scholarly journals Pediatric tracheostomy in COVID-19 pandemic: a review

2021 ◽  
Vol 8 (3) ◽  
pp. 602
Author(s):  
Santosh Kumar Swain ◽  
Ishwar Chandra Behera ◽  
Nishtha Ananda
Keyword(s):  
Pediatric Patient ◽  
Distress Syndrome ◽  
Close Association ◽  
Pediatric Intensive Care ◽  
Severe Form ◽  
Protective Equipment ◽  
Surgical Tracheostomy ◽  
Prolonged Ventilation ◽  
Operating Surgeon ◽  
High Chance

Coronavirus disease 2019 (COVID-19) is a highly contagious infection caused by a novel strain of coronavirus called severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The severity of the COVID-19 infection of the pediatric patient varies broadly between a mild cough and fever to severe form of diseases such as acute respiratory distress syndrome (ARDS) for which some may need intubation and followed by mechanical ventilation through tracheostomy in case of prolonged ventilation. Performing tracheostomy in pediatric patient pose a challenge for health care professional as there is high chance of spread of the disease in COVID-19 pandemic. Surgical tracheostomy is an aerosol generating procedure which causes high chance of spread of infections. There is increasing concern for high transmissibility of the virus to the operating surgeon with their assisting staff and other nearby patients. Pediatric tracheostomy should be performed with close association with pediatric otolaryngologists, anesthesiologists and pediatric intensive care physicians along with adequate personal protective equipment (PPE) for smooth and safe execution of the procedure.

Role of Sildenafil in Management of Pediatric Acute Respiratory Distress Syndrome

2021 ◽  
Author(s):  
Monika Janagill ◽  
Puneet Aulakh Pooni ◽  
Siddharth Bhargava ◽  
Shibba Takkar Chhabra
Keyword(s):  
Acute Respiratory Distress Syndrome ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Distress Syndrome ◽  
Pediatric Intensive Care ◽  
Inclusion Criteria ◽  
Northern India ◽  
Pulmonary Vasodilator ◽  
Pulmonary Arterial

AbstractAcute respiratory distress syndrome (ARDS) has high mortality and multiple therapeutic strategies have been used to improve the outcome. Inhaled nitric oxide (INO), a pulmonary vasodilator, is used to improve oxygenation. This study was conducted to determine the role of sildenafil, an oral vasodilator, to improve oxygenation and mortality in pediatric ARDS (PARDS). The prevalence of pulmonary hypertension in PARDS was studied as well. Inclusion criteria included children (1–18 years) with ARDS requiring invasive ventilation admitted to the pediatric intensive care unit of a teaching hospital in Northern India over a 1-year period of time. Thirty-five patients met the inclusion criteria. Cardiologist performed a detailed echocardiogram to determine pulmonary arterial pressure (PAP). Patients with persistent hypoxemia were started on oral sildenafil. The majority (77%) patients had a primary pulmonary etiology of PARDS. Elevated PAP (>25 mm Hg) was detected in 54.3% patients at admission. Sildenafil was given to 20 patients who had severe and persistent hypoxemia. Oxygenation improved in most patients after the first dose with statistically significant improvement in PaO2/FiO2 ratios at both 12 and 24 hours following initiation of therapeutic dosing of sildenafil. Improvement in oxygenation occurred irrespective of initial PAP. Outcomes included a total of 57.1% patients discharged, 28.6% discharged against medical advice (DAMA), and a 14.3% mortality rate. Mortality was related to the severity of PARDS and not the use of sildenafil. This is the first study to determine the effect of sildenafil in PARDS. Sildenafil led to improvement in oxygenation in nearly all the cases without affecting mortality. Due to unavailability of INO in most centers of developing countries, sildenafil may be considered as an inexpensive alternative in cases of persistent hypoxemia in PARDS. We recommend additional randomized controlled trials to confirm the effect of sildenafil in PARDS as determined in this study.

