at 5 days of age. Dermatology advice was followed for management of skin condition. Genetic testing confirmed an ABCA12 gene mutation. RESULTS: The ethical dilemma was how aggressive treatment should be should baby s condition worsen. The inability to maintain IV access for ventilation, sedation, pain relief and antibiotics remained a constant challenge. Following discussions with family a limitation of treatment agreement was put in place. However, with remarkable progress baby was discharged home at 2 months corrected age. CONCLUSION: There is a significant lack of literature regarding neonatal resuscitation advice in HI or similar life threatening genetic conditions and this highlights a dire need of a national guideline for resuscitating such conditions. 62

63 E-Posters EPNV EP-23: NON-INVASIVE POSITIVE PRESSURE VENTILATION (NIPPV) USING RAM CANNULA INTERFACE IN MANAGEMENT OF RESPIRATORY FAILURE IN A CHILDREN S HOSPITAL PICU Luke Noronha (United States of America), Andrea Talukdar, Machelle Dawson INTRODUCTION: Non-invasive positive pressure ventilation (NIPPV) is effective in managing respiratory failure in children. NIPPV avoids tracheal trauma, decreases sedation needs, ICU and hospital length of stay (LOS). The RAM cannula provides a novel interface for NIPPV. OBJECTIVES: Evaluate efficacy of RAM cannula in management of respiratory failure in children. HYPOTHESIS: RAM cannula reduces need for invasive mechanical ventilation and decreases PICU LOS. METHODS: Retrospective analysis of 50 patients treated with RAM cannula: January June Primary endpoint: Need for endotracheal intubation. Secondary endpoints: PICU LOS and duration of ventilation. Statistics include counts and percentages for categorical data and means, medians and standard deviation, for continuous data. Fisher s exact test compared categorical variables between patients intubated and not intubated. Independent sample t-test compared continuous data between groups. p-value < 0.05 was considered statistically significant. RESULTS: Analysis included RAM cannula experience in 50 children aged< 24 months. 11 patients (22%) progressed to intubation and 39 (78%) remained on RAM. Variables: Age, weight, ethnicity and etiology of respiratory failure Age and weight were comparable between intubated and non-intubated groups. Median RAM [47 hours] was significantly higher in patients remaining on RAM compared to those requiring intubation [12 hours] (p=0.0009). 64% of males and 100% African- American children advanced to invasive ventilation. Median PICU LOS of patients remaining on RAM cannula [80 hours] was significantly lower than patients requiring intubation [220 hours] (p<0.0001). CONCLUSION: RAM interface safely and effectively delivers NIPPV to children 63

64 EPNV E-Posters EP-24: BRONCHIAL SELECTIVE INTUBATION IN A PRETERM WITH INTERSTITIAL PULMONARY EMPHYSEMA Flavia Petrillo (Italy), Flavia Petrillo, Antonio Del Vecchio Persistent interstitial pulmonary emphysema is a rare condition that occurs in preterm infants who are particularly exposed to overdistension from mechanical ventilation or continuous positive airway pressure. PIE is characterized by abnormal accumulation of air in the pulmonary interstitium, due to disruption of the basement membrane. PIE may be present as diffuse bilateral involvement or a unilateral lesion. In unilateral PIE, mediastinal shift causes compressive atelectasis of the opposite lung, which leads to an increased need for higher ventilatory pressures, progressive overdistension of the affected lung and worsening of clinical condition. The management of infants suffering from PIE varies according to severity and stability of the patient, being either conservative treatment or aggressive surgical treatment. We report a case of a patient born at 32 weeks of EG by cesarean section for a premature rupture of the membranes in twin pregnancy. She didn t need the resuscitation manoeuvre at birth, but she developed mild respiratory distress few minutes after delivery, so she was moved in NICU in ncpap (max fio2 35%). She was treated with surfactant (INSURE) on her first day of life and she stopped ncpap on the fourth day. On the ninth day she newly developed respiratory distress ; X-Ray and TAC showed diffuse PIE of left lung. Therefore she was treated by selective intubation of the right bronchus for 48 hours, then the tube was replaced at carena for another 48 hours, so the baby was extubated. The baby was discharged without problems at 36 weeks of EG. 64

