[New Swedish National care process for pediatric obstructive sleep disordered breathing]. / Nytt vårdförlopp för barn med OSDB är godkänt att tas i bruk.

Obstructive sleep disordered breathing (OSDB) is a spectrum from habitual snoring and labored breathing to obstructive sleep apnea (OSA), which is common and potentially serious in children. The process contains a new question at child care centers, directed at caretakers with children at age 18 months and 3 years, concerning habitual snoring (3 times a week or more). A primary care doctor verifies the suspicion of OSDB in case of a positive answer to one of 7 additional questions or 4 status findings (e.g. tonsil hypertrophy). The process starts with the suspicion of OSDB, from the age of 18 months to 18 years, and ends when symptoms are improved after watchful waiting or upper airway surgery. National equality is a goal, with increased access to nocturnal respiratory recordings of children with comorbidities or doubtful cases. Also, with short waiting time to first visit at ORL department, and to surgery. Children with comorbidities or severe symptoms get postoperative follow-ups with a nurse after 6 months. The new ICD code for OSDB is R06.8A.

TTCOV19: timing of tracheotomy in SARS-CoV-2-infected patients: a multicentre, single-blinded, randomized, controlled trial.

BACKGROUND: Critically ill COVID-19 patients may develop acute respiratory distress syndrome and the need for respiratory support, including mechanical ventilation in the intensive care unit. Previous observational studies have suggested early tracheotomy to be advantageous. The aim of this parallel, multicentre, single-blinded, randomized controlled trial was to evaluate the optimal timing of tracheotomy. METHODS: SARS-CoV-2-infected patients within the Region Västra Götaland of Sweden who needed intubation and mechanical respiratory support were included and randomly assigned to early tracheotomy (≤ 7 days after intubation) or late tracheotomy (≥ 10 days after intubation). The primary objective was to compare the total number of mechanical ventilation days between the groups. RESULTS: One hundred fifty patients (mean age 65 years, 79% males) were included. Seventy-two patients were assigned to early tracheotomy, and 78 were assigned to late tracheotomy. One hundred two patients (68%) underwent tracheotomy of whom sixty-one underwent tracheotomy according to the protocol. The overall median number of days in mechanical ventilation was 18 (IQR 9; 28), but no significant difference was found between the two treatment regimens in the intention-to-treat analysis (between-group difference: - 1.5 days (95% CI - 5.7 to 2.8); p = 0.5). A significantly reduced number of mechanical ventilation days was found in the early tracheotomy group during the per-protocol analysis (between-group difference: - 8.0 days (95% CI - 13.8 to - 2.27); p = 0.0064). The overall correlation between the timing of tracheotomy and days of mechanical ventilation was significant (Spearman's correlation: 0.39, p < 0.0001). The total death rate during intensive care was 32.7%, but no significant differences were found between the groups regarding survival, complications or adverse events. CONCLUSIONS: The potential superiority of early tracheotomy when compared to late tracheotomy in critically ill patients with COVID-19 was not confirmed by the present randomized controlled trial but is a strategy that should be considered in selected cases where the need for MV for more than 14 days cannot be ruled out. Trial registration NCT04412356 , registered 05/24/2020.

Respiratory polygraphy in children with sleep-disordered breathing.

At-home respiratory polygraphy has been shown to be a reliable substitute for in-laboratory polysomnography in adults for diagnosing obstructive sleep apnea, but this is less well studied in children. One aim of this study was to examine the quality of at-home respiratory polygraphy in children with sleep-disordered breathing and to evaluate the interrater reliability of the results. Another aim was to study whether calibrated respiratory inductance plethysmography (RIP) flow can be used for the scoring of respiratory events when the airflow measurements are unreliable. Children aged 4-10 years, with sleep-disordered breathing, underwent at-home respiratory polygraphy. Of 113 polygraphies, only 46% were of acceptable quality, with missing nasal airflow being the most common problem (40%). The median recorded time with artifact-free signal present in three traces simultaneously was 228 min (0-610 min). Seventeen polygraphy studies were selected for further study. Each study was scored by two independent scorers, with and without the nasal airflow signal present, the latter relying on RIP flow for the scoring of respiratory events. The apnea-hypopnea index (AHI) from the four different measurements was compared using intraclass correlation coefficients (ICC). Comparison of the two scorers showed moderate agreement, with (ICC = 0.66) and without (ICC = 0.53) nasal airflow. One scorer had good agreement between AHI with and without nasal airflow (ICC = 0.81), whereas the other had poor agreement (ICC = 0.12). In conclusion, the scoring of respiratory events based on RIP flow is scorer dependent even for experienced scorers. The nasal airflow signal is frequently missing in paediatric respiratory polygraphies, which limits the usefulness of the method.