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Learning Objective: Hemodynamic monitoring during in?hospital transport of intubated patients is vital; however, no prospective randomized trials have evaluated the hemodynamic consequences of hand versus machine ventilation during transport among pediatric patients� post?cardiac surgery. The authors hypothesized that manual ventilation after pediatric cardiac surgery would alter hemodynamic and arterial blood gas (ABG) parameters during transport compared to mechanical ventilation. Design: A prospective randomized trial. Setting: Tertiary cardiac care hospital. Participants: Pediatric cardiac surgery patients. Materials and Methods: One hundred intubated pediatric patients were randomized to hand or machine ventilation immediately post?cardiac surgery during transport from the operating room to the pediatric post?operative intensive care unit (PICU). Hemodynamic variables, including end?tidal CO2 (ETCO2 ), oxygen saturation, heart rate, systolic blood pressure (SBP), diastolic blood pressure (DBP), peak airway pressure (Ppeak), and mean airway pressure (Pmean), were measured at origin, during transport, and at the destination. ABG was measured before and upon arrival in the PICU, and adverse events were recorded. The Chi?square test and independent t?test were used for comparison of categorical and continuous parameters, respectively. Results and Discussion: The mean transport time was comparable between hand?ventilated (5.77 � 1.46 min) and machine?ventilated (5.96 � 1.19 min) groups (P = 0.47). ETCO2 consistently dropped during transport and after shifting in the hand?ventilated group, with significantly higher ETCO2 excursion than in machine?ventilated patients (P < 0.05). SBP and DBP significantly decreased during transport (at 5 and 6 min intervals) and after shifting in hand?ventilated patients than in the other group (P < 0.05). Additionally, after shifting, a significant increase in Ppeak (P < 0.001), Pmean (P < 0.001), and pH (P < 0.001), and a decrease in pCO2 (P = 0.0072) was observed in hand?ventilated patients than machine?ventilated patients. No adverse event was noted during either mode of ventilation. Conclusion: Hand ventilation leads to more significant variation in ABG and hemodynamic parameters than machine ventilation in pediatric patients during transport post?cardiac surgery. Therefore, using a mechanical ventilator is the preferred method for transporting post?operative pediatric cardiac patients
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Objective To explore the clinical and pathologic characteristic of deep fungus infection under mechanical ventilation in neonate. Method The clinical datas of 18 neonates under mechanical ventilation approved with deep fungus infection by autopsy from 1985 to 2003 in our department were collected and analyzed.Results In 18 infants who survived deep fungus infection,2 cases were premature and 16 cases were mature,the birth weight and the numbers of patients were:2500 g 2 cases;Time under mechanical ventilation was 8-86 days and the average time under mechanical ventilation was 13 days. The pathogen caused deep fungus infection was Aspergillus(8/18),Candida albicans(6/18) and Mucor(4/18),respectively. The infected organ were lung(12/18),brain(2/18),liver(4/18) and gastrointestinal tract(2/18),respectively.Two of them were found been infected in lung and liver at the same time.Conclusions We must attach importance to deep fungus infection in neonate under machine ventilation.Aspergillus and Candida albicans were the main pathogen bacteria and lung was the main infected organ of neonatal deep fungus infection.Early diagnosis may be the efficiency approach to increase livability.