CONGRESS CENTRE MONTREUX, SWITZERLAND MAY 25 - … · FINAL PROGRAM CONGRESS CENTRE MONTREUX, SWITZERLAND MAY 25 - 28, 2016

FINAL PROGRAM

CONGRESS CENTRE MONTREUX, SWITZERLAND

MAY 25 - 28, 2016

www.epnv-montreux.org

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Notes

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Table of content

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

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The 13th 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) Switzerland• Thomas Berger Switzerland• Jürg Hammer Switzerland• Martin Kneyber The Netherlands• Laurent Storme France

Endorsed by:• The European Society of Pediatric and Neonatal Intensive Care (ESPNIC)

Educational CreditsThe EACCME (European Accreditation Council for Continuing Medical Education) has granted 21 European CME credits to the 13th EPNV congress.

The Swiss Society of Neonatology (SGI/SSMI) has granted 21 CME credits

Administrative SecretariatSymposium & Conference OrganizersRue Rousseau 30, CH - 1201 Geneva, SwitzerlandTel: +41 (0)22 839 84 84 - Fax: +41 (0)22 839 84 85Email: [email protected]

Conference Organization

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Welcome to the 13th European Conferenceon Pediatric and Neonatal Mechanical Ventilation

Dear Colleagues and Friends,

The 13th 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 pre-congress workshops that will focus on very practical bedside issues.

We are inviting you to participate and to make this 13th 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 2016.

Peter C. Rimensberger Congress Chairman

Welcoming Words

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Faculty & Workshop Leaders

Olivier Baud France

Thomas Berger Switzerland

Risha Bhatia 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

Daniel Lichtenstein France

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Faculty & Workshop Leaders

Alberto Medina Spain

Vicent Modesto i Alapont Spain

Vincent Muehlethaler 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

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Program at a Glance

Pre-Congress Workshops

Wednesday, May 25, 201608:00 - 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, 201608:00 - 12:00 Workshop 1c - Room Miles VI-IX Workshop 4 - Room Miles V

Main Conference

Thursday, May 26, 201612:30 - 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, 201608:00 - 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


11:00 - 12:00ORAL PRESENTATIONS 1

Room Miles VE-Posters

ORAL PRESENTATIONS 2 Room Miles VI-IX

12:00 - 13:45 Industry Sponsored Lunch Symposium - Room Miles VI-IX




19:00 Get Together Dinner

Saturday, May 28, 201608:30 - 09:15 Applied Physiology Lecture 3 - Room Miles V Applied Physiology Lecture 4 - Room Miles VI-IX



11:50 - 12:30 Closing Lecture - Room Miles V

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Scientific and Educational Program

Pre-Congress Workshops

Wednesday, May 25, 2016

May 25 - 26, 2016: Pre-Conference Workshops Wednesday (May 25): 10:00 – 19:00Thursday (May 26): 08:00 – 12:00

May 26 - 28, 2016: Main ConferenceThursday (May 26): 12:30 – 18:00 Friday (May 27): 08:00 – 18:00 Saturday (May 28): 08:30 – 12:30

From 08:00 Registration Opening

10:00 - 14:00 Room Miles VI-IXWorkshop 1a: Lung ultrasound in the neonatal and paediatric ICUWorkshop-Leaders: Daniel Lichtenstein (France), Nadya Yousef (France)

10:00 - 14:00 Room Miles VWorkshop 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: CO2 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)

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15:00 - 19:00 Room Miles VI-IXWorkshop 1b: Lung ultrasound in the neonatal and paediatric ICUWorkshop-Leaders: Daniel Lichtenstein (France), Nadya Yousef (France)

15:00 - 19:00 Room Miles VWorkshop 3: Understanding oxygenation and ventilation control conceptsIndustry 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) CO2 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


19:00 - 20:00 Room Miles VESPNIC General Assembly

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Thursday, May 26, 2016

08:00 - 12:00 Room Miles VI-IXWorkshop 1c: Lung ultrasound in the neonatal and paediatric ICUWorkshop-Leaders: Daniel Lichtenstein (France), Nadya Yousef (France)

08:00 - 12:00 Room Miles VWorkshop 4: Understanding ventilators, function principals, and specific clinical useIndustry 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


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Main Conference

Thursday, May 26, 2016

12:30-13:30 Room Miles VI-IXIndustry 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

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)


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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)

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, 2016

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)


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09:00 - 10:30 Room Miles VSESSION 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-IXSESSION 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)

09:50 - 10:15 Continuous ETCO2 measures in the NICU: We have to learn on how to use it Amir Kugelman (Israel)


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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)


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)


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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)

12:00 - 13:45 Room Miles VI-IXIndustry 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)


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13:45 - 15:15 Room Miles VSESSION 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)

14:45 - 15:15 Humidification: passive or active? Martin Kneyber (The Netherlands)

13:45 - 15:15 Room Miles VI-IXSESSION 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)



