RESUMO
Mycoplasma pneumoniae (MP)is one of the most common causes of community-acquired pneu-monia in children. The incidence of respiratory failure due to Mycoplasma pneumoniae pneumonia (MPP)is relatively rare despite the high prevalence of MP infection. Prevalence of respiratory failure was unsure in children,most of them presented with hypoxia or acute respiratory distress syndrome. Key clinical findings include cough,fever,and dyspnea along with diffuse abnormal findings in radiological examinations. Levels of inflammatory markers such as white blood cells and C-reactive protein are elevated. The exact pathogenesis of fulminant MPP remains unclear,radiological ima-ges usually showed bilateral infiltrates and pleural effusion commonly present in MPP cases with respiratory failure. Treatment options involve pairing the appropriate anti-mycoplasma agent with a corticosteroid which aimed at decrea-sing the hypersensitivity response,further research is necessary to determine the exact pathogenesis of MPP with respira-tory failure. Now,the most recent data in epidemiology,research situation,pathogenesis,clinical and X-ray presenta-tion,and treatment of respiratory failure with MPP are described.
RESUMO
Objective Some children with congenital heart defect would get serious acute respiratory distress syndrome in ICU postoperatively,which is a tough problem.We summarized the clinical effects of synchronized intermittent mandatory ventilation (SIMV)with expiratory high frequency ventilation (HFV) for these patients in our center.Methods A total of 13 pediatric patients,with(8.15 ±4.34)months old and (8.23 ±4.01 )kg weight,used SIMV with expiratory HFV from Jan 2012 to Aug 2013.Keeping the original SIMV conditions unchanged,the expiratory oscillation amplitude were 25 to 35 Ann(A)and the oscillation frequency of 7 to 9 hertz(Hz).All patients were divided into two groups to oxygenation index(OI)30 min before HFV,high OI group(OI≤20,n ﹦5)and low OI group(OI 〈20,n ﹦8).OI ﹦MAP ×FiO2 /PaO2 .The values of OI,PaO2 /FiO2 and PaCO2 of two groups were monitored before and at 2,6,24,48 h after HFV re-spectively.Results The values of OI of all 13 patients were 19.31 ±4.42 before HFV,and then decreased to 18.77 ±5.18,16.00 ±5.22,14.77 ±6.56,and 13.92 ±6.53 respectively at 2,6,24 and 48 hours later (P 〈0.01 ).But there was no significant difference of OI in high OI group in different time points.The val-ues of PaCO2 of all 13 patients were(43.46 ±5.67)mmHg(1 mmHg ﹦0.133 kPa)before HFV,and de-creased to(38.31 ±4.21)mmHg,(37.61 ±3.36)mmHg,(34.77 ±3.81 )mmHg,and(35.92 ±2.39)mmHg respectively at 2,6,24,and 48 hours after HFV(P 〈0.01 ).Three dead patients were all in high OI group. Conclusion The mortality rate of serious acute respiratory distress syndrome with congenital heart diseases postoperatively is high.SIMV with expiratory HFV can improve oxygenation and reduce carbon dioxide,and the effect is better when OI 〈20.
RESUMO
Objective To discuss the clinical application of noninvasive positive pressure ventila-tion for patients with acute respiratory distress syndrome (ARDS) as a result of cytomegalovirus (CMV) interstitial pneumonia after renaltransplantation. Methods There were 371 renal transplan-tation from March 2003 to October 2006, 27 patients were diagnosed as CMV pneumonia postopera-tion. Ten patients were treated with noninvasive positive pressure ventilation within the 11 patients who aggravated to ARDS. The clinical data of before and after mechanical ventilation were reviewed. Results Among patients received noninvasive positive pressure ventilation, 1 died of complication. Seven patients were cured by noninvasive positive pressure ventilation. Significant difference of the physiological index presented between the 7 patients cured with noninvasive positive pressure ventila-tion before and after the use of ventilation(P<0.05), and significant difference of the renal function also existed(P<0.05). Conclusion The major value of noninvasive positive pressure ventilation is to correct the hypoxemia.
