Efficacy of noninvasive high-frequency oscillatory ventilation versus nasal intermittent positive pressure ventilation as post-extubation respiratory support in preterm infants: a Meta analysis / 中国当代儿科杂志

OBJECTIVES@#To systematically evaluate the efficacy and safety of noninvasive high-frequency oscillatory ventilation (NHFOV) versus nasal intermittent positive pressure ventilation (NIPPV) as post-extubation respiratory support in preterm infants.@*METHODS@#China National Knowledge Infrastructure, Wanfang Data, Chinese Journal Full-text Database, China Biology Medicine disc, PubMed, Web of Science, and the Cochrane Library were searched for articles on NHFOV and NIPPV as post-extubation respiratory support in preterm infants published up to August 31, 2022. RevMan 5.4 software and Stata 17.0 software were used for a Meta analysis to compare related indices between the NHFOV and NIPPV groups, including reintubation rate within 72 hours after extubation, partial pressure of carbon dioxide (PCO2) at 6-24 hours after switch to noninvasive assisted ventilation, and the incidence rates of bronchopulmonary dysplasia (BPD), air leak, nasal damage, periventricular leukomalacia (PVL), intraventricular hemorrhage (IVH), and retinopathy of prematurity (ROP).@*RESULTS@#A total of 9 randomized controlled trials were included. The Meta analysis showed that compared with the NIPPV group, the NHFOV group had significantly lower reintubation rate within 72 hours after extubation (RR=0.67, 95%CI: 0.52-0.88, P=0.003) and PCO2 at 6-24 hours after switch to noninvasive assisted ventilation (MD=-4.12, 95%CI: -6.12 to -2.13, P<0.001). There was no significant difference between the two groups in the incidence rates of complications such as BPD, air leak, nasal damage, PVL, IVH, and ROP (P>0.05).@*CONCLUSIONS@#Compared with NIPPV, NHFOV can effectively remove CO2 and reduce the risk of reintubation, without increasing the incidence of complications such as BPD, air leak, nasal damage, PVL, and IVH, and therefore, it can be used as a sequential respiratory support mode for preterm infants after extubation.

Exercise Training Improved Pulmonary Gas Exchange Abnormalities in Pulmonary Hypertension due to Heart Failure: A Case Report

Abstract Heart failure (HF) is the most common cause of pulmonary hypertension (PH), and reduced exercise capacity and exertional dyspnea are the most frequent concerns in patients with PH-HF. Indeed, carbon dioxide end-tidal partial pressure (PETCO 2 ) during exercise is a well-established noninvasive marker of ventilation/perfusion ratio in PH. We aimed to evaluate the effect of aerobic exercise training on PETCO 2 response during exercise in a 59-year-old woman with PH secondary to idiopathic dilated cardiomyopathy. The patient with chronic fatigue and dyspnea at mild-to-moderate efforts was admitted to a cardiorespiratory rehabilitation program and had her cardiorespiratory response to exercise assessed during a cardiopulmonary exercise testing performed before and after three months of a thrice-weekly aerobic exercise training program. Improvements in aerobic capacity (23.9%) and endurance time (37.5%) and reduction in ventilatory inefficiency (-20.2%) was found after intervention. Post-intervention improvements in PETCO 2 at ventilatory anaerobic threshold (23.3%) and change in PETCO 2 kinetics pattern, with progressive increases from rest to peak of exercise, were also found. Patient also improved breathing pattern and timing of ventilation. This case report demonstrated for the first time that aerobic exercise training might be able to improve PETCO 2 response during exercise in a patient with PH-HF.

Safety of two ventilator weaning strategies after high-frequency oscillatory ventilation in preterm infants with respiratory distress syndrome: a prospective randomized controlled trial / 中国当代儿科杂志

OBJECTIVE@#To study the safety of two ventilator weaning strategies after high-frequency oscillatory ventilation (HFOV) for the treatment of neonatal respiratory distress syndrome (NRDS) in preterm infants.@*METHODS@#A prospective randomized controlled trial was conducted for 101 preterm infants with NRDS, with a gestational age of ≤32@*RESULTS@#There was no significant difference in the failure rate of ventilator weaning within 72 hours (8% vs 14%, @*CONCLUSIONS@#For preterm infants with NRDS, the strategy of weaning directly from HFOV is safe and reliable and can reduce the duration of invasive mechanical ventilation, and therefore, it holds promise for clinical application.