Burning of a Neonate due to a Pulse Oximeter: Arterial Saturation Monitoring

PEDIATRICS ◽  
1992 ◽  
Vol 89 (1) ◽  
pp. 154-155
Author(s):  
DANIEL B. SOBEL
Keyword(s):  
Mechanical Ventilation ◽  
Intensive Care ◽  
Case Report ◽  
Pulse Oximeter ◽  
Distress Syndrome ◽  
Pediatric Intensive Care ◽  
Supplemental Oxygen ◽  
Premature Neonate ◽  
Skin Development ◽  
Pulse Oximeter Probe

Monitoring of arterial hemoglobin saturations by pulse oximetry has become a fixture in neonatal and pediatric intensive care units, operating rooms, and in other hospital settings. Use with extremely premature neonates is especially beneficial because of their immature skin development and vulnerability to topical damage—whether due to chemicals, tape, or temperature.1,2 This report documents a case of a burn due to a presumed shorting of a pulse oximeter probe cable in an extremely premature neonate. CASE REPORT The patient was a 690-g Hispanic female neonate born prematurely at approximately 25 weeks' gestation with respiratory distress syndrome requiring mechanical ventilation and supplemental oxygen.

Adult Respiratory Distress Syndrome in a Pediatric Intensive Care Unit: Predisposing Conditions, Clinical Course, and Outcome

PEDIATRICS ◽  
1981 ◽  
Vol 67 (6) ◽  
pp. 790-795
Author(s):  
Raymond K. Lyrene ◽  
William E. Truog
Keyword(s):  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Adult Respiratory Distress Syndrome ◽  
Distress Syndrome ◽  
Clinical Course ◽  
Pediatric Intensive Care ◽  
Retrospective Chart Review ◽  
Trauma Mortality ◽  
Predisposing Conditions

Adult respiratory distress syndrome, commonly seen in adults, is not well recognized in children. A retrospective chart review was carried out to determine the relative incidence, predisposing conditions, clinical course, and outcome of children with adult respiratory distress syndrome. Fifteen patients were identified. The most common predisposing conditions were near-drowning and near-strangulation with a noticeable absence of major trauma. Mortality was 60%. Death was most often secondary to central nervous system complications. Air leak was the most common complication of treatment. Two of six survivors suffered major neurologic handicaps. Long-term pulmonary sequelae were minimal.

scholarly journals Impact of Personal Protective Equipment on the Performance of Emergency Pediatric Procedures by Prehospital Providers

2020 ◽  
pp. 1-8
Author(s):  
Maybelle Kou ◽  
Aaron J. Donoghue ◽  
Helen Stacks ◽  
Adam Kochman ◽  
Meghan Semião ◽  
...  
Keyword(s):  
Pediatric Patient ◽  
Personal Protective Equipment ◽  
Clinical Care ◽  
Chemical Exposure ◽  
Task Completion ◽  
Protective Equipment ◽  
Signed Rank ◽  
The Difference ◽  
Simulation Center ◽  
Bag Mask Ventilation

ABSTRACT Background: Personal protective equipment (PPE) is worn by prehospital providers (PHPs) for protection from hazardous exposures. Evidence regarding the ability of PHPs to perform resuscitation procedures has been described in adult but not pediatric models. This study examined the effects of PPE on the ability of PHPs to perform resuscitation procedures on pediatric patients. Methods: This prospective study was conducted at a US simulation center. Paramedics wore normal attire at the baseline session and donned full Level B PPE for the second session. During each session, they performed timed sets of psychomotor tasks simulating clinical care of a critically ill pediatric patient. The difference in time to completion between baseline and PPE sessions per task was examined using Wilcoxon signed-rank tests. Results: A total of 50 paramedics completed both sessions. Median times for task completion at the PPE sessions increased significantly from baseline for several procedures: tracheal intubation (+4.5 s; P = 0.01), automated external defibrillator (AED) placement (+9.5 s; P = 0.01), intraosseous line insertion (+7 s; P < 0.0001), tourniquet (+8.5 s; P < 0.0001), intramuscular injection (+21-23 s, P < 0.0001), and pulse oximetry (+4 s; P < 0.0001). There was no significant increase in completion time for bag-mask ventilation or autoinjector use. Conclusions: PPE did not have a significant impact on PHPs performing critical tasks while caring for a pediatric patient with a highly infectious or chemical exposure. This information may guide PHPs faced with the situation of resuscitating children while wearing Level B PPE.

