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ABSTRACT Objective: To analyze the contributions of telesimulation to the knowledge of mothers faced with foreign body airway obstruction in children under 1 year of age and identify the related factors. Methods: A quasi-experimental study of the pre- and post-test design carried out between April and September 2021 with 49 mothers from a city in São Paulo. It was organized into four stages: pre-test, telesimulation, immediate and late post-test (60 days later). All steps were carried out remotely via the free online platform Google Hangouts® and Google Forms®. Data analyzed by descriptive and analytical statistics. Results: There was a significant difference in the knowledge score between the assessments (p<0.001). Statistically significant relationships were identified between pre-test knowledge and choking experience (p=0.012), promotion of immediate knowledge and another child's choking (p=0.040) and schooling (p=0.006) and promotion of late knowledge with occupation (p=0.012) and choking of another child (p=0.011). Conclusions: There was a significant improvement in knowledge after telesimulation, especially among those who had never experienced a choking situation and had a higher level of education.
RESUMEN Objetivo: Analizar las contribuciones de la telesimulación en el conocimiento de las madres en situación de obstrucción de las vias respiratorias por cuerpo extraño em niños menores de un año e identificar los factores relacionados. Métodos: Estudio cuasi-experimental del tipo pre y post test realizado entre abril y septiembre de 2021 con 49 madres de un municipio de São Paulo. Se organizo en cuatro etapas: pretest, telesimulación, pos test inmediato y tardío (60 días después). Todos los trámites se realizaron de forma remota a través de la plataforma en línea gratuita Google Hangouts® y Google Forms®. Datos analizados por estadística descriptiva y analítica. Resultados: Hubo diferencia significativa en la puntuación de conocimiento entre las evaluaciones (p<0,001). Se identificaron relaciones estadísticamente significativas entre pretest conocimiento y experiencia de atragantamiento (p=0,012), promoción de conocimiento inmediato con otro atragantamiento (p=0,040) y escolaridad (p=0,006) y promoción de conocimiento tardio con ocupación (p=0,012). y asfixia por outro niño (p=0,011). Conclusiones: Hubo una mejora significativa en el conocimiento después de la telesimulación, especialmente entre aquellos que nunca habían experimentado una situación de atragantamiento y tenían un mayor nivel de educación.
RESUMO Objetivo: Analisar as contribuições da telessimulação no conhecimento de mães diante situação de obstrução de vias aéreas por corpo estranho em crianças menores de um ano e identificar os fatores relacionados. Métodos: Estudo quase experimental do tipo pré e pós-teste realizado entre abril e setembro de 2021 com 49 mães de um município paulista. Foi organizado em quatro etapas: pré-teste, telessimulação, pós-teste imediato e tardio (60 dias após). Todas as etapas foram conduzidas remotamente via plataforma on-line de acesso livre Google Hangouts® e Google Forms®. Os dados foram analisados por estatística descritiva e analítica. Resultados: Houve diferença significativa na pontuação de conhecimento entre as avaliações (p<0,001). Foram identificadas relações estatisticamente significativas entre conhecimento pré-teste e experiência de engasgo (p=0,012), promoção do conhecimento imediato com engasgo de outra criança (p=0,040) e escolaridade (p=0,006) e promoção do conhecimento tardio com ocupação (p=0,012) e engasgo de outra criança (p=0,011). Conclusões: Houve melhora significativa no conhecimento após telessimulação, especialmente entre aquelas que nunca vivenciaram situação de engasgo e com maior escolaridade.
