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Randomized trial of 140 preschool children in pediatric ED finds dragon-themed nebulizer mask substantially reduces fear and shortens treatment duration

Journal of pediatric nursing (PubMed)Oct 23, 2026

AI-summarized from the linked source. Educational brief, not medical advice.

Brief summary

A randomized controlled trial of 140 children aged 3–6 years in a pediatric emergency department found that using a dragon-themed nebulizer mask significantly decreased child fear scores (d = 3.05) and shortened treatment duration compared with standard clear masks.

What NurseJet pulled from the source

Inhalation therapy is frequently administered for acute respiratory distress in emergency settings, yet standard plastic masks often provoke intense fear and noncooperation in young children, prolonging treatment. In this parallel-group randomized controlled trial conducted between January and March 2026 at a tertiary pediatric emergency department in Istanbul (NCT06568120), 140 preschool children aged 3 to 6 years requiring nebulizer therapy were randomized 1:1 to either a dragon-themed colorful nebulizer mask (n=70) or a standard clear mask control group (n=70). A researcher-nurse recorded procedural metrics using a Demographic Information Form, the Fear Scale, and a Treatment Duration and Adherence Assessment Form. While baseline demographics were comparable (p > 0.05), children in the dragon-themed mask group experienced significantly lower fear scores (p < 0.001, Cohen d = 3.05; 95% CI: 2.56–3.54) and significantly shorter inhalation treatment durations (p = 0.012, Cohen d = 0.47; 95% CI: 0.14–0.81). Observed behavioral distress responses—such as crying, verbal refusal, anger, or mask removal attempts—did not differ significantly between groups (all p > 0.05).

Why this matters for nurses

Pediatric emergency and clinic nurses frequently encounter acute distress, terror, and combative resistance from young children during aerosolized medication delivery. When children scream or fight the mask, drug pulmonary deposition drops sharply and treatment stretches out. Demonstrating that an inexpensive, themed visual mask substantially cuts fear scores and speeds up delivery provides bedside nurses an immediate, non-pharmacological strategy to improve shift efficiency and soothe pediatric patients.

Bedside takeaway

In a 140-child pediatric ED RCT, a dragon-themed nebulizer mask significantly lowered fear scores (d = 3.05) and shortened inhalation duration (p = 0.012) compared to standard masks in children aged 3–6.

Key takeaways

Parallel-group RCT randomized 140 preschool children aged 3–6 requiring nebulizer therapy in a tertiary pediatric ED to a dragon-themed mask or standard mask.
Children receiving nebulization via the dragon-themed mask demonstrated markedly lower procedural fear scores (p < 0.001, Cohen d = 3.05).
Treatment application duration was significantly reduced in the dragon-themed mask group (p = 0.012, Cohen d = 0.47).
Overt behavioral resistance measures (crying, anger, active mask displacement) were statistically similar between groups (p > 0.05).
Findings support low-cost, child-friendly design adaptations to standard emergency respiratory equipment to diminish pediatric fear and improve workflow.

Practice implications

When initiating aerosolized bronchodilator or steroid therapy in preschool-age children, introduce child-friendly themed masks or gamified distraction to alleviate fear; secure an adequate seal around the nose and mouth while reassuring the child and caregiver throughout the nebulization cycle.

Limitations & cautions

Conducted at a single tertiary center in Turkey; open-label delivery precluded blinding of children, caregivers, and administering nurses; overt behavioral distress metrics showed no statistically significant between-group divergence.
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Journal of pediatric nursing (PubMed)

Journal of pediatric nursing (PubMed). The effect of using a dragon-themed nebulizer mask on treatment application duration, adherence, and fear in children presenting to the emergency department: A randomized controlled trial.

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https://pubmed.ncbi.nlm.nih.gov/42919686/

Professional education only

This summary does not replace clinical judgment, facility policy, provider orders, or official guidelines. Verify practice changes against the original source and local protocol.

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Internal and emergency medicine (PubMed)Oct 20, 2026Research Article

A multicenter triple-blind randomized controlled trial of 73 emergency department patients found intravenous ibuprofen (800 mg) produced significantly greater pain score reductions at 10 and 30 minutes and shorter ED stays compared with intravenous ketorolac (30 mg).

