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@#Objective To systematically review the clinical utilization of robotic bronchoscopes in diagnosis of pulmonary nodules, including MonarchTM and IonTM platforms, and then evaluate the efficacy and safety of the procedure. Methods PubMed, EMbase, Web of Science and Cochrane Central Register of Controlled Trials databases were searched by computer for literature about the biopsy of pulmonary nodules with robotic bronchoscope from January 2018 to February 14, 2022. The quality of research was evaluated with Newcastle-Ottawa Scale. RevMan 5.4 software was used to conduct the meta-analysis. Results Finally, 19 clinical studies with 1 542 patients and 1 697 targeted pulmonary nodules were included, of which 13 studies used the IonTM platform and 6 studies used the MonarchTM platform. The overall diagnostic rate of the two systems was 84.96% (95%CI 62.00%-95.00%), sensitivity for malignancy was 81.79%(95%CI 43.00%-96.00%), the mean maximum diameter of the nodules was 16.22 mm (95%CI 10.98-21.47), the mean procedure time was 61.86 min (95%CI 46.18-77.54) and the rate of complications occurred was 4.76% (95%CI 2.00%-15.00%). There was no statistical difference in the outcomes between the two systems. Conclusion Robotic bronchoscope provides a high efficacy and safety in biopsy of pulmonary nodules, and has a broad application prospect for pulmonary nodules diagnosis.
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Abstract Introduction Airway foreign bodies are emergencies involving multidisciplinary departments like Pediatrics, Aneasthesiology and Otorhinolaryngology. It is always a challenge to diagnose and manage patients who present late to our emergencies. Objective In the present study, we aim to analyze the various challenges faced during the management of tracheobronchial foreign bodies with delayed presentation. Methods A retrospective hospital record-based analysis of patients who presented to us with tracheobronchial foreign bodies from January 2017 to February 2020 was performed. All patients until the age of 16 years old were included in the present study. We assessed the demographics, preoperative, intraoperative and postoperative data of the patients. Results Seventeen patients were analyzed in the study. Among these, 44.4% of the patients had delayed presentation (> 1 month). The majority of the patients had an organic foreign body (Supari or betel nut). All patients underwent rigid bronchoscopy, followed by optical forceps-assisted removal of the foreign body. A total of 82% of the patients had granulations around the foreign body. Conclusion Management of delayed presentation tracheobronchial foreign body is a big challenge for Otorhinolaryngologists. The key factors for preventing complications in the definitive management of tracheobronchial foreign bodies are preoperative planning, multi-discipline teamwork, surgeon expertise and technique.
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Objective @#To discuss and summarize the preventive measures and treatment methods for aspiration/ingestion during dental procedures.@*Methods @# One case of aspiration during an implant operation was reported, and the literature on aspiration/ingestion during oral procedures was reviewed.@*Results@#An implant screwdriver accidentally slipped into the mouth of the patient during implant surgery. The patient experienced no obvious discomfort except a few coughs. The surgeon and assistant paused the procedure immediately to search for the screwdriver, but it was not found. The patient declared that there was no special abnormality, such as breathing disorder or chest distress, so we considered that the foreign body was ingestion. After the implant surgery was completed, no foreign body was found in the stomach via gastroscopy. Chest X-ray and CT showed a dense metal shadow in the lower lobe of the left lung. Under local anesthesia, bronchoscopy and biopsy forceps were used by respiratory physicians to clip out the foreign body. After removal of the foreign body, the patient had no obvious discomfort but a slight cough. Cephalexin and metronidazole were given for three days to prevent infection. Three days later, the patient had no complaints of respiratory discomfort. After reviewing the literature, we found that the operation should be paused immediately after aspiration/ingestion occurs during dental procedures and that the dental chair should be laid down to prevent the foreign body from descending deeper, which may increase the difficulty of removal and cause gastrointestinal and respiratory tract injury. The position of the foreign body should be determined by imaging examination, and the corresponding means to remove the foreign body should be performed.@*Conclusion @# Patients may have no obvious symptoms after aspiration/ingestion during dental procedures, and the foreign body can be removed after imaging examination.