scholarly journals Bedside Surgical Tracheostomy in the Intensive Care Unit during Covid-19 Pandemic

2020 ◽  
pp. 000348942094776
Author(s):  
Filippo Di Lella ◽  
Edoardo Picetti ◽  
Giovanni Ciavarro ◽  
Giovanni Pepe ◽  
Laura Malchiodi ◽  
...  
Keyword(s):  
Healthcare Workers ◽  
Healthcare Professionals ◽  
Distress Syndrome ◽  
Optimal Allocation ◽  
Northern Italy ◽  
University Hospital ◽  
Limited Resources ◽  
Tertiary Referral ◽  
Surgical Tracheostomy ◽  
Percutaneous Procedures

Objectives: To describe Otolaryngologists’ perspective in managing COVID-19 patients with acute respiratory distress syndrome (ARDS) requiring tracheostomy in the ICUs during the pandemic peak in a dramatic scenario with limited resources. Setting: Tertiary referral university hospital, regional hub in northern Italy during SARS CoV 2 pandemic peak (March 9th to April 10th, 2020). Methods: Technical description of open bedside tracheostomies performed in ICUs on COVID-19 patients during pandemic peak with particular focus on resource allocation and healthcare professionals coordination. A dedicated “airway team” was created in order to avoid transportation of critically ill patients and reduce facility contamination. Results: During the COVID-19 pandemic, bedside minimally invasive tracheostomy in the ICU was selected by the Authors over conventional surgical technique or percutaneous procedures for both technical and operational reasons. Otolaryngologists’ experience derived from direct involvement in 24 tracheostomies is reported. Conclusions: Tracheostomies on COVID-19 patients should be performed in a safe and standardized setting. The limited resources available in the pandemic peak required meticulous organization and optimal allocation of the resources to grant safety of both patients and healthcare workers.

scholarly journals Could Mesenchymal Stem Cell-Derived Exosomes Be a Therapeutic Option for Critically Ill COVID-19 Patients?

2020 ◽  
Vol 9 (9) ◽  
pp. 2762 ◽  
Author(s):  
Chiara Gardin ◽  
Letizia Ferroni ◽  
Juan Carlos Chachques ◽  
Barbara Zavan
Keyword(s):  
Heart Failure ◽  
Critically Ill ◽  
Myocardial Injury ◽  
Clinical Evidence ◽  
Distress Syndrome ◽  
Therapeutic Option ◽  
Viral Disease ◽  
Severe Form ◽  
Acute Myocardial Injury ◽  
Specific Antiviral Therapy

Coronavirus disease 2019 (COVID-19) is a pandemic viral disease originated in Wuhan, China, in December 2019, caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The severe form of the disease is often associated with acute respiratory distress syndrome (ARDS), and most critically ill patients require mechanical ventilation and support in intensive care units. A significant portion of COVID-19 patients also develop complications of the cardiovascular system, primarily acute myocardial injury, arrhythmia, or heart failure. To date, no specific antiviral therapy is available for patients with SARS-CoV-2 infection. Exosomes derived from mesenchymal stem cells (MSCs) are being explored for the management of a number of diseases that currently have limited or no therapeutic options, thanks to their anti-inflammatory, immunomodulatory, and pro-angiogenic properties. Here, we briefly introduce the pathogenesis of SARS-CoV-2 and its implications in the heart and lungs. Next, we describe some of the most significant clinical evidence of the successful use of MSC-derived exosomes in animal models of lung and heart injuries, which might strengthen our hypothesis in terms of their utility for also treating critically ill COVID-19 patients.

scholarly journals Novel Interventional Approaches for ALI/ARDS: Cell-Based Gene Therapy