Prospects and developments in the technologies of high frequency oscillatory ventilation / 生物医学工程学杂志

The high frequency oscillatory ventilation (HFOV) is characterized with low tidal volume and low mean airway pressure, and can well support the breathing of the patients with respiratory diseases. Since the HFOV was proposed, it has been widely concerned by medical and scientific researchers. About the HFOV, this paper discussed its current research status and prospected its future development in technologies. The research status of ventilation model, mechanisms and ventilation mode were introduced in detail. In the next years, the technologies in developing HFOV will be focused on: to develop the branched high-order nonlinear or volume-depended resistance-inertance-compliance (RIC) ventilation model, to fully understand the mechanisms of HFOV and to achieve the noninvasive HFOV. The development in technologies of HFOV will be beneficial to the patients with respiratory diseases who failed with conventional mechanical ventilation as one of considerable ventilation methods.

Comparação do impacto imediato das técnicas de oscilação oral de alta frequência sonorizada e sopro sonorizado com tubo de ressonância em idosas vocalmente saudáveis / Comparison of the immediate effect of voiced oral high-frequency oscillation and flow phonation with resonance tube in vocally-healthy elderly women

RESUMO Objetivo Verificar e comparar os efeitos imediatos da técnica de oscilação oral de alta frequência sonorizada (OOAFS) e sopro sonorizado com tubo de ressonância na autopercepção de sintomas vocais/laríngeos e na qualidade vocal de idosas. Método Participaram 14 mulheres idosas que realizaram as técnicas OOAFS e sopro sonorizado com tubo de ressonância de silicone, com wash-out de uma semana. Todas responderam questões sobre frequência e intensidade dos sintomas vocais/laríngeos; foram submetidas à gravação da vogal sustentada /a/ e contagem de números, para análise perceptivo-auditiva e acústica vocal. Foram extraídos os tempos máximos de fonação (TMF). Em seguida, sorteou-se a técnica a ser realizada: OOAFS ou tubo de ressonância, por três minutos em tom habitual. Após exercício, os mesmos procedimentos da avaliação inicial foram repetidos e as idosas responderam a um questionário de autoavaliação sobre os efeitos das técnicas. Os dados foram comparados antes e após aplicação das técnicas por meio dos testes ANOVA, Wilcoxon e Mann-Whitney; para as sensações vocais após técnicas, aplicou-se teste Quiquadrado(p<0,05). Resultados Ao comparar as técnicas, verificou-se diminuição da rugosidade e melhora da ressonância na contagem dos números após tubo de ressonância e manutenção dos resultados após OOAFS. Não houve mais diferenças significantes para as demais variáveis estudadas entre os grupos. Conclusão O sopro sonorizado com tubo de ressonância melhora a qualidade vocal de mulheres idosas. Além disso, ambos os exercícios apresentaram semelhanças na autopercepção dos sintomas vocais/laríngeos e sensações, sugerindo que a OOAFS é segura e pode ser empregada na terapia de voz nesta população.

