CT 3-Dimentional Airway Reconstruction-guided Intraluminal Placement of Endobronchial Blocker in Pediatric Patients: A Randomized Controlled Study

2020 ◽  
Author(s):  
Yingyi Xu ◽  
Na Zhang ◽  
Yonghong Tan ◽  
Minting Zeng ◽  
Jianning Hou ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Thoracic Surgery ◽  
Pulmonary Infection ◽  
Pediatric Patients ◽  
Mucosal Injury ◽  
Tracheal Extubation ◽  
Lung Collapse ◽  
Airway Reconstruction ◽  
Endobronchial Blocker ◽  
Postoperative Mechanical Ventilation

Abstract Background: The one-lung ventilation (OLV) with endobronchial blocking is commonly used in anesthesia for pediatric thoracic surgery. Bronchoscopy is commonly used to guide the endobronchial blocker placement. However, when bronchoscopy is not applicable, the proper placement of endobronchial blocker is challenging. The computed tomography (CT) 3-dimentional reconstruction may be used to accurately measure the airway of pediatric patients. The present study was aimed to propose a new approach of CT 3-dimentional airway reconstruction-guided endobronchial blocker placement in pediatric patients and to determine its efficiency in clinical application.Methods: A total of 127 pediatric patients of 0.5-3 years old who would undergo elective thoracic surgery under OLV were randomized into the bronchoscopy group and the CT group. The degree of lung collapse, postoperative airway mucosal injury, pulmonary infection within 72 h after surgery, trachyphonia after tracheal extubation, durations of postoperative mechanical ventilation, intensive care unit (ICU) stay, and hospitalization, the successful rate of the first blocker positioning, and the required time and repositionings for successful blocker placement were compared between the two groups.Results: The degree of lung collapse, postoperative airway mucosal injury, pulmonary infection within 72 h after surgery, trachyphonia after tracheal extubation, durations of postoperative mechanical ventilation, ICU stay, and hospitalization were similar between the two groups (all P > 0.05).Conclusions: For pediatric patients who would undergo surgery with OLV, preoperative CT 3-dimentional airway reconstruction could be used to guide endobronchial blocker placement, with a blocking efficiency similar to that of bronchoscopy-guided blocker placement.The trial was registered prior to patient enrollment at China Clinical Trial Registry (http://www.chictr.org.cn/showproj.aspx?proj=4344, Principal investigator: Yingyi Xu, Registration number: ChiCTR-TRC-14005232, Date of registration: 12 August 2014).

scholarly journals CT- 3-DimenSional airway evaluation-guided intraluminal placement of endobronchial blocker in pediatric patients: a randomized controlled study

2020 ◽  
Author(s):  
Yingyi Xu ◽  
Na Zhang ◽  
Wei Wei ◽  
Yonghong Tan ◽  
Minting Zeng ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Thoracic Surgery ◽  
Pulmonary Infection ◽  
Pediatric Patients ◽  
Mucosal Injury ◽  
Tracheal Extubation ◽  
Lung Collapse ◽  
3 Dimensional ◽  
Endobronchial Blocker ◽  
Postoperative Mechanical Ventilation

Abstract Background: One-lung ventilation (OLV) with endobronchial blocking is commonly used in anesthesia for pediatric thoracic surgery. Bronchoscopy is commonly used to guide the endobronchial blocker placement. However, when bronchoscopy is not applicable, the proper placement of endobronchial blocker is challenging. Computed tomography (CT)-3-DimenSional evaluation may be used to accurately measure the airway of pediatric patients. The present study was aimed to propose a new approach of CT-3-DimenSional airway evaluation-guided endobronchial blocker placement in pediatric patients and to determine its efficiency in clinical application. Methods: A total of 127 pediatric patients of 0.5-3 years old scheduled for elective thoracic surgery under OLV were randomized into the bronchoscopy group and the CT group. The degree of lung collapse, postoperative airway mucosal injury, pulmonary infection within 72 hour after surgery, hoarseness after tracheal extubation, Durations of postoperative mechanical ventilation, intensive care unit (ICU) stay, and hospitalization, the successful rate of the first blocker positioning, and the required time and repositionings for successful blocker placement were compared between the two groups. Results: The degree of lung collapse, postoperative airway mucosal injury, pulmonary infection within 72 hour after surgery, hoarseness after tracheal extubation, durations of postoperative mechanical ventilation, ICU stay, and hospitalization were similar between the two groups (all P > 0.05). Conclusions: For pediatric patients who would undergo surgery with OLV, preoperative CT 3-DimenSional airway evaluation could be used to guide endobronchial blocker placement, with a blocking efficiency similar to that of bronchoscopy-guided blocker placement.

scholarly journals CT- 3-DimenSional airway evaluation-guided intraluminal placement of endobronchial blocker in pediatric patients: a randomized controlled study

2020 ◽  
Author(s):  
Yingyi Xu ◽  
Na Zhang ◽  
Wei Wei ◽  
Yonghong Tan ◽  
Minting Zeng ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Thoracic Surgery ◽  
Pulmonary Infection ◽  
Pediatric Patients ◽  
Mucosal Injury ◽  
Tracheal Extubation ◽  
Lung Collapse ◽  
3 Dimensional ◽  
Endobronchial Blocker ◽  
Postoperative Mechanical Ventilation

