ABSTRACT
AIMS: To determine whether the use of negative pressure ventilation (NPV) was associated with a lower rate of endotracheal intubation in infants with recurrent apnoea secondary to acute bronchiolitis. METHODS: Retrospective review of two paediatric intensive care units (PICU) databases and case notes; one PICU offered NPV. RESULTS: Fifty two infants with bronchiolitis related apnoea were admitted to the two PICUs (31 to the NPV centre). There were no significant differences between infants in the two centres in age and weight on admission, gestational age at birth, birth weight, history of apnoea of prematurity or chronic lung disease, days ill before referral, respiratory syncytial virus status, oxygen requirement before support, and numbers retrieved from secondary care centres. Respiratory support was provided to all 31 infants in the NPV centre (23 NPV, 8 PPV), and 19/21 in the non-NPV centre (18 PPV, 1 CPAP); the NPV centre had lower rates of endotracheal intubation rates (8/31 v 18/21), shorter durations of stay (median 2 v 7 days), and less use of sedation (16/31 v 18/21). In the two years after the NPV centre discontinued use of NPV, 14/17 (82%) referred cases were intubated, with a median PICU stay of 7.5 days. CONCLUSIONS: The use of NPV was associated with a reduced rate of endotracheal intubation, and shorter PICU stay. A prospective randomised controlled trial of the use of NPV in the treatment of bronchiolitis related apnoea is warranted.
Subject(s)
Apnea/rehabilitation , Bronchiolitis/complications , Apnea/etiology , Female , Humans , Infant , Infant, Newborn , Intensive Care Units, Pediatric , Intensive Care, Neonatal , Length of Stay , Male , Recurrence , Respiration, Artificial , Treatment Outcome , Ventilators, Negative-PressureABSTRACT
Respiratory support using negative extrathoracic pressure or high-frequency chest wall oscillation was used to treat 3 infants with cystic fibrosis and respiratory failure who had not responded to maximal medical therapy. Beneficial clinical effects were noted in all three cases. Pulmonary function testing was performed in 2 cases, and measures of compliance increased.
Subject(s)
Cystic Fibrosis/therapy , Respiratory Insufficiency/therapy , Ventilators, Negative-Pressure , Cystic Fibrosis/complications , Cystic Fibrosis/pathology , Female , Humans , Infant , Infant, Newborn , Infant, Newborn, Diseases/therapy , Male , Respiratory Function Tests , Respiratory Insufficiency/etiology , Respiratory Sounds , Treatment OutcomeABSTRACT
Pulmonary and nonpulmonary complications of invasive positive pressure ventilation are well documented in the medical literature. Many of these complications may be minimized by the use of noninvasive ventilation. During various periods of medical history, negative pressure ventilation, a form of noninvasive ventilation, has been used successfully. We report the use of negative pressure ventilation with a chest cuirass to avoid or decrease the complications of invasive positive pressure ventilation in three critically ill infants at two institutions. In each of these cases, chest cuirass ventilation improved the patient's clinical condition and decreased the requirement for more invasive therapy. These cases illustrate the need for further clinical evaluation of the use of negative pressure ventilation utilizing a chest cuirass.
Subject(s)
Respiration, Artificial/methods , Respiratory Insufficiency/prevention & control , Ventilators, Negative-Pressure , Acute Disease , Bulbar Palsy, Progressive/etiology , Humans , Infant , Male , Positive-Pressure Respiration/adverse effects , Respiration, Artificial/instrumentation , Respiratory Insufficiency/physiopathology , Respiratory MechanicsABSTRACT
Three unusual presentations of Salmonella infection in Asian infants in Nepal are described. Salmonella infections have protean manifestations and should be considered in the differential diagnosis of acute illness of obscure aetiology, especially in Salmonella-endemic areas.