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Objective:To investigate the diagnostic value of rapid on-site evaluation (ROSE) technique in the mucosal biopsy under respiratory endoscopy in children with active tuberculosis.Methods:Clinical data of 40 patients with active tuberculosis diagnosed in Department of Respiratory Intervention, Qilu Children′s Hospital, Shandong University from June 2017 to January 2020 were retrospectively analyzed.Results:(1) There were 33 cases of tracheobronchial tuberculosis and 7 cases of tuberculous pleurisy in the 40 cases, among them 9 cases were difficult to diagnose.(2)Among 33 cases of tracheobronchial tuberculosis, 24 cases (72.7%) of caseous necrosis breaking into the lumen, and 9 cases (27.3%) of mucosal swelling and external pressure.Cytological ROSE (C-ROSE) showed granuloma, epithelioid cells and lymphocytic infiltration with all bronchial mucosal biopsies.Different positives results of microbiological ROSE (M-ROSE) in different biopsy parts: positive results were found 6 times at caseous necrosis (13.6%, 6/44 times), 4 times at granulation hyperplasia (12.5%, 4/32 times), 2 times at hyperemia and edema (22.2%, 2/18 times), 0 time at yellow-white necrosis, and 54 times at the junction between lesions and normal mucosa (81.8%, 54/66 times). The mucosal pathology showed granuloma, exudation and necrosis, including 22 cases with tuberculous granuloma, 5 cases with characteristic tuberculous nodules, and 11 cases with positive acid-fast staining.(3)Seven cases of tuberculous pleurisy, serious pleural adhesion, pleural hyperemia and edema were observed under thoracoscopy.After clearing the adhesive tape, scattered caseous miliary nodules were found in pleura in 4 cases with a difficult clinical diagnosis.The C-ROSE of smear on thoracoscopic biopsy were characterized by necrotic and histopathic cell, with multinucleated giant cells, but granuloma was rare.M-ROSE in different parts: 8 times positive for millet nodules (80.0%), 0 time positive for adhesion band, 2 times positive for congestion oedema (14.3%); biopsy pathology showed granuloma and necrosis, with 3 cases characteristic tuberculosis nodules and 2 cases positive for anti-acid staining.(4)Pathogenic microorganisms were detected in 19 children using next generation sequencing (NGS) and Mycobacterium tuberculosis/Rifampicin resistance real-time nucleic acid amplification detection technology (Xpert MTB/RIF), including 7 positive for NGS (36.8%), 8 positive (42.1%) and 5 positive for both NGS and Xpert MTB/RIF (26.3%).Conclusions:Respiratory endoscopy combined with ROSE technique has important clinical significance in early diagnosis of active tuberculosis in children, and it is worth of promotion and applying.
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BACKGROUND@#It is a great challenge for surgeons to resect pulmonary nodules with small volume, deep position and no solid components under video-assisted thoracoscopic surgery. The purpose of this study is to explore the feasibility and necessity of the localization of pulmonary nodules by injecting indocyanine green (ICG) under the guidance of magnetic navigation bronchoscope and the resection of small pulmonary nodules under the fluoroscope.@*METHODS@#Between December 2018 and August 2019, sixteen consecutive patients with 30 peripheral lung lesions in our hospital received fluorescent thoracoscopic pulmonary nodule resection. Electromagnetic navigation bronchoscope (ENB) was performed before surgery to guide ICG to the target lesion.@*RESULTS@#All patients underwent magnetic navigation-guided pulmonary nodule localization, and surgical resection was performed immediately after localization was completed. The average size of the nodules was (11.12±3.65) mm. The average navigation time was (12.06±2.74) minutes, and the average interval between dye labeling and lung resection was (25.00±5.29) minutes. All lesions were completely resected, the localization success rate was 100.00%, no bleeding and other complications occurred after the localization, the postoperative pathological results confirmed the accuracy of the staining.@*CONCLUSIONS@#Indocyanine green injection under the guidance of magnetic navigation bronchoscope is an effective way to locate pulmonary nodules, which can locate small and untouchable lesions in the lung. This method can help surgeons identify lesions more quickly and accurately. It is practical and worthy of promotion.