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15:45 - 18:00 Room Miles VSESSION 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-IXSESSION 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)

17:00 - 17:30 Ventilation strategies to prevent, BPD and ventilation strategies to support the BDP patient Pierre-Henri Jarreau (France)


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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

Saturday, May 28, 2016

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)



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09:45 - 11:45 Room Miles VSESSION 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)


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09:45 - 11:45 Room Miles VI-IXSESSION 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)

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)


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Oral Presentations

OP-01 SF ratio like predictive marker of the mortality rate in acute respiratory distress syndrome in pediatric intensive care unitVicent Modesto i Alapont (Spain)

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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)

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OP-03 Impact of the synchronized nasal intermitent mandatory ventilation by neurally adjusted ventilatory assist (nava) in premature infants with respiratory failureCelso Rebello (Brazil)

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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) firstMireia Garcia Cuscó (United Kingdom)

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OP-06 Ultrasound for Diaphragmatic Dysfunction in Post-Operative Cardiac ChildrenHussam Hamadah (Saudi Arabia)

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OP-07 Pressure and oscillation transmission with modern HFOV oscillators: bench comparisonDaniele De Luca (Switzerland)

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OP-08 Influence of gestational age on lung volume response to a sustained inflation at birth in preterm lambsDavid Tingay (Australia)

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Table of Abstracts

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Table of Abstracts

OP-09 Optimal target range of closed-loop insired oxygen support in preterm infants (opticlio study)Thomas Bachman (United States of America)

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OP-10 Selecting the optimum target range for closed loop FIO2-SpO2 control: a synthesis of clinical trialsThomas Bachman (United States of America)

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OP-11 Surfactant protein B gene polymorphism in neonates with respiratory distress syndromeJeong-Ho Han (South Korea)

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OP-12 Ultrasound TAP Block for postoperative pain control in mechanical ventilated neonatesDario Galante (Italy)

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OP-14 Neurally adjusted ventilatory assist (nava) in preterm newborn infants with respiratory distress syndrome - a randomized controlled trialMerja Kallio (Finland)

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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 groupSylvie Laroche (France)

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Table of Abstracts

E-Posters

EP-01 Extubation after spontaneous breathing trial with automatic tube compensation (ATC) vs pressure support (PS).David Arjona (Spain)

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EP-02 Gaps between the evidence of clinical effectiveness and the patterns of use of automated FIO2 control in polish nicusThomas Bachman (United States of America)

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EP-03 Evaluation of differences in relative effectiveness of automated FIO2 among sites in a multicenter trialThomas Bachman (United States of America)

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EP-04 Safety and Efficacy of Lung Recruitment Maneuvers in Pediatric Post-Operative Cardiac PatientsHarjot Bassi (United States of America)

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EP-05 Airflow obstruction in the postoperative pediatric patients with tetrology of fallot, pulmonary atresia and major aortopulmonary collateralsHarjot Bassi (United States of America)

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EP-06 In-depths analysis of ventilatory parameters in infants ventilated with volume-guaranteed HFOV using computational data retrieval and processingGusztav Belteki (United Kingdom)

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EP-07 A novel technique for detailed computational analysis of neonatal ventilator modes, parameters and alarmsGusztav Belteki (United Kingdom)

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Table of Abstracts

EP-08 Less invasive surfactant administration in the nordic countriesLars Björklund (Sweden)

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EP-09 Outcome of INSURE in Preterm Infants with Respiratory Distress Syndrome : a single center experienceMihye Bae (South Korea)

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EP-10 Use of Heated, Humidified High-Flow Nasal Cannula in Neonatal Intensive Care Unit: A Taiwan SurveyKe-Yun Chao (Taiwan)

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EP-11 Instillation of DNAse via flexible fibreoptic bronchoscopy in newborn infants with severe respiratory diseaseTheodore Dassios (United Kingdom)

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EP-12 Feasibility of longitudinal assessment of quantified oxygenation impairment in bronchopulmonary dysplasia in infancyTheodore Dassios (United Kingdom)

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EP-13 Rescue Noninvasive high frequency ventilation (NHFOV) feasibility and safety for BPD-developing babies with pending intubation: pilot prospective studyValentina Giovanna Dell’Orto (France)

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EP-14 Bronhoalveolar lavage in severe neonatal respiratory distressMihaela Demetrian (Romania)

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EP-15 The role of circulating progenitor cells in neonatal lung injuryVasiliki Soubasi-Griva (Greece)

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Table of Abstracts

EP-16 Correlation of the inflammatory mediator, the oxidative stress marker and the transpulmonary pressure as the lung stress Ririe Fachrina Malisie (Indonesia)

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EP-17 Analyze the parameters of respiratory mechanics based on the parameter settings of mechanical ventilationBoudhar Kamel (Algeria)

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EP-18 Low-Invasive-Surfactant-Administration – A New BeginningCrivceanscaia Larisa (Moldova)

