scholarly journals Preliminary Effectiveness and Safety of High Frequency Oscillation in Addition to Mechanical Insufflation and Exsufflation for Intratracheal Mucus Removal in Patients With Neuromuscular Disease: Protocol for a Prospective Study (Preprint)

2018 ◽  
Author(s):  
Hiroyuki Awano ◽  
Masashi Nagai ◽  
Ryosuke Bo ◽  
Mariko Murao ◽  
Yusuke Ishida ◽  
...  

BACKGROUND Mechanical insufflation-exsufflation (MI-E) is necessary for noninvasive management of respiratory clearance in patients with neuromuscular disorders (NMDs). Its utility has been proven, and the technique is recommended in a number of international guidelines for the management of patients with NMDs. However, the clearance of thick secretions adhering to the tracheobronchial walls could be problematic when these patients suffer from respiratory tract infections. To improve the effectiveness of the noninvasive technique, a novel device combining MI-E with high frequency oscillation (HFO) has been developed. However, the efficacy of HFO therapy in NMDs has not been well studied. OBJECTIVE The aim of this study was to elucidate the effect of MI-E combined with HFO for mucus removal in NMD patients. To evaluate its efficacy, changes in transcutaneous oxygen saturation (SpO2), which may predict intratracheal mucus removal, will be measured before and after use of MI-E. METHODS This is a single-center, nonblinded, nonrandomized prospective study that will enroll 5 subjects hospitalized in Kobe University Hospital owing to respiratory tract infection. All subjects will receive MI-E therapy a few times daily and will receive HFO every other day, for 6 days. Before and after MI-E use, SpO2 will be obtained and the change in SpO2 (ΔSpO2) between MI-E with and without HFO will be calculated. For every subject, the average of ΔSpO2 with or without HFO will be obtained and the null hypothesis that there is a mean change of 0 in the SpO2 between MI-E with and without HFO will be tested using the paired t test. If the treatment with HFO is found to be statistically significantly superior to the treatment without HFO, the study will conclude that HFO addition is more efficacious than no HFO addition. RESULTS A total of 2 subjects have already been recruited and enrolled in this study as of August 2018. CONCLUSIONS This unique protocol will assess the efficacy of adding HFO to MI-E during the acute phase of respiratory tract infection in patients with NMDs. INTERNATIONAL REGISTERED REPOR DERR1-10.2196/12102

2019 ◽  
Vol 67 (2) ◽  
pp. 341-347
Author(s):  
Norma Constanza Corrales-Zúñiga ◽  
Nelly Patricia Martínez-Muñoz ◽  
Sara Isabel Realpe-Cisneros ◽  
Carlos Eberth Pacichana-Agudelo ◽  
Leandro Guillermo Realpe-Cisneros ◽  
...  

Introducción. Es frecuente que muchos niños sometidos a procedimientos con anestesia general tengan historia de infección viral respiratoria superior reciente o activa.Objetivo. Realizar una revisión narrativa acerca de las pautas de manejo anestésico para los niños con infección reciente o activa de la vía aérea superior.Materiales y métodos. Se realizó una búsqueda estructurada de la literatura en las bases de datos ProQuest, EBSCO, ScienceDirect, PubMed, LILACS, Embase, Trip Database, SciELO y Cochrane Library con los términos Anesthesia AND Respiratory Tract Infections AND Complications; Anesthesia AND Upper respiratory tract infection AND Complications; Anesthesia, General AND Respiratory Tract Infections AND Complications; Anesthesia, General AND Upper respiratory tract infection AND Complications; Anesthesia AND Laryngospasm OR Bronchospasm. La búsqueda se hizo en inglés con sus equivalentes en español.Resultados. Se encontraron 56 artículos con información relevante para el desarrollo de la presente revisión.Conclusiones. Una menor manipulación de la vía aérea tiende a disminuir la frecuencia de aparición y severidad de eventos adversos respiratorios perioperatorios. No existe evidencia suficiente para recomendar la optimización medicamentosa en pacientes con infección respiratoria superior.


2009 ◽  
Vol 30 (10) ◽  
pp. 952-958 ◽  
Author(s):  
Fernando Bellissimo-Rodrigues ◽  
Wanessa Teixeira Bellissimo-Rodrigues ◽  
Jaciara Machado Viana ◽  
Gil Cezar Alkmim Teixeira ◽  
Edson Nicolini ◽  
...  

