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Pediatrics and Neonatology Dec 2019Precise estimation of respiratory function is essential to optimise neonatal respiratory care. However, current clinical scores have not been validated with quantitative...
AIM
Precise estimation of respiratory function is essential to optimise neonatal respiratory care. However, current clinical scores have not been validated with quantitative measures of respiratory function. The aim of this study was to develop a physiological scoring system to predict low respiratory dynamic compliance of <0.6 ml/cmHO/kg.
METHODS
Forty-four newborn infants were studied before (dynamic compliance) and shortly after scheduled extubation (physiological signs). A novel scoring system was developed based on the association between physiological signs and dynamic compliance.
RESULTS
The respiratory rate was identified as the primary independent variable for dynamic compliance in the univariate analysis. The prediction score for low dynamic compliance comprised the presence of nasal flaring, see-saw respiration, suprasternal/intercostal retraction, and the respiratory rate ranks (0-3). The area under the receiver-operating characteristics curve of the composite score had discriminatory capability of 0.86 (95% confidence interval: 0.75-0.97) to predict low dynamic compliance with the optimal cut-off value of ≥3 (sensitivity, 0.882; specificity, 0.667).
CONCLUSION
Our novel scoring system might help predict newborn infants with low dynamic compliance, who may require escalation of respiratory support, or transfer to higher level units.
Topics: Female; Humans; Infant, Newborn; Lung Compliance; Male; ROC Curve; Respiration, Artificial; Respiratory Distress Syndrome, Newborn
PubMed: 30905442
DOI: 10.1016/j.pedneo.2019.02.006 -
Journal of Cardiothoracic Surgery Nov 2021Median sternotomy remains the most common approach in cardiovascular surgery. Recently, minimally invasive procedures, such as minimally invasive cardiac surgery, robot...
BACKGROUND
Median sternotomy remains the most common approach in cardiovascular surgery. Recently, minimally invasive procedures, such as minimally invasive cardiac surgery, robot surgery, and catheter therapy have been developed in cardiovascular surgery. However, all these surgeries cannot be performed by minimally invasive approaches. Several complications associated with median sternotomy have been reported, although post-sternotomy hemorrhage from the posterior intercostal artery is extremely rare.
CASE PRESENTATION
We present a case of posterior intercostal artery bleeding following lower partial sternotomy. A 79-year-old man underwent aortic valve replacement using lower partial median inverted L-shaped sternotomy that cut into the right second intercostal space. A postoperative chest radiograph indicated a hematoma in the right upper chest wall and pleural effusion. Hence, we inserted a drainage tube immediately. Approximately 2 hours after the surgery, his blood pressure gradually decreased. Blood drainage was observed from the tube, and the amount of blood drainage was not large. Contrast-enhanced computed tomography revealed a huge hematoma and hemorrhage from the fourth right posterior intercostal artery. Immediately, we performed emergency surgery. The lower partial sternotomy was repeated. We detected the origin of the bleeding that was identified in the right fourth posterior intercostal artery, and the bleeding was stopped. The postoperative course was uneventful.
CONCLUSIONS
This case highlights the possibility of intraoperative bleeding from the intercostal artery, even in the absence of clearly rib fracture. In our case, we did not identify the cause of bleeding, although we suggest the inhomogeneous stress on the posterior ribs upon attaching the sternal retractor for lower partial sternotomy may have affected the posterior intercostal artery.
Topics: Aged; Aortic Valve; Arteries; Heart Valve Prosthesis Implantation; Hemorrhage; Humans; Male; Minimally Invasive Surgical Procedures; Sternotomy; Treatment Outcome
PubMed: 34802439
DOI: 10.1186/s13019-021-01718-1 -
Journal of Laboratory Physicians 2019species are typical nosocomial pathogens causing infections and high mortality, almost exclusively in compromised hospitalized patients. sp. are intrinsically less...
BACKGROUND
species are typical nosocomial pathogens causing infections and high mortality, almost exclusively in compromised hospitalized patients. sp. are intrinsically less susceptible to antibiotics and have propensity to acquire resistance. Multidrug-resistant (MDR) sp. blood infection in the neonatal intensive care unit patients create a great problem in hospital settings.
AIMS
A prospective data analysis was performed over a one year period of all neonates admitted with sepsis who developed infection and their antibiotic susceptibility pattern was carried out.
MATERIALS AND METHODS
Blood samples of infected neonates were collected aseptically and cases of septicemia were identified. Speciation of species was done. Various risk factors were identified and their drug-sensitivity test was performed.
