-
Pediatrics in Review Oct 2014Respiratory distress presents as tachypnea, nasal flaring, retractions, and grunting and may progress to respiratory failure if not readily recognized and managed.... (Review)
Review
Respiratory distress presents as tachypnea, nasal flaring, retractions, and grunting and may progress to respiratory failure if not readily recognized and managed. Causes of respiratory distress vary and may not lie within the lung. A thorough history, physical examination, and radiographic and laboratory findings will aid in the differential diagnosis. Common causes include transient tachypnea of the newborn, neonatal pneumonia, respiratory distress syndrome (RDS), and meconium aspiration syndrome (MAS). Strong evidence reveals an inverse relationship between gestational age and respiratory morbidity. (1)(2)(9)(25)(26) Expert opinion recommends careful consideration about elective delivery without labor at less than 39 weeks’ gestation. Extensive evidence, including randomized control trials, cohort studies, and expert opinion, supports maternal group B streptococcus screening, intrapartum antibiotic prophylaxis, and appropriate followup of high-risk newborns according to guidelines established by the Centers for Disease Control and Prevention. (4)(29)(31)(32)(34) Following these best-practice strategies is effective in preventing neonatal pneumonia and its complications. (31)(32)(34). On the basis of strong evidence, including randomized control trials and Cochrane Reviews, administration of antenatal corticosteroids (5) and postnatal surfactant (6) decrease respiratory morbidity associated with RDS. Trends in perinatal management strategies to prevent MAS have changed. There is strong evidence that amnioinfusion, (49) oropharyngeal and nasopharyngeal suctioning at the perineum, (45) or intubation and endotracheal suctioning of vigorous infants (46)(47) do not decrease MAS or its complications. Some research and expert opinion supports endotracheal suctioning of nonvigorous meconium-stained infants (8) and induction of labor at 41 weeks’ gestation (7) to prevent MAS.
Topics: Diagnosis, Differential; Humans; Infant, Newborn; Lung; Meconium Aspiration Syndrome; Pneumonia; Respiratory Distress Syndrome, Newborn; Respiratory Sounds; Risk Factors; Transient Tachypnea of the Newborn
PubMed: 25274969
DOI: 10.1542/pir.35-10-417 -
Jornal de Pediatria 2020To provide cutting-edge information for the management of community-acquired pneumonia in children under 5 years, based on the latest evidence published in the... (Review)
Review
OBJECTIVE
To provide cutting-edge information for the management of community-acquired pneumonia in children under 5 years, based on the latest evidence published in the literature.
DATA SOURCE
A comprehensive search was conducted in PubMed, by using the expressions: "community-acquired pneumonia" AND "child" AND "etiology" OR "diagnosis" OR "severity" OR "antibiotic". All articles retrieved had the title and the abstract read, when the papers reporting the latest evidence on each subject were identified and downloaded for complete reading.
DATA SYNTHESIS
In the era of largely implemented bacterial conjugate vaccines and widespread use of amplification nucleic acid techniques, respiratory viruses have been identified as the most frequent causative agents of community-acquired pneumonia in patients under 5 years. Hypoxemia (oxygen saturation ≤96%) and increased work of breathing are signs most associated with community-acquired pneumonia. Wheezing detected on physical examination independently predicts viral infection and the negative predictive value (95% confidence interval) of normal chest X-ray and serum procalcitonin <0.25ng/dL was 92% (77-98%) and 93% (90-99%), respectively. Inability to drink/feed, vomiting everything, convulsions, lower chest indrawing, central cyanosis, lethargy, nasal flaring, grunting, head nodding, and oxygen saturation <90% are predictors of death and can be used as indicators for hospitalization. Moderate/large pleural effusions and multilobar infiltrates are predictors of severe disease. Orally administered amoxicillin is the first line outpatient treatment, while ampicillin, aqueous penicillin G, or amoxicillin (initiated initially by intravenous route) are the first line options to treat inpatients.
CONCLUSIONS
Distinct aspects of childhood community-acquired pneumonia have changed during the last three decades.
Topics: Anti-Bacterial Agents; Child; Child, Preschool; Community-Acquired Infections; Cross-Sectional Studies; Humans; Infant; Pneumonia
PubMed: 31518547
DOI: 10.1016/j.jped.2019.08.003 -
American Family Physician Dec 2015Newborn respiratory distress presents a diagnostic and management challenge. Newborns with respiratory distress commonly exhibit tachypnea with a respiratory rate of...