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Background: Tracheal strictures are known to recur after dilatation, so they need stenting to prevent recurrence. The objective was to study role of air way stenting (Duman- silica stent) in benign stricture trachea management.Methods: A hospital based prospective study was carried out among 15 cases (as these cases are very rare, author could study only 15 cases) presented with various clinical features suggestive of tracheal strictures. They were examined and managed by putting tracheal stent for up to eight months period. All cases were followed at regular intervals till 14months after the stent was placed. The outcome was studied.Results: The tracheal strictures have been found to be more in the age group of 25-30 years. The male to female ratio was 4:1 i.e. for everyone female case there were four male cases. Thus, the tracheal strictures have been more common among the males compared to the females. All of the patients presented with severe stridor, breathing difficulty, and poor exercise tolerance. Most common cause of tracheal stricture was prolonged mechanical ventilatory support >8 days due to organo phosphorus poisoning in past 3months and all of them were males. All cases had good outcome at the end of 14months of follow up. All cases had normal findings. No one developed foreign body reaction, nor did no one develop granuloma formation at the stent site. After stent removal flexible bronchoscopy repeated after 3rd month and 6th month.Conclusions: Tracheal stenting is very useful procedure in the management of air way strictures
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Background: Forced expiratory volume in 1 second (FEV1) to forced vital capacity ratio (FVC) is being used to diagnose the obstructive lung diseases. Forced manoeuvre (FVC) or relaxed/slow manoeuvre (SVC) can be used to determine vital capacity (VC). In healthy individuals the difference between SVC and FVC (SVC-FVC) is minimal whereas in the presence of airway obstruction this difference will become significant. The present study was done with the objective to detect and compare the airway obstruction by determining the FEV1/FVC and FEV1/ SVC ratios.Methods: This was a prospective cross-sectional study done at OPD, Government Thiruvoteeswarar hospital of thoracic medicine/Kilpauk medical college during the period from September 2016 to February 2017among the patients presenting with symptoms of obstructive airway disease. The sample comprised of 353 patients who underwent spirometry according to standard of ATS/ERS guidelines. As per the criteria, the patients are classified into four groups, by spirometry.Results: The analysis of FEV1/FVC revealed the presence of airway obstruction in 131 (37%) individuals compared to 165 (46%) individuals by the analysis of Fev1/SVC ratio. In the obstruction and mixed groups, the difference in vital capacity SVC – FVC is statistically superior (p<0.05) when compared to normal and restriction groups.Conclusions: The FEV1/SVC ratio detected the presence of airway obstruction in more individuals than did FEV1/FVC ratio and hence FEV1/SVC considered as more reliable factor in the detection of obstructive airway diseases.
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Background: The Global Initiative for Chronic Obstructive Lung Disease (GOLD) defines chronic obstructive pulmonary disease (COPD) as “a disease state characterized by airflow limitation that is not fully reversible. Due to progressive airflow limitation, the patients become increasingly symptomatic leading to worsening in their health-related quality of life (HRQOL). Objective of present study was to examine that correlation of health related quality of life with the chronic obstructive pulmonary disease.Methods: One hundred twenty consecutive stable COPD patients (diagnosed as per GOLD guidelines), without any co-morbid conditions (diabetes, congestive heart failure, coronary artery disease, hypertension) were recruited in this study after intuitional ethical clearance and informed consents. The health-related quality of life (HRQOL) was assessed using Hindi SGRQ-C. Forced expiratory volume in first one second (FEV1), forced vital capacity (FVC) and FEV1/FVC% and reversibility were measured using Spirolab III (Medical International Research USA, Inc.). The descriptive and the Pearson’s correlation coefficient were done in data treatment with SPSS version 20.Results: The component of SGRQ scores were as follows: Symptom score: 31.27±14.6 (range 2.3-64); Activity score: 59.01±23.08) (range 0-100); Impact score 42.19±22.25 (range 0-88.8) and the total score was = 45.34±17.96 (range 1.1.-88.6). There were significant negative correlations between all the parameters of SGRQ and FEV1% predicted (i.e. with lower FEV1% parameters of SGRQ will be high).Conclusions: Indian patients with COPD show significantly reduced HRQOL as measured by disease specific questionnaire SGRQ, similar to COPD patients in other countries. In our study, only FEV1 % predicted was significantly correlated with HRQOL, all other measures including GOLD staging were not significantly associated with HRQOL.