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Primary and secondary airway problems directly affect mortality and disability in critically ill children in pediatric intensive care unit(PICU). Soft bronchoscope, as an important method for the diagnosis and interventional treatment of airway lesions in critically ill children in PICU, requires standardized seamless nursing cooperation throughout the whole process.This article discussed the nursing cooperation before, during and after soft bronchoscope operation in PICU.
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Children in the pediatric intensive care unit who continue to have ventilator-assisted breathing are often difficult to get off-line due to respiratory system disease, cardiovascular system disease, nervous system disease, nutritional status, genetic metabolism, abnormal diaphragm movement and other factors.Through the diagnosis and treatment of flexible bronchoscope, the etiology could be identified, the ventilation function is effectively improved, and the cure rate of weaning difficulty increases.This paper discussed the etiological diagnosis and treatment of flexible bronchoscopy in children with difficulty in weaning from pediatric intensive care unit.
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@#Increasing peripheral pulmonary nodules are detected given the growing adoption of chest CT screening for lung cancer. The invention of electromagnetic navigation bronchoscope provides a new diagnosis and treatment method for pulmonary nodules, which has been demonstrated to be feasible and safe, and the technique of microwave ablation through bronchus is gradually maturing. The one-stop diagnosis and treatment of pulmonary nodules can be completed by the combination of electromagnetic navigation bronchoscopy and microwave ablation, which will help achieve local treatment through the natural cavity without trace.
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Introduction: Non-resolving or slowly resolving pneumonia is not uncommon, affecting 10–20% of patients admitted withcommunity-acquired pneumonia (CAP). Non-resolving pneumonia is a challenging clinical problem. Incidence of non-resolvingpneumonia was found to be 10–15% among hospitalized patients with CAP and of them 6% developed progressive pneumonia.This study aims to evaluate the patients of non-resolving or slowly resolving pneumonias to establish the cause of it.Methodology: It is a prospective, observational study taken up by the Department of Pulmonary Medicine of SVS MedicalCollege and Hospital, Mahabubnagar, Telangana. All the enrolled cases of non-resolving or slowly resolving pneumonia whichsatisfy the inclusive criteria were taken into the study from June 2017 to December 2018. A total of 28 patients were satisfyingthe inclusion criteria and were further studied for evaluating the causative factors. The study was started after taking the approvalof the Institutional Ethics Committee, SVS Medical College and Hospital, Mahabubnagar, Telangana.Observation and Results: The mean age of the patients was 48.2 years. Of 28 patients, 18 (64.2%) were male and 10 (35.7%)were female with a male:female ratio – 1.8:1. Fever (81%) and cough (86%) were the most common symptoms. Smoking wasthe most common comorbidity noted (60.7%) followed by alcoholism (46.6%), diabetes (39.28%), hypertension (25%), andchronic obstructive pulmonary disease (21.4%). The most common cause of non-resolution of pneumonia in this study wastuberculosis 11 (39.28%) followed by bacterial pneumonias 9 (32.1%) which were caused by drug-resistant organisms. Othercauses were malignancy 6 (21.4%), foreign body 1 (3.57%), and fungal pneumonia 1 (3.57%).
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Percutaneous tracheostomy (PCT) is considered the most widely accepted technique in critical care setting specifically in patients requiring prolonged invasive mechanical ventilation. Although PCT is considered a safe procedure it can lead to certain life threatening complications one of which is massive subcutaneous emphysema. We report a post operative case of coronary artery bypass graft surgery requiring prolonged mechanical ventilation due to repeated aspiration leading to pneumonia. Bedside PCT was done leading to immediate massive diffuse facial and orbital emphysema. We discuss here the recognition and management of such complications.