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Acute low back pain (LBP) accounts for high emergency department utilization, yet clinicians continually seek non-opioid parenteral analgesics that provide rapid, dependable relief without prohibitive adverse profiles. In this multicenter, triple-blind randomized clinical trial conducted across three academic hospital emergency departments, 73 adult patients presenting with acute LBP were randomized to receive either intravenous ibuprofen (800 mg, n=34) or intravenous ketorolac (30 mg, n=39). Analgesic infusions were prepared in quadruplicate blocks by trained head nurses, maintaining blinding for patients, investigators, and biostatisticians. Pain was recorded on a 100-mm Visual Analog Scale (VAS) at baseline, 10 minutes, and 30 minutes post-infusion. Mean VAS pain scores were significantly lower in the ibuprofen arm at 10 minutes (49.6 vs 57.4; p = 0.013) and at 30 minutes (32.2 vs 40.7; p = 0.038). Furthermore, 70.6% of ibuprofen patients achieved mild pain levels by 30 minutes versus 35.9% of ketorolac recipients (p < 0.001). Mean ED length of stay was also significantly shorter in the ibuprofen cohort, while rescue analgesia requirements and drug-related adverse events did not differ between arms.

Key takeaways

Multicenter triple-blind RCT randomized 73 ED patients with acute low back pain to IV ibuprofen 800 mg (n=34) or IV ketorolac 30 mg (n=39).
IV ibuprofen yielded significantly lower VAS pain scores at both 10 minutes (49.6 vs 57.4, p = 0.013) and 30 minutes (32.2 vs 40.7, p = 0.038).
Twice as many patients achieved mild pain intensity at 30 minutes with ibuprofen compared to ketorolac (70.6% vs 35.9%, p < 0.001).
Mean ED length of stay was significantly reduced in the ibuprofen cohort, without any increase in adverse drug events or rescue analgesia.
Findings support IV ibuprofen as an effective, rapid-acting, non-opioid parenteral alternative to ketorolac for acute musculoskeletal back pain in the ED.

Why this matters on shift

Emergency nurses manage acute musculoskeletal back pain daily and frequently administer IV NSAIDs to avoid opioid exposure. Ketorolac has traditionally served as the default parenteral non-opioid, but these triple-blind findings show IV ibuprofen (800 mg) delivers faster and deeper pain reduction within the critical first 30 minutes, doubles the rate of relief down to mild pain, and facilitates earlier discharge without added complications.

Bedside takeaway

In a triple-blind ED RCT of 73 adults with acute low back pain, IV ibuprofen (800 mg) achieved lower VAS pain scores at 10 and 30 minutes and higher mild-pain rates (70.6% vs 35.9%) than IV ketorolac (30 mg).

Nursing implications

Verify renal function, volume status, GI bleeding history, and pregnancy status prior to parenteral NSAID infusion; administer IV ibuprofen over the ordered infusion time and evaluate pain response using a standardized scale at 10 and 30 minutes to determine if rescue analgesia is needed.

Limitations & cautions

Modest total sample size (73 patients) across three university centers; evaluation period concluded at 30 minutes without tracking long-term recurrence or post-discharge outcomes.
AI-summarized from the linked source. Review the original article before applying to practice.

Citations · exact source links

Internal and emergency medicine (PubMed). Intravenous ibuprofen versus ketorolac for acute low back pain in the emergency department: a triple-blind randomized clinical trial.

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Pediatrics (PubMed)Oct 20, 2026Research Article

A randomized crossover simulation trial of 123 emergency clinicians found that real-time device feedback dramatically improved pediatric bag-valve-mask ventilation quality, increasing guideline-adherent tidal volumes from 16.2% to 87.0%.

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Manual bag-mask ventilation is a critical, lifesaving intervention for children suffering acute respiratory arrest, but delivery of appropriate pediatric tidal volumes without barotrauma or gastric insufflation remains challenging. In a single-anonymized, randomized crossover trial across five emergency medical services agencies in three US metropolitan areas, 123 emergency clinicians ventilated a high-fidelity manikin simulating a 3-year-old child in respiratory arrest. Participants completed two sequential 2-minute ventilation trials—one with real-time visual feedback using the EOLifeX ventilation feedback device (VFD) and one without feedback—separated by a 10-minute washout period. Real-time feedback increased adherence to age-recommended tidal volumes from 16.2% to 87.0%. Ventilation rate adherence improved from 65.0% to 88.6%, and minimal mask leak (<30%) was maintained in 88.4% of breaths with feedback compared to 80.0% without feedback.

Key takeaways

Randomized crossover simulation study evaluated 123 emergency clinicians ventilating a simulated 3-year-old toddler.
Unassisted baseline ventilation rarely met pediatric standards, with only 16.2% of breaths delivering guideline-recommended tidal volumes.
Real-time visual feedback increased guideline-compliant tidal volume delivery to 87.0% and rate adherence from 65.0% to 88.6%.
Mask seal with less than 30% leak improved from 80.0% to 88.4% when feedback was active.

Why this matters on shift

Pediatric emergency nurses and rapid response teams frequently provide manual ventilation during arrests and severe respiratory compromise. Because children have high chest wall compliance and low functional residual capacity, unguided manual bagging frequently leads to severe hyperventilation or dangerous overdistention. Objective feedback devices provide immediate visual cues that safeguard against excessive tidal volumes and erratic rates.

