Pediatric pulmonology
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Pediatric pulmonology · Jan 1991
Effects of endotracheal tube size and ventilator settings on the mechanics of a test system during intermittent flow ventilation.
The effect of varying the size of standard neonatal endotracheal tubes on delivered tidal volumes (VT), resistance (R), dynamic compliance (Cdyn), and resistive work of breathing (WOB) was measured in a test system during intermittent flow ventilation at different ventilator settings. The experiments were performed with a Sechrist infant ventilator connected to a Dräger Test Lung via standard neonatal endotracheal tubes. R, inspiratory (Ri), and expiratory resistance (Re) as well as WOB were significantly affected by endotracheal tube size. ⋯ Also, ventilator settings with respect to the peak inspiratory pressure (PIP) - positive end-expiratory pressure (PEEP) difference had a significant influence on Cdyn for both tube sizes. On the other hand, flow and inspiratory time adjustments had no significant effect on ventilatory parameters. Endotracheal tube size and ventilator settings should be considered when comparing the pulmonary function tests in intubated and non-intubated newborn infants.
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Pediatric pulmonology · Jan 1991
Pilot study for the development of a monitoring device for ventilated children.
Airway pressure and air flow were measured at the endotracheal tube in 13 children on a variety of ventilators. These signals were stored for analysis on a computer. Further data sets were obtained after 24 hours or following major interventions. ⋯ There was minimal interference with patient care. This pilot study demonstrates that changes in respiratory mechanics can be displayed safely and easily in ventilated patients using resistance and compliance loops. Further work is necessary to confirm the usefulness of real time of these displays.
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Pediatric pulmonology · Jan 1991
Cold air challenge of airway reactivity in children: a correlation of transcutaneously measured oxygen tension and conventional lung functions.
For pharmacological challenges, a correlation between the induced changes of the transcutaneously measured oxygen tension (PtcO2) and of conventional pulmonary function tests (PFTs) has been documented. We performed a 4-minute cold air challenge (CACh) in 17 children with bronchial asthma under continuous monitoring of PtcO2, and correlated observed changes with CACh-induced alterations of conventional PFTs. ⋯ Changes of FVC, PEF, and Vmax50 correlated significantly as well. PtcO2 can complement or substitute for conventional PFTs in assessing the response to CACh in children.
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Pediatric pulmonology · Jan 1991
Effect of positive end-expiratory pressure on respiratory compliance in children with acute respiratory failure.
We studied the effect of positive end-expiratory pressure (PEEP) on the compliance of the respiratory system (Crs) in 25 children (age, 3 weeks to 10 years) requiring mechanical ventilation. Functional residual capacity (FRC) measurements were performed at 2 cm H2O increments, from 0 to 18 cm H2O of PEEP, and the FRC values were regressed versus PEEP. Static Crs, Crs/kg, and specific compliance (Crs/FRC) were calculated for each PEEP level. ⋯ We concluded that static respiratory compliance improves in most (but not all) children with acute respiratory failure when FRC is normalized. Static respiratory compliance reaches maximum levels at PEEP values that are close (but not equal) to those that result in FRC normalization. Thus, assessment of the effect of PEEP on compliance is required in individual patients.
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Pediatric pulmonology · Jan 1991
Comparative StudyPulse oximetry versus measured arterial oxygen saturation: a comparison of the Nellcor N100 and the Biox III.
Pulse oximetry is noninvasive, fast, and simple, making it a very popular way of assessing oxygenation in pediatric patients. However, there are few studies that establish the accuracy of this technology over a wide range of oxygen saturations in children. This study, done in 47 children aged from 1 day to 16 years with congenital heart disease and undergoing cardiac catheterization, compared the direct measurement of arterial oxygen saturation to values from pulse oximetry. ⋯ For both devices, the error increased with decreasing saturations, being progressively larger below a saturation of 80%. The difference between the actual saturation and that measured by pulse oximetry bore no relationship to the presence of carboxyhemoglobin, methemoglobin, fetal hemoglobin, bilirubin, cardiac index, or age of the patient. In conclusion, pulse oximetry, while a very useful technology in pediatrics, must be interpreted with some caution in children with severe cyanosis.