2011 ◽  
Vol 2011 ◽  
pp. 1-7 ◽  
Author(s):  
Ying-Gang Zhu ◽  
Jie-Ming Qu ◽  
Jing Zhang ◽  
Hong-Ni Jiang ◽  
Jin-Fu Xu
Keyword(s):  
Gene Therapy ◽  
Therapeutic Strategy ◽  
Distress Syndrome ◽  
Therapeutic Strategies ◽  
Severe Form ◽  
Pharmacological Treatments ◽  
Ventilator Support ◽  
Cell Lineages ◽  
Multiple Cell ◽  
Cell And Gene Therapy

Acute lung injury (ALI) and its more severe form, acute respiratory distress syndrome (ARDS), continue to be a major cause of morbidity and mortality in critically ill patients. The present therapeutic strategies for ALI/ARDS including supportive care, pharmacological treatments, and ventilator support are still controversial. More scientists are focusing on therapies involving stem cells, which have self-renewing capabilities and differentiate into multiple cell lineages, and, genomics therapy which has the potential to upregulate expression of anti-inflammatory mediators. Recently, the combination of cell and gene therapy which has been demonstrated to provide additive benefit has opened up a new chapter in therapeutic strategy and provides a basis for the development of an innovative approach for the prevention and treatment of ALI/ARDS.

scholarly journals Purification and Properties of a New Virus from Black Currant, Its Affinities with Nepoviruses, and Its Close Association with Black Currant Reversion Disease

1997 ◽  
Vol 87 (4) ◽  
pp. 404-413 ◽  
Author(s):  
A. Lemmetty ◽  
S. Latvala ◽  
A. T. Jones ◽  
P. Susi ◽  
W. J. McGavin ◽  
...  
Keyword(s):  
Close Association ◽  
Chenopodium Quinoa ◽  
Severe Form ◽  
Causal Agent ◽  
Rt Pcr ◽  
Black Currant ◽  
Virus Particles ◽  
Virus Rna ◽  
Purification And Properties ◽  
Line Patterns

Black currant reversion is a virus-like disease whose causal agent has not been identified. In rooted cuttings of a black currant plant affected with the severe form of the disease, pronounced chlorotic line patterns and ringspots developed in newly emerging leaves. From such symptom-bearing leaves, a virus was mechanically transmitted with difficulty to Chenopodium quinoa and, from this host, to other herbaceous test plants. The virus was purified and partially characterized, and the purified viri-ons were used for antiserum production. Virus particles were isometric, approximately 27 nm in diameter, and sedimented as two nucleoprotein components. They contained a protein species with a molecular mass of 55 kDa, which was readily degraded into a 54-kDa protein and two major RNA components of about 6,700 and 7,700 nucleotides (nt), each with a poly(A) tail. Most of these properties are shared by nepoviruses, but the virus was serologically unrelated to 14 nepoviruses or putative nepovi-ruses tested. However, the deduced sequence of 1,260 nt at the 3′ end of one of the viral RNA species was distinct from any known viral sequence, except that it contained short regions of homology to the 3′ terminal sequences of RNAs of seven other nepoviruses and two comovi-ruses. To detect this virus in Ribes plants, primers were designed from the known sequence to amplify a 210-nt region of the cDNA of the virus RNA using an immunocapture reverse transcriptase polymerase chain reaction (IC-RT-PCR) protocol. Using this assay for the virus, we associated its presence with two recognized forms of black currant reversion disease occurring in Finland, Scotland, or New Zealand. We also detected the virus in vector gall mites from reverted plants and in black currant plants on which such vector mites had fed. However, the virus was not detected by IC-RT-PCR in known healthy Ribes plants; in Ribes plants free from reversion, but affected by three other distinct virus-like diseases of Ribes; or in plants infected with arabis mosaic, strawberry latent ringspot, or raspberry ringspot nepoviruses. These data suggest that this virus may be the causal agent of reversion disease, and it is tentatively called black currant reversion associated virus.

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