ABSTRACT Purpose To verify and compare the immediate effects of the voiced oral high-frequency oscillation (VOHFO) technique and the phonation into a silicone resonance tube in the elderly self-perception of vocal and laryngeal symptoms and in their voice quality. Methods 14 elderly women, over 60 years old, performed the VOHFO and phonation into a resonance tube technique (35cm in length and 9mm in diameter) with one-week interval between both to avoid carry-over effect. Initially, all participants answered questions regarding the frequency and intensity of their vocal/laryngeal symptoms. Recordings of the sustained vowel /a/ and counting numbers were performed for posterior perceptual and acoustic analyses of the voice quality. The maximum phonation time (MPT) for /a/, /s/, /z/ and counting numbers were also obtained. After that, a draw lot established which technique (VOHFO or resonance tube) would be initially applied for three minutes. After the exercise performance the same procedures were carried out and the elderly women answered a self-assessment questionnaire about the effect of the techniques in her voice, larynx, breathing and articulation. Comparison pre and post each technique were analyzed using ANOVA, Wilcoxon and Mann-Whitney tests. The sensations after the techniques were assessed using the Chi-square test (p<0.05). Results The comparison of both techniques showed decrease in roughness and improvement in resonance for counting numbers after the resonance tube and same outcomes post VOHFO. There were no significant differences for the other analyzed variables between groups. Conclusion The phonation into a resonance tube exercise improves the vocal quality of elderly women. In addition, both exercises are similar regarding self-perception of vocal / laryngeal symptoms and sensations post three minutes of the technique, suggesting that VOHFO can be safely applied in voice therapy for this population.

Management of acute respiratory distress syndrome in a child with adenovirus pneumonia: case report and literature review / Manejo da síndrome do desconforto respiratório agudo em criança com pneumonia por adenovírus: relato de caso e revisão da literatura

ABSTRACT Objective: To report the case of a child who developed acute respiratory distress syndrome (ARDS) from a pulmonary infection by adenovirus. Case description: A female patient aged 2 years and 6 months, weighting 10,295 grams developed fever, productive cough and vomiting, later on progressing to ARDS despite initial therapy in accordance with the institutional protocol for ARDS treatment. The child evolved to refractory hypoxemia and hypercapnia, requiring high parameters of mechanical pulmonary ventilation and use of vasoactive agents. In the treatment escalation, the patient received steroids, inhaled nitric oxide (iNO), was submitted to the prone position, started oscillatory high-frequency ventilation (HFOV) and extracorporeal membrane oxygenation (ECMO) was indicated due to severe refractory hypoxemia. During this time, the patient's clinical response was favorable to HFOV, improving oxygenation index and hypercapnia, allowing the reduction of vasoactive medications and mechanical ventilation parameters, and then the indication of ECMO was suspended. The patient was discharged after 26 days of hospital stay without respiratory or neurological sequelae. Comments: Adenovirus infections occur mainly in infants and children under 5 years of age and represent 2 to 5% of respiratory diseases among pediatric patients. Although most children with adenovirus develop a mild upper respiratory tract disease, more severe cases can occur. ARDS is a serious pulmonary inflammatory process with alveolar damage and hypoxemic respiratory failure; Adenovirus pneumonia in children may manifest as severe pulmonary morbidity and respiratory failure that may require prolonged mechanical ventilation. Exclusive pulmonary recruitment and HFOV are advantageous therapeutic options.

RESUMO Objetivo: Descrever paciente que evoluiu com síndrome do desconforto respiratório agudo (SDRA) a partir de infecção pulmonar por adenovírus. Descrição do caso: Paciente de dois anos e seis meses, sexo feminino, peso de 10295 g, que apresentou com quadro de febre, tosse produtiva e vômitos, evoluindo para SDRA. Apesar da terapêutica inicial em conformidade com o protocolo institucional de tratamento da SDRA, a criança evoluiu para hipoxemia e hipercapnia refratárias, necessitando de elevados parâmetros de ventilação pulmonar mecânica e utilização de agentes vasoativos. No escalonamento da terapêutica, a paciente recebeu terapias adjuvantes, foi iniciada ventilação oscilatória de alta frequência (VOAF) e indicada oxigenação por membrana extracorpórea (OMEC) pela hipoxemia grave refratária. Nesse ínterim, a paciente apresentou resposta clínica favorável à VOAF, melhorando do quadro ventilatório e possibilitando a redução das medicações vasoativas e dos parâmetros de ventilação mecânica. A paciente recebeu alta hospitalar após 26 dias de internação, sem sequelas respiratórias ou neurológicas. Comentários: As infecções por adenovírus ocorrem principalmente em lactentes e crianças com menos de cinco anos de idade e representam de 2 a 5% das doenças respiratórias entre os pacientes pediátricos. Embora a maioria das crianças com infecção por adenovírus desenvolva doença leve do trato respiratório superior, casos mais graves podem ocorrer com comprometimento do trato respiratório inferior. A pneumonia por adenovírus em crianças pode se manifestar com morbidade pulmonar grave e insuficiência respiratória com risco de vida, o que resulta na necessidade de suporte mecânico prolongado. O recrutamento pulmonar exclusivo pela VOAF pode ser uma opção terapêutica útil.