Abstract Background: One-lung ventilation (OLV) with endobronchial blocking is commonly used in anesthesia for pediatric thoracic surgery. Bronchoscopy is commonly used to guide the endobronchial blocker placement. However, when bronchoscopy is not applicable, the proper placement of endobronchial blocker is challenging. Computed tomography (CT)-3-DimenSional evaluation may be used to accurately measure the airway of pediatric patients. The present study was aimed to propose a new approach of CT-3-DimenSional airway evaluation-guided endobronchial blocker placement in pediatric patients and to determine its efficiency in clinical application. Methods: A total of 127 pediatric patients of 0.5-3 years old scheduled for elective thoracic surgery under OLV were randomized into the bronchoscopy group and the CT group. The degree of lung collapse, postoperative airway mucosal injury, pulmonary infection within 72 hour after surgery, hoarseness after tracheal extubation, Durations of postoperative mechanical ventilation, intensive care unit (ICU) stay, and hospitalization, the successful rate of the first blocker positioning, and the required time and repositionings for successful blocker placement were compared between the two groups. Results: The degree of lung collapse, postoperative airway mucosal injury, pulmonary infection within 72 hour after surgery, hoarseness after tracheal extubation, durations of postoperative mechanical ventilation, ICU stay, and hospitalization were similar between the two groups (all P > 0.05). Conclusions: For pediatric patients who would undergo surgery with OLV, preoperative CT 3-DimenSional airway evaluation could be used to guide endobronchial blocker placement, with a blocking efficiency similar to that of bronchoscopy-guided blocker placement.

scholarly journals Tracheostomy in Postoperative Pediatric Cardiac Surgical Patients—The Earlier, the Better

2021 ◽  
Author(s):  
Chalattil Bipin ◽  
Manoj K. Sahu ◽  
Sarvesh P. Singh ◽  
Velayoudam Devagourou ◽  
Palleti Rajashekar ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Cardiac Surgery ◽  
Hospital Stay ◽  
Pediatric Patients ◽  
Tertiary Care ◽  
Surgical Patients ◽  
Surgical Intensive Care Unit ◽  
Care Hospital ◽  
Surgical Intensive Care ◽  
Nutrition Supplementation

Abstract Objectives This study was aimed to assess the benefits of early tracheostomy (ET) compared with late tracheostomy (LT) on postoperative outcomes in pediatric cardiac surgical patients. Design Present one is a prospective, observational study. Setting The study was conducted at a cardiac surgical intensive care unit (ICU) of a tertiary care hospital. Participants All pediatric patients below 10 years of age, who underwent tracheostomy after cardiac surgery from January2019 to december2019, were subdivided into two groups according to the timing of tracheostomy: “early” if done before 7 days or “late” if done after 7 days postcardiac surgery. Interventions ET versus LT was measured in the study. Results Out of all 1,084 pediatric patients who underwent cardiac surgery over the study period, 41 (3.7%) received tracheostomy. Sixteen (39%) patients underwent ET and 25 (61%) underwent LT. ET had advantages by having reduced risk associations with the following variables: preoperative hospital stay (p = 0.0016), sepsis (p = 0.03), high risk surgery (p = 0.04), postoperative sepsis (p = 0.001), C-reactive protein (p = 0.04), ventilator-associated pneumonia (VAP; p = 0.006), antibiotic escalation (p = 0.006), and antifungal therapy (p = 0.01) requirement. Furthermore, ET was associated with lesser duration of mechanical ventilation (p = 0.0027), length of ICU stay (LOICUS; p = 0.01), length of hospital stay (LOHS; p = 0.001), lesser days of feed interruption (p = 0.0017), and tracheostomy tube change (p = 0.02). ET group of children, who had higher total ventilation-free days (p = 0.02), were decannulated earlier (p = 0.03) and discharged earlier (p = 0.0089). Conclusion ET had significant benefits in reduction of postoperative morbidities with overall shorter mechanical ventilation, LOICUS, and LOHS, better nutrition supplementation, lesser infection, etc. These benefits may promote faster patient convalescence and rehabilitation with reduced hospital costs.