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EP-19 Effective Tidal Volume in Very Low Birth Weight Infants with High Frequency Oscillatory Ventilation Soonmin Lee (South Korea)

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EP-20 Regional ventilation using muti-plane and patient tailored eit approach in an infant with congenital regional hyperinflationDavid G Tingay (Australia)

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EP-21 Infection from Virus A-H2N1 and pneumonia from Candida Albicans: treatment with early NIV,apheresis and capsofungin.Leonardo Milella (Italy)

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EP-22 Ethical dilemma and challenges in resuscitation/management of newborn with harlequin ichthyosisAesha Mohammedi (United Kingdom)

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EP-23 Non-invasive positive pressure ventilation (nippv) using ram cannula interface in management of respiratory failure in a children’s hospital picuLuke Noronha (United States of America)

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Table of Abstracts

EP-24 Bronchial selective intubation in a preterm with interstitial pulmonary emphysemaFlavia Petrillo (Italy)

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EP-25 NAVA in a child with Miller-Fisher Syndrome: repetita iuvatEmanuele Rossetti (Italy)

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EP-26 Spontaneous breathing during high frequency oscillatory ventilationSjoerdtje Slager (The Netherlands)

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EP-27 Treatment of cepacia syndrome with nebulized meropenem & amikacin & intravenous methylprednisolone in a patient with infective exacerbation of bronchiectasis Herng Lee Tan (Singapore)

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EP-28 A case of rhizomelic chondrodyslasia punctata in newbornHatice Tatar Aksoy (Turkey)

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EP-29 Minor Differences in Dead Space Ratios after Palliation of Hypoplastic Left Heart Syndrome are Not Correlated with Changes in Clinical OutcomesBrigham Willis (United States of America)

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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 UNITVicent 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=0.7018 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.

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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% (2.3-32.8%), 46.6% (36.4-60.9%), 29.7% (6.7-55.2%). Rates of complete dissociations were 4.9% (1.0-15.7%) multiple MV with NA, 3.0% (1.1-7.2%) 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 0.99. 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.

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OP-03: IMPACT OF THE SYNCHRONIZED NASAL INTERMITENT MANDATORY VENTILATION BY NEURALLY ADJUSTED VENTILATORY ASSIST (NAVA) IN PREMATURE INFANTS WITH RESPIRATORY FAILURECelso 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 (FiO2 ≥0.40 in CPAP= 7cmH2O to maintain SpO2 88-94%) 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.

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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) FIRSTMireia 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.

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OP-06: ULTRASOUND FOR DIAPHRAGMATIC DYSFUNCTION IN POST-OPERATIVE CARDIAC CHILDRENHussam 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 post-operative children admitted to PCICU during 2015. 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.

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OP-07: PRESSURE AND OSCILLATION TRANSMISSION WITH MODERN HFOV OSCILLATORS: BENCH COMPARISONDaniele 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/cmH2O, Resistance 50 cmH2O/L/sec; restrictive: compliance 0.3 mL/cmH2O, Resistance 50 cmH2O/L/sec; mixed: compliance 0.3 mL/cmH2O, Resistance 150 cmH2O/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 cmH2O 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 cmH2O on average). In terms of oscillation transmission at the lung Fabian-III+ reaches the best performance: (OPRd 0.25, 0.15, 0.1 cmH2O, 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.

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OP-08: INFLUENCE OF GESTATIONAL AGE ON LUNG VOLUME RESPONSE TO A SUSTAINED INFLATION AT BIRTH IN PRETERM LAMBSDavid 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 (Tstable) within the lung during a SI at birth.

DESIGN/METHODS: A 40 cmH2O 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. Tstable within the whole lung, gravity-dependent and non-gravity-dependent hemithoraces were determined from exponential modelling of the SI volume-time relationship.

RESULTS: Tstable 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 (VSI) at Tstable 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 Tstable 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.

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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 FiO2 control (A-FiO2) improves the proportion of time spent within the target range (TR) and reduces the time in SpO2 extremes, compared to manual control in preterm infants. However, it is unknown to what extent narrowing the TR during A-FiO2 results in tighter control of the SpO2. Our aim was to compare the efficacy of A-FiO2 using three different SpO2 TRs with the same midpoint.

METHODS: Preterm infants receiving non-invasive ventilator support with FiO2 >0.21 were randomized to three SpO2 TRs (86-94%, 88-92%, 89-91%) for 24 hours each. The 3 A-FiO2 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-FiO2 within our intended SpO2 TR were high, (74%, 73% and 70% respectively, P=ns). Narrowed TR resulted in less time with SpO2 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 SpO2 >94% increased slightly (16% vs. 22% vs. 19%, P=NS). Time with SpO2 >98% was not different among the 3 ranges. There were no differences between the two tighter TRs. Use during all three A-FiO2 ranges reflected significantly better control than during manual adjustment (P<0.001).

