Flexible bronchoscopy as a valuable diagnostic and therapeutic tool in pediatric intensive care patients: a report on 5 years of experience.

OBJECTIVE: To evaluate the clinical role of flexible bronchoscopy (FB) in pediatric and neonatal intensive care units (ICUs). DESIGN: A retrospective review of all patients receiving FB procedures between January 2005 and December 2009. SETTING: Pediatric and neonatal ICUs of a tertiary care multi-disciplinary teaching hospital located in northern Taiwan. PATIENTS: A total of 358 ICU patients (223 males) who received 725 FB procedures. MEASUREMENTS AND MAIN RESULTS: The medical records were reviewed and analyzed. Mean age for the first time FB was 35.7 (±48.9 SD) months old and 68.2% of them were <3 years old. Among them, unexplained retraction or tachypnea (32.0%) and stridor (20.1%) were the two leading indications for FB. The positive finding rate of FB was 87.2%, with airway malacia (47.8%) being the most common, especially in patients <3 years old. Positive lesion sites were approximately equally distributed between the upper (51.1%) and lower (50.6%) airways. Concomitant findings in the esophagus were found in 15.4% of the patients. There were 518 interventional FBs (71.4%, 518/725 procedures) which were performed on 201 (56.1%, 201/358) patients; FB-aided endotracheal intubation (180/518, 34.7%) and laser therapy (109/518, 21.0%) were the two leading techniques used. No patient suffered from any long-term complications or mortality associated with the FB procedures. CONCLUSIONS: FB is a safe and valuable diagnostic and therapeutic tool for patients in pediatric and neonatal ICUs.

Life-threatening anaphylactic reaction after the administration of airway topical lidocaine.

A 9-year-old boy who developed a life-threatening anaphylaxis reaction of the airway and subsequent dyspnea and circulation collapse because of instilled the topical lidocaine into the airway within 2 min before performing flexible bronchoscopy (FB). FB revealed swollen airway mucosa and extensive foamy secretion that severely compromised the ventilation lumen. Rapid detection with FB and immediate resuscitation, including prompt administration of epinephrine, volume expander, and positive pressure ventilation with pure oxygen via an endotracheal tube, were successfully save the patient's life.

Tracheal foreign body after laser supraglottoplasty: a hidden but risky complication of an aluminum foil tape-wrapped endotracheal tube.

Wrapping of the endotracheal tube with aluminum foil tape can prevent laser-beam-induced ignition of the tube during laryngoplasty. However, this modified endotracheal tube may pose complications. Two newborn infants had a portion of the foil tape trapped in their trachea after extubation from laser supraglottoplasty. One infant was totally asymptomatic. The other infant's symptoms were masked by the concurrent tracheomalacia. Both residual tapes were radiolucent on chest radiographs. Flexible endoscopy was the suitable and safe modality for an accurate diagnosis and immediate retrieval of the residual tapes in one session.

Spirometric reference equations for healthy children aged 6 to 11 years in Taiwan.

BACKGROUND: Spirometry is a valuable technique for evaluating pulmonary function, but there were few normative reference values for young children in Taiwan, and none for the last 10 years. The objective of our study was to establish updated reference values and equations for children aged 6-11 years in northern Taiwan. METHODS: A total of 309 healthy children (153 boys and 156 girls) were enrolled in the present study. The data of at least 3 trials for each child were collected, and the highest values analyzed. The analyzed pulmonary function parameters were focused on forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1), peak expiratory flow rate (PEF), forced expiratory flow between 25% and 75% expired volume (FEF25-75), and the ratio of FEV1/FVC. RESULTS: The results revealed that there were mostly no significant differences between boys and girls, and the standing height (H, cm) was the factor with the highest correlation with the pulmonary function parameters. Regression equations of the major pulmonary function parameters for both boys and girls were obtained: FVC = -2.690 + 0.0330H; FEV1 = -2.559 + 0.0311H; PEF = -300.231 + 3.938H; FEF25-75 = -3.218 + 0.0425H (p < 0.001). CONCLUSION: Our study determined the updated normative values and reference equations for Chinese children aged 6-11 years living in northern Taiwan. These values can be used as normative reference values to evaluate pulmonary function in diseased children with the same ethnicity and lifestyle.

The conductive property of ZnO QDs-SiO2 and ZnO QDs-SiO(x)N(y) nanocomposite films.

The dc and ac conductive properties of ZnO QDs-SiO2 and ZnO QDs-SiO(x)N(y) nancomposite films prepared by the target-attached sputtering method are investigated. Both two nanocomposite samples reveal a typical characteristic of a metal-oxide varistor (MOV) on the J-E plots with distinct threshold electric fields (E(th)) which are affected by the molecular bonding configurations in the matrix and at the dot/matrix interfaces. The two systems exhibit dissimilar dependences of dc conductivity (sigma(dc)) on the ZnO content, revealing the limitation of conventional percolation models in which the surface interaction term is usually ignored. The ac conduction behaviors of the two nanocomposite systems were also analyzed and their percolation concentrations V(c) (22.75% for ZnO QDs-SiO2 and 20.78% for ZnO QDs-SiO(x)N(y)) are determined by the construction of master curves. Analytical results illustrated that the dielectric matrix type indeed affects the defect configuration and transport behaviors inside ZnO dots. Hence, manipulation of dielectric matrix type can possibly achieve various optical and electrical properties in ZnO QDs-dielectric nanocomposite systems.