Clinical analysis of 9 patients with acute laryngitis and negative pressure pulmonary edema / 中华实用儿科临床杂志

ABSTRACT

Objective To investigate the clinical characteristics and treatment of negative pressure pulmonary edema (NPPE) with acute laryngitis in children,and to monitor the change of inflammatory factors.Methods The data of 9 cases with NPPE and acute laryngitis in Pediatric Intensive Care Unit of Xuzhou Children's Hospital from August 2010 to March 2015 were analyzed.Ten children of acute laryngitis without NPPE in our hospital were selected as the control group.The changes of the TNF-α and IL-6 between the 2 groups were compared before and after treatment.Results (1) All the 9 children in NPPE group were associated with third degree laryngeal obstruction.The onset of NPPE in 8 cases varied from 8 minutes to half an hour following relief of obstruction,and 1 child with NPPE occurred 2hours after relief of obstruction.Four of the 9 children had pink frothy pulmonary secretions but the other 5 children did not.NPPE chest radiograph showed diffuse interstitial and alveolar infiltrates.All these patients received these therapeutic measures including mechanical ventilation,retaining high positive end expiratory pressure (PEEP) (5-8 cmH2O,1 cmH2O =0.098 kPa),glucocorticoids,limiting the fluid input volume to 60-80 mL/(kg · d).Three of the 9 cases were treated with diuretics.The disappearance of rales on chest auscultation varied from 6 hours to 30 hours.Duration of mechanical ventilation was less than 48 hours,and all the children were cured.(2) The levels of TNF-α and IL-6 in NPPE group were significantly higher than those in the control group before treatment [(369.16 ± 48.19) ng/L vs(281.77 ± 45.59) ng/L,(30.39 ± 9.60) ng/L vs (20.43 ± 4.80) ng/L,P ＜ 0.05].After 48-hour treatment,the levels of TNF-α and IL-6 in both groups significantly decreased compared with before treatment (all P ＜ 0.01);and the levels of TNF-α and IL-6 in NPPE group were (281.10 ±47.45) ng/L and (20.04 ±5.87) ng/L,respectively,which were also significantly higher than those in the control group(P ＜ 0.05).Conclusions NPPE is manifested by rapid onset of respiratory distress rapidly after relief of the airway obstruction.Imaging suggested edema change.The prognosis will be good if early support of breath and limiting the fluid input volume are applied properly.The inflammatory response is one of the possible mechanisms of NPPE.