Objective.To evaluate the effectiveness of the oral application of a 0.12% solution of Chlorhexidine for prevention of respiratory tract infections among intensive care unit (ICU) patients.Design.The study design was a double-blind, randomized, placebo-controlled trial.Setting.The study was performed in an ICU in a tertiary care hospital at a public university.Patients.Study participants comprised 194 patients admitted to the ICU with a prospective length of stay greater than 48 hours, randomized into 2 groups: those who received Chlorhexidine (n = 98) and those who received a placebo (n = 96).Intervention.Oral rinses with Chlorhexidine or a placebo were performed 3 times a day throughout the duration of the patient's stay in the ICU. Clinical data were collected prospectively.Results.Both groups displayed similar baseline clinical features. The overall incidence of respiratory tract infections (RR, 1.0 [95% confidence interval [CI], 0.63-1.60]) and the rates of ventilator-associated pneumonia per 1,000 ventilator-days were similar in both experimental and control groups (22.6 vs 22.3; P = .95). Respiratory tract infection-free survival time (7.8 vs 6.9 days; P = .61), duration of mechanical ventilation (11.1 vs 11.0 days; P = .61), and length of stay (9.7 vs 10.4 days; P = .67) did not differ between the Chlorhexidine and placebo groups. However, patients in the Chlorhexidine group exhibited a larger interval between ICU admission and onset of the first respiratory tract infection (11.3 vs 7.6 days; P = .05). The chances of surviving the ICU stay were similar (RR, 1.08 [95% CI, 0.72-1.63]).Conclusion.Oral application of a 0.12% solution of Chlorhexidine does not prevent respiratory tract infections among ICU patients, although it may retard their onset.


Author(s):  
ATIKA WAHYU PUSPITASARI ◽  
OLYVA CESSARI LARAS SERUNI ◽  
LINA NADHILAH

Objective: Acute respiratory tract infection (ARTI) is common and has the highest death rate in children, especially in growing countries such asIndonesia. The aim of the research is to identify drug-related problems (DRPs) in pediatric ARTI patients based on the DRP classification by Cipolle,Strand, and Morley, which included categories such as unnecessary drug therapy, need additional therapy, ineffective drug, dosage adjustments suchas too low or too high, and adverse drug reaction which is drug interaction.Methods: The design of the study was cross-sectional and descriptive with a retrospective method. The sample of the study was the overall prescriptionsto upper respiratory tract infection patients in Tebet Subdistrict Health Center from July to December 2018 that fulfilled all of the inclusion criteria,using the total sampling method. Total samples that were analyzed were from 179 sheets of prescription with a total of 498 prescriptions.Results: The results of the research based on each parameter were inaccurate drug selection (9.5%), inaccurate indication (12.8%), mismatched dose(79.9%), and drug interaction (0.6%).Conclusion: DRPs in ARTI pediatric patients resulted in a high-risk condition so that the health facilities need to improve their prescribing pattern andmonitor and manage each therapy as well as do a routine prescription assessment to minimize the incidence of DRPs and achieve a rational drug usage.


2019 ◽  
Vol 74 (11) ◽  
pp. 3371-3378 ◽  
Author(s):  
Magdalena Nowakowska ◽  
Tjeerd van Staa ◽  
Anna Mölter ◽  
Darren M Ashcroft ◽  
Jung Yin Tsang ◽  
...  

Abstract Objectives To identify the rates of potentially inappropriate antibiotic choice when prescribing for common infections in UK general practices. To examine the predictors of such prescribing and the clustering effects at the practice level. Methods The rates of potentially inappropriate antibiotic choice were estimated using 1 151 105 consultations for sinusitis, otitis media and externa, upper respiratory tract infection (URTI) and lower respiratory tract infection (LRTI) and urinary tract infection (UTI), using the Clinical Practice Research Datalink (CPRD). Multilevel logistic regression was used to identify the predictors of inappropriate prescribing and to quantify the clustering effect at practice level. Results The rates of potentially inappropriate prescriptions were highest for otitis externa (67.3%) and URTI (38.7%) and relatively low for otitis media (3.4%), sinusitis (2.2%), LRTI (1.5%) and UTI in adults (2.3%) and children (0.7%). Amoxicillin was the most commonly prescribed antibiotic for all respiratory tract infections, except URTI. Amoxicillin accounted for 62.3% of prescriptions for otitis externa and 34.5% of prescriptions for URTI, despite not being recommended for these conditions. A small proportion of the variation in the probability of an inappropriate choice was attributed to the clustering effect at practice level (8% for otitis externa and 23% for sinusitis). Patients with comorbidities were more likely to receive a potentially inappropriate antibiotic for URTI, LRTI and UTI in adults. Patients who received any antibiotic in the 12 months before consultation were more likely to receive a potentially inappropriate antibiotic for all conditions except otitis externa. Conclusions Antibiotic prescribing did not always align with prescribing guidelines, especially for URTIs and otitis externa. Future interventions might target optimizing amoxicillin use in primary care.