CONCLUSION: Tighter A-FiO2 control ranges led to reduced time with lower SpO2 and no significant increased exposure to higher SpO2.

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OP-10: SELECTING THE OPTIMUM TARGET RANGE FOR CLOSED LOOP FIO2-SPO2 CONTROL: A SYNTHESIS OF CLINICAL TRIALSThomas 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 SpO2 management. Much of the uncertainty about optimum target ranges (TR) revolves around the challenges of manual FiO2-titration. Automated control (Auto-FiO2) is becoming available. Four systems have been clinically evaluated with a variety of SpO2 TRs. Our aim was to determine factors relating to selection of the optimum TR for Auto-FiO2.

METHODS: All trials investigating Auto-FiO2 were reviewed. Those including a comparison between set TRs were selected. TR characteristics (width, midpoint) and effectiveness parameters (SpO2: median/distribution, time in TR and extremes) were prospectively defined.

RESULTS: Three studies from 9 centers met the criteria, including 273 days of Auto-FiO2 control in 143 preterm infants. Seven target ranges were evaluated, all within an envelop of 86%-95%. TRs included four SpO2 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 SpO2. However, there was an interaction between the midpoint and the width, with clinically relevant differences at SpO2 extremes associated primarily with the high or low control points.

CONCLUSION: When using Auto-FiO2 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.

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OP-11: SURFACTANT PROTEIN B GENE POLYMORPHISM IN NEONATES WITH RESPIRATORY DISTRESS SYNDROMEJeong-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.

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OP-12: ULTRASOUND TAP BLOCK FOR POSTOPERATIVE PAIN CONTROL IN MECHANICAL VENTILATED NEONATESDario 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 < 0.0001) 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.

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OP-14: NEURALLY ADJUSTED VENTILATORY ASSIST (NAVA) IN PRETERM NEWBORN INFANTS WITH RESPIRATORY DISTRESS SYNDROME - A RANDOMIZED CONTROLLED TRIALMerja 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 2013.

RESULTS: The median durations of invasive ventilation were 34.7 hours (IQR 22.8-67.9 h) and 25.8 h (15.6-52.1 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.

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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 GROUPSylvie 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 16.65 [11.2-20] ppm and 20 [18-20] ppm, respectively. The highest doses used were identical for both groups (20 ppm). Median treatment duration was 3 days [0.3-18.5] in PPHN, and 3.9 days [0.17-61] 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.

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.

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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 H2O. 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

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EP-02: GAPS BETWEEN THE EVIDENCE OF CLINICAL EFFECTIVENESS AND THE PATTERNS OF USE OF AUTOMATED FIO2 CONTROL IN POLISH NICUSThomas 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 FiO2 (AUTO-FiO2) 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-FiO2 effectiveness and its routine use in Poland.

METHODS: We reviewed all the published studies of the use of AUTO-FiO2. We extracted information reported, including the target range, study population (EGA, weight, age and indication for use), metrics of safety (extreme SpO2 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-FiO2 was used in 283 infants at 7 centers. Clinician assessment of the effectiveness of AUTO-FiO2 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-FiO2 usually started in the first day or two of life with the goal of automating routine FiO2 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.

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EP-03: EVALUATION OF DIFFERENCES IN RELATIVE EFFECTIVENESS OF AUTOMATED FIO2 AMONG SITES IN A MULTICENTER TRIALThomas Bachman (United States of America)

OBJECTIVE: Many studies have demonstrated potential for automated FiO2 adjustment (Auto-FiO2) to improve SpO2 control in preterm infants. Auto-FiO2 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 SpO2 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 SpO2 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 SpO2: target range (8.2-4.4%), <80% (1.9-0.3 %), >98% (1.8-0.3 %)]. There were differences in subject stability among centers [routine SpO2 target range (45%-76%), desaturations/hour (5.5-0.4)]. 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.

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EP-04: SAFETY AND EFFICACY OF LUNG RECRUITMENT MANEUVERS IN PEDIATRIC POST-OPERATIVE CARDIAC PATIENTSHarjot 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 post-operative pediatric cardiac patients.

METHODS: A retrospective chart review was performed on a sample of post-operative 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.

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EP-05: AIRFLOW OBSTRUCTION IN THE POSTOPERATIVE PEDIATRIC PATIENTS WITH TETROLOGY OF FALLOT, PULMONARY ATRESIA AND MAJOR AORTOPULMONARY COLLATERALSHarjot 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 2015. 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.

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EP-06: IN-DEPTHS ANALYSIS OF VENTILATORY PARAMETERS IN INFANTS VENTILATED WITH VOLUME-GUARANTEED HFOV USING COMPUTATIONAL DATA RETRIEVAL AND PROCESSINGGusztav 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.