65 E-Posters EPNV EP-25: NAVA IN A CHILD WITH MILLER-FISHER SYNDROME: REPETITA IUVAT Emanuele Rossetti (Italy), Roberto Bianchi, Sergio Picardo Here we report a 6-year-old child with Miller-Fisher Syndrome. After 3 days of fever with cervical lympho-adenomegaly, he had complained diplopia, inappetence, aphonia, and urine incontinence. In day 4 he fainted suddenly due to autonomic nervous system dysfunction worsening, and thus requiring invasive mechanical respiratory support. In the meanwhile, diagnostic blood and cerebrospinal fluid samples were examined, cerebral MRI and EMG were performed, and prompt immunoglobulin bolus treatment was assessed, according to international guidelines for acute polyradiculoneuritis management. Hence, in order to provide fast-track weaningoff mechanical ventilation and on behalf of a previous experience in pediatric polyradiculoneuritis, we started early NAVA in day 3 after PCU admission. After NAVA cathether was placed, the diaphragmatic electrical activity was less than 0.5 μv, and therefore the NAVA level was set at 1.5 cmh2o/μv that corresponded to PS 18 cmh2o; the PEEP was set at 5 cmh2o. With NAVA, the patient seemed well synchronized with mechanical ventilation, calm and collaborative despite midazolam infusion tapering. He maintained stable arterial blood gases progressively and no atelectasis developed. The NAVA led to wean off invasive mechanical ventilation in 4 days with a NAVA level of 0.5 due to EAdi of 1.8 μv, hence starting NAVA-NIV with Helmet interface for the following 5 days. Finally, the child was discharged to the neuro-rehabilitative ward in the day 10 after admission: such outcome overcame every best wishes among PICU intensivists and nurses staff. To date, after intensive rehabilitation efforts, the child is again attending gym time at school actually. 65

66 EPNV E-Posters EP-26: SPONTANEOUS BREATHING DURING HIGH FREQUENCY OSCILLATORY VENTILATION Sjoerdtje Slager (The Netherlands), Dick G. Markhorst, Martin C. J. Kneyber OBJECTIVES: Spontaneous breathing during paediatric high frequency oscillatory ventilation (HFOV) remains controversial because it assumedly causes tidal volume (V T ) to approximate V T during conventional mechanical ventilation (CV), eliminating the potential benefits of HFOV (i.e. low V T ). We studied whether spontaneous breathing during HFOV with high frequency and power settings results in lower V T than during HFOV with low frequency and power settings or during CV. MATERIALS AND METHODS: A series of experiments was performed on a test lung with simulated spontaneous breathing connected to an HFO 3100A ventilator (CareFusion, Yorba Linda, USA). Flow proximal to the endotracheal tube (ETT) was recorded for combinations of different frequencies, power settings, and ETT sizes. Mean HFOV stroke volumes superimposed on spontaneous breaths (SV) were compared with Kruskal-Wallis and post-hoc Mann-Whitney U tests. (SPSS v. 22). RESULTS: Increasing frequency from 5 to 15 Hz significantly decreased HFOV SV (p < 0.001). At frequency 15 Hz and power settings 100 HFOV SV was 3.06 ml ± 0.31 ml, 4.57 ml ± 1.04 ml and 8.15 ml ± 2.67 ml for ETT size 3, 4, and 5 mm respectively, resulting in VT s of ml, ml and ml respectively, when superimposed on spontaneous breaths of 5 ml/kg. Spontaneous breathing during CV would result in VT s of 21 ml, 60 ml, and 120 ml (6 ml/kg) respectively. CONCLUSION: In spontaneous breathing during HFOV, the use of high frequency and power settings significantly reduces HFOV stroke volume and HFOV V T remains slightly lower than V T in CV. 66