Tracheal Extubation of Deeply Anesthetized Pediatric Patients

1999 ◽  
Vol 88 (4) ◽  
pp. 742-745 ◽  
Author(s):  
Robert D. Valley ◽  
Justin T. Ramza ◽  
Pauletta Calhoun ◽  
Eugene B. Freid ◽  
Ann G. Bailey ◽  
...  
Keyword(s):  
Pediatric Patients ◽  
Tracheal Extubation

Factors Associated with Respiratory Support after Cesarean Hysterectomy

2021 ◽  
Vol 104 (8) ◽  
pp. 1347-1353
Keyword(s):  
Mechanical Ventilation ◽  
Hospital Stay ◽  
Hospital Length Of Stay ◽  
Respiratory Support ◽  
Blood Components ◽  
Factors Associated ◽  
Cesarean Hysterectomy ◽  
Asa Classification ◽  
The Relationship ◽  
Postoperative Mechanical Ventilation

Background: Cesarean hysterectomy is a major operation that causes massive hemorrhage and larger fluid resuscitation. Thus, postoperative mechanical ventilation support is required in some patients, involving longer hospital stay and high cost of hospital care. Objective: To find the predictive factors for postoperative respiratory support in pregnant women underwent cesarean hysterectomy. Materials and Methods: A retrospective review of patients underwent cesarean hysterectomy between January 2014 and June 2019 was conducted. Patient characteristics, anesthetic records and hospital length of stay were reviewed. The relationship between factors and postoperative mechanical ventilator (PMV) was also analyzed. Results: A total of 180 patients were included in the present study, wherein, 64 patients (35%) required PMV and 30 patients (16%) needed postoperative oxygen support. Multivariable logistic regression was used to identify the relationship between PMV and the associated factors. The authors found the American Society of Anesthesiologists (ASA) classification and the volume of intraoperative blood components replacement (packed red blood cells [PRC] and fresh frozen plasma [FFP]) were significantly related to PMV: ASA3 16.51 (95% CI 1.89 to 144.33), ASA4 183.25 (95% CI 2.92 to 11,500.65), p=0.003; PRC 1.0028 (95% CI 1.0008 to 1.0047), p=0.001; FFP 1.0022 (95% CI 1.0000 to 1.0043), p=0.029, respectively. Conclusion: Postoperative mechanical ventilation was found in one-third of the cesarean hysterectomy patients and associated with ICU admission along with increased in post-operative length of hospital stay. The ASA classification and intraoperative volume of blood components replacement were significantly associated with PMV. Factors associated significantly with respiratory support were ASA classification and duration surgery. Keywords: Factors associated; Respiratory support; Cesarean hysterectomy

scholarly journals Pediatric patients with home mechanical ventilation: The health services landscape

2018 ◽  
Vol 54 (1) ◽  
pp. 40-46 ◽  
Author(s):  
Sarah A. Sobotka ◽  
Dipika S. Gaur ◽  
Denise M. Goodman ◽  
Rishi K. Agrawal ◽  
Jay G. Berry ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Health Services ◽  
Pediatric Patients ◽  
Home Mechanical Ventilation

scholarly journals Estimation of change in pleural pressure in assisted and unassisted spontaneous breathing pediatric patients using fluctuation of central venous pressure: A preliminary study

PLoS ONE ◽  
2021 ◽  
Vol 16 (3) ◽  
pp. e0247360
Author(s):  
Nao Okuda ◽  
Miyako Kyogoku ◽  
Yu Inata ◽  
Kanako Isaka ◽  
Kazue Moon ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Spontaneous Breathing ◽  
Pediatric Patients ◽  
Venous Pressure ◽  
Balloon Catheter ◽  
Pleural Pressure ◽  
Respiratory Effort ◽  
Central Venous ◽  
Mechanically Ventilated ◽  
Esophageal Balloon

Background It is important to evaluate the size of respiratory effort to prevent patient self-inflicted lung injury and ventilator-induced diaphragmatic dysfunction. Esophageal pressure (Pes) measurement is the gold standard for estimating respiratory effort, but it is complicated by technical issues. We previously reported that a change in pleural pressure (ΔPpl) could be estimated without measuring Pes using change in CVP (ΔCVP) that has been adjusted with a simple correction among mechanically ventilated, paralyzed pediatric patients. This study aimed to determine whether our method can be used to estimate ΔPpl in assisted and unassisted spontaneous breathing patients during mechanical ventilation. Methods The study included hemodynamically stable children (aged <18 years) who were mechanically ventilated, had spontaneous breathing, and had a central venous catheter and esophageal balloon catheter in place. We measured the change in Pes (ΔPes), ΔCVP, and ΔPpl that was calculated using a corrected ΔCVP (cΔCVP-derived ΔPpl) under three pressure support levels (10, 5, and 0 cmH2O). The cΔCVP-derived ΔPpl value was calculated as follows: cΔCVP-derived ΔPpl = k × ΔCVP, where k was the ratio of the change in airway pressure (ΔPaw) to the ΔCVP during airway occlusion test. Results Of the 14 patients enrolled in the study, 6 were excluded because correct positioning of the esophageal balloon could not be confirmed, leaving eight patients for analysis (mean age, 4.8 months). Three variables that reflected ΔPpl (ΔPes, ΔCVP, and cΔCVP-derived ΔPpl) were measured and yielded the following results: -6.7 ± 4.8, − -2.6 ± 1.4, and − -7.3 ± 4.5 cmH2O, respectively. The repeated measures correlation between cΔCVP-derived ΔPpl and ΔPes showed that cΔCVP-derived ΔPpl had good correlation with ΔPes (r = 0.84, p< 0.0001). Conclusions ΔPpl can be estimated reasonably accurately by ΔCVP using our method in assisted and unassisted spontaneous breathing children during mechanical ventilation.

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