Newborn respiratory distress presents a diagnostic and management challenge. Newborns with respiratory distress commonly exhibit tachypnea with a respiratory rate of more than 60 respirations per minute. They may present with grunting, retractions, nasal flaring, and cyanosis. Common causes include transient tachypnea of the newborn, respiratory distress syndrome, meconium aspiration syndrome, pneumonia, sepsis, pneumothorax, persistent pulmonary hypertension of the newborn, and delayed transition. Congenital heart defects, airway malformations, and inborn errors of metabolism are less common etiologies. Clinicians should be familiar with updated neonatal resuscitation guidelines. Initial evaluation includes a detailed history and physical examination. The clinician should monitor vital signs and measure oxygen saturation with pulse oximetry, and blood gas measurement may be considered. Chest radiography is helpful in the diagnosis. Blood cultures, serial complete blood counts, and C-reactive protein measurement are useful for the evaluation of sepsis. Most neonates with respiratory distress can be treated with respiratory support and noninvasive methods. Oxygen can be provided via bag/mask, nasal cannula, oxygen hood, and nasal continuous positive airway pressure. Ventilator support may be used in more severe cases. Surfactant is increasingly used for respiratory distress syndrome. Using the INSURE technique, the newborn is intubated, given surfactant, and quickly extubated to nasal continuous positive airway pressure. Newborns should be screened for critical congenital heart defects via pulse oximetry after 24 hours but before hospital discharge. Neonatology consultation is recommended if the illness exceeds the clinician's expertise and comfort level or when the diagnosis is unclear in a critically ill newborn.
Topics: Continuous Positive Airway Pressure; Education, Medical, Continuing; Female; Humans; Infant, Newborn; Intubation; Male; Practice Guidelines as Topic; Respiratory Distress Syndrome, Newborn; Surface-Active Agents; Treatment Outcome
PubMed: 26760414
DOI: No ID Found -
The American Journal of Emergency... Apr 2017To determine whether the presence of nasal flaring is a clinical sign of respiratory acidosis in patients attending emergency departments for acute dyspnea. (Observational Study)
Observational Study
OBJECTIVE
To determine whether the presence of nasal flaring is a clinical sign of respiratory acidosis in patients attending emergency departments for acute dyspnea.
METHODS
Single-center, prospective, observational study of patients aged over 15 requiring urgent attention for dyspnea, classified as level II or III according to the Andorran Triage Program and who underwent arterial blood gas test on arrival at the emergency department. The presence of nasal flaring was evaluated by two observers. Demographic and clinical variables, signs of respiratory difficulty, vital signs, arterial blood gases and clinical outcome (hospitalization and mortality) were recorded. Bivariate and multivariate analyses were performed using logistic regression models.
RESULTS
The sample comprised 212 patients, mean age 78years (SD=12.8), of whom 49.5% were women. Acidosis was recorded in 21.2%. Factors significantly associated with the presence of acidosis in the bivariate analysis were the need for pre-hospital medical care, triage level II, signs of respiratory distress, presence of nasal flaring, poor oxygenation, hypercapnia, low bicarbonates and greater need for noninvasive ventilation. Nasal flaring had a positive likelihood ratio for acidosis of 4.6 (95% CI 2.9-7.4). In the multivariate analysis, triage level II (aOR 5.16; 95% CI: 1.91 to 13.98), the need for oxygen therapy (aOR 2.60; 95% CI: 1.13-5.96) and presence of nasal flaring (aOR 6.32; 95% CI: 2.78-14.41) were maintained as factors independently associated with acidosis.
CONCLUSIONS
Nasal flaring is a clinical sign of severity in patients requiring urgent care for acute dyspnea, which has a strong association with acidosis and hypercapnia.
Topics: Acidosis, Respiratory; Aged; Aged, 80 and over; Blood Gas Analysis; Case-Control Studies; Dyspnea; Emergency Service, Hospital; Female; Humans; Hypercapnia; Logistic Models; Male; Middle Aged; Multivariate Analysis; Noninvasive Ventilation; Nose; Oxygen Inhalation Therapy; Physical Examination; Prospective Studies; Severity of Illness Index; Triage
PubMed: 28007319
DOI: 10.1016/j.ajem.2016.12.008 -
Emergencias : Revista de La Sociedad... Feb 2015To determine whether the presence of nasal flaring is a clinical sign of severity and a predictor of hospital mortality in emergency patients with dyspnea.
OBJECTIVES
To determine whether the presence of nasal flaring is a clinical sign of severity and a predictor of hospital mortality in emergency patients with dyspnea.
MATERIAL AND METHODS
Prospective, observational, single-center study. We enrolled patients older than 15 years of age who required attention for dyspnea categorized as level II or III emergencies according to the Andorran Medical Triage system. Two observers evaluated the presence of nasal flaring. We recorded demographic and clinical variables, including respiratory effort, vital signs, arterial blood gases, and clinical course (hospital admission and mortality). Bivariable analysis was performed and multivariable logistic regression models were constructed.
RESULTS
We enrolled 246 patients with a mean (SD) age of 77 (13) years; 52% were female. Nasal flaring was present in 19.5%. Patients with nasal flaring had triage levels indicating greater severity and they had more severe tachypnea, worse oxygenation, and greater acidosis and hypercapnia. Bivariable analysis detected that the following variables were associated with mortality: age (odds ratio [OR], 1.05; 95% CI, 1.01-1.10), prehospital care from the emergency medical service (OR, 3.97; 95% CI, 1.39-11.39), triage level II (OR, 4.19; 95% CI, 1.63-10.78), signs of respiratory effort such as nasal flaring (OR, 3.79; 95% CI, 1.65-8.69), presence of acidosis (OR, 7.09; 95% CI, 2.97-16.94), and hypercapnia (OR, 2.67; 95% CI, 1,11-6,45). The factors that remained independent predictors of mortality in the multivariable analysis were age, severity (triage level), and nasal flaring.
