Nederlands tijdschrift voor geneeskunde
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Ned Tijdschr Geneeskd · Feb 1999
Clinical Trial[Results of extracorporeal membrane oxygenation in 100 newborns with cardiorespiratory insufficiency].
To describe the results of treatment with extracorporeal membrane oxygenation (ECMO) in newborns with severe cardiorespiratory insufficiency. ⋯ The 100 children comprised 66 boys and 34 girls, with a mean age of 2 days (range: 1-15). Indications for ECMO treatment were: meconium aspiration syndrome: 39 with 37 survivors (95%), congenital diaphragmatic hernia: 31 with 23 survivors (74%), sepsis or pneumonia: 20 with 14 survivors (70%) and 'others' among which persistent pulmonary hypertension of the newborn: 10 with 8 survivors (80%). Eighteen children died (18%). Causes of death were rebound pulmonary hypertension (9 times), intracranial haemorrhage (4), multi-organ failure (3) and pulmonary problems (2). The most important complications during treatment were bleeding problems (29), clotting problems (20) and infections (11).
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Ned Tijdschr Geneeskd · Jan 1999
Case Reports[Pleural empyema in mechanically ventilated patients with pneumonia].
Two males aged 41 and 32 years developed pneumonia which responded inadequately to antibiotic treatment and necessitated mechanical ventilation. It was only after surgical and digital opening, drainage of pus pockets and daily pleural lavage that the clinical picture improved. The microorganisms cultured from both patients included Streptococcus milleri, probably acquired by aspiration. ⋯ For the diagnosis, ultrasonographic and CT imaging, followed by pleural puncture are used. Simple parapneumonic effusions are managed by drainage with or without rinsing with normal saline, while in advanced empyema, instillations with fibrinolytic agents have proved safe and effective. Sometimes, video-assisted thoracoscopic or conventional surgery is necessary to clear the pleural space, while in complicated cases, extensive surgical procedures are warranted.
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Acute respiratory distress in children is often a consequence of asthma. Other causes are subglottic laryngitis, epiglottitis, aspiration of a foreign body, acute bacterial pneumonia or pneumothorax. History and physical examination should differentiate between the various diseases. ⋯ In case of aspiration of a foreign body, like a peanut, immediate action is needed to prevent irreversible damage to the airways. Subglottic laryngitis and epiglottitis are both characterized by an inspiratory stridor; in case of epiglottitis immediate action is needed, while in case of subglottic laryngitis observation time is available in most cases. Pneumothorax as a cause of acute breathlessness is rare in childhood; it should be considered in male smoking leptosomic asthmatic adolescents.
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Three women aged 30, 38 and 34 years, originating from Morocco, the Dominican Republic and Turkey, had been suffering since several years from, among other things, oral aphthae, vaginal ulcers and skin lesions without specific abnormalities at examination of blood and biopsies. The diagnosis of Behçet's disease was made and immunomodulating treatment instituted, following which the patients improved. Behçet's disease is a chronic inflammatory multisystemic disorder of unknown aetiology. ⋯ Because symptoms manifest themselves over many years the disease can be missed or misdiagnosed easily. There is no laboratory test available to support the diagnosis, so that the diagnosis is based on clinical symptomatology. The incidence is increasing due to migration from areas with higher prevalence.
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Mechanical ventilation in both children and adults is still associated with development of lung injury, both short term and long term. In particular, ventilation with high tidal volumes and low positive end-expiratory pressures (PEEP) contributes significantly to development of lung injury. Suggested preventive measures consist of limiting peak inflation pressures, preventing high tidal volumes, and applying high PEEP to prevent alveolar collapse. ⋯ The degree of inflammation depends on the ventilator settings and mode of ventilation. This inflammatory reaction may not be limited to the lungs but, via inflammatory mediators, may cause multiple organ dysfunction as well. Future research needs to be concentrated on how to modify this ventilator induced inflammatory reaction in order to prevent lung injury as well as systemic injury.