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MedEdPORTAL : the Journal of Teaching... Aug 2020Pediatric bacterial tracheitis is a rare but life-threatening upper airway infection with mortality rates estimated as high as 20%, typically affecting children between...
INTRODUCTION
Pediatric bacterial tracheitis is a rare but life-threatening upper airway infection with mortality rates estimated as high as 20%, typically affecting children between 6 months and 12 years old. Given such high mortality rates, we felt it was important to train medical personnel to evaluate and manage this condition.
METHODS
This simulation-based curriculum was developed for health care professionals involving the evaluation and management of an 8-year-old male with symptoms of fever, stridor, worsening barking cough, and increased work of breathing. Critical actions included identifying stridor and airway respiratory distress; monitoring and supporting airway, breathing, and circulation; administering racemic epinephrine and dexamethasone; and identifying and treating bacterial tracheitis as the underlying cause. Scenario-specific debriefing tools were put together to elicit scenario feedback and aid in formative learning.
RESULTS
The scenario was conducted with six fellows and 12 residents and medical students. Per the survey data, the case was rated as highly relevant (median = 5) and highly realistic (median = 5) by participants on a 5-point Likert scale.
DISCUSSION
Pediatric bacterial tracheitis is a low frequency, but high-risk scenario that was amenable to simulation as an educational modality and was well-received by participants. The debriefing tools were implemented as a means of helping instructors customize the scenario for learners based on respective educational backgrounds and learning styles.
Topics: Child; Curriculum; Humans; Learning; Male; Pediatric Emergency Medicine; Surveys and Questionnaires; Tracheitis
PubMed: 32875092
DOI: 10.15766/mep_2374-8265.10946 -
Revista Brasileira de Terapia Intensiva 2019Ventilator-associated lower respiratory tract infection is one of the most frequent complications in mechanically ventilated patients. Ventilator-associated... (Review)
Review
Ventilator-associated lower respiratory tract infection is one of the most frequent complications in mechanically ventilated patients. Ventilator-associated tracheobronchitis has been considered a disease that does not warrant antibiotic treatment by the medical community for many years. In the last decade, several studies have shown that tracheobronchitis could be considered an intermediate process that leads to ventilator-associated pneumonia. Furthermore, ventilator-associated tracheobronchitis has a limited impact on overall mortality but shows a significant association with increased patient costs, length of stay, antibiotic use, and duration of mechanical ventilation. Although we still need clear evidence, especially concerning treatment modalities, the present study on ventilator-associated tracheobronchitis highlights that there are important impacts of including this condition in clinical management and epidemiological and infection surveillance.
Topics: Anti-Bacterial Agents; Bronchitis; Humans; Pneumonia, Ventilator-Associated; Respiration, Artificial; Respiratory Tract Infections; Tracheitis
PubMed: 31967230
DOI: 10.5935/0103-507X.20190079 -
American Family Physician May 2011Croup is a common illness responsible for up to 15 percent of emergency department visits due to respiratory disease in children in the United States. Croup symptoms... (Review)
Review
Croup is a common illness responsible for up to 15 percent of emergency department visits due to respiratory disease in children in the United States. Croup symptoms usually start like an upper respiratory tract infection, with low-grade fever and coryza followed by a barking cough and various degrees of respiratory distress. In most children, the symptoms subside quickly with resolution of the cough within two days. Croup is often caused by viruses, with parainfluenza virus (types 1 to 3) as the most common. However, physicians should consider other diagnoses, including bacterial tracheitis, epiglottitis, foreign body aspiration, peritonsillar abscess, retropharyngeal abscess, and angioedema. Humidification therapy has not been proven beneficial. A single dose of dexamethasone (0.15 to 0.60 mg per kg usually given orally) is recommended in all patients with croup, including those with mild disease. Nebulized epinephrine is an accepted treatment in patients with moderate to severe croup. Most episodes of croup are mild, with only 1 to 8 percent of patients with croup requiring hospital admission and less than 3 percent of admitted patients requiring intubation.