Bedside takeaway

In a randomized crossover study of 123 emergency clinicians ventilating a 3-year-old child manikin, real-time feedback increased guideline-adherent tidal volume delivery from 16.2% to 87.0% and rate adherence from 65.0% to 88.6%.

Nursing implications

When delivering bag-mask ventilation to pediatric patients, use two-person technique when possible to optimize mask seal, utilize volume-limiting and feedback-guided adjuncts per unit protocol, and maintain deliberate, age-appropriate ventilation rates.

Limitations & cautions

Simulation manikin model evaluating simulated respiratory arrest rather than live clinical patient outcomes; short 2-minute testing intervals may not reflect clinician physical fatigue during prolonged resuscitations.
AI-summarized from the linked source. Review the original article before applying to practice.

Citations · exact source links

Pediatrics (PubMed). Prehospital Pediatric Ventilation Quality Following Use of a Feedback Device: A Randomized Study.

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AI-summarized from the linked source. Review the original article before applying to practice.

Critical care medicine (PubMed)Oct 15, 2026Research Article

A multicenter randomized controlled trial of 87 critically ill adults found no significant differences in 24-hour weaning success (94% vs 81% vs 77%) or duration between flow-reduction-first, FiO2-reduction-first, or simultaneous HFNC weaning.

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High-flow nasal cannula (HFNC) is standard supportive therapy for acute hypoxemic respiratory failure, yet clinical teams lack consensus on the optimal stepwise de-escalation sequence. The multicenter, randomized controlled SLOWH trial enrolled 102 adults across three tertiary care intensive care units who achieved clinical stability on HFNC and met standardized weaning criteria (PaO2/FiO2 >= 150 or SpO2 >= 92% on FiO2 <= 0.40 and flow <= 30 L/min). Following exclusions, 87 patients were randomized to flow reduction first (FR, n=31), FiO2 reduction first (OR, n=26), or simultaneous reduction (SR, n=30). The primary outcome was successful transition to conventional oxygen therapy without HFNC resumption, noninvasive ventilation, or endotracheal intubation within 24 hours. Weaning success was achieved in 94% of the FR group, 81% of the OR group, and 77% of the SR group (p = 0.15). Median weaning duration was also comparable: 31.0 hours for FR, 29.5 hours for OR, and 29.5 hours for SR (p = 0.87).

Key takeaways

Multicenter RCT of 87 adults across 3 tertiary ICUs compared flow-first (n=31), oxygen-first (n=26), and simultaneous (n=30) HFNC de-escalation.
Weaning success rates at 24 hours did not significantly differ between strategies: 94% flow-first, 81% oxygen-first, and 77% simultaneous (p = 0.15).
Median weaning duration was approximately 30 hours across all three arms (31.0 hr vs 29.5 hr vs 29.5 hr, p = 0.87).
Findings indicate bedside clinicians can individualize HFNC weaning order based on patient comfort and work of breathing without compromising weaning success.

Why this matters on shift

ICU and step-down nurses frequently manage HFNC titration and weaning trials at the bedside. Evidence demonstrating clinical equivalence across sequential flow reduction, FiO2 reduction, and simultaneous titration allows nurses and respiratory therapists to tailor the weaning trajectory to individual patient physiology—such as prioritizing flow reduction for airway comfort or FiO2 reduction to limit oxygen toxicity.

Bedside takeaway

In an 87-patient multicenter RCT of critically ill adults, flow-first (94%), FiO2-first (81%), and simultaneous (77%) HFNC weaning showed comparable 24-hour success rates (p=0.15) and similar median weaning durations (~30 hours).

Nursing implications

Assess work of breathing, accessory muscle use, and oxygenation saturation during HFNC de-escalation; whether titrating flow or FiO2 first, titrate gradually per provider orders and monitor closely for respiratory fatigue within the initial 24 hours of step-down.

Limitations & cautions

Relatively modest sample size (87 completed participants) may have been underpowered to detect small differences between weaning arms; conducted in tertiary academic centers with dedicated protocols.
AI-summarized from the linked source. Review the original article before applying to practice.

Citations · exact source links

Critical care medicine (PubMed). Weaning Strategies for High-Flow Nasal Cannula in Critically Ill Adults: A Randomized Clinical Trial.

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AI-summarized from the linked source. Review the original article before applying to practice.

Key takeaways

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Limitations & cautions

Exact source links

More updates for this clinical area

Triple-blind randomized trial of 73 ED patients finds intravenous ibuprofen achieves superior acute pain relief compared with ketorolac for acute low back pain

Randomized simulation trial of 123 emergency clinicians finds real-time feedback increases pediatric bag-mask ventilation volume compliance from 16% to 87%

Multicenter randomized trial finds flow-first, oxygen-first, and simultaneous HFNC weaning yield equivalent success rates in critically ill adults