67 E-Posters EPNV EP-27: TREATMENT OF CEPACIA SYNDROME WITH NEBULIZED MEROPENEM & AMIKACIN & INTRAVENOUS METHYLPREDNISOLONE IN A PATIENT WITH INFECTIVE EXACERBATION OF BRONCHIECTASIS Herng Lee Tan (Singapore), Jan Hau Lee, Koh Cheng Thoon, Anne Goh Cepacia syndrome, an overwhelming infection caused by Burkholderia cepacia has significant morbidity and mortality. We report a case of cepacia syndrome that was successful treated with pulsed steroids and combination antibiotics. The patient was first diagnosed with bronchiectasis in 2005 and followed-up at our hospital from the age of 15. She was admitted and intubated for increasing respiratory distress due to infective exacerbation of bronchiectasis secondary to Burkholderia cepacia. Post intubation, patient required high ventilatory settings with persistent respiratory acidosis (worst ph and P a CO mmhg when on PIP 30 cm H 2 O, PEEP 9 cm H 2 O, frequency 27/min, achieving tidal volume of 8 ml/kg). Despite being on fortum, piperacillin/tazobactam, gentamicin, clarithromycin and itraconazole, patient's lower respiratory tract culture persistently grew Burkholderia cepacia and Pseudomonas aeruginosa. Due to spiking fever with maximum temperature of 40.5oC, highest C-reactive protein of mg/l and highest total white blood count of 36 x 109/L, she was diagnosed with cepacia syndrome. Nebulized meropenem and amikacin, and intravenous methylprednisolone were initiated. She was subsequently switched to Airway Pressure Release Ventilation to optimize weaning from mechanical ventilation. Thereafter, her gas exchange improved along with decrease in ventilatory support. She was extubated to continuous positive airway pressure of 10 cm H 2 O after 15 days of intubation and weaned to 1L/min oxygen 5 days later. Due to the rarity of cepacia syndrome in non-cystic fibrosis patients, a test for cystic fibrosis was sent which subsequently came back as positive. 67

68 EPNV E-Posters EP-28: A CASE OF RHIZOMELIC CHONDRODYSLASIA PUNCTATA IN NEWBORN Hatice Tatar Aksoy (Turkey), Arzu Yilmaz, Bülent Alioglu The authors report the case of newborn presenting the main findings of the syndrome; shortening of the proximal long bones, punctate calcifications located in the epiphyses of long bones, dysmorphic face, cataract, restricted joint mobility. The term infant was admitted to the NICU because of its atypical facial appearance and extremity anomalies after birth. The male infant was born at 39 weeks of gestation from the thirth pregnancy of a healthy 20-year-old mother and 29-year-old related father. There was no history of exposure to any known embryopathic agents. On the physical examination BW was 2520 gr (10-25 percentiles), height was 45 cm (3-10 percentiles), head circumference was 33,5 cm ( percentiles). There was a depressed nasal bridge, shortness of the upper extremities, bilateral cataract. In the skeletal survey, there were proximal shortness, thick and short diaphyses, large and irregular metaphyses in the long bones, punctate calcifications in the epiphyses. Secundum ASD and thin PDA were detected on echocardiography. Cavum vergae and minimal dilatation in the right ventricle were observed on cranial ultrasonography. Bilateral cataract was seen on the ophthalmological examination. Parents were informed about this disease and genetic counseling was given. The patient was discharged with clinical diagnosis of rhizomelic chondrodysplasia punctata on ninth day of life. The case is 11 months of age and weighing 4000 gr, and is fed orally. He was operated twice for bilateral cataracts. PCP is a rare disease. The prognosis is bad and the treatment is merely supportive. 68