Topics: Adrenal Cortex Hormones; Child; Croup; Diagnosis, Differential; Epinephrine; Humans
PubMed: 21534520
DOI: No ID Found -
Frontiers in Public Health 2022This paper aims to explore the direct associations of antibiotics prescription with clinical diagnosis and bacterial detection. It also analyses the relations of...
OBJECTIVES
This paper aims to explore the direct associations of antibiotics prescription with clinical diagnosis and bacterial detection. It also analyses the relations of clinical diagnosis with symptoms and bacterial detection, with a hope of revealing indirect links to antibiotic prescription.
METHODS
The study was implemented in one village clinic and one township health center in each of four rural residential areas in Anhui Province, China. Observations were conducted to record clinical diagnosis and antibiotic prescription. A semi-structured questionnaire survey was used to collected patients' sociodemographic information and reported symptoms. Sputum and throat swabs were collected for bacterial culture.
RESULTS
Among 1,068 patients presenting in the study settings who received a diagnosis of respiratory tract infection (RTI), 87.8% of prescriptions included an antibiotic and 35.8% included two or more antibiotics. Symptomatic RTI patients to the site clinics were diagnosed mainly as having upper respiratory tract infection (32.0%), bronchitis/tracheitis (23.4%), others (16.6%), pharyngitis (11.1%), common cold (8.0%), pneumonia/bronchopneumonia (4.6%) and tonsillitis (4.3%). These clinical diagnosis were associated with symptoms to a varied degree especially for upper respiratory tract infection and bronchitis/tracheitis. Prescription of any antibiotics was positively associated with diagnosis of bronchitis/tracheitis (OR: 5.00, 95% CI: 2.63-9.51), tonsillitis (OR: 4.63, 95% CI: 1.48-14.46), pneumonia/bronchopneumonia (OR: 4.28, 95% CI: 1.40-13.04), pharyngitis (OR: 3.22, 95% CI: 1.57-6.59) and upper respiratory tract infection (OR: 3.04, 95% CI: 1.75-5.27). Prescription of two or more antibiotics was statistically significant related to diagnosis of bronchitis/ tracheitis (OR: 2.20, 95% CI: 1.44-3.35) or tonsillitis (OR: 2.97, 95% CI: 1.47-6.00). About 30% of the patients were identified with some type of bacteria. Bacteria detection was linked with pharyngitis (OR: 0.50, 95% CI: 0.28-0.88) but not prescription of antibiotics.
CONCLUSIONS
Antibiotics prescription were found with a strong relation to diagnosis of RTIs given by the clinician but was not associated with the presence of bacteria in patient samples. Part of the diagnosis may have been given by the clinician to justify their antibiotics prescription. There is clear need to use additional measures (e.g., symptoms) in conjunction with diagnosis to supervise or audit excessive antibiotics use.
Topics: Anti-Bacterial Agents; Bacteria; Bronchitis; Bronchopneumonia; China; Humans; Outpatients; Pharyngitis; Prescriptions; Respiratory Tract Infections; Tonsillitis; Tracheitis
PubMed: 35223737
DOI: 10.3389/fpubh.2022.810348 -
BMJ Case Reports Jul 2011A 2-year-old girl presented to the James Paget University Hospitals Trust with croup-like symptoms and was later discharged with dexamethasone syrup. The patient...
A 2-year-old girl presented to the James Paget University Hospitals Trust with croup-like symptoms and was later discharged with dexamethasone syrup. The patient re-presented 6 h later following maternal concern with signs of acute respiratory distress. After a period of clinical stability, she acutely decompensated without any prior signs of a life-threatening deterioration. She was managed using nebulised epinephrine and showed signs of clinical improvement. Although improvement persisted, the child showed signs of exhaustion following the preceding events and was later intubed with an endotracheal tube and transferred to the paediatric intensive care unit at Addenbrooke's University Hospital, Cambridge. Endotracheal aspiration later grew parainfluenza virus, rhinovirus and Staphylococcus aureus and the patient was diagnosed with the exceptionally rare life threatening complications of croup, bacterial tracheitis. The patient was discharged from intensive care 7 days later and has since made a full recovery.