Inflammatory lung injury in rabbits: effects of high-frequency oscillatory ventilation in the prone position / Lesão inflamatória pulmonar em coelhos: efeitos da ventilação oscilatória de alta frequência em posição prona

ABSTRACT Objective: To compare the effects that prone and supine positioning during high-frequency oscillatory ventilation (HFOV) have on oxygenation and lung inflammation, histological injury, and oxidative stress in a rabbit model of acute lung injury (ALI). Methods: Thirty male Norfolk white rabbits were induced to ALI by tracheal saline lavage (30 mL/kg, 38°C). The injury was induced during conventional mechanical ventilation, and ALI was considered confirmed when a PaO2/FiO2 ratio < 100 mmHg was reached. Rabbits were randomly divided into two groups: HFOV in the supine position (SP group, n = 15); and HFOV with prone positioning (PP group, n = 15). For HFOV, the mean airway pressure was initially set at 16 cmH2O. At 30, 60, and 90 min after the start of the HFOV protocol, the mean airway pressure was reduced to 14, 12, and 10 cmH2O, respectively. At 120 min, the animals were returned to or remained in the supine position for an extra 30 min. We evaluated oxygenation indices and histological lung injury scores, as well as TNF-α levels in BAL fluid and lung tissue. Results: After ALI induction, all of the animals showed significant hypoxemia, decreased respiratory system compliance, decreased oxygenation, and increased mean airway pressure in comparison with the baseline values. There were no statistically significant differences between the two groups, at any of the time points evaluated, in terms of the PaO2 or oxygenation index. However, TNF-α levels in BAL fluid were significantly lower in the PP group than in the SP group, as were histological lung injury scores. Conclusions: Prone positioning appears to attenuate inflammatory and histological lung injury during HFOV in rabbits with ALI.

RESUMO Objetivo: Comparar os efeitos das posições prona e supina durante ventilação oscilatória de alta frequência (VOAF) sobre oxigenação e inflamação pulmonar, lesão histológica e estresse oxidativo em um modelo de lesão pulmonar aguda (LPA) em coelhos. Métodos: Trinta coelhos Norfolk machos brancos foram submetidos à LPA por meio de lavagem traqueal com salina (30 ml/kg, 38°C). A lesão foi induzida durante a ventilação mecânica convencional, e a LPA foi considerada confirmada na presença de relação PaO2/FiO2 < 100 mmHg. Os coelhos foram aleatoriamente divididos em dois grupos: VOAF em posição supina (grupo PS, n = 15); e VOAF em posição prona (grupo PP, n = 15). Para a VOAF, a pressão média das vias aéreas foi inicialmente estabelecida em 16 cmH2O. No 30º, 60º e 90º min após o início do protocolo de VOAF, a pressão média das vias aéreas foi reduzida para 14, 12 e 10 cmH2O, respectivamente. No 120º min, os animais foram recolocados ou permaneceram na posição supina por mais 30 min. Foram avaliados os índices de oxigenação e escores histológicos de lesão pulmonar, bem como os níveis de TNF-α em lavado broncoalveolar e tecido pulmonar. Resultados: Após a indução da LPA, todos os animais apresentaram hipoxemia significativa, diminuição da complacência do sistema respiratório, diminuição da oxigenação e aumento da pressão média das vias aéreas em comparação aos valores basais. Não houve diferenças estatisticamente significativas entre os dois grupos, em nenhum dos momentos avaliados, quanto a PaO2 e índice de oxigenação. Entretanto, os níveis de TNF-α no lavado broncoalveolar foram significativamente menores no grupo PP que no grupo PS, assim como os escores histológicos de lesão pulmonar. Conclusões: A posição prona parece atenuar a lesão pulmonar inflamatória e histológica durante a VOAF em coelhos com LPA.

