ABSTRACT
Childhood diseases such as bronchial asthma and acute bronchiolitis have both been linked to lower airway obstruction with the possibility of developing acute lung injury. Management usually necessitates the intervention of mechanical ventilation with its risks and complications. In addition, serum levels of lnterleukin-4 [IL-4] and Interleukin-5 [IL-5] have been found to be associated in the pathogenesis of this condition and are known to be elevated in these patients. This study was designed to evaluate the use of IL-4 and IL-5 as predictive factors and markers of inflammation for a successful response to non-invasive ventilation [NIV] in children with acute severe lower airway obstruction. This iia prospective study that included 40 cases presented with acute respiratory distress secondary to lower airway obstruction including acute exacerbations of asthma and acute bronchiolitis. Cases were classified randomly into two groups; Group A: patients who received NIV plus standard conventional therapy if needed, and Group B: control patients who received only standard conventional therapy without NIV. Serum IL-4 and IL-5 were measured in all patients on admission and after treatment. We have found that there was significant improvement of all the clinical parameters in addition to a reduction in the need of invasive ventilation. There were also a significant reduction in the serum levels of the studied interleukins 4 and 5 after the completion of therapy as indicated by p<.001 in both cytokines. This may give a key for the importance of the early use of NIV as a first line of treatment of severe cases of lower airway obstruction and highlights the importance of using serum IL-4 and IL-5 as parameters of improvement
ABSTRACT
The main objective of this survey is to describe the current practice of thoracic anesthesia in the Middle Eastern [ME] region. A prospective online survey. An invitation to participate was e-mailed to all members of the ME thoracic- anaesthesia group. A total of 58 members participated in the survey from 19 institutions in the Middle East. Questions concerned ventilation strategies during one-lung ventilation [OLV], anesthesia regimen, mode of postoperative analgesia, use of lung isolation techniques, and use of i.v. fluids. Volume-controlled ventilation was favored over pressure-controlled ventilation [62% vs 38% of respondents, P < 0.05]; 43% report the routine use of positive end-expiratory pressure. One hundred percent of respondents report using double-lumen tube [DLT] as a first choice airway to establish OLV. Nearly a third of respondents, 31.1%, report never using bronchial blocker [BB] in their thoracic anesthesia practice. Failure to pass a DLT and difficult airway are the most commonly cited indications for BB use. Regarding postoperative analgesia, the majority 61.8% favor thoracic epidural analgesia over other techniques [P < 0.05]. Our survey provides a contemporary snapshot of the ME thoracic anesthetic practice