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

Maternal carriage and neonatal colonization of streptococcus agalactiae in Tabriz, Northwest Iran

Group B Streptococcus [GBS] is a major cause of severe systemic and local infections in newborns. This study was performed to evaluate the presence of GBS in pregnant women and their newborns in Tabriz, Iran. Vaginal specimens were collected from 965 women who were candidate for vaginal delivery for bacteriological study of group B streptococci. Several samples from various sites of the newborns' body [ear canal, nose, navel, and groin] were also obtained to study the colonization rate in newborns after vaginal delivery. Identification of GBS strains was accomplished by bacteriological and serological tests. During the study period, 327 microorganisms were isolated from vaginal specimens of pregnant women from which 5.2% were Streptococcus agalactiae. Serotypes of S. agalactiae strains in our study were Ia [17.6%], Ib [13.4%], II [14.2%], III [9.5%], IV [8.2%], V [19.5%] and nontypable [17.6%]. All of the newborns were followed up for eight weeks. Low carriage rate of GBS in vaginal canal of women in this area and probably lack of more virulent serotypes of GBS may explain the rarity of disease due to Streptococcus agalactiae in our region

Survey of relationship between asthma and epilepsy

Asthma attacks can result in respiratory alkalosis and decreased level of Ionized calcium and cerebral Vasoconstriction. Different studies indicate that Alkalosis and decreased level of CO2 can increase convulsive activities and neuronal excitability. This condition may increase level of Dopamin and risk of convulsion. This study was conducted to survey the relationship between asthma and epilepsy. In an Analitical- cross sectional study 400 Asthmatic patients who were reffered to outpatient clinic of Tabriz university of Medical sciences from January 2004 to July 2006, were concurrently surveyed for Epilepsy too. The results analyzed with Z test for one proportion. Number of patients who had two disease of asthma and Epilepsy concurrently was 12 which 7 of them were male and 5 female respectively. Mean age of patients was 5 +/- 2/3 with confidence interval [Ci = 3/5 - 6/5] Comparison of Asthmatic patients who were epileptic with Normal population was significant [P=0/009] Considering epilepsy prevalence rate of%1 in normal population and%3 in asthmatic patients and risk of respiratory alkalosis in asthmatic it is slrongly recommended to have special attention to Asthma attacks, in epileptic too

Risk factors of respiratory failure in children with Guillain Barre syndrome

Guillain Barre Syndrome is the most common peripheral neuropathy causing respiratory failure, and about 10-30% of these patients require mechanical ventilation sometimes during their illness. Ninety one children under 15 years old with GBS were studied over a period of 3 years. Thirteen [14.4%] of these patients required assisted ventilation. A comparison was made between the clinical, electrodiagnostic, and laboratory data from patients who required mechanical ventilation and those who did not. Progression to respiratory failure necessitating mechanical ventilation was highly likely to occur in those with younger age [p=0.001], cranial nerve involvement [p=0.03], and loss of deep tendon reflexes in upper limbs [p=0.04], lack of motor unit action potential [p=0.009] or presentation of fibrillation potentials [p<0.0001] on electromyography and markedly attenuated [>80%] CMAP amplitude on nerve conduction study [p<0.0001] were significantly more common in the ventilated group. While inherently unpredictable, the clinical course of patients with severe GBS may be predictable to some extent, on the basis of clinical information and electrodiagnostic findings

Clinical efficacy of salbutamol spray in treatment of bronchiolitis

Bronchiolitis is the most common lower respiratory tract infection during first year of life and the cause of about 1% of infant's hospitalizations. The treatment is mainly supportive but many studies have emphasized the role of bronchodilators. This study was aimed to show the efficacy of salbutamol spray. In a Randomized controlled trial, 100 patients with bronchiolitis were randomly divided it, to two groups [50 patients to each]. First group received salbutamol spray [2 puffs via spacer every 4 hours] and second group nebulized 1/1000 epinephrine [0.2 mg/kg plus 3.5cc solin every 4 hours]. Inclusion criteria: infants attueage of 2-12 months with bronchiolitis were diagnosed as lower respiratory tract infection accompanied by fever, rhinitis, tachypnea, wheezing, and dyspnea. Exclusion criteria: patients with cardiac or pulmonary problems, history of bronchodilator the rap or hospital admission with wheezing, history of corticosteroid consumption and ICU admission due to severe bronchiolitis. The age and the gender differences were not significant [p=0.2 and 0.6 respectively]. Outcome indicators such as length of hospital stay and the time needed to restart normal nutrition had no significant differences [p=0.1 and p=0.47 respectively]. Considering feasibility of access and participation of parents in treatment and lack of significant differences between two groups, we suggest using salbutamol spray in treatment of bronchiolitis

[Diagnosis of Airway malacia via virtual bronchoscopy]

The term of malacia refers to softness and in medical terminolog refers to weakness of bone or cartilage. Laryngomalacia is the most common congenital abnormality of larynx and the patient may suffer from recurrent aspiration. Tracheomalacia refers to tracheal weakness and usually results in airway collapse due to cartilage defect. Bronchomalacia is used to describe the weakness and collapsibility of one or both main bronchus. All of the above mentioned diseases can be diagnosed by bronchoscopy but this method is invasive and may interfere with diagnosis, on the other hand it is intolerable in young individual and severly ill, and patients with coagulopathy. This study was conducted to show the role of virtual bronchoscopy in diagnosis of laryngo-tracheo-bronchomalacia. In a peri- experimental study during 3 years [Nov 2003-Oct 2006] 35 patients who had clinical sign and symptom of airway malacia were studied via virtual bronchoscopy. From 35 patients percentage of male and female was 65/7% and 34/3%, respectively and the mean age was 3/7 +/- 1/6 months. The result of virtual bronchoscopy for laryngomalcia, bronchomalacia, tracheomalacia, laryngotracheomalacia and laryngobronchomalacia was 42.8%, 25.7%, 20%, 8.5% and 2.9%, respectively. Virtual bronchoscopy because of non-invasive and speed imaging and excellent ability of assessment of airway stenosis, can be considered as substitution for bronchoscopy