Research advances in the methods for weaning from high-frequency oscillatory ventilation in neonates / 中国当代儿科杂志

Neonatal respiratory failure is a serious clinical illness commonly seen in the neonatal intensive care unit (NICU). Although clinicians want to maximize noninvasive respiratory support, some low-birth-weight preterm infants may require invasive respiratory support from the beginning. As an important respiratory management technique for the treatment of respiratory failure, high-frequency oscillatory ventilation (HFOV) allows gas exchange by rapid delivery at a tidal volume lower than or equal to anatomy death volume. Continuous distending pressure was applied to achieve uniform lung expansion, reduce repeated contraction of lung tissue, and exert a protective effect on lung tissue, and so it is preferred by clinicians and has been widely used in clinical practice. However, no consensus has been reached on the methods for weaning from HFOV. This article reviews the methods for weaning from HFOV, so as to provide help for clinical practice.

Investigating the mechanism of the high frequency ventilation for the oscillation airflow between left and right lungs / 生物医学工程学杂志

Traditionally, adequate tidal volume is considered to be a necessary condition to support respiratory patient breathing. But the high frequency ventilation (HFV) with a small tidal volume can still support the respiratory patient breathing well. In order to further explore the mechanisms of HFV, the pendelluft ventilation between left and right lungs was proposed in this paper. And a test platform by using two fresh sheep lungs was developed for investigating the pendelluft ventilation between the left and right lungs. Furthermore, considering the viscous resistance ( ), inertance ( ) and lung compliance ( ) in the lung, a second-order lung ventilation model was designed to inspect and evaluate the pendelluft ventilation between left lung and right lungs. On referring to both results of experiments in practice and simulation in MATLAB Simulink, between the left and right lungs, the phase difference in their airflow happens during HFV at some frequencies. And the pendelluft ventilation between the left and right lungs is resulted by the phase difference, even if the total airflow entering a whole lung is 0. Under HFV, the pendelluft ventilation between left and right lungs will benefit the lungs being more adequately ventilated, and will be improve the utilization rate of oxygen in the lungs.

A Rare Case of Lethal Prenatal-Onset Infantile Cortical Hyperostosis

Infantile cortical hyperostosis, or Caffey's disease, usually presents with typical radiological features of soft tissue swelling and cortical thickening of the underlying bone. The disease can be fatal when it presents antenatally, especially before a gestational age of 35 weeks. This fatal, premature form of the disease is known to occur in various ethnic groups around the globe, and approximately 30 cases have been reported in English literature. This paper is unique in that it is the first paper to report a lethal form of prenatal-type infantile cortical hyperostosis diagnosed in South Korea. Born at gestational age of 27 weeks and 4 days, the patient had typical features of polyhydramnios, anasarca, hyperostosis of multiple bones, micrognathia, pulmonary hypoplasia, and hepatomegaly. The patient was hypotonic, and due to pulmonary hypoplasia and persistent pulmonary hypertension, had to be supported with high frequency ventilation throughout the entire hospital course. Due to the disease entity itself, as well as prolonged parenteral nutrition, liver failure progressed, and the patient expired on day 38 when uncontrolled septic shock was superimposed. The chromosome karyotype of the patient was normal, 46, XX, and COL1A1 gene mutation was not detected.

