Analysis of risk factors on mucus formation in children with mycoplasma pneumonia / 中国综合临床

Objective To explore the risk factors of Mycoplasma pneumoniae pneumonia ( MPP ) combined with mucous plug in children. Methods A retrospective analysis was carried out on the clinical data of one hundred and forty-nine patients with MMP who received fiber bronchoscope from September 2013 to September 2016. Based on the airway mucosal lesions seen through the bronchoscope,patients were divided into two groups:the mucous plug group( 82 cases) and the control group( 67 cases) . The risk factors of mucous plug in MMP children were analyzed through single factor and multifactor analysis. Area under curve ( AUC ) was calculated according to receiver operator characteristic ( ROC ) curve to evaluate the diagnostic value of independent risk factor. Results The result of univariate analysis showed that,in the mucous plug group,the age was (5.88±2.01)ages,pleural effusion cases was 64.63％,febrile course was (10.65±2.87)d,CRP was (50. 99±20. 23) mg/L,serum LDH was (429. 94±160. 28)U/L,significantly higher than those in the control group ( age(5. 12±2. 15)ages,pleural effusion cases was 28. 36％,febrile course was(8. 97±3. 01)d,CRP was (20. 89±9. 98) mg/L and serum LDH was(300. 12±125. 14)U/L),the differences were statistically significant (P<0. 05) . Multiple factors analysis showed that age of onset, febrile course, CRP, serum LDH were the independent risk factors, the differences were statistically significant ( 95％CI= 2. 054 ～ 18. 305, 1. 539 ～21. 778,1. 159 ～ 24. 565,1. 883 ～ 9. 469,P<0. 05) . . ROC curve analysis indicated that the AUC of CRP and LDH was 0. 897,0. 829,respectively. Conclusion Old age,long febrile course,and high level of CRP and LDH are the independent risk factors for the mucous plug formation in MPP children. The diagnostic value of CRP is higher than that of LDH. Monitoring these factors can help the doctor determine whether the patient need do bronchoscope without delay and prevent the formation of mucous plug and improve the prognosis.

Risk factors of airway mucous plug caused byMycoplasma pneumoniae pneumonia in children / 临床儿科杂志

Objective To analyze the risk factors of mucous plug caused byMycoplasma pneumoniae pneumonia (MPP) in children and guide clinical therapy to decrease the incidence of sequela caused by airway inlfammatory obstruc-tion.Methods We conducted a retrospective study of the clinical data of 116 children with MPP who received ifber broncho-scope from January 2012 to January 2014 admitted to the respiratory department of the Children's Hospital of Hebei provience. Based on the airway mucosal lesions seen through the bronchoscope, the subjects were divided into the mucous plug group (n=67) and the control group (n=49). Gender, age of onset, febrile course, pleural effusion, white blood cell counts, neutrophil ratio, C reactive protein (CRP), serum lactate dehydrogenase level (LDH), initial time of received macrolides and ifber bronchoscope were compared between the two groups. If the Results of single factor analysis showedP<0.05, the indicators were analyzed by the logistic regression analysis. The receiver operator characteristic (ROC) curve was drawn to evaluate the predictability of logistic regression model.Results The Results of single factor analysis showed that age of onset, febrile course, CRP, serum LDH, pleural effusion cases in the mucous plug group were higher than those in control group (P<0.05). The Results of the logis-tic regression analysis showed that older than three years (OR=7.45), febrile course more than 10 days (OR=4.01), the level of CRP and LDH higher than 40 mg/L (OR=5.41) and 350 U/L (OR=3.63) were respectively the risk factors of mucous plug caused by MPP in children. The area under the ROC curve is 0.846 (95%CI: 0.773-0.919,P=0.000).Conclusions MPP children with age older than three years, or with febrile course more than 10 days, or with the level of CRP and LDH higher than 40 mg/L and 350 U/L has the possibility of forming a mucous plug.

Airway Obstruction due to Huge Dried Mucous Plug Discovered during Induction of Anesthesia : A case report

Endotracheal obstruction may cause serious complications, including cardiovascular instability, pneumothorax, pulmonary edema and even brain death. A 21-year-old man was scheduled to undergo an open reduction for an orbital fracture. The patient had tracheostomy with an 8.0 mm tracheostomy tube 3 weeks ago and was breathing well spontaneously. When the cuff of tracheostomy tube was inflated for assisted manual ventilation and the induction of anesthesia, signs of partial endotracheal obstruction were observed, including high airway pressure, low tidal volume and high ETCO2. Large dried mucous plug was impacted in the tracheostomy tube. After removing this plug with a sterile surgical forcep, effective ventilation was recovered without complications. The case like this nearly fatal obstruction by large dried mucous plug was rarely reported, but it should be considered cautiously when a patient uses tracheostomy tube as an airway before general anesthesia.

Airway Obstruction due to Mucous Plug During General Inhalation Anesthesia with Double Lumen Endobronchial Tube: A case report / 대한마취과학회지

Acute airway obstruction during endotracheal anesthesia is embarrassing and critical situation which requires early diagnosis and immediate management. A 57-year-old man was scheduled for right pneumonectomy for a destroyed lung by fibroatelectatic changes and pleural calcification of right lung. We experienced high arterial PCO2 and inspiratory resistance during Left - Sided Double Lumen Endobronchial anesthesia in the left decubitus position. We exchanged tube after failure of suction and found airway obstruction due to mucous plug attached to the bevel of the endobronchial lumen.