69 E-Posters EPNV EP-29: MINOR DIFFERENCES IN DEAD SPACE RATIOS AFTER PALLIATION OF HYPOPLASTIC LEFT HEART SYNDROME ARE NOT CORRELATED WITH CHANGES IN CLINICAL OUTCOMES Brigham Willis (United States of America), Sindhu Pandurangi, Chasity Wellnitz, Janet Foote, John Nigro, Daniel Velez PURPOSE: Available surgical procedures in the first stage of the palliation of hypoplastic left heart syndrome (HLHS) are currently the Norwood procedure with Blalock-Taussig (BT) shunt, Norwood with a Sano shunt, or a hybrid procedure combining surgical pulmonary artery band placement and catheter-based stenting of the ductus arteriosus. However, little is known about the differences in pulmonary function and outcomes between the three groups. METHODS: We conducted a chart review of 14 neonates who underwent stage 1 palliation for HLHS,.Demographic, hemodynamic, and outcome information was collected. Physiologic and respiratory variables (including Vd/Vt and dynamic compliance) were measured preoperatively, postoperatively, and at multiple time points from 6 to 120 hours postoperatively. Outcome measures collected included maximum postoperative lactate, time to extubation, hospital length of stay, and mortality. RESULTS: 7 patients underwent Norwood with BT shunt, 5 underwent a Sano shunt, and 2 underwent the hybrid procedure. Linear regression comparing Vd/Vt and dynamic compliance across all times points among the 3 groups did not show any significant differences (p = 0.79). When stratified by shunt size, patients with a 3.0 mm BT shunt or with a Sano shunt had higher Vd/Vt ratios from 0-48 hours (p = 0.02). Length of mechanical ventilation, hospital length of stay, and mortality also did not differ significantly among the 3 surgical groups. CONCLUSION: Patients with 3.0 mm BT and Sano shunts had higher Vd/Vt ratios through 48 hours postoperatively. It is unclear what influence these differences may have on prognosis or management. 69

70 EPNV Index of Authors 70 Name Abstract number Page Alioglu, Bülent EP Andersson, Sture EP Angelescu, Ioana EP Arjona, David EP Asija, Ritu EP Ziad Assaf OP Bachman, Thomas OP-09 - OP-10 - EP-02 - EP Bae, Mihye EP Barbanti, Claudio OP Bassi, Harjot EP-04 - EP Belteki, Gusztav EP-06 - EP Ben Ammar, Rafik EP Bianchi, Roberto EP Björklund, Lars EP Blokpoel, Robert OP Bohm, Stephan OP Böhm, Stephan H EP Borrego, Raul EP Bossley, Cara EP Boussard, Charlotte OP Brito, Gabriela OP Burke, Siobhan OP Byun, Shinyun EP Cambonie, Gilles OP Chao, Ke-Yun EP Chen, Yi-Ling EP Chien, Yu-Hsuan EP Chowdhury, Olie EP Clarke, Sheila EP Curley, Anna EP Dargaville, Peter OP Dassios, Theodore EP-11 - EP Dawson, Machelle EP-23 63

71 Index of Authors EPNV Name Abstract number Page de Luca, Daniele OP-07 - EP Debray, Agathe OP Del Vecchio, Antonio EP del Villar Guerra, Pablo OP Dell'Orto, Valentina OP-07 - EP Dellaca, Raffaele OP Demetrian, Mihaela EP Dijkstra, Sandra OP Djusman, Sri Widya EP Drossou, Vasiliki EP Efstathiou, Nikos EP Elbarbary, Mahmoud OP Eun, Ho Sun EP Fachrina Malisie, Ririe EP Fagundes, Luciana OP Foote, Janet EP Fule, Balazs OP Galante, Dario OP Garcia Cuscó, Mireia OP Gibson, David EP Goh, Anne EP Grecu, Georgeta EP Gutierrez, María EP Hamadah, Hussam OP Han, Jeong-Ho OP Han, Youngmi EP Hancock, Rachel OP Heiring, Christian EP Herrera, María EP Hickey, Ann EP Hijazi, Omar OP Ismail, Sameh OP Jonsson, Baldvin EP Kabbani, Mohamed OP