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Background: Studies are required to establish the utility and safety of use of the procedure of the flexible bronchoscopy under various circumstances and the various settings. Aim: To study outcome of pediatric non resolving pneumonias with the aid of pediatric flexible bronchoscopy Material and Methods: Present study was hospital based prospective study. We selected 100 cases in 1 year to 8 years age group, with radiological features persisting after 3 weeks of optimal antibiotics, their sputum for AFB, and gastric lavage for AFB was negative, sputum culture was sterile. We did pediatric flexible bronchoscopy (Olympus BF3C30, outer diameter of 3.2 mm), under short general anesthesia. All the procedures were uneventful, no reported morbidity or mortality after the procedure, Followed after the procedure till radiological shadows disappear. Results: The most common finding of the flexible bronchoscopy was normal airway anatomy – with thick mucopurulent secretions was found in 55% of the cases. In the normal airway anatomy – with thick mucopurulent secretions, 20 showed TB gene positive. In the normal airway anatomy with thick mucus plug obstructing total lumen of affected air way was sterile in all 18 cases. Foreign body impacted in bronchus in 12 cases. Mediastinal lymph node compressing main stem bronchus was identified in 6 cases. Conclusion: Paediatric flexible bronchoscopy is very useful investigation in non-resolving pneumonias.
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Objective@#To explore the levels and clinical significance of MCP-4, IL-25, TNF-α and CysLTR-1 in bronchoalveolar lavage fluid(BALF)of children with refractory mycoplasma pneumoniae pneumonia(RMPP)and their correlation with serum C-reactive protein(CRP).@*Methods@#One hundred and nine children diagnosed as RMPP who underwent fiberoptic bronchoscopy in acute stage(course of disease within 2 weeks)were selected as the experimental group.According to the manifestations of mucosa, secretions and lumen under bronchoscope, the patients were divided into RMPP1 group(68 cases of severe pathological injury under bronchoscope)and RMPP2 group(41 cases of mild pathological injury under bronchoscope). They were divided into RMPP1 wheezing group(20 cases), RMPP1 non- wheezing group(48 cases), RMPP2 wheezing group(15 cases)and RMPP2 non-wheezing group(26 cases).15 children with non-mycoplasma pneumoniae pneumonia(NMPP)and non-wheezing lobar pneumonia in the same period were selected as control group 1.At the same time, 15 children without pneumonia underwent bronchial foreign body(FB)removal as control group 2.The levels of MCP-4, IL-25, TNF-α and CysLTR-1 in BALF of children in experimental group were determined by double antibody sandwich ELISA.Serum CRP, D dimer(DD), ALT and peripheral blood neutrophil percentage(N%)were also detected.@*Results@#(1)The levels of CRP, DD, ALT and N% in RMPP1 group with severe bronchoscopic manifestations were higher than those in RMPP2 group with relatively mild bronchoscopic manifestations(all P<0.05). (2)The mean levels of IL-25(117.8 ng/L), TNF-α(26.01ng/L), CysLTR-1(0.71 ng/L)and MCP-4(53.38 ng/L)in RMPP1 wheezing group were higher than those in the other five groups(P<0.05). The mean levels of IL-25(85.79 ng/L), TNF-α(19.2 ng/L), CysLTR-1(0.59 ng/L)and MCP-4(44.16ng/L)cells in RMPP2 wheezing group were higher than those in RMPP2 non-wheezing group, NMPP group and FB group(all P<0.05). There was no statistical difference between the other two groups(P>0.05). (3)CRP was positively correlated with IL-25, MCP-4 and TNF-a(all P<0.05), but not with CysLTR-1.@*Conclusion@#(1)Clinical laboratory indicators such as CRP, DD, ALT and N% can assist in early identification of RMPP.The higher the above indicators, the more serious performance of RMPP under microscope.(2)Cytokines MCP-4, IL-25, CysLTR-1 and TNF-α all participate in the pathogenesis of RMPP, and may play an important role in the occurrence of wheezing and development of asthma in children induced by MP infection.(3)Serum CRP levels were positively correlated with the levels of IL-25, MCP-4 and TNF-α in BALF of RMPP wheezing children.Both MCP-4 and IL-25 selectively affected Th2-induced Th2 cells.CRP is associated with IL-25 and MCP-4 who mediated immune inflammation injury.It is speculated that CRP may also cause Th2-mediated immune inflammation injury by affecting Th2 cells.
