ABSTRACT
BACKGROUND: The Study Group on Accreditation and Quality Improvement of the Italian Society of Pediatrics has developed an observational study about the hospital management of pediatric patients affected by severe asthma, in order to evaluate how the Guidelines for severe asthma in childhood are applied in the daily practice. METHODS: This study included patients between 2 and 17 years, hospitalized or under short intensive observation for acute asthma. The data collection was carried out through the compilation of on-line forms. The statistical technique used was the Chi Square test. RESULTS: 409 forms were filled in by 32 Italian Centers. 17% of the patients showed severe asthma, 59% moderate and 24% mild. On arrival at the Emergency Room the oximetry was measured in 95% of the patients, the respiratory rate in 64% while the heart rate in 88% of them. 48% of the children were exposed to chest X-ray. More than half of the children received oxygen therapy, 98.5% received short-acting beta-2 agonists and systemic steroid therapy was given to 82% of children, mainly orally. At discharge only half of the children were provided with written instructions for the management of any subsequent asthmatic episode. The analysis of the collected data highlights that not all the children had their oxygen saturation measured, although this parameter is one of the main indicators of disease severity, as well as the respiratory rate, which was detected in a minimal percentage of cases. The frequency of chest X-ray was extremely high, even though it does not have any indication in the majority of asthma cases. The evaluation of the therapeutic treatment denotes an adequate use of the oxygen therapy according to the oximetry values found on arrival, but an abuse of steroid therapy. Critical issues emerge at discharge: children are not always educated about the home management of the disease and the self-evaluation of the illness seriousness. CONCLUSION: The pediatric network has become an excellent system of monitoring of the clinical management of asthmatic children, highlighting strengths and weaknesses on which to focus actions of improvement.
Subject(s)
Asthma/therapy , Guideline Adherence , Hospitals/standards , Pediatrics/standards , Quality Assurance, Health Care/methods , Adolescent , Child , Child, Preschool , Female , Humans , Infant , Italy , Male , Pediatrics/methodsABSTRACT
BACKGROUND: Appropriate ventilation together with improvement of clinical care of premature babies can contribute to reducing lung inflammation, known to represent the "primum movens" of bronchopulmonary dysplasia (BPD). High-frequency oscillatory ventilation (HFOV) and volume-guarantee (VG) ventilation are effective in the treatment of neonatal respiratory distress syndrome (RDS). OBJECTIVE: To assess the potential of HFOV and VG to prevent BPD in the acute phase of RDS, by a randomised clinical study evaluating lung inflammation in premature infants. STUDY DESIGN: Forty infants (gestational age 25-32 weeks) with RDS were assigned to assist-control ventilation plus VG (Vt = 5 ml/kg) or HFOV (both with a Dräger Babylog 8000 plus ventilator). Levels of interleukin (IL) 6, IL8 and tumour necrosis factor were determined in tracheal aspirate on days 1, 3 and 7 of life. RESULTS: In the HFOV group IL6 levels were significantly higher on day 3 (0.5 (0.2) vs assisted-control ventilation plus VG group 0.1 (0.2) ng/ml) and oxygen dependency was significantly longer (36 (23) vs assisted-control ventilation plus VG group 19 (11) days). CONCLUSION: VG ventilation is an effective lung-protective strategy to be used in acute RDS, inducing a lower expression of early inflammation markers than HFOV. Whether the use of this initial ventilatory strategy contributes to the prevention of BPD requires further studies.
Subject(s)
High-Frequency Ventilation/methods , Infant, Premature, Diseases/therapy , Positive-Pressure Respiration/methods , Respiratory Distress Syndrome, Newborn/therapy , Bronchoalveolar Lavage Fluid/chemistry , Bronchopulmonary Dysplasia/prevention & control , Female , High-Frequency Ventilation/adverse effects , Humans , Infant, Newborn , Infant, Premature , Infant, Premature, Diseases/diagnosis , Inflammation Mediators/analysis , Interleukins/analysis , Male , Respiratory Distress Syndrome, Newborn/diagnosis , Respiratory Distress Syndrome, Newborn/mortality , Tumor Necrosis Factor-alpha/analysisSubject(s)
Anastomosis, Surgical , Blood Vessel Prosthesis , Catheterization , Graft Occlusion, Vascular/therapy , Polytetrafluoroethylene , Pulmonary Artery/surgery , Subclavian Artery/surgery , Anastomosis, Surgical/adverse effects , Blood Pressure/physiology , Blood Vessel Prosthesis/adverse effects , Catheterization/methods , Child, Preschool , Combined Modality Therapy , Graft Occlusion, Vascular/drug therapy , Graft Occlusion, Vascular/physiopathology , Heparin/therapeutic use , Humans , Infant , Infant, Newborn , Oxygen/blood , Pulmonary Artery/physiopathology , Urokinase-Type Plasminogen Activator/therapeutic useABSTRACT
We describe a simple immunoturbidimetric method for measuring both IgG and albumin in CSF and serum, which enables the calculation of CSF indices. For each protein, only one calibration curve is used for both CSF and serum samples. The assay protocol is simple and similar for both tests. Sensitivity and versatility of the method afford measurements over a very wide range of concentrations (approx. 0.007 to 94 g/l for IgG and 0.06 to 92.40 g/l for albumin). Precision studies (triplicates for 6 runs over 15 days) gave overall CVs: less than or equal to 2.9 and 4.9% for IgG in CSF (11.5 mg/l) and serum (10.28 g/l); less than or equal to 1.3 and 1.1% for albumin in CSF (115 mg/l) and serum (76.89 g/l). Comparison studies showed good correlation with radial immuno-diffusion (r greater than or equal to 0.995 and 0.976 for IgG and albumin) and rate nephelometry (r greater than or equal to 0.967 and 0.982 for IgG and albumin). Thus, the method under investigation proved to be reliable and appears to be particularly suitable for the routine work.
