Study on tracheal intubation related severe subglottic stenosis under laryngeal mask by using holmium laser combined with argon plasma coagulation and cryotherapy through bronchoscopy / 中华实用儿科临床杂志

Objective To explore the operating methods,the effectiveness and safety for 2 cases of tracheal in-tubation related severe subglottic stenosis under laryngeal mask by using bronchoscopy in the diagnosis and interven-tional treatment. Methods Two male patients ( age at 4 and 11 months) both had difficulty breathing and weaning failure after endotracheal intubation,who were diagnosed with severe subglottic stenosis through CT and bronchoscopy examination. All parents signed their consent after being fully informed of treatment risks. Two cases were treated under bronchoscopic holmium laser combined with argon plasma coagulation and freezing treatment by using the laryngeal mask. The clinical data, complications and postoperative outcome and follow-up were analyzed. Results Two cases were operated successfully,the subglottic granulation tissue of 1 case was completely removed,2 cases of patients had subglottic narrow annular completely removed, and there was no problem for 4. 0 mm bronchoscope to get through,postoperative tracheal catheter was successfully extracted,dyspnea was significantly improved. Two cases imme-diately showed well open after treatment,7 d,30 d and 90 d through endoscopic examination. During the operation,oxy-gen saturation decreased and heart rate increased fast or slowed down,but after operation and oxygen got resumed,they immediately recovered,and there were no abnormal hemodynamic changes during and after operation. The two cases were still under follow-up. Conclusions The laryngeal mask holmium laser,argon plasma coagulation and cryotherapy can be used to remove acquired granulation tissue hyperplasia caused by subglottic stenosis,which is safe and effective, and the short-term effect was remarkable. Long-term effect still needs to be further assessed through follow-up.

Management and prevention of foreign body aspiration in children / 中华实用儿科临床杂志

Objective To put forward the prevention advice on foreign body suction,and to discuss the effica-cy,safety and application experience of flexible bronchoscopy in the diagnosis and treatment of tracheobronchial foreign bodies in children. Methods The treatment experience of 38 cases for airway foreign body removal with flexible bron-choscopy and granulation tissue proliferation in Argon plasma coagulation ( APC ) ( argon knife ) combining carbon dioxide( CO2 ) cryotherapy in Bayi Children′s Hospital Affiliated to General Hospital of Beijing Military Command from January 2013 to December 2014 were reviewed,and the clinical data including age,gender,treatment time for inhaled foreign body,clinical and X-ray manifestations,location of the foreign body,treatment with bronchoscopy with APC and cryotherapy,complications and outcomes were analyzed. Results There were 38 cases of patients including 31 male (81. 6%) and 7 female(18. 4%),aged from 10 months to 14 years old,with mean age 28. 5 months;among them there were 30 cases with definite history of foreign body,accounting for 78. 9%;the most common clinical symptom was cough among the cases,accounting for 84. 3%;X ray showed 15 cases with ipsilateral lung atelectasis,accounting for 39. 5%, emphysema in 17 cases,accounting for 44. 7%,pneumonia change in 6 cases,accounting for 15. 8%,there were 11 ca-ses who had lung computerized tomography examination when coming to the hospital,and only 1 case could be seen to have foreign body shadow;microscopic examination found that inhaled foreign body in the right bronchus accounted for 57. 9%,and peanut was the main foreign body inhalation in this group;only 4 cases(10. 5%) had definite diagnosis and foreign body removal within 24 h after foreign body aspiration,moreover,34 cases(89. 5%) with foreign body aspi-ration got the diagnosis and treatment after 24 h;crying was the primary inducement for inhaled foreign body. All the 38 cases of children with inhaled foreign body experienced removal under flexible bronchoscopy. There were 19 cases (50. 0%) who had granulation tissue proliferation around the foreign body,among which 5 cases of foreign body was wrapped by the proliferation of granulation tissue,with APC dealing with the granulation tissue of foreign body surface to remove foreign body after exposure,then giving CO2 cryotherapy. Nevertheless,there were 9 cases of foreign body who had granulation tissue but was not wrapped,receiving CO2 cryotherapy directly after the foreign body removal. One case of this group had bradycardia during the surgery,and 2 cases had postoperative bleeding,but there was no death cases with foreign bodies removal. Conclusions Education is the key to prevent foreign body aspiration in infants under 3 years old. Flexible bronchoscopy is safe to remove foreign bodies from the respiratory tract and has fewer complications, so it is one of the alternative methods in diagnosis and treatment of foreign body inhalation.