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Objective@#To investigate the value of Cytomegalovirus(CMV) DNA real-time quantitative-polymerase chain reaction(RT-PCR) in different body fluids for diagnosing CMV pneumonia in immunocompetent infants.@*Methods@#The clinical data of immunocompetent infants with CMV pneumonia who were treated in Pediatric Intensive Care Unit of Guangdong Women and Children′s Hospital from January 1st, 2016 to February 5th, 2018 were retrospectively analyzed.The clinical data included CMV DNA load of bronchoalveolar lavage fluid(BALF), urine, blood and cerebrospinal fluid(CSF); blood immunoglobulin(Ig)M CMV, alanine aminotransferase (ALT), X-ray and CT test of chest, combined infection, clinical manifestation and treatment.@*Results@#Nine hundred and twenty-six infants received bronchoalveolar lavage by bronchoscope, and 34 cases were diagnosed as immunocompetent with CMV pneumonia.The infants with CMV pneumonia: the positive percentage of urine CMV DNA, blood CMV DNA, blood IgM CMV and ALT elevation were 100.0%(34/34 cases), 61.8%(21/34 cases), 52.9%(18/34 cases) and 20.6%(7/34 cases), respectively.There was no difference in positive percentage between blood CMV DNA and blood IgM CMV (χ2=0.5, P>0.05). Both the positive percentages of blood CMV DNA and blood IgM CMV were lower than those in the urine CMV DNA, and the differences were statistically significant (χ2=16.1, 20.9, all P<0.05). The positive percentages of ALT elevation were lower than those in the positive percentage of urine CMV DNA, blood CMV DNA and blood IgM CMV, and the differences were statistically significant (χ2=44.8, 11.9, 7.7, all P<0.05). Ten patients′ CSF CMV DNA were tested, and they were all negative.The median load of CMV DNA in BALF, urine and blood was 170.0×105 copies/L, 130.0×105 copies/L and 6.0×105 copies/L.There was no difference in median load between BALF and urine (U=561, P>0.05). BALF CMV DNA load and blood CMV DNA load had a weak positive correlation (r=0.35, P<0.05), BALF CMV DNA load and age had a negative correlation (r=-0.42, P<0.05), and urine CMV DNA load and blood CMV DNA load had a positive correlation (r=0.52, P<0.05). No matter whether blood IgM CMV was positive, BALF CMV DNA load had no differences (U=92, P>0.05). The main radiographic signs were pulmonary interstitial lesions.Thirty-four immunocompetent infants with CMV pneumonia, 18 patients (52.9%) with symptoms lasted for over 2 weeks, 20 patients (58.8%) had complicated infections.They all received inductive treatment of Ganciclovir, 55.9%(19/34 cases) patients′ urine CMV DNA turned to be negative.When patients got combined infections by bacteria or mycoplasma, antibiotics were used.All discharged patients had symptoms relieved and signs improved.@*Conclusions@#BALF RT-PCR is instant, sensitive and distinctive method to diagnose CMV pneumonia.Urine RT-PCR gets specimens conveniently and safely, its positive percentage and DNA load are present well according to BALF, and is suitable for screening and monitoring CMV infection.Blood CMV DNA load and blood IgM CMV indicate viral dissemination and immunocompetence, but it is not recommended for diagnosing CMV pneumonia solely.
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Transbronchial lung biopsy(TBLB)has been widely used and has successfully helped in the diagnosis of lung diseases in adults. However,TBLB is less used in children with lung diseases. In order to recognize the skills of TBLB,the authors introduced the applications of TBLB in interventional respiratory diseases in children.
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OBJECTIVE: To evaluate the diagnostic and therapeutic value of flexible bronchoscopy in children with necro⁃tizing pneumonia. METHODS: Clinical data of children diagnosed with necrotizing pneumonia in the Department of Pedi⁃atrics of the First Hospital of Jilin University from December 2016 to December 2017 were collected. The general clini⁃cal manifestations,laboratory examination results,chest X-ray or lung CT,flexible bronchoscope and other examinations of all the children were analyzed retrospectively. Based on the characteristics,diagnosis,treatment and prognosis,the ad⁃vantages of flexible bronchoscopy in this disease were analyzed. RESULTS: All the 32 cases were diagnosed as necrotizing pneumonia by imaging examination,with an average diagnosis time of 14.1 d. All 32 cases of children with necrotizing pneumonia received flexible bronchoscopy and alveolar lavage. The alveolar lavage in 32 cases presented turbidity mito⁃ta-like changes,which had high sensitivity in the diagnosis of necrotizing pneumonia. The average time for mitota-like changes in alveolar lavage was 6.7 days. CONCLUSION: Flexible bronchoscopy is an important method in the diagnosis and treatment of necrotizing pneumonia,and the change of alveolar lavage fluid is a sensitive index for early prediction of necrotizing pneumonia.
