Pediatric pulmonology
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Pediatric pulmonology · Mar 1997
Randomized Controlled Trial Comparative Study Clinical TrialAerosol delivery to wheezy infants: a comparison between a nebulizer and two small volume spacers.
Inhalation therapy for wheezy infants with either a nebulizer or a pressurized metered-dose inhaler (pMDI) through a spacer is common practice. The aim of our study was to compare aerosol delivery to wheezy infants from a nebulizer and from a pMDI via two small volume spacers. Twenty wheezy infants (aged 4-12 months) were recruited. ⋯ There was no weight dependence in drug deposition on the filter for the two spacers, but, drug deposition increased with the subject's weight for the nebulizer. We have shown that aerosol delivery to wheezy infants from a pMDI through small volume spacers is effective and that a higher percentage of the total amount of salbutamol is delivered than from a nebulizer. The weight dependence in drug deposition for the nebulizer can be of clinical relevance.
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Pediatric pulmonology · Mar 1997
Assessment of pulmonary function in the early phase of ARDS in pediatric patients.
Scant data are available on lung function in acute respiratory distress syndrome (ARDS) in pediatric patients. We measured respiratory mechanics by single-breath occlusion and maximum expiratory flow-volume curves by forced deflation in ten critically ill infants with clinical ARDS. Ten mechanically ventilated infants without lung disease served as the control group. ⋯ The inhomogeneous distribution of lung injury in ARDS restricts the validity of respiratory mechanics measurements that rely on a single-compartment model. However, the forced deflation technique allows accurate spirometric assessments of the severity of restrictive (and obstructive) lung function changes in intubated infants with severe ARDS. Such measurements can be incorporated into lung injury scoring systems to classify the severity of the disease process for the purpose of outcome evaluation and to evaluate the effect of therapeutic interventions.
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Pediatric pulmonology · Mar 1997
Acute respiratory distress syndrome caused by respiratory syncytial virus.
Acute respiratory distress syndrome (ARDS) complicating severe respiratory syncytial virus (RSV) infection has been described in only a few infants. In contrast to the low mortality rates usually associated with RSV infections (< 5%), mortality rates in the range of 40-70% have been reported in pediatric patients with ARDS. However, studies on patients with ARDS are usually lumped with respect to causation, and the disease course of RSV-induced ARDS has not been previously studied. ⋯ Only one patient (who had immunodeficiency) died, and all others were successfully managed on conventional mechanical ventilation. We conclude that RSV-induced respiratory failure represents a relatively benign cause of ARDS in pediatric patients. Our observations support the notion of differentiating ARDS with respect to causation, especially when novel and experimental therapy is considered and mortality rates are analyzed.
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Pediatric pulmonology · Mar 1997
Randomized Controlled Trial Clinical TrialHospitalization patterns in severe acute asthma in children.
We set out to determine associations between hospitalization and disease severity before and 2 hours after initiation of asthma therapy in the Emergency Department, and to describe the outcome of patients admitted and discharged. This is a retrospective review of data and charts from a randomized, double blind, placebo-controlled trial (R. C. ⋯ Baseline O2 saturation < 92% indicated a longer hospital stay (75.3 +/- 51 hours vs. 43.0 +/- 24.4 hours, P = 0.015) and a later onset of infrequent nebulizations (46.7 +/- 35.1 vs. 26.6 +/- 17.4 hours, P = 0.006). By 2 hours, those with a post-treatment FEV1 % pred < or = 30% and an asthma score > or = 6 of 9 had a high likelihood of hospitalization (86 and 80%, respectively, combined probability 100%), whereas FEV1 % pred > or = 60% and total asthma score < 3 were associated with successful discharge (probability of 92 and 83%, respectively). We conclude that pre-treatment assessments were not associated with hospitalization, while patients with post-treatment FEV1 % pred < or = 30% and a score > or = 6 had high likelihood of hospitalization.
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Pediatric pulmonology · Mar 1997
Case ReportsMineral oil lipoid pneumonia in a child with anoxic encephalopathy: treatment by whole lung lavage.
We describe a case of exogenous lipoid pneumonia in a child with anoxic encephalopathy who was taking mineral oil for constipation. Computed tomography produced images suggesting this condition, and the diagnosis was confirmed by demonstrating the presence of lipid-laden alveolar macrophages in the bronchoalveolar lavage fluid. Despite discontinuing the offending agent, the pulmonary infiltrates did not improve; however, successful resolution was obtained by whole lung lavage.