72 EPNV Index of Authors 72 Name Abstract number Page Kallio, Merja OP Kamel, Boudhar EP Kantziou, Katerina EP Karen, McCall OP Kneyber, Martin OP Kneyber, Martin C. J. EP Koliakos, George EP Koopman, Alette OP Koskela, Ulla OP Kyriazis, George EP Larisa, Crivceanscaia EP Laroche, Sylvie OP Lecourt, Laurent OP Lee, Jan Hau EP Lee, Narae EP Lee, Soonmin EP Leger, Pierre-Louis OP Liet, Jean Michel OP Lim, Joo Hee EP López, Jorge OP Loron, Gauthier OP Mantea, Alina EP Markhorst, Dick G. EP Martin, Carmen EP Mauriat, Philippe OP Mayordomo, Juan OP McCall, Karen E EP Medina, Alberto OP Meneses, Jucille OP Miedema, Martijn EP Mildner, Reinout OP Milella, Leonardo EP Modesto i Alapont, Vicent OP Mohammedi, Aesha EP-22 62

73 Index of Authors EPNV Name Abstract number Page Morandi, Tiffany EP Morley, Colin EP-06 - EP-07 - EP Mu, Shu-Chi EP Namgung, Ran EP Nigro, John EP-04 - EP Noronha, Luke EP Onland, Wes OP-09 - OP Pandurangi, Sindhu EP Park, Kook In EP Park, Kyounghee EP Park, Min Soo EP Peltoniemi, Outi OP Petrillo, Flavia EP Picardo, Sergio EP Pirnuta, Andra EP Pokka, Tytti OP Philippe Pouard OP Pudjiadi, Antonius H EP Rebello, Celso OP Richardson, Kristi EP Ross-Russell, Robert EP Rossetti, Emanuele EP Saarela, Timo OP Santos, Paula EP Shaath, Ghassan OP Shankar-Aguilera, Shivani OP-07 - EP Slager, Sjoerdtje EP Soubasi-Griva, Vasiliki EP Suo-Palosaari, Maria OP Talukdar, Andrea EP Tan, Herng Lee EP Tatar Aksoy, Hatice EP te Pas, Arjan OP Tenaglia, Christine EP

74 EPNV Index of Authors Name Abstract number Page Thanikkel, Leo EP Thoon, Koh Cheng EP Tingay, David OP-08 - EP Tsai, Li-Yi EP van den Heuvel, Maria OP-09 - OP van Kaam, Anton OP-09 - OP-10 - EP van Zanten, Henriette OP Velez, Daniel EP Vidru, Andreea EP Waldmann, Andreas OP-08 - EP Wellnitz, Chasity EP Wilinska, Maria OP-10 - EP Willis, Brigham EP-04 - EP Yagui, Ana Cristina OP Yilmaz, Arzu EP Youssef, Nadya EP Zolio, Bianca OP

75 NEW ESPNIC SUMMER SCHOOL HOTEL LA VILLA, CALVI, CORSICA, JUNE 13-15, ESPNIC INVITES YOU TO OUR FIRST ANNUAL SUMMER PAEDIATRIC & NEONATAL INTENSIVE CARE WORKSHOP Based on the courses run at the ESPNIC congresses, this 3-day refresher course is targeted at candidates preparing for the European Paediatric/Neonatal Intensive Care Diploma (EPIC Diploma ), as well as individuals who want to refresh their knowledge in paediatric intensive care medicine. Led by key speakers and experts from the ESPNIC sections, this course provides an insight into current topics and controversies in ventilation, sepsis & hemodynamics and renal issues including renal replacement therapy on ICU. Each area will have both dedicated theory and practical components. Speakers include Peter Rimensberger (Past Medical President ESPNIC & Member of the Respiratory Section) Joe Brierley (Medical President of ESPNIC & Chair of the ESPNIC Diploma Advisory Board), Joris Lemson (Chair of the Cardiodynamic Section), Akash Deep (Chair of Renal Section), and Andrew Darbyshire (Chair of Nursing Section & Member of the EPIC Diploma Assessment Development Committee) PROGRAMME AT A GLANCE: June 13 th 15:00-19:30: Basic and advanced hemodynamic assessment June 14 th 07:30-12:00: What should I know when ventilating a patient (respiratory mechanics, ventilator modes, concepts of lung protective ventilation revisited) June 14 th 15:30-19:30: Advanced ICU care of children with severe sepsis June 15 th 07:30-12:00: Renal failure and renal replacement therapy in the PICU Registration & accommodation packages available!