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Objective To investigate the value of Cytomegalovirus(CMV) DNA real-time quantitative-polymerase chain reaction(RT-PCR) in different body fluids for diagnosing CMV pneumonia in immunocompetent infants.Methods The clinical data of immunocompetent infants with CMV pneumonia who were treated in Pediatric Intensive Care Unit of Guangdong Women and Children's Hospital from January 1st,2016 to February 5th,2018 were retrospectively analyzed.The clinical data included CMV DNA load of bronchoalveolar lavage fluid (BALF),urine,blood and cerebrospinal fluid(CSF);blood immunoglobulin(Ig) M CMV,alanine aminotransferase (ALT),X-ray and CT test of chest,combined infection,clinical manifestation and treatment.Results Nine hundred and twenty-six infants received bronchoalveolar lavage by bronchoscope,and 34 cases were diagnosed as immunocompetent with CMV pneumonia.The infants with CMV pneumonia:the positive percentage of urine CMV DNA,blood CMV DNA,blood IgM CMV and ALT elevation were 100.0％ (34/34 cases),61.8％ (21/34 cases),52.9％ (18/34 cases) and 20.6％ (7/34 cases),respectively.There was no difference in positive percentage between blood CMV DNA and blood IgM CMV (x2 =0.5,P ＞ 0.05).Both the positive percentages of blood CMV DNA and blood IgM CMV were lower than those in the urine CMV DNA,and the differences were statistically significant (x2 =16.1,20.9,all P ＜0.05).The positive percentages of ALT elevation were lower than those in the positive percentage of urine CMV DNA,blood CMV DNA and blood IgM CMV,and the differences were statistically significant (x2 =44.8,11.9,7.7,all P ＜ 0.05).Ten patients' CSF CMV DNA were tested,and they were all negative.The median load of CMV DNA in BALF,urine and blood was 170.0 × 105 copies/L,130.0 x 105 copies/L and 6.0 x 105 copies/L.There was no difference in median load between BALF and urine (U =561,P ＞ 0.05).BALF CMV DNA load and blood CMV DNA load had a weak positive correlation (r =0.35,P ＜ 0.05),BALF CMV DNA load and age had a negative correlation (r =-0.42,P ＜ 0.05),and urine CMV DNA load and blood CMV DNA load had a positive correlation (r =0.52,P ＜ 0.05).No matter whether blood IgM CMV was positive,BALF CMV DNA load had no differences (U =92,P ＞ 0.05).The main radiographic signs were pulmonary interstitial lesions.Thirty-four immunocompetent infants with CMV pneumonia,18 patients (52.9％) with symptoms lasted for over 2 weeks,20 patients (58.8％) had complicated infections.They all received inductive treatment of Ganciclovir,55.9％ (19/34 cases) patients' urine CMV DNA turned to be negative.When patients got combined infections by bacteria or mycoplasma,antibiotics were used.All discharged patients had symptoms relieved and signs improved.Conclusions BALF RT-PCR is instant,sensitive and distinctive method to diagnose CMV pneumonia.Urine RT-PCR gets specimens conveniently and safely,its positive percentage and DNA load are present well according to BALF,and is suitable for screening and monitoring CMV infection.Blood CMV DNA load and blood IgM CMV indicate viral dissemination and immunocompetence,but it is not recommended for diagnosing CMV pneumonia solely.
