A rare case of type II negative pressure pulmonary edema following extraction of inhaled peanuts in a 21-month-old boy

To date, only one case of pediatric type II negative pressure pulmonary edema (NPPE) caused by removal of an endobronchial foreign body has been documented. We report another case of type II NPPE that developed after extraction of inhaled peanuts. A 21-month-old boy who presented with wheezing and intermittent cough for 1 month after eating peanuts was admitted to our department. A chest computed tomographic scan showed foreign bodies lodged in the right main bronchus. Fiberoptic bronchoscopy was performed, and three pieces of peanuts were removed. Fifteen minutes after this procedure, the child grew restless and started coughing with frothy pink sputum. Tachypnea and rales were observed. A chest radiograph showed patchy opacification in both lungs, especially in the right lower zone, leading to the diagnosis of type II NPPE. Intravenous furosemide and dexamethasone were immediately administered, followed by non-invasive continuous positive airway pressure ventilation. Twelve hours later, the patient recovered uneventfully and was discharged home the following day. In conclusion, pediatric type II NPPE rapidly occurs following the relief of upper airway obstruction. Clinicians need to be aware of the acuteness and manifestations of type II NPPE to make an early diagnosis and initiate prompt treatment.

Enteral Feeding for Children on Bilevel Positive Pressure Ventilation for Status Asthmaticus

A retrospective data analysis was conducted to evaluate enteral nutrition practices for children admitted with status asthmaticus in a single-center pediatric intensive care unit. Of 406 charts, 315 were analyzed (63% male); 135 on bilevel positive airway pressure ventilation (BIPAP) and 180 on simple mask. Overall median age and weight were 6.0 (interquartile range [IQR]: 6.0) years and 24.8 (IQR: 20.8) kg, respectively. All children studied were on full feeds while still on BIPAP and simple mask; 99.3 and 100% were fed per oral, respectively. Median time to initiation of feeds and full feeds was longer in the BIPAP group, 11.0 (IQR: 20) and 23.0 hours (IQR: 26), versus simple mask group, 4.3 (IQR: 7) and 12.0 hours (IQR: 15), p = 0.001. The results remained similar after adjusting for gender, weight, clinical asthma score at admission, use of adjunct therapy, and duration of continuous albuterol. By 24 hours, 81.5% of patients on BIPAP and 96.6% on simple mask were started on feeds. Compared with simple mask, patients on BIPAP were sicker with median asthma score at admission of 4 (IQR: 2) versus 3 (IQR: 2) on simple mask, requiring more adjunct therapy (80.0 vs. 43.9%), and a longer median length of therapy of 41.0 (IQR: 41) versus 20.0 hours (IQR: 29), respectively, p = 0.001. There were no complications such as aspiration pneumonia, and none required invasive mechanical ventilation in either group. Enteral nutrition was effectively and safely initiated and continued for children admitted with status asthmaticus, including those on noninvasive bilevel ventilation therapy.

Evaluating the effectiveness of patient education and the feasibility of health technology (eHealth interventions) in improving sleep quality and blood pressure secondary to greater adherence to continuous positive airway pressure ventilation in persons with obstructive sleep apnoea: A literature review (Preprint)

UNSTRUCTURED Obstructive sleep apnoea is a highly burdensome condition that predominantly affects adults and not only impairs daily functioning but also confers a heightened risk of adverse cardiovascular health, particularly among those who are poorly compliant with continuous positive airway pressure ventilation therapy. In the growing era of high population demand and rising complexity, greater efforts are needed at the individual level if outcomes are to improve in the future. Therefore, this literature review sought to explore the effect of patient education upon sleep quality and blood pressure as secondary effects of CPAP adherence in adults. A search for relevant literature was performed using MEDLINE, EMBASE and the Cochrane library. Articles were restricted to peer-review, English language and publication in the last 10 years. Articles were appraised using CASP, relevant data was extracted using systematic proformas and the outcomes were analysed using descriptive analysis and narrative synthesis. Nine studies were included in the first analysis where there was a highly significant association between education provision and CPAP adherence (MD=1.19 hours/night, Z=3.67, p=0.0002), than compared to usual care. The second analysis was informed from five studies and this showed a positive association between education and sleep quality, but the effect was marginally insignificant (MD=0.54, Z=1.89, p=0.06), than compared to usual care. Both analyses were not affected by inter-study heterogeneity (both p<0.01). Overall, this review showed that the provision of education with moderate to high intensity provides meaningful effects upon CPAP adherence and sleep quality. Narrative findings also revealed improvements in blood pressure and other health outcomes, which are supported by previous studies. Despite some limitations, care providers should be proactivity in education provision using a continuous approach through the disease course as this is likely to lead to improvements in outcomes. Finally, future research is needed in the form of a high-quality randomised trial to help explore the effects of education delivered through eHealth mediums.

Evaluating the effectiveness of patient education and the feasibility of health technology (eHealth interventions) in improving sleep quality and blood pressure secondary to greater adherence to continuous positive airway pressure ventilation in persons with obstructive sleep apnoea: A literature review (Preprint)

UNSTRUCTURED Obstructive sleep apnoea is a highly burdensome condition that predominantly affects adults and not only impairs daily functioning but also confers a heightened risk of adverse cardiovascular health, particularly among those who are poorly compliant with continuous positive airway pressure ventilation therapy. In the growing era of high population demand and rising complexity, greater efforts are needed at the individual level if outcomes are to improve in the future. Therefore, this literature review sought to explore the effect of patient education upon sleep quality and blood pressure as secondary effects of CPAP adherence in adults. A search for relevant literature was performed using MEDLINE, EMBASE and the Cochrane library. Articles were restricted to peer-review, English language and publication in the last 10 years. Articles were appraised using CASP, relevant data was extracted using systematic proformas and the outcomes were analysed using descriptive analysis and narrative synthesis. Nine studies were included in the first analysis where there was a highly significant association between education provision and CPAP adherence (MD=1.19 hours/night, Z=3.67, p=0.0002), than compared to usual care. The second analysis was informed from five studies and this showed a positive association between education and sleep quality, but the effect was marginally insignificant (MD=0.54, Z=1.89, p=0.06), than compared to usual care. Both analyses were not affected by inter-study heterogeneity (both p<0.01). Overall, this review showed that the provision of education with moderate to high intensity provides meaningful effects upon CPAP adherence and sleep quality. Narrative findings also revealed improvements in blood pressure and other health outcomes, which are supported by previous studies. Despite some limitations, care providers should be proactivity in education provision using a continuous approach through the disease course as this is likely to lead to improvements in outcomes. Finally, future research is needed in the form of a high-quality randomised trial to help explore the effects of education delivered through eHealth mediums.