scholarly journals Economic Impact of Changes in Neonatal Intensive Care Unit Ventilation Strategies with the Advent of New Noninvasive Ventilation Techniques: A Review and Proposed Assessment Framework for High Flow Therapy as a Routine Respiratory Support Paradigm

10.36469/9840 ◽  
2015 ◽  
Vol 3 (1) ◽  
pp. 34-42
Author(s):  
Jan B. Pietzsch ◽  
Abigail M. Garner ◽  
Michael McQueen
Keyword(s):  
Intensive Care ◽  
Economic Impact ◽  
Neonatal Intensive Care ◽  
High Flow ◽  
Respiratory Support ◽  
Sensitivity Analyses ◽  
Base Case ◽  
Model Parameters ◽  
Current Standard ◽  
Term Infants

Background: High flow therapy (HFT) has been demonstrated to be a safe and effective noninvasive respiratory support technique for the treatment of pre-term infants in neonatal intensive care. Objectives: Our objective was to develop a quantitative framework based on available evidence to estimate the economic impact of adoption of a HFT respiratory support strategy compared to current standard of care. Methods: Model parameters were derived from a recent study comparing respiratory modality utilization between five US-based neonatal intensive care units (NICUs) adopting a HFT strategy and a larger pool of NICUs in the Vermont-Oxford Network (VON), and from single center experience. We computed the total cost difference between the respiratory support strategies based on published cost data. Parameter uncertainty was tested in sensitivity analyses. Results: The constructed model projected expected cost savings of $2,317 for the HFT strategy for the base case. Results were sensitive to length of HFT use, length of CMV, cost of HFT, and length of nCPAP support. Conclusions: Adoption of a HFT strategy appears to be associated with meaningful savings in total NICU episode of care costs, primarily because of reductions in the time of conventional mechanical ventilation. Further research is warranted to substantiate these findings.

Admission of Term Infants to Neonatal Intensive Care: A Population-Based Study

Birth ◽  
2007 ◽  
Vol 34 (4) ◽  
pp. 301-307 ◽  
Author(s):  
Sally K. Tracy ◽  
Mark B. Tracy ◽  
Elizabeth Sullivan
Keyword(s):  
Intensive Care ◽  
Neonatal Intensive Care ◽  
Population Based ◽  
Term Infants ◽  
Population Based Study

scholarly journals Each Additional Day of Antibiotics Is Associated With Lower Gut Anaerobes in Neonatal Intensive Care Unit Patients

2019 ◽  
Vol 70 (12) ◽  
pp. 2553-2560
Author(s):  
Ashley M Rooney ◽  
Kathryn Timberlake ◽  
Kevin A Brown ◽  
Saumya Bansal ◽  
Christopher Tomlinson ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Neonatal Intensive Care Unit ◽  
Neonatal Intensive Care ◽  
Cross Sectional Study ◽  
Taxonomic Composition ◽  
Term Infants ◽  
Cross Sectional ◽  
Adjusted Risk ◽  
Treatment Regimens

Abstract Background Discontinuation of inappropriate antimicrobial therapy is an important target for stewardship intervention. The drug and duration-dependent effects of antibiotics on the developing neonatal gut microbiota needs to be precisely quantified. Methods In this retrospective, cross-sectional study, we performed 16S rRNA sequencing on stool swab samples collected from neonatal intensive care unit patients within 7 days of discontinuation of therapy who received ampicillin and tobramycin (AT), ampicillin and cefotaxime (AC), or ampicillin, tobramycin, and metronidazole (ATM). We compared taxonomic composition within term and preterm infant groups between treatment regimens. We calculated adjusted effect estimates for antibiotic type and duration of therapy on the richness of obligate anaerobes and known butyrate-producers in all infants. Results A total of 72 infants were included in the study. Term infants received AT (20/28; 71%) or AC (8/28; 29%) with median durations of 3 and 3.5 days, respectively. Preterm infants received AT (32/44; 73%) or ATM (12/44; 27%) with median durations of 4 and 7 days, respectively. Compositional analyses of 67 stool swab samples demonstrated low diversity and dominance by potential pathogens. Within 1 week of discontinuation of therapy, each additional day of antibiotics was associated with lower richness of obligate anaerobes (adjusted risk ratio [aRR], 0.84; 95% confidence interval [CI], .73–.95) and butyrate-producers (aRR, 0.82; 95% CI, .67–.97). Conclusions Each additional day of antibiotics was associated with lower richness of anaerobes and butyrate-producers within 1 week after therapy. A longitudinally sampled cohort with preexposure sampling is needed to validate our results.

scholarly journals Sensitivity Analyses for Modeling Evolving Reactivity of Granular Iron for the Treatment of Trichloroethylene

Water ◽  
2018 ◽  
Vol 10 (12) ◽  
pp. 1878
Author(s):  
Sung-Wook Jeen
Keyword(s):  
Numerical Model ◽  
Permeable Reactive Barrier ◽  
Sensitivity Analyses ◽  
Base Case ◽  
Model Parameters ◽  
Iron Corrosion ◽  
Predictive Tool ◽  
Previous Modeling Study ◽  
Granular Iron

To better predict long-term performance of a remediation system, parameters of a numerical model should be constrained with care by calibrating with reliable experimental data. This study conducted sensitivity analyses for model parameters, which were shown to represent reasonably well the observed geochemical behaviors for the column experiments that evaluated evolving reactivity of granular iron for the treatment of trichloroethylene (TCE) resulting from precipitation of secondary minerals. The particular model parameters tested include iron corrosion rate, aragonite and Fe2(OH)2CO3 precipitation rates, and proportionality constants for each mineral. For sensitivity analyses, a specific parameter was systematically changed, while other parameters were fixed at the values for the base case. The ranges of parameters tested were determined based on the previous modeling study. The results showed that the most important and sensitive model parameters were secondary mineral precipitation rates. Also, not only absolute precipitation rate for each mineral but also relative precipitation rates among different minerals were important for system performance. With help of sensitivity analysis, the numerical model can be used as a predictive tool for designing an iron permeable reactive barrier (PRB) and can provide implications for the long-term changes in reactivity and permeability of the system.

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