Topics: Child, Preschool; Croup; Female; Humans; Paramyxoviridae Infections; Picornaviridae Infections; Rhinovirus; Severity of Illness Index; Staphylococcal Infections; Tracheitis
PubMed: 22689599
DOI: 10.1136/bcr.03.2011.4014 -
Ear, Nose, & Throat Journal Jul 2010
Topics: Acute Disease; Adult; Anti-Bacterial Agents; Asthma; Gastroesophageal Reflux; Histamine H2 Antagonists; Humans; Male; Proton Pump Inhibitors; Temporomandibular Joint Disorders; Tracheitis
PubMed: 20628980
DOI: 10.1177/014556131008900710 -
Revista Brasileira de Terapia Intensiva Mar 2018The concept of ventilator-associated tracheobronchitis is controversial; its definition is not unanimously accepted and often overlaps with ventilator-associated... (Review)
Review
The concept of ventilator-associated tracheobronchitis is controversial; its definition is not unanimously accepted and often overlaps with ventilator-associated pneumonia. Ventilator-associated tracheobronchitis has an incidence similar to that of ventilator-associated pneumonia, with a high prevalence of isolated multiresistant agents, resulting in an increase in the time of mechanical ventilation and hospitalization but without an impact on mortality. The performance of quantitative cultures may allow better diagnostic definition of tracheobronchitis associated with mechanical ventilation, possibly avoiding the overdiagnosis of this condition. One of the major difficulties in differentiating between ventilator-associated tracheobronchitis and ventilator-associated pneumonia is the exclusion of a pulmonary infiltrate by chest radiography; thoracic computed tomography, thoracic ultrasonography, or invasive specimen collection may also be required. The institution of systemic antibiotic therapy does not improve the clinical impact of ventilator-associated tracheobronchitis, particularly in reducing time of mechanical ventilation, hospitalization or mortality, despite the possible reduced progression to ventilator-associated pneumonia. However, there are doubts regarding the methodology used. Thus, considering the high prevalence of tracheobronchitis associated with mechanical ventilation, routine treatment of this condition would result in high antibiotic usage without clear benefits. However, we suggest the institution of antibiotic therapy in patients with tracheobronchitis associated with mechanical ventilation and septic shock and/or worsening of oxygenation, and other auxiliary diagnostic tests should be simultaneously performed to exclude ventilator-associated pneumonia. This review provides a better understanding of the differentiation between tracheobronchitis associated with mechanical ventilation and pneumonia associated with mechanical ventilation, which can significantly decrease the use of antibiotics in critically ventilated patients.
Topics: Anti-Bacterial Agents; Bronchitis; Critical Illness; Diagnosis, Differential; Drug Resistance, Multiple, Bacterial; Humans; Pneumonia, Ventilator-Associated; Respiration, Artificial; Tracheitis
PubMed: 29742211
DOI: 10.5935/0103-507x.20180014 -
Paediatrics & Child Health Jan 2004Bacterial tracheitis is due to a secondary bacterial infection of the trachea, resulting in the formation of mucopurulent exudates that may acutely obstruct the upper...
Bacterial tracheitis is due to a secondary bacterial infection of the trachea, resulting in the formation of mucopurulent exudates that may acutely obstruct the upper airway, resulting in a life-threatening condition. Bacterial tracheitis should be considered in the differential diagnosis of any child with acute upper airway obstruction. This diagnosis should also be considered in any child with viral croup that is nonresponsive to conventional therapy. The only definitive way to diagnose bacterial tracheitis is by direct visualization of the trachea via bronchoscopy; however, this may not be required in all cases. Management includes close observation and monitoring, early initiation of broad spectrum antibiotics, pain management and aggressive airway clearance techniques. The decision to intubate should be individualized based on the severity of symptoms, age of child and accessibility of personnel skilled at emergency intubation techniques. If diagnosed and treated early, complete recovery is expected.