Infecciones respiratorias agudas bajas en niños menores de 2 años: hospitalizaciones durante el invierno del año 2014 / Low acute respiratory infections in children under 2 years: 2014 winter hospitalizations / Infecções agudas das vias respiratórias inferiores em crianças menores de 2 anos: hospitalizações em 2014

Durante el invierno las infecciones respiratorias agudas bajas (IRAB) determinan un incremento en la demanda asistencial, afectando sobre todo a los niños más pequeños. El objetivo de la investigación fue describir las características clínicas, modalidades de tratamiento y evolución de los menores de 2 años hospitalizados en el Hospital Pediátrico-Centro Hospitalario Pereira Rossell por IRAB de etiología viral durante el invierno de 2014. Se realizó un estudio descriptivo, retrospectivo, describiendo las características de los menores de 2 años hospitalizados del 9/6 al 21/9/2014 por IRAB de probable etiología viral. Se describieron las características epidemiológicas y clínicas, el tratamiento realizado y la evolución de los pacientes. En el período evaluado egresaron 742 niños (34% de los egresos de la institución). Tenían una mediana de edad de 4 meses; 18% presentaba al menos un factor de riesgo de IRAB grave. Se identificó al virus respiratorio sincicial en 59,6%. La estadía hospitalaria tuvo una mediana de 4 días. En las salas de cuidados moderados se aplicó ventilación no invasiva a 46 niños, y oxigenación de alto flujo a 129 niños, logrando una mejoría clínica en el 87,0% y el 87,6% respectivamente. Ingresaron a unidades de cuidados intensivos 217 niños, 54% requirió asistencia ventilatoria mecánica. Dos pacientes fallecieron. En el período evaluado los niños pequeños con IRAB representaron una importante proporción de los egresos, con importante carga asistencial. La mayoría eran niños sin factores de riesgo. La aplicación de las técnicas de tratamiento en cuidados moderados fue efectiva, permitiendo disminuir la demanda de camas de cuidados intensivos.

During the winter, low acute respiratory infections (LARI) determine an increase in care demand, especially affecting younger children. The objective of the research was to describe the clinical characteristics, treatment modalities and evolution of children under 2 years of age hospitalized at the Hospital Pediátrico-Centro Hospitalario Pereira Rossell for viral etiology LARI during the 2014 winter. A descriptive, retrospective study was conducted, describing the characteristics of children under 2 years hospitalized between 9/6 and 9/21/2014 for LARI of probable viral etiology. The following features were described: epidemiological and clinical characteristics, treatment performed and patient's evolution. During the period evaluated, 742 children were discharged (34% of the institution's admissions). They had a median age of 4 months; 18% had at least one risk factor for severe LARI. Respiratory syncytial virus was identified in 59.6%. The hospital stay had a median of 4 days. In moderate care rooms noninvasive ventilation was applied to 46 children, and high flow oxygenation to 129 children, achieving clinical improvement in 87.0% and 87.6%, respectively. Two hundred and seventeen children were admitted 54% required mechanical ventilation. Two patients died. In the evaluated period small children with LARI represented a significant proportion of the discharges, with an important burden of care. The majority were children without risk factors. The application of treatment techniques in moderate care was effective, allowed a decrease in the demand for intensive care beds.

Durante o inverno, as infecções respiratórias agudas baixas (IRAB) determinam o aumento da demanda de cuidados, afetando especialmente as crianças menores. O objetivo da pesquisa foi descrever as características clínicas, as modalidades de tratamento e a evolução de crianças menores de dois anos hospitalizados no Hospital Pediátrico-Centro Hospitalario Pereira Rossell devido a IRAB de etiologia viral, durante o inverno de 2014. Foi realizado um estudo descritivo e retrospectivo, descrevendo as características das crianças menores de 2 anos hospitalizadas entre 9/6 e 21/9/2014 devido a IRAB de provável etiologia viral. Descreveram-se: características epidemiológicas e clínicas, tratamento realizado e evolução dos pacientes. Durante o período avaliado, 742 crianças foram hospitalizadas (34% dos ingressos da instituição). Tinham uma idade média de 4 meses; 18% tinham pelo menos um fator de risco para IRAB severa. O vírus sincicial respiratório foi identificado em 59,6%. A estadia hospitalaria teve uma mediana de 4 dias. Em salas de cuidados moderados, a ventilação não invasiva foi aplicada a 46 crianças e a oxigenação de alto fluxo a 129 crianças, atingindo melhora clínica em 87,0% e 87,6%, respectivamente. Foram internadas em unidades de terapia intensiva 217 crianças, 54% necessitaram de ventilação mecânica. Dois pacientes faleceram. No período avaliado, as crianças pequenas com IRAB representaram uma proporção significativa das despesas, com um carga importante de atendimento. A maioria carecia de fatores de risco. A aplicação de técnicas de tratamento em cuidados moderados foi eficaz, permitindo uma diminuição da demanda por leitos de terapia intensiva.