2018 ◽  
Vol 1 (1) ◽  
pp. 5-8
Author(s):  
Henish Shakya ◽  
Saurav Singh ◽  
Ashish Lakhey

Introduction: Lower respiratory tract infection is a major cause of death in children in a developing country and anemia is found to be one of the commonest associated cofactors. This study was aimed to determine association of anemia in children with lower respiratory tract infections.Materials and Methods: The retrospective study was done over a one-year period for children under 5 years of age, admitted in Pediatric Ward of a tertiary Hospital in Lalitpur. The study included 100 diagnosed cases of lower respiratory tract infections as per WHO criteria and 100 age and sex matched patients who did not have respiratory complaints as controls, excluding prematurity, chronic diseases, malnutrition and severe systemic illness. Appropriate clinical history, examination routine investigations like hemoglobin, peripheral smear, and Chest X-ray were included.Results: The age distribution maximum children were in the age group of 3 months to 23 months with significant association with prevalence of both pneumonia (p value 0.005) and anemia (p value 0.002). Anemia was found to be a significant risk factor for LRTI (p value < 0.001) with odds ratio of 2.68 and 95% CI (1.51 – 4.75).Conclusions: Anemia was significantly found to be associated with lower respiratory tract infections and these children were found to be 2.68 times more susceptible to lower respiratory tract infections. Early diagnosis and prevention of anemia is thus important to reduce the incidence of lower respiratory tract infections in children.Nepalese Medical Journal. vol.1, No. 1, 2018, page: 5-8


2021 ◽  
Author(s):  
lei zhang ◽  
Meimei Lai ◽  
Tao Ai ◽  
Huilling Liao ◽  
Yijie Huang ◽  
...  

Abstract Aim: The hospitalized children with Mycoplasma pneumonia (M. pneumonia) infection caused by respiratory tract infection in Chengdu were studied and analysis of the epidemiological characteristics was carried out to provide a theoretical basis for clinical diagnosis and treatment.Method: 22882 hospitalized children with respiratory tract infections between January 2014 and December 2020 were collected M. pneumonia IgM antibody was detected by indirect immunofluorescence method and passive agglutination method. Demographic characteristics, clinical diagnose and laboratory data of these children were analyzed.retrospectively.. Result : The 4213 specimens with M. pneumonia were tested positive, the total positive rate was18.41%(18.30% in male and 22.72% in female). Higher positive rates were found in female children,Look from the statistical analysis results, the consistency between the two sets of data is low(x2=198.078、P<0.01). The results of different age patients with contrast different M. pneumonia infection degree were statistically significant(F=162.7532、P<0.01),there was higher M. pneumonia positive rate in Preschoolers and school-age children ,33.98% and 32.98%, respectively.The incidence rate of M. pneumonia in 2017 and 2019 was significantly higher than average (F=538.95, P<0.01)The difference of incidence rate of M. pneumonia was not significant in different months in 2014, 2015 and 2020 (P>0.05). But the probability of M .pneumonia infection patients was much higher from April to May and September to October in2016,2017,2018 and 2019(P<0.05). There was no correlation about M. pneumonia infection with temperature and humidity( P>0.05),there was negative correlation with PM2.5(R=0.09362, P<0.01)and PM10.(R=0.1185, P<0.01).There was no difference about constituent ratio of case of M. pneumonia infection between 2014 and 2019 (F=32.34,P>0.05).The Common respiratory diseases of M. pneumonia infection, bronchopneumonia accounts for the highest proportion,followed the exacerbation of asthma and severe pneumonia.There was significantly difference about constituent ratio of case of M. pneumonia infection between in 2020 and in other years (F=159.35,P<0.01) .The Common respiratory diseases of M. pneumonia infection, bronchopneumonia accounts for the highest proportion,followed the acute bronchitis and exacerbation of asthma.Conclusion:The distribution and epidemiological trend of M. pneumonia in patients with respiratory tract infection showed the risk of inflammation was connected with the gender, age, year and month, no relationship with temperature and humidity in Chengdu,.Higher M. pneumonia positive rate was shown in the children with bronchial pneumonia and exacerbation of asthma.The prevention measures which controlled the COVID-19 disease had effectively controlled the infection rate of M. pneumonia.


2021 ◽  
Vol 41 (1) ◽  
pp. 111-114
Author(s):  
Shatanik Sarkar ◽  
Chaitali Patra ◽  
Shibani Pal ◽  
Arkapriya Pramanik

Recurrent respiratory tract infections, a cause of concern for both parents and paediatricians, can have various etiologies entitled to different organ systems. Diagnosing the exact cause warrants both clinical acumen and timely investigations. Here, we are reporting an infant with recurrent respiratory tract infections, where adequate clinical examination prompted us to diagnose the extra-respiratory cause with simple investigations.


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