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Objective To explore the factors influencing patient compliance to automatic continuous positive airway pressure (auto-CPAP) treatment in patients with obstructive sleep apnea-hypopnea syndrome (OSAHS). Methods Retrospective analysis was done on 102 patients diagnosed as OSAHS by polysomnography (PSG), who were treated for sleep snoring symptoms between Oct. 2016 and Dec. 2017. All patients received auto-CPAP treatment. The age, gender, body mass index (BMI), Epworth sleepiness scale (ESS) score, nasal obstruction symptom evaluation (NOSE) score and Mallampati score were recorded and analyzed. The patients were divided into compliance group and non-compliance group by the Kribbs standard, and χ2 test and two sample t test were used to analyze the differences of the above indicators between the two groups. Logistic regression model was used to evaluate the risk factors of treatment compliance of OSAHS by auto-CPAP. Results The 102 patients, aged (42.2±10.0) years (ranging from 31 to 83 years), included 89 males and 13 females. Sixty-five (63.7%) patients had good compliance and were assigned to the compliance group, and 37 (36.3%) patients had poor compliance and were assigned to the non-compliance group. The ESS score, NOSE score and Mallampati score were significantly different between the two groups (all P0.05). Logistic regression analysis showed that the ESS score (OR=1.183, 95% CI 1.046-1.338; P= 0.008) and Mallampati score (OR=2.075, 95% CI 1.121-3.839; P=0.020) were independent risk factors of compliance. Conclusion ESS score, NOSE score, and Mallampati score are the influencing factors of treatment compliance to auto- CPAP in the OSAHS patients. ESS score and Mallampati score are the independent risk factors for treatment compliance.
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Bronchial asthma is a respiratory system disease char-acterized by airway remodeling as a pathological basis. Repeated inflammatory infiltration and tissue damage repair can lead to airway remodeling. At present,the mechanism of airway remod-eling is not comprehensive. Studies have shown that epithelial-mesenchymal transition (EMT) plays an important role in the genesis and development of airway remodeling. Airway epithelial cells can be induced to mesenchymal transition through a variety of secretion factors and signaling pathways,leading to airway re-modeling in asthma. This review summarizes the study of EMT and airway remodeling in asthma,providing a reference for clini-cal follow-up treatment and research.
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Objective To investigate the influence of two different mechanical ventilation modes of bi-level positive airway pressure ventilation(BIPAP)and synchronized intermittent ventilation (SIMV)on the respiratory function and clinical curative effect in children patients with severe hand foot and mouth disease(HFMD)complicating neurogenic pulmonary edema.Methods Thirty children patients with severe HFMD complicating neurogenic pulmonary edema receiving mechanical ventilation were divided into the SIMV group (control group)and BIPAP group (experimental group).The lung protective ventilation strategy was applied in both groups.After 30 min use of SIMV and positive end expiratory pressure (PEEP)ventilation,the experimental group changed to use the BIPAP ventilation mode,while the control group still used the initial parameters.The airway peak pressure,alveolar plat-form (Pplat)pressure,lung compliance,pH value,arterial blood CO2 partial pressure (PaCO2 )and oxygenation index (PaO2/FiO2 )at 0 h (baseline value),24,48,72 h after mechanical ventilation were monitored.Besides,the duration of mechanical ventila-tion,28 d mortality rate and the length of ICU stay were observed.Results Thirty children patients smoothly spent their acute re-spiratory failure period.One case in each group during the later period of treatment was transferred to the other hospital for contin-uous therapy.Among them the transferred case in the control group finally died due to give up treatment.The rest 28 cases all were cured and discharged from hospital.The 28 d mortality rates in the two groups were 6.67% and 0% respectively,with no statistical difference (P >0.05).Compared with the control group,the airway peak pressure,Pplat and PaCO2 after mechanical ventilation for 24,48,72 h in the experimental group were significantly decreased(P <0.05);the lung compliance and PaO2/ FiO2 improvement was significantly higher than that in the control group(P <0.05);meanwhile the duration of mechanical ventilation and the length of ICU stay in the experimental group were shorter than those in the control group (P <0.05).Conclusion The BIPAP mode used in the mechanical ventilation therapy of the children patients with severe HFMD complicating neurogenic pulmonary edema can pro-vide better effective ventilation,improve oxygenation and respiratory function,and shorten the duration of mechanical ventilation.
