Mastodawn

ScienceOpen Sep 4, 2025

'Development and Validation of a Neurological Outcome Prediction Score for Children Requiring Mechanical Ventilation: The NOPS-VC Score' - a #JaypeeJournals 'Preventive and Emergency Medicine Insights' publication on #ScienceOpen:

📄🔓 https://www.scienceopen.com/document?vid=6edb1c27-b0ac-4280-87c2-75d8b0a492e0

#NOPSVCScore #NeurocriticalCare #MechanicalVentilation #PediatricICU

Development and Validation of a Neurological Outcome Prediction Score for Children Requiring Mechanical Ventilation: The NOPS-VC Score

<div xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="section"> <a class="named-anchor" id="d880065e158">  </a> <h5 class="section-title" id="d880065e159">Background and aims</h5> <p dir="auto" id="d880065e161">Currently, no validated scoring system exists to predict neurological outcomes in mechanically ventilated children. We aimed to develop and validate such a score in this population. </p> </div><div xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="section"> <a class="named-anchor" id="d880065e163">  </a> <h5 class="section-title" id="d880065e164">Patients and methods</h5> <p dir="auto" id="d880065e166">We developed the NOPS-VC score, comprising eight items. Each parameter is rated on a Likert scale, where a minimum score of 1 indicates no significant risk, and a maximum score of 3 represents the highest risk for poor neurological outcomes. The face and content validity of the score were assessed using the content validity index (CVI) and content validity ratio. Neurological outcomes were determined at discharge and at 6 months of follow-up. Construct validity was assessed by correlating the NOPS-VC score with the Pediatric Cerebral Performance Category score, functional status scale (FSS), intelligence quotient (IQ), Vineland Adaptive Behavior Scale, gross motor function measure (GMFM), child behavior checklist, and pediatric quality of life inventory. </p> </div><div xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="section"> <a class="named-anchor" id="d880065e168">  </a> <h5 class="section-title" id="d880065e169">Results</h5> <p dir="auto" id="d880065e171">Among 170 participants, 87 had good functional outcomes. The scale-level content validity index (S-CVI/UA) was 0.95, and S-CVI/Ave was 0.9, indicating excellent content validity. The one-factor model demonstrated a good fit, with all item loadings exceeding 0.7 [Tucker–Lewis index (TLI) = 0.95, comparative fit index (CFI) = 0.96, root mean squared error of approximation (RMSEA) = 0.067 (0.059–0.074)]. The area under the receiver operating characteristic (ROC) curve for the maximum and baseline NOPS-VC scores was 0.92 and 0.91, respectively. The optimal cutoff value for both scores was 18, with sensitivity/specificity of 82/97% for the maximum score and 80/97% for the baseline score. Construct validity showed strong correlations ( <i>r</i> ≥ 0.70) with all parameters. </p> </div><div xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="section"> <a class="named-anchor" id="d880065e176">  </a> <h5 class="section-title" id="d880065e177">Conclusion</h5> <p dir="auto" id="d880065e179">The NOPS-VC score, when applied at the initiation of mechanical ventilation in critically ill children, demonstrates strong validity in predicting neurological outcomes at 6 months, with an optimal cutoff value of 18. </p> </div><div xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="section"> <a class="named-anchor" id="d880065e181">  </a> <h5 class="section-title" id="d880065e182">How to cite this article</h5> <p dir="auto" id="d880065e184">Tomar A, Panda PK, Elwadhi A, Tiwari LK, Sharawat IK. Development and Validation of a Neurological Outcome Prediction Score for Children Requiring Mechanical Ventilation: The NOPS-VC Score. Indian J Crit Care Med 2025;29(7):578–585. </p> </div>

ScienceOpen

Todd Fraser

Sep 18, 2023

New podcast!