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EP-07: A NOVEL TECHNIQUE FOR DETAILED COMPUTATIONAL ANALYSIS OF NEONATAL VENTILATOR MODES, PARAMETERS AND ALARMSGusztav 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 medico-legal purposes.

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EP-08: LESS INVASIVE SURFACTANT ADMINISTRATION IN THE NORDIC COUNTRIESLars 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 e-mailed 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.

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EP-09: OUTCOME OF INSURE IN PRETERM INFANTS WITH RESPIRATORY DISTRESS SYNDROME : A SINGLE CENTER EXPERIENCEShinyun 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 2015. 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.

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EP-10: USE OF HEATED, HUMIDIFIED HIGH-FLOW NASAL CANNULA IN NEONATAL INTENSIVE CARE UNIT: A TAIWAN SURVEYKe-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.

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EP-11: INSTILLATION OF DNASE VIA FLEXIBLE FIBREOPTIC BRONCHOSCOPY IN NEWBORN INFANTS WITH SEVERE RESPIRATORY DISEASETheodore 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 2016, 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) FiO2 requirement before FFB was 0.42 (0.34-1.0) and 24 hours after the FFB 0.31 (0.3-0.9). Median (range) mean airway pressure before FFB was 14 (13-18) cmH20 and 24 hours after FFB was 11 (11-17) cmH2O.

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.

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EP-12: FEASIBILITY OF LONGITUDINAL ASSESSMENT OF QUANTIFIED OXYGENATION IMPAIRMENT IN BRONCHOPULMONARY DYSPLASIA IN INFANCYTheodore 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 (FiO2) was altered to vary transcutaneous oxygen saturation (SpO2) between 88% and 96%. Shunt and V/Q ratio were derived using a computer algorithm by plotting and analysing at least three pairs of FiO2 and SpO2 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 (207-264) days. Initial V/Q and shunt were 0.46 (0.31-0.52) and 9 (2-15) respectively. V/Q and shunt at follow up were 0.51(0.29-0.82) 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.

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EP-13: RESCUE NONINVASIVE HIGH FREQUENCY VENTILATION (NHFOV) FEASIBILITY AND SAFETY FOR BPD-DEVELOPING BABIES WITH PENDING INTUBATION: PILOT PROSPECTIVE STUDYValentina 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 CO2,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 FiO2 >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 (SatO2,FiO2,main airway pressure,PtcCO2,PtcO2) 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 SatO2 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.

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EP-14: BRONHOALVEOLAR LAVAGE IN SEVERE NEONATAL RESPIRATORY DISTRESSMihaela 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.

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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 1st,3rd,9th,18th and 45th 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.

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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 end-inspiratory 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 (ΔPtp plateau) before (1,80±2,28 cmH2O) and after recruitment (11,0±5,83 cmH2O) of the intervention group was significant increase as compare with the control group before (1,25±3,68 cmH2O) and after (3,25±1,18 cmH2O) recruitment, with p value 0,049 respectively. ΔPtp 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.

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EP-17: ANALYZE THE PARAMETERS OF RESPIRATORY MECHANICS BASED ON THE PARAMETER SETTINGS OF MECHANICAL VENTILATIONBoudhar 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 (2012-2014), 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 < 0.0001).

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.

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EP-18: LOW-INVASIVE-SURFACTANT-ADMINISTRATION – A NEW BEGINNINGCrivceanscaia 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 2016 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. 88.24% 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.

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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 CO2 (DCO2) is much more efficient during high frequency ventilation, and determined by the frequency and tidal volume. DCO2 value has much individual variance, appropriate DCO2 and tidal volume is not yet established.

AIM: The aim of this study is to analyze the DCO2 value, tidal volume, minute volume delivered with Dräger VN500 and correlate with serum pCO2.

METHODS: Twelve very low birth weight infants, admitted to the NICU from March 2015 to February 2016, 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, DCO2 value showed 68.4 ± 32.7. when the patient showed the hypercapnia state, measured VT/kg showed 1.58 ± 0.25 mL/kg, DCO2 value showed 32.4 ± 15.7. DCO2 value were significantly correlated with pCO2 (p=0.024).

CONCLUSION: In VLBW infant treated with HFOV, 2.1 mL/kg of tidal volume and 70 of DCO2 are recommended for maintaining normocapnia state. Further large scaled study is needed.

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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 high-resolution 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.

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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 15th day, capsofungin at 22th day. Home discharged in 27th day. The follow-up was done for 30th days with normalization of x-ray and haematic exams

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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.

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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 2013-June 2015. 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 failureAge 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

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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.

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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 weaning-off 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.

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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 (VT) to approximate VT during conventional mechanical ventilation (CV), eliminating the potential benefits of HFOV (i.e. low VT). We studied whether spontaneous breathing during HFOV with high frequency and power settings results in lower VT 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 20.56 mL, 54.57 mL and 108.15 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 VT remains slightly lower than VT in CV.