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Objective To explore the levels and clinical significance of MCP-4,IL-25,TNF-α and CysLTR-1 in bronchoalveolar lavage fluid (BALF) of children with refractory mycoplasma pneumoniae pneumonia (RMPP) and their correlation with serum C-reactive protein (CRP).Methods One hundred and nine children diagnosed as RMPP who underwent fiberoptic bronchoscopy in acute stage (course of disease within 2 weeks) were selected as the experimental group.According to the manifestations of mucosa,secretions and lumen under bronchoscope,the patients were divided into RMPP1 group (68 cases of severe pathological injury under bronchoscope) and RMPP2 group (41 cases of mild pathological injury under bronchoscope).They were divided into RMPP1 wheezing group (20 cases),RMPP1 non-wheezing group (48 cases),RMPP2 wheezing group (15 cases) and RMPP2 non-wheezing group (26 cases).15 children with non-mycoplasma pneumoniae pneumonia (NMPP) and non-wheezing lobar pneumonia in the same period were selected as control group 1.At the same time,15 children without pneumonia underwent bronchial foreign body (FB) removal as control group 2.The levels of MCP-4,IL-25,TNF-α and CysLTR-1 in BALF of children in experimental group were determined by double antibody sandwich ELISA.Serum CRP,D dimer (DD),ALT and peripheral blood neutrophil percentage (N％) were also detected.Results (1) The levels of CRP,DD,ALT and N％ in RMPP1 group with severe bronchoscopic manifestations were higher than those in RMPP2 group with relatively mild bronchoscopic manifestations (all P ＜ 0.05).(2) The mean levels of IL-25 (117.8 ng/L),TNF-α (26.01ng/L),CysLTR-1 (0.71 ng/L) and MCP-4 (53.38 ng/L) in RMPP1 wheezing group were higher than those in the other five groups (P ＜ 0.05).The mean levels of IL-25 (85.79 ng/L),TNF-α (19.2 ng/L),CysLTR-1 (0.59 ng/L) and MCP-4 (44.16ng/L) cells in RMPP2 wheezing group were higher than those in RMPP2 non-wheezing group,NMPP group and FB group (all P ＜0.05).There was no statistical difference between the other two groups (P ＞ 0.05).(3) CRP was positively correlated with IL-25,MCP-4 and TNF-a (all P ＜ 0.05),but not with CysLTR-1.Conclusion (1) Clinical laboratory indicators such as CRP,DD,ALT and N％ can assist in early identification of RMPP.The higher the above indicators,the more serious performance of RMPP under microscope.(2) Cytokines MCP-4,IL-25,CysLTR-1 and TNF-α all participate in the pathogenesis of RMPP,and may play an important role in the occurrence of wheezing and development of asthma in children induced by MP infection.(3) Serum CRP levels were positively correlated with the levels of IL-25,MCP-4 and TNF-α in BALF of RMPP wheezing children.Both MCP-4 and IL-25 selectively affected Th2-induced Th2 cells.CRP is associated with IL-25 and MCP-4 who mediated immune inflammation injury.It is speculated that CRP may also cause Th2-mediated immune inflammation injury by affecting Th2 cells.
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Objective To explore the clinical characteristics of bronchial foreign bodies in children. Method The clinical data of 147 children with exogenous bronchial foreign body admitted between 2014 and 2016 were retrospectively analyzed, and the applications of rigid bronchoscopy and flexible bronchoscopy for foreign body extraction were compared. Results All 147 cases were diagnosed with bronchial foreign bodies by chest CT, chest X-ray or respiratory endoscopy. In these cases (104 boys and 43 girls) , 87.8％ of whom were aged 1-3 years, the most common types of bronchial foreign body were nuts. The common complications were bronchial mucosal granulation tissue hyperplasia (88 cases, 59.86％) , pneumonia (56 cases, 38.1％) , atelectasis (15 cases, 10.2％) , respiratory failure (14 cases, 9.52％) and bronchiectasis (4 cases, 2.72％) respectively. The foreign bodies were removed by soft bronchoscopy in 106 cases which were successfully removed at one time in 100 cases. Respiratory endoscopy was undergone in 141 cases to remove foreign bodies, and flexible bronchoscope was applied in 106 (72.11％) cases and foreign bodies were successfully removed in first attempt in 100 cases (94.34％) . Rigid bronchoscope was used in 35 cases (23.81％) and foreign bodies were successfully removed in first attempt in 28 cases (80.0％) . Conclusion The majority of children with bronchial foreign body are male. Both flexible and rigid bronchoscopes can remove exogenous foreign bodies in the lower respiratory tract.