76 EPNV Sponsors and Exhibitors The Organizing Committee of the 13 th European Conference on Pediatric and Neonatal Mechanical Ventilation Congress would like to thank the following companies and institutions for their support. ACUTRONIC MEDICAL SYSTEMS AG Booth No. 1 Sponsor Workshop 2, Wednesday May 25, ANANDIC MEDICAL SYSTEMS Booth No. 6 BIOPACK MEDICAL Sponsor: Lunch symposium, Thursday May 26, CAREFUSION Booth No. 14 Sponsor Workshop 2, Wednesday May 25, 76 ESPNIC European Society of Paediatric and Neonatal Intensive Care Booth No. 15

77 Sponsors and Exhibitors EPNV HAMILTON MEDICAL AG Booth No. 7 IMTMEDICAL Booth No. 5 Sponsor Workshop 3, Wednesday May 25, INTERSURGICAL Booth No. 4 MAQUET Booth No. 2 Sponsor Workshop 3, Wednesday May 25, & Lunch symposium on Friday, May 27, MEDIN MEDICAL INNOVATIONS Booth No. 8 MEDTRONIC / COVIDIEN Sponsor Workshop 2, Wednesday May 25, 77

78 EPNV Sponsors and Exhibitors METRAN Booth No. 10 Sponsor Workshop 2, Wednesday May 25, PEAKMEDICAL Booth No. 12 RADIOMETER Booth No. 16 RESMED Booth No. 9 SENTEC Booth No. 9 Sponsor Workshop 3, Wednesday May 25, SLE Booth No. 3 Sponsor Workshop 3, Wednesday May 25, 78

79 Sponsors and Exhibitors EPNV STEPHAN Booth No. 11 Sponsor Workshop 3, Wednesday May 25, & Workshop 4, Thursday May 26, SWISSTOM & CRADL Booth No. 13 CITY OF MONTREUX Welcome Reception Sponsor 79

80 EPNV Exhibition Plan EPNV - Exhibitors List 01 - Acutronic 05 - Imtmedical 02 - Maquet 06 - Anandic Medical Systems 03 - SLE 07 - Hamilton Medical 04 - Intersurgical 08 - Medin Medical Innovations desk 1 Entrance is Hall coffee break coffee break E-Poster area coffee break Speaker Room TERRASSE 80

81 Exhibition Plan EPNV 09 - SenTec / ResMed 10 - Metran 11 - Stephan 12 - PeakMedical 13 - Swisstom & CRADL 14 - CareFusion 15 - ESPNIC 16 - Radiometer Congress Room - First Floor Room Miles Davis V Foyer Miles Davis Room Miles Davis VI - IX 81

82 EPNV General Information Montreux Music & Convention Center 2M2C Address: Avenue Claude Nobs 5, 1820 Montreux Phone : +41 (0) Registration desk opening hours Wednesday 25 May : 08:00-19:00 Thursday 26 May : 07:00-20:00 Friday 27 May : 07:30-18:00 Saturday 28 May : 08:00-13:00 Official language English is the official language of the congress. No simultaneous interpretation will be provided. WIFI Free WIFI is available in the congress center. UserName : EPNV password : epnv Evaluation form In order to provide you with meetings of highest possible quality you are kindly requested to complete an evaluation form, which is also a requirement of accreditation by the European Council for Continuing Medical Education (EAC- CME). You will receive the form at the registration desk. 82