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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 7.089 and PaCO2 149 mmHg when on PIP 30 cm H2O, PEEP 9 cm H2O, 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 300.9 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 H2O 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.

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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 ( 25-50 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.

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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.

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Index of Authors

Name Abstract number Page

Alioglu, Bülent EP-28 68

Andersson, Sture EP-08 48

Angelescu, Ioana EP-14 54

Arjona, David EP-01 41

Asija, Ritu EP-05 45

Ziad Assaf OP-15 40

Bachman, ThomasOP-09 - OP-10 - EP-02 - EP-03

35 - 36 - 42 - 43

Bae, Mihye EP-09 49

Barbanti, Claudio OP-15 40

Bassi, Harjot EP-04 - EP-05 44 - 45

Belteki, Gusztav EP-06 - EP-07 46 - 47

Ben Ammar, Rafik EP-13 53

Bianchi, Roberto EP-25 65

Björklund, Lars EP-08 48

Blokpoel, Robert OP-02 29

Bohm, Stephan OP-08 34

Böhm, Stephan H EP-20 60

Borrego, Raul EP-01 41

Bossley, Cara EP-11 51

Boussard, Charlotte OP-07 33

Brito, Gabriela OP-03 30

Burke, Siobhan OP-05 31

Byun, Shinyun EP-09 49

Cambonie, Gilles OP-15 40

Chao, Ke-Yun EP-10 50

Chen, Yi-Ling EP-10 50

Chien, Yu-Hsuan EP-10 50

Chowdhury, Olie EP-11 51

Clarke, Sheila EP-22 62

Curley, Anna EP-12 52

Dargaville, Peter OP-08 34

Dassios, Theodore EP-11 - EP-12 51 - 52

Dawson, Machelle EP-23 63

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Index of Authors


de Luca, Daniele OP-07 - EP-13 33 - 53

Debray, Agathe OP-07 33

Del Vecchio, Antonio EP-24 64

del Villar Guerra, Pablo OP-01 28

Dell'Orto, Valentina OP-07 - EP-13 33 - 53

Dellaca, Raffaele OP-08 34

Demetrian, Mihaela EP-14 54

Dijkstra, Sandra OP-02 29

Djusman, Sri Widya EP-16 56

Drossou, Vasiliki EP-15 55

Efstathiou, Nikos EP-15 55

Elbarbary, Mahmoud OP-06 32

Eun, Ho Sun EP-19 59

Fachrina Malisie, Ririe EP-16 56

Fagundes, Luciana OP-03 30

Foote, Janet EP-29 69

Fule, Balazs OP-05 31

Galante, Dario OP-12 38

Garcia Cuscó, Mireia OP-05 31

Gibson, David EP-22 62

Goh, Anne EP-27 67

Grecu, Georgeta EP-14 54

Gutierrez, María EP-01 41

Hamadah, Hussam OP-06 32

Han, Jeong-Ho OP-11 37

Han, Youngmi EP-09 49

Hancock, Rachel OP-05 31

Heiring, Christian EP-08 48

Herrera, María EP-01 41

Hickey, Ann EP-11 51

Hijazi, Omar OP-06 32

Ismail, Sameh OP-06 32

Jonsson, Baldvin EP-08 48

Kabbani, Mohamed OP-06 32

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Index of Authors


Kallio, Merja OP-14 39

Kamel, Boudhar EP-17 57

Kantziou, Katerina EP-15 55

Karen, McCall OP-08 34

Kneyber, Martin OP-02 29

Kneyber, Martin C. J. EP-26 66

Koliakos, George EP-15 55

Koopman, Alette OP-02 29

Koskela, Ulla OP-14 39

Kyriazis, George EP-15 55

Larisa, Crivceanscaia EP-18 58

Laroche, Sylvie OP-15 40

Lecourt, Laurent OP-15 40

Lee, Jan Hau EP-27 67

Lee, Narae EP-09 49

Lee, Soonmin EP-19 59

Leger, Pierre-Louis OP-15 40

Liet, Jean Michel OP-15 40

Lim, Joo Hee EP-19 59

López, Jorge OP-01 28

Loron, Gauthier OP-15 40

Mantea, Alina EP-14 54

Markhorst, Dick G. EP-26 66

Martin, Carmen EP-01 41

Mauriat, Philippe OP-15 40

Mayordomo, Juan OP-01 28

McCall, Karen E EP-20 60

Medina, Alberto OP-01 28

Meneses, Jucille OP-03 30

Miedema, Martijn EP-20 60

Mildner, Reinout OP-05 31

Milella, Leonardo EP-21 61

Modesto i Alapont, Vicent OP-01 28

Mohammedi, Aesha EP-22 62

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Index of Authors


Morandi, Tiffany EP-04 44

Morley, Colin EP-06 - EP-07 - EP-12 46 - 47 - 52

Mu, Shu-Chi EP-10 50

Namgung, Ran EP-19 59