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Abstract Neonates and small infants with craniofacial malformation may be very difficult or impossible to mask ventilate or intubate. We would like to report the fiberoptic intubation of a small infant with Treacher Collins Syndrome using the technique described by Ellis et al. Case report: An one month-old infant with Treacher Collins Syndrome was scheduled for mandibular surgery under general endotracheal anesthesia. Direct laryngoscopy for oral intubation failed to reveal the glottis. Fiberoptic intubation using nasal approach and using oral approach through a 1.5 size laryngeal mask airway were performed; however, both approach failed because the fiberscope loaded with a one 3.5 mm ID uncuffed tube was stuck inside the nasal cavity or inside the laryngeal mask airway respectively. Therefore, the laryngeal mask airway was keep in place and the fiberoptic intubation technique described by Ellis et al. was planned: the tracheal tube with the 15 mm adapter removed was loaded proximally over the fiberscope; the fiberscope was advanced under video-screen visualization into the trachea; the laryngeal mask airway was removed, leaving the fiberscope in place; the tracheal tube was passed completely through the laryngeal mask airway and advanced down over the fiberscope into the trachea; the fiberscope was removed and the 15 mm adapter was reattached to the tracheal tube. Conclusion: The fiberoptic intubation method through a laryngeal mask airway described by Ellis et al. can be successfully used in small infants with Treacher Collins Syndrome.
Resumo Os recém-nascidos e crianças pequenas com malformação craniofacial podem ser muito difíceis ou impossíveis de ventilar por máscara ou de intubar. Gostaríamos de relatar a intubação com fibra óptica de um bebê com síndrome de Treacher Collins usando a técnica descrita por Ellis et al. Relato de caso: Uma criança de um mês de idade com síndrome de Treacher Collins foi programada para cirurgia mandibular sob anestesia geral endotraqueal. A laringoscopia direta para intubação oral não revelou a glote. A intubação com fibra óptica usando as abordagens nasal e oral por meio de máscara laríngea de tamanho 1,5 foi tentada, mas ambas as abordagens falharam porque o fibroscópio portando um tubo sem balonete de 3,5 mm ficou preso no interior da cavidade nasal ou dentro da máscara laríngea, respectivamente. Portanto, a máscara laríngea foi mantida no lugar e a técnica de intubação com fibra óptica descrito por Ellis et al. foi planejada: o tubo traqueal com o adaptador de 15 mm removido foi colocado proximalmente sobre o fibroscópio; o fibroscópio foi avançado na traquéia sob visualização em tela devídeo; a máscara laríngea foi removida, deixando o fibroscópio no lugar; o tubo traqueal foi passado completamente através da máscara laríngea e avançado para baixo sobre o fibroscópiona traquéia; o fibroscópio foi removido e o adaptador de 15 mm foi recolocado no tubo traqueal. Conclusão: O método de intubação com fibra óptica através de uma máscara laríngea descrito por Ellis et al. pode ser usado com sucesso em bebês com síndrome de Treacher Collins.
Subject(s)
Humans , Male , Infant , Laryngeal Masks , Airway Management , Mandibulofacial Dysostosis/surgery , Fiber Optic TechnologyABSTRACT
Huge goitor can lead to tracheal compression and hence difficulty in intubation. This is compounded by severe obesity. Failed tracheal intubation in difficult intubation is a serious event that may lead to increased patient morbidity and mortality. Current intubation rescue techniques and combination of different rescue techniques may increase the success rate of difficult intubation. In a 47-year-old female patient, with severe obesity and a huge goiter, our attempts at intubation using direct laryngoscope, video laryngoscope, and awake fiberoptic bronchoscope had failed. We succeeded by applying video laryngoscope to improve visualization of the airway and fiberoptic bronchoscope as a stylet for endotracheal tube.