PubMed: 19654977
DOI: 10.1093/pch/9.1.25 -
Respiratory Care Mar 2003Acute obstructive respiratory emergencies in children are a common cause of emergency department visits. The severity of these conditions ranges from mild, self-limited... (Review)
Review
Acute obstructive respiratory emergencies in children are a common cause of emergency department visits. The severity of these conditions ranges from mild, self-limited disease to life-threatening forms of rapidly progressive airway obstruction. A high index of suspicion is necessary for prompt diagnosis and treatment. This review discusses general principles of assessing and managing respiratory emergencies in children, as well as clinical characteristics and treatment of specific conditions such as croup, epiglottitis, bacterial tracheitis, retropharyngeal abscess, foreign bodies, and inhalational injuries.
Topics: Acute Disease; Child; Emergency Service, Hospital; Emergency Treatment; Humans; Pediatrics; Radiography; Respiratory Therapy; Respiratory Tract Diseases; United States
PubMed: 12667275
DOI: No ID Found -
PloS One 2020Being a typical ground-breeding bird of the agricultural landscape in Germany, the pheasant has experienced a strong and persistent population decline with a hitherto...
Being a typical ground-breeding bird of the agricultural landscape in Germany, the pheasant has experienced a strong and persistent population decline with a hitherto unexplained cause. Contributing factors to the ongoing negative trend, such as the effects of pesticides, diseases, predation, increase in traffic and reduced fallow periods, are currently being controversially discussed. In the present study, 62 free-ranging pheasant chicks were caught within a two-year period in three federal states of Germany; Lower Saxony, North Rhine-Westphalia and Schleswig-Holstein. The pheasant chicks were divided into three age groups to detect differences in their development and physical constitution. In addition, pathomorphological, parasitological, virological, bacteriological and toxicological investigations were performed. The younger chicks were emaciated, while the older chicks were of moderate to good nutritional status. However, the latter age group was limited to a maximum of three chicks per hen, while the youngest age class comprised up to ten chicks. The majority of chicks suffered from dermatitis of the periocular and caudal region of the head (57-94%) of unknown origin. In addition, intestinal enteritis (100%), pneumonia (26%), hepatitis (24%), perineuritis (6%), tracheitis (24%), muscle degeneration (1%) and myositis (1%) were found. In 78% of the cases, various Mycoplasma spp. were isolated. Mycoplasma gallisepticum (MG) was not detected using an MG-specific PCR. Parasitic infections included Philopteridae (55%), Coccidia (48%), Heterakis/Ascaridia spp. (8%) and Syngamus trachea (13%). A total of 8% of the chicks were Avian metapneumovirus (AMPV) positive using RT-PCR, 16% positive for infectious bronchitis virus (IBV) using RT-PCR, and 2% positive for haemorrhagic enteritis virus (HEV) using PCR. All samples tested for avian encephalomyelitis virus (AEV), infectious bursal disease virus (IBDV) or infectious laryngotracheitis virus (ILTV) were negative. The pool samples of the ten chicks were negative for all acid, alkaline-free and derivative substances, while two out of three samples tested were positive for the herbicide glyphosate. Pheasant chick deaths may often have been triggered by poor nutritional status, probably in association with inflammatory changes in various tissues and organs as well as bacterial and parasitic pathogens. Theses impacts may have played a major role in the decline in pheasant populations.
Topics: Animals; Female; Galliformes; Germany; Health Status; Male; Nutritional Status
PubMed: 32544211
DOI: 10.1371/journal.pone.0234044