RESULTS
The incidence of neonatal septicemia due to species was 13.7% (49/357). Predominant species isolated was (98%). The major symptoms were lethargy and poor feeding. The major signs were tachypnea, intercostal retraction, and respiratory distress. The major fetal risk factors were low birth weight and prematurity. High degree of resistance was observed to the various antibiotics used. Majority of the isolates (95.9%) were MDR while 93.68% were resistant to carbapenems as well as extensively drug resistant. However, all the strains were sensitive to colistin.
CONCLUSION
MDR septicemia in neonatal patients is becoming alarmingly frequent and is associated with significant mortality and morbidity. Therefore, rational antibiotic use is mandatory along with an effective infection control policy in neonatal intensive care areas of each hospital to control infection and improve outcome.
PubMed: 30983798
DOI: 10.4103/JLP.JLP_129_18 -
Journal of Global Infectious Diseases 2024The severity of COVID-19 in the general population ranges from minimally symptomatic disease to critical illness, which may require hospitalization and progress to death.
INTRODUCTION
The severity of COVID-19 in the general population ranges from minimally symptomatic disease to critical illness, which may require hospitalization and progress to death.
METHODS
A retrospective cohort study carried out with all positive cases of COVID-19 reported in the municipality of Foz do Iguaçu (PR) between the period from March 2020 to December 2021. Data were collected from Bank Notifies COVID-19 is the name of the information system that provides notifications by professionals of suspected and confirmed cases of the disease. Data were analyzed using descriptive statistical techniques and calculation of relative risk.
RESULTS
24,647 confirmed cases were identified in the study; among these, 22,211 (90.1%) were not hospitalized and 2436 (9.9%) were hospitalized. Among the 2436 patients hospitalized for COVID-19, 947 (38.9%) died and 1489 (61.1%) recovered. Among the 22,211 outpatients, 93 (0.4%) died and 22,118 (99.6%) recovered. An association between death and the following characteristics was identified among the cases that were hospitalized: male gender, all age groups over 40 years, indigenous race/color, hospital staylength of more than 10 days,hospitalization in a Unified Health System (SUS) bed and in an Intensive Care Unit (ICU). According to the clinical characteristics of symptoms and comorbidities, the following prevailed:ities dyspnea, intercostal retraction, cyanosis, hypertension, diabetes, obesity, cardiovascular disease, smoking, lung disease, kidneydisease, neurological disease, neoplasia, and immunodeficiency. Among the cases that were not hospitalized, death was associated with: malegender, all age groups over 50 years, dyspnea, cyanosis, hypertension, diabetes, obesity, cardiovascular disease, kidney disease, neurological disease, neoplasia, and liver disease.
CONCLUSIONS
Older adults, male, and Caucasian people are commonly affected by COVID-19 and can evolve with aggravation when they have modifiable risk factors such as obesity and smoking, as well as nonmodifiable risk factors such as: cardiovascular disease, neurological disease, renal, hypertension, diabetes, and immunosuppression.
PubMed: 38680758
DOI: 10.4103/jgid.jgid_72_23 -
Indian Journal of Anaesthesia Mar 2021Pain of open thoracotomy is treated with systemic analgesics, thoracic epidural and paravertebral blocks which have associated adverse effects and complications....
BACKGROUND AND AIMS
Pain of open thoracotomy is treated with systemic analgesics, thoracic epidural and paravertebral blocks which have associated adverse effects and complications. Research shows ultrasound guided erector spinae plane block (US-ESPB) as a simpler and safer alternative. As paucity of data of US-ESPB in paediatric thoracotomies exists. We aimed at studying the analgesic efficacy of US-ESPB for paediatric thoracotomy.
METHODS
In a prospective observational study, 30 children, 1-12 years age undergoing thoracotomy with decortication under general anaesthesia with US-ESPB were observed. At induction, patient received intravenous (IV) fentanyl 3 μg/kg for analgesia and standard general endotracheal anaesthesia was administered. US-ESPB was given at fourth thoracic vertebral level with 0.25% bupivacaine 0.3 ml/kg. Changes in haemodynamic parameters at skin incision, rib retraction, pleural incision, intercostal drain insertion, and skin closure were noted. Intraoperatively, additional fentanyl was administered, if required and its dose and time were noted. Postoperative pain was assessed by visual analogue scale (VAS) (0-10) for ≥6 years and by face, leg, activity, cry, consolability (FLACC) score (0-10) for <6 years at post extubation, 30 minutes and hourly postoperatively. Descriptive statistical analysis was done using Statistical Package for the Social Sciences (SPSS) version 20.
RESULTS
Additional analgesic was not required in 14/30 patients (46.67%) intraoperatively and within 6 hours (7.4 ± 1.26) post-operatively. Five of the remaining 16 patients, required IV 1 μg/kg fentanyl only once intraoperatively. Median pain score was 2 in first four postoperative hours.