CONCLUSION
In patients requiring emergency care for dyspnea, nasal flaring is a clinical sign of severity and a predictor of mortality.
PubMed: 29077330
DOI: No ID Found -
Facial Plastic Surgery : FPS Apr 2011Nasal obstruction can be due to internal and external valve problems that can be seen before and after rhinoplasty. The main scope of this article is to concentrate on...
Nasal obstruction can be due to internal and external valve problems that can be seen before and after rhinoplasty. The main scope of this article is to concentrate on surgical solutions to these problems. To overcome nasal obstruction at the internal valve, spreader grafts, spreader flaps, upper lateral splay graft, butterfly graft, flaring suture, M-plasty, Z-plasty, and suspension sutures have been described. The management of the external valve problems is possible by using lateral crural dissection and repositioning, lateral crural strut grafts, alar battens, lateral crural turn-in flap, alar rim grafts, and various other methods. It is not easy to decide which techniques would work best in every case. After a thorough examination and analysis, the underlying cause of the nasal obstruction can be understood, and one or multiple procedures can be chosen according to each individual problem.
Topics: Humans; Nasal Obstruction; Nose; Plastic Surgery Procedures; Rhinoplasty
PubMed: 21404160
DOI: 10.1055/s-0030-1271298 -
JAMA Facial Plastic Surgery 2015
Topics: Follow-Up Studies; Humans; Nasal Cavity; Nasal Obstruction; Nasal Septum; Rhinoplasty; Suture Techniques; Treatment Outcome
PubMed: 26402557
DOI: 10.1001/jamafacial.2015.1116 -
Medicina Intensiva Apr 2010To determine if the presence of nasal flaring is indicative of severe respiratory insufficiency.
OBJECTIVE
To determine if the presence of nasal flaring is indicative of severe respiratory insufficiency.
METHODS
Prospective observational study of patients consulting in the Emergency Department because of dyspnea whose triage level is II or III in the Spanish Triage System (MAT-SET). Vital signs, SpO2, arterial blood gases and nasal flaring presence were recorded, as well as the need for hospital admission and length of hospital stay. Data are presented as median (25-75th percentile).
RESULTS
A total of 43 patients were analyzed (70% men, aged 77 (67-82) years), 7 of whom showed nasal flaring. Those having flaring had higher respiratory rate (36 (34-40) vs. 25 (20-28) vs., p=0.001) and were more acidotic (pH 7.34 [7.23-7.40] vs. 7.42 [7.39-7.46] vs., p=0.03) than patients without this sign. There were no differences between groups in SpO2, PaCO2, heart rate and arterial pressure. There were no differences in the rate of hospital admission-(6 patients [85.7%] in nasal flaring group vs 29 patients [80.5%] in the non nasal flaring group [p=0,06], or in the length of the hospital stay-3 days [1-16] in nasal flaring group vs. 6 days [1-10] in the non nasal flaring group, p=0.6). All patients with nasal flaring had tachypnea.
CONCLUSION
In our study, nasal flaring does not indicate severity in dyspneic patients in spite of its association with tachypnea and acidosis.
Topics: Aged; Aged, 80 and over; Dyspnea; Female; Humans; Male; Nose; Physical Examination; Predictive Value of Tests; Prospective Studies; Severity of Illness Index
PubMed: 19954861
DOI: 10.1016/j.medin.2009.09.008 -
Clinics in Plastic Surgery Jan 2022Treatment of nasal base deformities is critical for a successful rhinoplasty. Several anatomic variations are seen on nasal base. Alar base deformities can be horizontal... (Review)
Review
Treatment of nasal base deformities is critical for a successful rhinoplasty. Several anatomic variations are seen on nasal base. Alar base deformities can be horizontal excess or deficiency, vertical excess or deficiency, cephalic malposition or caudal malposition of alar base, wide or narrow nostril sills, and columellar base deformities. Columellar base should be addressed before alar base resections. Correction of columellar base deformities and positioning of medial crural footplates should be the primary step of nasal base surgery to attain aesthetic ideals of the columellar base and improve external nasal valve function. The most common deformities requiring alar base modification include wide nasal base, alar flaring, large nostril size, and asymmetries of nostrils or alae. There are 3 basic types of excision on alar base surgery. (1) Alar wedge excision, (2) nostril sill excision, and (3) combined alar wedge and nostril sill excision. The alar wedge excision is an elliptical excision placed in the alar crease that is used to reduce the size and shorten the vertical length of alar lobule and correct the excessive flaring on the frontal view. Nostril sill excision is the technique which is used to decrease interalar distance and nostril sill length, and reduce the size of nostril. The combined alar wedge and nostril sill excision is used in cases with wide alar base and additionally, there is excessive flaring and large alar lobule.
Topics: Esthetics; Humans; Nasal Cavity; Nasal Septum; Nose; Orthopedic Procedures; Rhinoplasty
PubMed: 34782134
DOI: 10.1016/j.cps.2021.08.007