Argon plasma coagulation combined CO2 freezing through the flexible bronchoscope for treatment of airway granulation proliferation in children / 中华儿科杂志

<p><b>OBJECTIVE</b>To explore the safety and the efficacy of bronchoscopic argon plasma coagulation (APC) combined with CO2 freezing for the treatment of airway granulation hyperplasia after pediatric airway stenting.</p><p><b>METHOD</b>From April 2010 to December 2012, APC combined CO2 cryotherapy was performed for granulation tissue hyperplasia in 8 children after airway stenting, their clinical data, complications and postoperative outcomes and follow-up data were analyzed.</p><p><b>RESULT</b>Five of the 8 cases were male and 3 female, when stenting their age was 2 to 17 months, the average age was (8.63 ± 5.50) months. Granulation tissue hyperplasia appears in the range of bracket covering, common to both ends of the stent. The time from stentinging to find hyperplasia of granulation tissue was 20 days to 19 months. As a result, in 30%-100% of children airway narrowing was found. We applied APC treatment when the bronchoscopy found hyperplasia lesions, then we used CO2 cryotherapy, i.e., freezing was persisted for 1 min twice and more, then the probe was moved until the APC burning area was entirely frozen, dyspnea in children were significantly improved and two cases of atelectasis patients' lung were completely re-expanded. Eight patients had varying degrees of postoperative low to moderate fever, three cases had a small amount of active bleeding after APC treatment, hemostasis was achieved after topical application of endoscopic injection of epinephrine or reptilase bleeding and freezing, no complications occurred with CO2 cryotherapy. According to the efficacy criteria in this article, the result was significantly effective in 6 cases, effective in 1 case, and partially effective in 1 case.</p><p><b>CONCLUSION</b>APC combined with CO2 cryotherapy may be one of the optional methods that rapidly eliminates granulation tissue and remove the airway obstruction, so it can be used in treatment of pediatric airway' benign lesions.</p>

Clinical application of blood purification (artificial liver) in treatment of acute liver failure in children / 中华儿科杂志

