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1.
Pediatr Crit Care Med ; 24(8): 652-661, 2023 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-37092829

RESUMO

OBJECTIVES: Diaphragm ultrasound is a novel alternative to esophageal pressure measurements in the evaluation of diaphragm function and activity, but data about its reliability in a pediatric setting are lacking. We aimed to compare the esophageal pressure swing (∆P es , gold standard) with the diaphragmatic thickening fraction (DTF) as a measure of inspiratory effort in sedated children. Additionally, we studied the effect of positive end-expiratory pressure (PEEP) on the end-expiratory thickness of the diaphragm (DT ee ). DESIGN: Prospective open-label non-randomized interventional physiological cohort study. SETTING: Operating room in tertiary academic hospital. PATIENTS: Children 28 days to 13 years old scheduled for elective surgery with general anesthesia, spontaneously breathing through a laryngeal mask airway, were eligible for inclusion. Exclusion criteria were disorders or previous surgery of the diaphragm, anticipated difficult airway or acute cardiopulmonary disease. All measurements were performed prior to surgery. INTERVENTIONS: Patients were subjected to different levels of respiratory load, PEEP and anesthetic depth in a total of seven respiratory conditions. MEASUREMENTS AND MAIN RESULTS: The esophageal pressure and diaphragm thickening fraction were simultaneously recorded for five breaths at each respiratory condition. The relation between ∆P es and DTF was studied in a mixed model. We analyzed 407 breaths in 13 patients. Both DTF ( p = 0.03) and ∆Pes ( p = 0.002) could detect respiratory activity, and ∆P es and DTF were associated across respiratory conditions ( p < 0.001; R2 = 31%). With increasing inspiratory load, ∆P es increased significantly, while DTF did not ( p = 0.08). Additionally, DT ee did not differ significantly between 10, 5, and 0 cm H 2 O PEEP ( p = 0.08). CONCLUSIONS: In spontaneously breathing sedated children and across different respiratory conditions, DTF could differentiate minimal or no inspiratory effort from substantial inspiratory effort and was associated with ∆P es . Increased efforts resulted in higher ∆P es but not larger DTF.


Assuntos
Diafragma , Respiração Artificial , Humanos , Criança , Diafragma/diagnóstico por imagem , Estudos Prospectivos , Estudos de Viabilidade , Reprodutibilidade dos Testes , Estudos de Coortes , Respiração Artificial/métodos
3.
World Allergy Organ J ; 16(3): 100759, 2023 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-37025251

RESUMO

Perioperative hypersensitivity constitutes an important health issue, with potential dramatic consequences of diagnostic mistakes. However, safe and correct diagnosis is not always straightforward, mainly because of the application of incorrect nomenclature, absence of easy accessible in-vitro/ex-vivo tests and uncertainties associated with the non-irritating skin test concentrations. In this editorial we summarize the time line, seminal findings, and major realizations of 25 years of research on the mechanisms, diagnosis, and management of perioperative hypersensitivity.

4.
Acta Neurochir (Wien) ; 154(5): 807-13, 2012 May.
Artigo em Inglês | MEDLINE | ID: mdl-22392014

RESUMO

OBJECTIVE: Chronic microvascular compressions of the eighth nerve induce a slowing down of signal transmission in the auditory nerve, electrophysiologically characterized by IPL I-III prolongation. METHODS: The authors hypothesize this is compensated by an active slowing down of signal transmission of the contralateral input at the level of the brainstem, characterized by contralateral IPL III-V prolongation. RESULTS: Differences between ipsilateral and contralateral IPL I-III and IPL III-V are analyzed before and after microvascular decompression. ABR diagnostic criteria for microvascular compression are ipsilateral IPL I-III prolongation or ipsilateral peak II decrease + ipsilateral IPL I-III prolongation. With IPL I-III as diagnostic criterion, unlike preoperatively the difference between the ipsi- and contralateral IPL I-III is significant postoperatively. When using the stricter diagnostic criterion of IPL I-III + peak II, there is a preoperative significant difference between ipsi- and contralateral IPL I-III, but postoperatively the difference between the ipsi- and contralateral IPL I-III is not significant. CONCLUSIONS: Preoperatively, there is a marginal significant difference between the ipsi- and contralateral IPL III-V, which disappears postoperatively.


Assuntos
Nervo Coclear/fisiopatologia , Zumbido/fisiopatologia , Adulto , Idoso , Tronco Encefálico/fisiopatologia , Tronco Encefálico/cirurgia , Nervo Coclear/cirurgia , Potenciais Evocados Auditivos do Tronco Encefálico , Feminino , Humanos , Masculino , Cirurgia de Descompressão Microvascular , Pessoa de Meia-Idade , Zumbido/cirurgia
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