83 General Information EPNV Certificate of attendance You can pick up your certificate of attendance at the registration desk after you have submitted the evaluation form. Speaker ready room A speaker preview room will be provided for all oral presentations on the ground floor of the congress center. Presentations must be in PowerPoint form only (MAC or PC) and saved on an empty USB key. All presenters must announce themselves to the AV technician in the Speaker preview room at least 60 minutes before the scheduled session time. An audio, video and basic running check of the PPT will be double checked at this time. Oral presentations Most of the lectures will be available on the congress website after the congress. 83

84 EPNV Social Program Welcome Reception - Thursday, May 26, After the sessions in the exhibition hall of the congress. The welcome reception will start at 18:00 in the exhibition area of the congress venue. Get together Dinner - Friday, May 27, Visit the Chillon Castle and have dinner in a medieval room! This majestic castle has dominated the lake since the 13th century. It was first a strategic check point established by the rich and powerful House of Savoy on a much-travelled road for their benefit and profit. Its history and heritage have now made it an iconic Swiss location. Departure: 19:00 by bus in front of the congress center 84 Participation in the Get together Dinner: CHF 80 (excl. VAT) per person; tickets available at the registration desk.

85 General Conditions EPNV We would like to bring your attention that the conference rooms have limited capacity. In case of big affluence, only the first registrations will be accepted. Prices All payment should be made in Swiss Francs (CHF). Delegate ESPNIC Member Delegate Low, lower-middle, upper-middle income Countries Low, lower-middle, upper-middle income Countries ESPNIC Member Nurses ESPNIC Nurses On site 700 CHF 600 CHF 550 CHF 450 CHF 500 CHF 400 CHF Participants fee includes: - Program and abstract book - 1 lunch - Coffee breaks - Welcome Reception - All administration and handling Workshops: - Member, non-member, nurse: CHF / workshop - Low, lower-middle, upper-middle income Countries participants: CHF / workshop Participation in the congress dinner: CHF 80 (excl. VAT) per person Payment Options We accept credit cards (Visa, Mastercard and American Express). All payments should be made in Swiss Francs (CHF). Please note that personal checks are not accepted. 85

86 EPNV General Conditions Confirmation / Invoice Confirmation and invoice: your booking will be confirmed by . Confirmation and invoice will be sent to you within 72 hours, if you do not receive them please contact the Congress office directly. Cancellation Policy Cancellations will be accepted until April 15,. The full amount will be refunded less 100 CHF to cover cancellation costs. No refunds will be made for cancellations received after this date. Cancellations must be made in writing by , fax or airmail to the congress secretariat. Reimbursement will not be given for late arrival, unused services, unattended events or early departure from the congress. Badges Delegates will receive a name-badge at the reception desk, upon registration. The badge must be worn prominently in order to gain access to the congress area during all scientific and social events. Admission will be refused to anyone not in possession of an appropriate badge. Insurance Neither the organization nor the conference agency are responsible for individual medical, travel or personal insurance. Delegates are requested to arrange their own travel and health insurance. The organizers cannot assume liability for changes in the programme due to external circumstances. 86

87 About Montreux EPNV The town of Montreux nestles in a sheltered Lake Geneva bay, surrounded by vineyards and against the breathtaking backdrop of snow-covered Alps. The Montreux Jazz Festival, which takes place in June/July and features concerts on a variety of stages and parks is very famous. Because of the exceptionally mild climate Montreux is called the capital of the Vaud Riviera. Plants associated with the Mediterranean, such as pines, cypresses and palm trees grow here. Charlie Chaplin, Freddie Mercury and several other famous people of world-renown lived and continue to live on the Vaud Riviera. The long, flower-bordered lake promenade which links Vevey and Montreux going all the way to Chillon Castle is simply asking to be strolled along. Cultural events, such as the Montreux Jazz Festival, as well as countless excursion options to the mountainous hinterland or on the lake make Montreux the most popular excursion and holiday destination. Many of the houses along the lakeside road, including the magnificent Fairmont Le Montreux Palace, date from the hayday of the Belle Epoque. 87

