The anatomical dead space is the total volume of the conducting airways from the nose or mouth to the terminal bronchioles, and in ventilated infants includes the apparatus dead space (endotracheal tube and flow sensor). The physiological dead space is the anatomical dead space plus alveolar dead space. 4, 5Īn important influence on the appropriate size of the delivered volume during mechanical ventilation is the size of the dead space, the volume of inhaled gas that does not take part in gas exchange. 3 Inappropriately small tidal volumes can be associated with a prolonged duration of mechanical ventilation, a pro-inflammatory state and an increased work of breathing. 2 Delivery of inappropriately large tidal volumes can lead to alveolar over-distension and development of chronic respiratory morbidity. 1 Use of volume-targeted ventilation is a lung protective strategy as it potentially avoids too high or too low delivered volumes. Newborn infants often require respiratory support with invasive mechanical ventilation, unfortunately such infants can develop chronic respiratory morbidity.
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Home visitation also provides interventionists with regular opportunities to directly observe and address risk factors in the home environment, which may enable them to provide more specific and relevant guidance to caregivers regarding healthy changes to household routines and aspects of the physical home environment. Delivering pediatric obesity treatment in the home setting may increase completion of intervention visits, which would result families receiving a higher overall intervention dosage 12. School schedules, lack of transportation, and the challenge of arranging affordable childcare represent additional barriers. These interventions have traditionally been delivered in healthcare settings, such as academic medical centers, which may present obstacles to participation among low-income families who often have difficulty accessing the healthcare system 10, 11. Several meta-analyses support the efficacy of family-based interventions 7– 9. The current standard of care treatment for pediatric overweight/obesity consists of family-based interventions that target children’s eating patterns, physical and sedentary activity, and sleep 5, 6. As pediatric obesity is highly predictive of future chronic disease risk 2– 4, disseminating effective pediatric obesity treatments in disadvantaged populations is essential for reducing health disparities. Children from low-income households are roughly twice as likely to have obesity as those from higher-income households 1. |
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