CONCLUSION
US-ESPB provided effective supplemental intraoperative and postoperative analgesia in nearly half of the paediatric thoracotomy patients.
PubMed: 33776114
DOI: 10.4103/ija.IJA_1461_20 -
Indian Journal of Otolaryngology and... Oct 2019Foreign body ingestion is common in infants and children, but they can pose a difficult situation and a diagnostic problem if the foreign body is embedded in the soft...
Foreign body ingestion is common in infants and children, but they can pose a difficult situation and a diagnostic problem if the foreign body is embedded in the soft tissues of the pharynx. To the best of our knowledge, this is the first case reported with such an unusually shaped foreign body having three sharp ends embedded at two different locations in the hypopharynx of a kid such small in age giving rise to respiratory as well as feeding problem. Secondly, a sharp foreign body penetrating arytenoid causing its swelling and inflammation, thus compromising the glottic opening and producing stridor is a rare phenomenon. We present a case of a 9 months old male infant who presented in ENT emergency with complaints of vomiting, refusal to accept solid as well as liquid feed for 5 days and sudden onset of abnormal grunting sounds on breathing for 1 day. Chest examination revealed intercostal retractions with decreased air entry bilaterally and conducted sounds in chest on auscultation. Abdomen examination revealed no abnormalities, and routine blood and urine investigations were also within normal limits. A metallic foreign body with three sharp ends was visualized in the neck X-ray, the retrieval of which by rigid hypopharyngoscopy relieved the symptoms.
PubMed: 31741920
DOI: 10.1007/s12070-015-0908-6 -
Journal of Clinical Medicine Sep 2022Ultrasound-guided pre-procedural planning decreases complications from bedside thoracentesis. Although rare, intercostal artery (ICA) laceration is a serious...
Ultrasound-guided pre-procedural planning decreases complications from bedside thoracentesis. Although rare, intercostal artery (ICA) laceration is a serious complication that occurs when vulnerable intercostal arteries (VICA) are no longer protected by the superior rib. We sought to determine if increasing patient age is associated with greater odds of encountering a VICA. Randomly selected in-patients underwent pre-procedural planning for a mock posterior bedside thoracentesis. ICAs were categorized as vulnerable if they were visible within the corresponding intercostal space (ICS). We recorded where the VICA entered and exited the ICS as well as its unshielded length. A total of 40 patients (20 male) were enrolled and 240 ICS (6 ICS per patient) were scanned. Within this cohort, 25% of patients were noted to have at least one VICA. We could not demonstrate any relationship between the patient's age or location of the ICS, with the odds of encountering a VICA (odds ratio (OR) = 1.0, = 0.76; OR = 0.85, = 0.27, respectively). Given the haphazard nature of VICA distribution and poor outcomes associated with inadvertent laceration, we recommend that ICA screening at the site of needle insertion be routinely performed prior to thoracentesis.
PubMed: 36233656
DOI: 10.3390/jcm11195788 -
Critical Care (London, England) 2009To determine whether subjecting patients to 100 ml of additional dead space after a 120-minute weaning trial could predict readiness for extubation. (Clinical Trial)
Clinical Trial
INTRODUCTION
To determine whether subjecting patients to 100 ml of additional dead space after a 120-minute weaning trial could predict readiness for extubation.
METHODS
This was a prospective, non-randomised pilot study in an intensive care unit at a university hospital with 14 beds. It included all non-tracheostomised patients with improvement of the underlying cause of acute respiratory failure, and those with no need for vasoactive or sedative drugs were eligible. Patients fulfilling the Consensus Conference on Weaning extubation criteria after 120 minutes spontaneous breathing (n = 152) were included. To the endotracheal tube, 100 cc dead space was added for 30 minutes. Patients tolerating the test were extubated; those not tolerating it received six hours of supplementary ventilation before extubation. The measurements taken and main results were: arterial pressure, heart rate, respiratory rate, oxygen saturation, end-tidal carbon dioxide and signs of respiratory insufficiency were recorded every five minutes; and arterial blood gases were measured at the beginning and end of the test. Extubation failure was defined as the need for mechanical and non-invasive ventilation within 48 hours of extubation.
RESULTS
Twenty-two patients (14.5%) experienced extubation failure. Only intercostal retraction was independently associated with extubation failure. The sensitivity (40.9%) and specificity (97.7%) yield a probability of extubation failure of 75.1% for patients not tolerating the test versus 9.3% for those tolerating it.
CONCLUSIONS
Observing intercostal retraction after adding dead space may help detect susceptibility to extubation failure. The ideal amount of dead space remains to be determined.