88 EPNV About Montreux Highlights Rochers-de-Naye the Rochers-de-Naye rack-railway, after overcoming a difference in altitude of 1600 metres, reaches one of the most beautiful vantage points in western Switzerland. Golden Pass Line the panorama train operates between Montreux, Gstaad and the Bernese Oberland with connections to Lucerne. Lake Geneva Shipping Company the ships, some of which are still powered by paddles, take visitors to the picturesque lakeside resorts. NEW! Welcome to Chaplin s World Embark on an extraordinary adventure across time and through the magical world of cinema. Prepare to be moved by one of the most surprising artists of the 20th century. Chaplin's World is open 7 days a week from 10 am to 6 pm. More information: Banks and currency exchange The local currency is the Swiss Franc (CHF). Banking hours are from Monday to Friday: 9am 12 noon / 2pm 5pm. Saturday closed. 1 CHF = 0.90 Euros 1 CHF = 1.04 USD (exchange rate valid on May ) Shopping Shops in Montreux are open Monday to Friday from 8:30 am to 7 pm and Saturday from 8:30 am to 6 pm. 88 Tourist Board Montreux Tourisme Pavillon d information, 1820 Montreux Phone : +41 (0)

89 REGISTER NOW AND SAVE! Early Registration Deadline: June 29th,

90 Map of Montreux EPNV 5 1 Grand Hotel Suisse-Majestic Avenue des Alpes 45, 1820 Montreux Invited speakers Hotel Situation: 5 minutes from the congress center 2 Hotel Eden Palace au Lac Rue du Théâtre 11, 1820 Montreux Situation: 15 minutes from the congress center 3 Hotel Helvetie Avenue de Casino 32, 1820 Montreux Situation: 15 minutes from the congress center 4 Hotel La Rouvenaz Rue du Marché 1, 1820 Montreux Situation: 10 minutes from the congress center 90 5 Chillon Castle - Congress Dinner location

91 Special offer Get 10% off the printed book or ebook! Use the following token on springer.com HqSRwSrAr2nzH5e (Valid 05/25/ - 06/25/) P. Rimensberger (Ed.) Pediatric and Neonatal Mechanical Ventilation From Basics to Clinical Practice 2015, X, 1642 p. 405 illus., 109 illus. in color. Meets the need for a comprehensive reference covering the full scope of mechanical ventilation in children and neonates Clearly documents the use of mechanical ventilation in various pathologies Allows both students and experienced physicians to extract essential information easily Considers technical and equipment issues in the context of the financial constraints experienced in developing countries Printed book Hardcover 199, $ *213,99 (D) 219,99 (A) CHF ebook Available from your library or springer.com/shop MyCopy Printed ebook for just $ springer.com/mycopy Written by outstanding authorities from all over the world, this comprehensive new textbook devoted to pediatric and neonatal ventilation puts the focus on the effective delivery of respiratory support to children, infants, and newborns. In the early chapters, developmental issues concerning the respiratory system are considered, physiological and mechanical principles are introduced, and airway management and conventional and alternative ventilation techniques are discussed. Thereafter, the rational use of mechanical ventilation in various pediatric and neonatal pathologies is explained, with the emphasis on a practical step-by-step approach. Respiratory monitoring and safety issues in ventilated patients are considered in detail, and many other topics of interest to the bedside clinician are covered, including the ethics of withdrawal of respiratory support and educational issues. Throughout, the text is complemented by numerous illustrations and key information is clearly summarized in tables and lists, providing the reader with clear "take home messages". Order online at springer.com Need help? Go to springer.com/help/orders The first price and the and $ price are net prices, subject to local VAT. Prices indicated with * include VAT for books; the (D) includes 7% for Germany, the (A) includes 10% for Austria. Prices indicated with ** include VAT for electronic products; 19% for Germany, 20% for Austria. All prices exclusive of carriage charges. Prices and other details are subject to change without notice. All errors and omissions excepted. Distribution rights for India: CBS Publishers, New Delhi, India

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