Nigro, John EP-04 - EP-29 44 - 69

Noronha, Luke EP-23 63

Onland, Wes OP-09 - OP-10 35 - 36

Pandurangi, Sindhu EP-29 69

Park, Kook In EP-19 59

Park, Kyounghee EP-09 49

Park, Min Soo EP-19 59

Peltoniemi, Outi OP-14 39

Petrillo, Flavia EP-24 64

Picardo, Sergio EP-25 65

Pirnuta, Andra EP-14 54

Pokka, Tytti OP-14 39

Philippe Pouard OP-15 40

Pudjiadi, Antonius H EP-16 56

Rebello, Celso OP-03 30

Richardson, Kristi EP-04 44

Ross-Russell, Robert EP-12 52

Rossetti, Emanuele EP-25 65

Saarela, Timo OP-14 39

Santos, Paula EP-01 41

Shaath, Ghassan OP-06 32

Shankar-Aguilera, Shivani OP-07 - EP-13 33 - 53

Slager, Sjoerdtje EP-26 66

Soubasi-Griva, Vasiliki EP-15 55

Suo-Palosaari, Maria OP-14 39

Talukdar, Andrea EP-23 63

Tan, Herng Lee EP-27 67

Tatar Aksoy, Hatice EP-28 68

te Pas, Arjan OP-09 35

Tenaglia, Christine EP-04 44

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Index of Authors


Thanikkel, Leo EP-12 52

Thoon, Koh Cheng EP-27 67

Tingay, David OP-08 - EP-20 34 - 60

Tsai, Li-Yi EP-10 50

van den Heuvel, Maria OP-09 - OP-10 35 - 36

van Kaam, Anton OP-09 - OP-10 - EP-20 35 - 36 - 60

van Zanten, Henriette OP-09 35

Velez, Daniel EP-29 69

Vidru, Andreea EP-14 54

Waldmann, Andreas OP-08 - EP-20 34 - 60

Wellnitz, Chasity EP-29 69

Wilinska, Maria OP-10 - EP-02 36 - 42

Willis, Brigham EP-04 - EP-29 44 - 69

Yagui, Ana Cristina OP-03 30

Yilmaz, Arzu EP-28 68

Youssef, Nadya EP-13 53

Zolio, Bianca OP-03 30

www.espnic-online.org

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 13th | 15:00-19:30: Basic and advanced hemodynamic assessment

June 14th | 07:30-12:00: What should I know when ventilating a patient (respiratory mechanics, ventilator modes, concepts of lung protective ventilation revisited)

June 14th | 15:30-19:30: Advanced ICU care of children with severe sepsis

June 15th | 07:30-12:00: Renal failure and renal replacement therapy in the PICU

Registration & accommodation packages available !

ESPNIC SUMMER SCHOOLHOTEL LA VILLA, CALVI, CORSICA, JUNE 13-15, 2016

NEW

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Sponsors and Exhibitors

ACUTRONIC MEDICAL SYSTEMS AGwww.acutronic-medical.ch Booth No. 1Sponsor Workshop 2, Wednesday May 25, 2016

ANANDIC MEDICAL SYSTEMS www.anandic.comBooth No. 6

BIOPACK MEDICALwww.biopackmedical.chSponsor: Lunch symposium, Thursday May 26, 2016

CAREFUSIONwww.carefusion.comBooth No. 14Sponsor Workshop 2, Wednesday May 25, 2016

ESPNICEuropean Society of Paediatricand Neonatal Intensive Carewww.espnic-online.orgBooth No. 15

The Organizing Committee of the 13th European Conference on Pediatric and Neonatal Mechanical Ventilation Congress would like to thank the following companies and institutions for their support.

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HAMILTON MEDICAL AGwww.hamilton-medical.comBooth No. 7

IMTMEDICAL www.imtmedical.comBooth No. 5Sponsor Workshop 3, Wednesday May 25, 2016

INTERSURGICALwww.intersurgical.comBooth No. 4

MAQUETwww.maquet.com Booth No. 2Sponsor Workshop 3, Wednesday May 25, 2016& Lunch symposium on Friday, May 27, 2016

MEDIN MEDICAL INNOVATIONSwww.medingmbh.comBooth No. 8

MEDTRONIC / COVIDIENwww.medtronic.comSponsor Workshop 2, Wednesday May 25, 2016

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METRANwww.metran.co.jpBooth No. 10Sponsor Workshop 2, Wednesday May 25, 2016

PEAKMEDICALwww.peakmedic.comBooth No. 12

RADIOMETERwww.radiometer.com/tcBooth No. 16

RESMED www.resmed.comBooth No. 9

SENTECwww.sentec.chBooth No. 9Sponsor Workshop 3, Wednesday May 25, 2016

SLEwww.sle.co.ukBooth No. 3Sponsor Workshop 3, Wednesday May 25, 2016

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STEPHANwww.stephan-gmbh.comBooth No. 11Sponsor Workshop 3, Wednesday May 25, 2016& Workshop 4, Thursday May 26, 2016