TRIAL REGISTRATION
Current Controlled Trials ISRCTN76206152.
Topics: Aged; Aged, 80 and over; Decision Making; Female; Humans; Intensive Care Units; Intubation, Intratracheal; Male; Middle Aged; Pilot Projects; Predictive Value of Tests; Prospective Studies; Respiratory Dead Space; Spain; Ventilator Weaning
PubMed: 19366440
DOI: 10.1186/cc7783 -
European Annals of Otorhinolaryngology,... Oct 2012Laryngomalacia is defined as collapse of supraglottic structures during inspiration. It is the most common laryngeal disease of infancy. Laryngomalacia presents in the...
Laryngomalacia is defined as collapse of supraglottic structures during inspiration. It is the most common laryngeal disease of infancy. Laryngomalacia presents in the form of stridor, a high-pitched, musical, vibrating, multiphase inspiratory noise appearing within the first 10 days of life. Signs of severity are present in 10% of cases: poor weight gain (probably the most contributive element), dyspnoea with permanent and severe intercostal or xyphoid retraction, episodes of respiratory distress, obstructive sleep apnoea, and/or episodes of suffocation while feeding or feeding difficulties. The diagnosis is based on systematic office flexible laryngoscopy to confirm laryngomalacia and exclude other causes of supraglottic obstruction. Rigid endoscopy under general anaesthesia is only performed in the following cases: absence of laryngomalacia on flexible laryngoscopy, presence of laryngomalacia with signs of severity, search for any associated lesions prior to surgery, discrepancy between the severity of symptoms and the appearance on flexible laryngoscopy, and/or atypical symptoms (mostly aspirations). The work-up must be adapted to each child; however, guidelines recommend objective respiratory investigations in infants presenting signs of severity.
Topics: Diagnosis, Differential; Failure to Thrive; Humans; Infant; Infant, Newborn; Laryngomalacia; Laryngoscopy; Respiratory Sounds; Severity of Illness Index; Sleep Apnea, Obstructive
PubMed: 23078980
DOI: 10.1016/j.anorl.2012.03.005 -
BMJ Open Dec 2016Open chest surgery (thoracotomy) is considered the most painful of surgical procedures. Forceful wound retraction, costochondral dislocation, posterior costovertebral... (Comparative Study)
Comparative Study Randomized Controlled Trial
Randomised controlled pilot study to investigate the effectiveness of thoracic epidural and paravertebral blockade in reducing chronic post-thoracotomy pain: TOPIC feasibility study protocol.
INTRODUCTION
Open chest surgery (thoracotomy) is considered the most painful of surgical procedures. Forceful wound retraction, costochondral dislocation, posterior costovertebral ligament disruption, intercostal nerve trauma and wound movement during respiration combine to produce an acute, severe postoperative pain insult and persistent chronic pain many months after surgery is common. Three recent systematic reviews conclude that unilateral continuous paravertebral blockade (PVB) provides analgesia at least equivalent to thoracic epidural blockade (TEB) in the postoperative period, has a lower failure rate, and symptom relief that lasted months. Crucially, PVB may reduce the development of subsequent chronic pain by intercostal nerve protection or decreased nociceptive input. The overall aim is to determine in patients who undergo thoracotomy whether perioperative PVB results in reducing chronic post-thoracotomy pain (CPTP) compared with TEB. This pilot study will evaluate feasibility of a substantive trial.
METHODS AND ANALYSIS
TOPIC is a randomised controlled trial comparing the effectiveness of TEB and PVB in reducing CPTP. This is a pilot study to evaluate feasibility of a substantive trial and study processes in 2 adult thoracic centres, Heart of England NHS Foundation Trust (HEFT) and University Hospital of South Manchester NHS Foundation Trust (UHSM). The primary objective is to establish the number of patients randomised as a proportion of those eligible. Secondary objectives include evaluation of study processes. Analyses of feasibility and patient-reported outcomes will primarily take the form of simple descriptive statistics and where appropriate, point estimates of effects sizes and associated 95% CIs.
ETHICS AND DISSEMINATION
The study has obtained ethical approval from NHS Research Ethics Committee (REC number 14/EM/1280). Dissemination plan includes: informing patients and health professionals; engaging multidisciplinary professionals to support a proposal of a definitive trial and submission for a full HTA application dependent on the success of the study.
TRIAL REGISTRATION NUMBER
ISRCTN45041624; Pre-results.
Topics: Analgesia, Epidural; Chronic Pain; Feasibility Studies; Humans; Nerve Block; Pain, Postoperative; Pilot Projects; Research Design; Single-Blind Method; Thoracic Vertebrae; Thoracotomy
PubMed: 27909035
DOI: 10.1136/bmjopen-2016-012735