Validity of pulse oximetry in detection of hypoxaemia in children: comparison of ear, thumb and toe probe placements

This study of paediatric intensive care patients aimed to determine where pulse oximetry probes should be placed to obtain the most accurate and reliable readings of peripheral oxygen saturation [SpO[2]]. Using arterial blood gas analysis [SaO[2]] as the gold standard and SpO[2] < 92% and SaO[2] < 90% as indicators of hypoxaemia, negative predictive values of SpO[2] were 96%, 98% and 98% at the ear, thumb and big toe respectively in 110 children, and 93% at all 3 sites in 90 neonates. The highest clinical agreement between SaO[2] and SpO[2] was for ear probes in children [kappa = 0.70] and the lowest was for big toe probes [kappa = 0.57 and 0.28 in children and neonates respectively]

PICU extubation failure: the role of neuromuscular disorders

Neuromuscular disorders [diseases of the motor unit], can cause respiratory problems such as impaired cough reflex, chest deformity, recurrent pneumonia and acute respiratory failure; these are the worst most common complications of these diseases and the leading cause of death in such patients [1, 2]. Their management hence, very often, entails admission to the Pediatric Intensive Care Unit [PICU] [3,4] and during this phase, endotracheal intubation is almost always necessary, to maintain the patency of airways and to apply Positive Pressure Ventilation [PPV]. However, endotracheal intubation is always temporary, and its success or failure depends on the timely decision of its termination to restore the normal respiration or to avoid the risk of recurring respiratory failure [5, 6]. We designed this study to evaluate the role of neuromuscular disorders in causing extubation failure as compared to that of other risk factors. In an analytical cross-sectional study, the risk factors of reintubation and duration of mechanical ventilation in two groups of 30 patients each, was compared, the first successful extubation and the second with extubation failure. Neuromuscular disorders [including Spinal Muscular Atrophy, Guillain-Barre' Syndrome, Congenital Myopathies and Muscular Dystrophies] were the main underlying diseases in extubation-failure group [P= 0.0002]. Hypercapnia [PaCO[2]>50[mmHg]] was shown to be the most common cause of both the first intubation [P=0.001] and reintubation [P=0.004] in the group of patients who failed extubation. The mean duration of intubation and mechanical ventilation was longer in patients with neuromuscular disorders who had extubation failure [P= 0.01]. This study showed that, as underlying problems, neuromuscular disorders are the most common causes of prolonged intubation which defeat weaning from the ventilator and result in reintubation by inducing hypercapnia. Therefore the weaning process needs to be done gradually in these patients, and in conjunction with supportive measures, such as close observation for at least for 72 hours following extubation to monitor any possibility of recurrence of hypercapnic respiratory failure