SWISSTOM & CRADLwww.swisstom.comBooth No. 13

CITY OF MONTREUXwww.commune-de-montreux.chWelcome Reception Sponsor


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Exhibition Plan

1

TERRASSE

desk

Miles Davis Hall

E-Posterarea

Entrance

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co�ee break

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01 - Acutronic

02 - Maquet

03 - SLE

04 - Intersurgical

05 - Imtmedical

06 - Anandic Medical Systems

07 - Hamilton Medical

08 - Medin Medical Innovations

EPNV 2016 - Exhibitors’ List

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EPNV 2016 - Exhibitors’ List

Exhibition Plan

Room Miles Davis V

RoomMiles Davis VI - IX

Foyer Miles Davis

Congress Room - First Floor

09 - SenTec / ResMed

10 - Metran

11 - Stephan

12 - PeakMedical

13 - Swisstom & CRADL

14 - CareFusion

15 - ESPNIC

16 - Radiometer

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General Information

Montreux Music &Convention Center – 2M2C

Address:Avenue Claude Nobs 5, 1820 MontreuxPhone : +41 (0)21 962 20 00www.2m2c.ch

Registration desk opening hoursWednesday 25 May 2016: 08:00-19:00Thursday 26 May 2016: 07:00-20:00Friday 27 May 2016: 07:30-18:00Saturday 28 May 2016: 08:00-13:00

Official languageEnglish is the official language of the congress. No simultaneous interpretation will be provided.

WIFIFree WIFI is available in the congress center.

UserName : EPNV2016password : epnv2016

Evaluation formIn order to provide you with meetings of highest possible quality you are kin-dly 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.

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General Information

Certificate of attendanceYou can pick up your certificate of attendance at the registration desk after you have submitted the evaluation form.

Speaker ready roomA 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 an-nounce themselves to the AV technician in the Speaker preview room at least 60 minutes before the scheduled session time. An audio, video and basic run-ning check of the PPT will be double checked at this time.

Oral presentationsMost of the lectures will be available on the congress website after the congress.

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Social Program

Welcome Reception - Thursday, May 26, 2016After 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, 2016Visit 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

Participation in the Get together Dinner: CHF 80 (excl. VAT) per person; tickets available at the registration desk.

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General Conditions

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.

PricesAll payment should be made in Swiss Francs (CHF).

Participants fee includes:- Program and abstract book- 1 lunch- Coffee breaks- Welcome Reception- All administration and handling

Workshops: - Member, non-member, nurse: CHF 100.00 / workshop- Low, lower-middle, upper-middle income Countries participants: CHF 70.00 / workshop

Participation in the congress dinner: CHF 80 (excl. VAT) per person

Payment OptionsWe 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.

On site

Delegate 700 CHF

ESPNIC Member Delegate 600 CHF

Low, lower-middle, upper-middle income Countries

550 CHF

Low, lower-middle, upper-middle income Countries – ESPNIC Member

450 CHF

Nurses 500 CHF

ESPNIC Nurses 400 CHF

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Confirmation / InvoiceConfirmation and invoice: your booking will be confirmed by email. Confirma-tion and invoice will be sent to you within 72 hours, if you do not receive them please contact the Congress office directly.

Cancellation PolicyCancellations will be accepted until April 15, 2016.

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 e-mail, 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.

BadgesDelegates 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 indivi-dual 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.

General Conditions

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About Montreux

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 op-tions to the mountainous hinterland or on the lake make Montreux the most popular excursion and holiday destination. Many of the houses along the lake-side road, including the magnificent Fairmont Le Montreux Palace, date from the hayday of the Belle Epoque.

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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, Gs-taad and the Bernese Oberland with connections to Lucerne.

• Lake Geneva Shipping Company – the ships, some of which are still powe-red 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 ma-gical 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: www.chaplinsworld.com

Banks and currency exchangeThe 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 Euros1 CHF = 1.04 USD(exchange rate valid on May 2016)

ShoppingShops in Montreux are open Monday to Friday from 8:30 am to 7 pmand Saturday from 8:30 am to 6 pm.

Tourist BoardMontreux TourismePavillon d’information, 1820 MontreuxPhone : +41 (0)84 886.84.84www.montreuxriviera.com

REGISTER NOW AND SAVE!Early Registration Deadline: June 29th, 2016

REGISTER NOW AND SAVE!Early Registration Deadline: June 29th, 2016

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Map of Montreux

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

5 Chillon Castle - Congress Dinner location

5

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Notes

www.epnv-montreux.org

Documents

CONGRESS CENTRE MONTREUX, SWITZERLAND MAY 25 - … · FINAL PROGRAM CONGRESS CENTRE MONTREUX, SWITZERLAND MAY 25 - 28, 2016