Ventilación no invasiva y oxigenoterapia de alto flujo en niños en salas de cuidados moderados. Experiencia en la Unidad de Cuidados Respiratorios Especiales Agudos del Hospital Pediátrico del CHPR durante 2013-2016 / Non-invasive ventilation and high-flow oxygen therapy in children in moderate care rooms. Experience at the Special Respiratory Acute Care at the CHPR from 2013 to 2016 / Ventilação não invasiva e oxigenoterapia de alto fluxo em crianças em consultórios de atenção de nível moderado. Experiência na Unidade de Cuidados Respiratórios Especiais Agudos do Hospital Pediátrico do CHPR durante 2013-2016

Resumen: Introducción: las infecciones respiratorias agudas bajas (IRAB) constituyen un importante problema de salud en invierno. El centro de referencia nacional en Uruguay ofrece a niños con IRAB ventilación no invasiva (VNI) y cánula nasal de alto flujo (CNAF) en cuidados moderados. Objetivo: describir las características clínicas, tratamiento y evolución de los niños asistidos en la Unidad de Cuidados Respiratorios Especiales Agudos (CREA) del Hospital Pediátrico de referencia nacional. Material y método: estudio retrospectivo, descriptivo. Se incluyeron todos los niños hospitalizados por IRAB asistidos en CREA que recibieron VNI y/o CNAF entre 1/1/13 y 31/12/16. Se revisaron historias clínicas. Variables: características clínicas, tratamientos, complicaciones, evolución y destino. Resultados: se asistieron 650 niños (348 con CNAF; 302 con VNI); sexo masculino 63% (407). Bronquiolitis 63% (406), se detectó virus respiratorio sincicial (VRS) en 60% (388). Media de edad en niños que recibieron CNAF 11 meses (9 días-108 meses); promedio duración de la técnica: 3 días. Requirieron ingreso a unidades de cuidados intensivos (UCI): 12% (43); asistencia ventilatoria mecánica (AVM): 6% (22). Media de edad en niños que recibieron VNI :12 meses (1-132 meses); media de duración de la técnica: 3 días. Requirieron ingreso a UCI 16% (49); AVM: 9,6% (29). No se registraron fallecimientos ni complicaciones graves. Conclusiones: el 85% de los niños completó su tratamiento en la Unidad CREA. El porcentaje de niños que requirió AVM fue bajo. La implementación de estas técnicas en cuidados moderados redujo la necesidad de ingreso a UCI y probablemente la necesidad de AVM.

Summary: Introduction: acute lower respiratory tract infections (LRTI) are a major health problem in winter. The National Reference Center in Uruguay offers children with LRTI, non-invasive ventilation (NIV) and high-flow nasal cannula (CNAF) in moderate care. Objective: to describe the clinical characteristics, treatment and evolution of the children assisted in Special Respiratory Care Acute (CREA unit), in a national pediatric reference hospital. Patients and methods: retrospective, descriptive study. All children hospitalized for LRTI assisted in CREA who received NIV and / or CNAF between 1/1/13 and 12/31/16 were included in the study. Clinical records were reviewed. Variables: clinical characteristics, treatment, complications, evolution and destination. Results: a total of 650 children were assisted (348 with CNAF, 302 with NIV); male sex 63% (407). Bronchiolitis 63% (406), Respiratory Syncytial Virus (RSV) was detected in 60% (388). Mean age in children receiving CNAF was 11 months (9 days - 108 months); mean duration of technique was 3 days. Required admission to intensive care unit (ICU): 12% (43); invasive ventilation (IV) 6% (22). Mean age in children receiving NIV 12 months (1-132 months); mean duration of technique 3 days. Required admission to the ICU 49 (16%); IV 29 (9.6%). There were no deaths or serious complications. Conclusions: 85% of this group of children completed their treatment in the CREA unit. The percentage of children who required IV was low. The implementation of these techniques in moderate care reduced the need to enter an ICU and the need for IV.