<p><b>OBJECTIVE</b>To investigate the clinical application, indication, timing and prognosis of blood purification (artificial liver, BP) in treatment of acute liver failure in children.</p><p><b>METHOD</b>Artificial liver was used to treat 30 cases of pediatric acute liver failure (PALF), who were hospitalized in pediatric intensive care unit of Bayi Children's Hospital Affiliated to Beijing Military Command General Hospital, during March 2010 to July 2013. Simple plasma exchange (PE) mode was used for PALF without complications, while PE combined with continuous veno-venous hemodiafiltration (CVVHDF) mode was used for PALF with cerebral edema and/or hepatorenal syndrome and/or serious abnormality of electrolyte and acid-base balance.</p><p><b>RESULT</b>Sixteen cases survived and restored hepatic function, with a survival rate of 53.3%. Single PE therapy could significantly decrease total bilirubin (TBIL) from (293.96 ± 214.52) µmol/L to (155.64 ± 140.97) µmol/L (P = 0.033), increase prothrombin time activity (PTA) from (34.50 ± 18.34) % to (60.50 ± 33.97) % (P = 0.013), while it did not significantly influence ammonia from (156.43 ± 67.23) µmol/L to (124.03 ± 62.58) µmol/L (P = 0.156) and alanine transarninase (ALT) from (752.53 ± 1 291.84) U/L to (132.00 ± 98.57) U/L (P = 0.066). PE + CVVHDF therapy could significantly ameliorate TBIL from (326.90 ± 233.85) µmol/L to (157.53 ± 125.31) µmol/L (P = 0.033), ALT from (1 476.64 ± 1 728.18) U/L to (169.38 ± 207.18) U/L (P = 0.019), ammonia from (215.83 ± 83.92) µmol/L to (141.25 ± 63.09) µmol/L (P = 0.022) and PTA from (36.68 ± 23.13)% to (71.75 ± 50.50) % (P = 0.044). Prothrombin time (PT) from (29.71 ± 17.75)s to (16.27 ± 6.38)s (P = 0.008) , ALT from (1 574.11 ± 1 775.96) U/L to (145.81 ± 113.89 ) U/L (P = 0.003) , TBIL from (233.16 ± 219.70) µmol/L to (75.19 ± 86.07) µmol/L (P = 0.012) , ammonia from (182.75 ± 90.07) µmol/L to (101.81 ± 37.14) µmol/L (P = 0.002) and PTA from (38.38 ± 20.39)% to (83.13 ± 41.68)% (P = 0.001) in survived cases significantly ameliorated after BP therapy. TBIL from (394.04 ± 192.80) µmol/L to (249.34 ± 113.97) µmol/L (P = 0.023) in died cases declined significantly after BP therapy, while alteration of PT, ALT, ammonia , and PTA had no statistical significance (P > 0.10) after BP therapy.</p><p><b>CONCLUSION</b>PE + CVVHDF therapy could significantly ameliorate not only TBIL and PTA but also ammonia and ALT compared with single PE therapy. The decline of only an index like TBIL or ALT after BP therapy could not improve the prognosis. The inconsistency between serum bilirubin and ALT levels was an important factor that suggested poor prognosis of ALF, and it might increase survival rate to use BP therapy before that inconsistency emerged.</p>

The application of continuous blood purification in children with severe sepsis and regulation on the inflammatory factor of interleukin-6 and tumor necrosis factor-α / 中国小儿急救医学

Objective To evaluate the clinical effect of continuous blood purification (CBP) in treatment of children with severe sepsis,and analyze the changes of severity of illness and inflammatory factors,which can provide the proof for treatment of children with severe sepsis.Methods Twenty cases with severe sepsis admitted to pediatric intensive care unit of Bayi Children's Hosptial Affiliated to General Hospital of Beijing Military Commond from Aug 2008 to May 2011 were treated with CBP.The mean arterial blood pressure,boost dosages,urine output,arterial blood gases,and oxygenation index were collected before CBP and 12,24,48 hours after CBP treatment.The levels of interleukin (IL)-6 and tumor necrosis factor (TNF)-α were determined by enzyme-linked immunosorbent assay.Pediatric critical illness scores were assessed before and 48 h after CBP treatment.Results After the treatment of CBP,16 children were clinical improvement,2 died,2 abandoned the treatment.CBP was effective in the treatment by rising the mean arterial blood pressure (P ＜ 0.01),decreasing the dosages of dopamine and epinephrine (P ＜ 0.01),increasing urine output(P ＜ 0.01).The value of pH and base excess returned to normal basically.The levels of IL-6 and TNF-α were(706.90 ± 275.95) ng/L,(989.67 ± 386.33) ng/L before the CBP.The levels of IL-6 and TNF-α decreased to (162.59 ± 63.47) ng/L,(439.08 ± 159.37) ng/L at 48 h after CBP treatment (P ＜0.01).The pediatric critical illness scores were 67.59 ± 25.02 and 87.05 ± 32.81 before CBP and at 48 h after CBP,which showed significant difference (P ＜ 0.01).Conclusion The treatment of CBP can remove inflammatory factors in children with severe sepsis and improve the severity of illness.