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Background: The measurement of ECO may represent a new method for the non-invasive monitoring of airway inflammation and oxidant stress in Chronic Obstructive Pulmonary Disease, asthma, bronchiectasis, cystic fibrosis patients. Quantification of lung oxidative stress in stable COPD patients by measuring ECO levels may also contribute to the understanding of the pathophysiology of COPD. Aims & Objective: To study the utility of measuring Exhaled Carbon Monoxide (ECO) level in addition to Pulmonary Function Test (Spirometry) in the monitoring of Chronic Obstructive Pulmonary Disease (COPD). Materials and Methods: COPD patients who were smokers and with a history of exposure to wood smoke (n =60) and healthy non-smokers as control (n =40) were selected as subjects by fulfilling the exclusion criteria as per the GOLD guidelines. Clinical examinations and spirometry including reversibility test were made following the standard protocol/procedure. ECO was measured using a MICRO III Smokerlyser. Results: The difference in level of ECO between COPD cases and healthy non-smokers was highly significant (F = 23.897; df = 98; p < 0.0001). The difference in the level of ECO among different groups (mild, moderate, severe and very severe) was highly significant (F=15.995; df =2; p<0.0001). ECO level in female COPD cases who were exposed to wood smoke was elevated (4.11 ± 1.323) when compared to healthy female non-smokers (1.50 ± 0.519) and the difference was highly significant. (F =1.593; df = 30; p < 0.0001). Conclusion: ECO levels in COPD cases vary with different grades of air way obstruction. We concluded that measuring the level of ECO in COPD cases along with spirometry forms a new approach for better understanding of pathophysiology of COPD cases, with indirect assessment of airway inflammation, oxidative stress and severity of airway obstruction.
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Objetivos: descrever um caso de apneia obstrutiva do sono que não melhorou com o tratamento padrão com pressão positiva contínua em vias aéreas (CPAP - continuous positive airway pressure). Relato do Caso: paciente masculino, 74 anos, com síndrome da apneia obstrutiva do sono em tratamento com pressão adequada no CPAP, manteve sintomas de sonolência e fadiga associados ao surgimento de apneias centrais. Conclusões: o relato configura um caso de apneia complexa do sono.
Aims: To describe a case of obstructive sleep apnea that worsened with continuous positive airway pressure (CPAP) standard treatment. Case Report: A 74 year-old man with obstructive sleep apnea syndrome was in treatment with adequate CPAP pressure, but persisted with excessive sleepiness and fatigue associated to the emergence of central apneas. Conclusions: This case is identified as complex sleep apnea.
Sujets)
Humains , Mâle , Syndrome d'apnées obstructives du sommeil/thérapie , Ventilation en pression positive continueRésumé
Objective; To investigate the diagnostic value of coronal airway CT scan for foreign body aspiration in children. Methods; The X rays and CT findings in 51 cases of foreign body aspiration confirmed by endoscopy were reviewed . Results; The shape and location of foreign body in 51 cases were all distinctively showed on CT images. 6 of 8 cases of tracheal foreign body aspiration and 37 of 43 cases of bronchial foreign body aspiration were diagnosed with radiographic signs. Conclusion; The coronal CT scan has a compacity of demonstrating the foreign body intensively and dinstinctively, and can be used as an important diagnostic method for foreign body aspiration.
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Congenital lobar emphysema is a rare disease and a cause of respiratory distress in early infancy. The most common location of pulmonary involvement is the left upper lobe. We diagnosed a case of congenital lobar emphysema in a 5-month-old female infant, who had a complex heart disease using flexible bronchoscopy. In spite of palliative heart surgery, respiratory difficulty and cyanosis did not improve and weaning from artificial ventilation was not possible. Chest X-ray and CT scan showed persistent hyperinflation in the left upper lobe. So, we performed flexible bronchoscopy. The findings showed no cartilage and patent bronchus during inspiration, but complete collapse during expiration due to a check valve effect in the left upper lobar bronchus. After excision of the involved lobe, the patient improved from respiratory distress. The observed airway patency during inspiration, and dynamic airway collapse on expiration suggest that bronchomalacia contributed to lung overinflation in this case.