Oesophageal manometry and pleural pressure monitoring in ARDS, with Tai Pham

https://osler.app.link/T6isrpbgbDb

#medtwitter #ICU #intensivecare #intensivist #mechanicalventilation #ARDS #FOAMed #FOAMcc #criticalcare #criticalcaremedicine

[email protected] moved Sep 10, 2023

Beneficios de entrenar músculos respiratorios (inspiratorios y espiratorios) en pacientes con #ELA #ALS

Entre otras cosas, retrasan el inicio de ventilación mecánica invasiva hasta por 12 meses
#IMV #MechanicalVentilation

https://n.neurology.org/content/100/15/e1634

Respiratory Strength Training in Amyotrophic Lateral Sclerosis

Background and Objective The objective of this study was to evaluate the short-term physiologic effect and one-year functional effect of a 12-week inspiratory and expiratory respiratory strength training (RST) program in individuals with amyotrophic lateral sclerosis (ALS). Methods A double-blinded, randomized, sham-controlled trial was conducted in 45 individuals with early-stage ALS. Participants were randomized into 12 weeks of active RST (30% load, n = 23) or sham RST (0% load, n = 22). An intent-to-treat analysis was conducted. Linear regression of pre-post change with group status and pretest scores as predictors was conducted. Primary outcomes included maximum expiratory and inspiratory pressure (MEP, MIP), and secondary outcomes were cough spirometry and forced vital capacity. Exploratory follow-up outcomes included one-year global and bulbar decline (ALS Functional Rating Scale-Revised [ALSFRS-R] total and bulbar subscale slope), oral intake status, and time to noninvasive ventilation (NIV). Results TheRST completion rate was 91% with no RST-related adverse events. A 12-week RST program led to increases in MEP ( p = 0.004), but not MIP ( p = 0.33). On average, MEP increased by 20.8 cm H2O after active RST (95% CI +7.6 to +33.9) and decreased by 1.0 cm H2O (95% CI −9.1 to +7.2) after sham RST. Mean MIP increased by 8.9 cm H2O (95% CI +1.5 to +16.3) and 4.8 cm H2O (95% CI −0.6 to +10.2) for the active and sham groups, respectively. Regarding secondary outcomes, RST led to significant increases in cough peak inspiratory flow ( p = 0.02); however, it did not affect cough expiratory flow ( p = 0.06) or FVC ( p = 0.60). Regarding 12-month outcomes, a significant difference in the ALSFRS-R bulbar subscale slope was observed across treatment groups, with a more than two-fold faster rate of bulbar decline in the sham vs active RST groups observed (−0.29 vs −0.12 points/month, p = 0.02). Total ALSFRS-R slope, feeding status, and time to NIV did not differ across treatment groups ( p > 0.05). Discussion RST was well tolerated and led to improvements in some, but not all, short and long-term outcomes. RST represents a proactive rehabilitative intervention that could increase physiologic capacity of specific breathing and airway clearance functions during the early stages of ALS. Further work is needed to determine optimal training intensity, resistance load specifications, and potential long-term functional outcomes. Classification of Evidence This study provides Class II evidence that a mild-intensity respiratory strength training program improves maximum expiratory pressure, but not maximum inspiratory pressure, in patients with early-stage ALS. ALS= : amyotrophic lateral sclerosis; ALSFRS-R= : Amyotrophic Lateral Sclerosis Functional Rating Scale-Revised; EMR= : electronic medical record; FVC= : forced vital capacity; MEP= : maximum expiratory pressure; MIP= : maximum inspiratory pressure; NIV= : noninvasive ventilation; PEG= : percutaneous endoscopic gastrostomy; PEF= : peak expiratory flow; PIF= : peak inspiratory flow; RST= : respiratory strength training; SD= : standard deviation

Neurology

Todd Fraser

Nov 13, 2022

We are far more aware of ventilator induced lung injury these days. Keeping pressures down in fully ventilated patients is an important preventative measure.

However, in those who are self ventilating, could patient effort be contributing to lung injury?

Antonio Pesenti joined me on the podcast to discuss

Listen free at Osler : https://osler.app.link/EEQXialCUub

#MedMastodon #intensivecare #ICU #intensivist #mechanicalventilation #FOAMed #FOAMcc