Resumo: Introdução: as infecções respiratórias agudas baixas (IRAB) são um importante problema de saúde no inverno. O centro de referência nacional no Uruguai oferece ventilação não invasiva (NIV) e cânula nasal de alto fluxo (CNAF) em cuidados moderados às crianças com IRAB. Objetivo: descrever as características clínicas, tratamento e evolução das crianças atendidas na Unidade Especial de Tratamento Respiratório Agudo (CREA) do Hospital de Referência Nacional de Pediatria. Pacientes e métodos: estudo retrospectivo, descritivo. No estudo foram incluídas todas as crianças hospitalizadas por causa da IRAB atendidas no CREA que receberam VNI e / ou CNAF entre 1/1/13 e 31/12/16. Foram revisadas as histórias clínicas. Variáveis: características clínicas, tratamentos, complicações, evolução e destino. Resultados: 650 crianças foram atendidas (348 com CNAF, 302 com NIV); sexo masculino 63% (407). Bronquiolite 63% (406), o Vírus Respiratório Sincicial (VRS) foi detectado em 60% (388). Idade média em crianças que receberam CNAF: 11 meses (9 dias-108 meses); Duração média da técnica: 3 dias. Necessidade para admissão nas unidades de terapia intensiva (UTI): 12% (43); assistência ventilatória mecânica (MAV) 6% (22). Idade média em crianças que receberam VNI: 12 meses (1-132 meses); duração média da técnica: 3 dias. Deveram ser admitidos na UTI: 16% (49); AVM 9,6% (29). Nenhuma morte ou complicações sérias foram registradas. Conclusões: 85% das crianças completaram o tratamento na unidade CREA. A porcentagem de crianças que necessitaram de AVM foi baixa. A implementação dessas técnicas em cuidados moderados reduziu a necessidade de internação na UTI e, provavelmente, a necessidade de MAV.

Treatment and prognosis of pulmonary hemorrhage in preterm infants during 2007-2016 / 中国当代儿科杂志

<p><b>OBJECTIVE</b>To study the treatment and prognosis of pulmonary hemorrhage in preterm infants.</p><p><b>METHODS</b>A total of 106 preterm infants diagnosed with pulmonary hemorrhage, who were hospitalized in the neonatal ward of Peking University Third Hospital between 2007 and 2016, were enrolled. These patients were divided into 2007-2011 group (34 cases) and 2012-2016 group (72 cases) according to the time of hospitalization, divided into conventional-frequency ventilation group (43 cases) and high-frequency oscillatory ventilation (HFOV) group (63 cases) according to the respiratory support method used after the development of pulmonary hemorrhage, and divided into non-operation group (34 cases) and operation group (14 cases) according to whether PDA ligation was performed for the unclosed PDA before pulmonary hemorrhage. The general data, treatment, and prognosis were compared between different groups.</p><p><b>RESULTS</b>Compared with the 2007-2011 group, the 2012-2016 group had higher rates of HFOV and PDA ligation (P<0.05), a lower mortality rate during hospitalization (P<0.05), a longer length of hospital stay (P<0.05), and higher incidence rates of intracranial hemorrhage and bronchopulmonary dysplasia (P<0.05). Compared with the conventional-frequency ventilation group, the HFOV group had a lower mortality rate during hospitalization (P<0.05), a longer length of hospital stay (P<0.05), and higher incidence rates of intracranial hemorrhage and bronchopulmonary dysplasia (P<0.05). Compared with the non-operation group, the operation group had a lower mortality rate during hospitalization (P<0.05), a longer length of hospital stay (P<0.05), and higher incidence rates of intracranial hemorrhage and bronchopulmonary dysplasia (P<0.05).</p><p><b>CONCLUSIONS</b>The application of HFOV and PDA ligation can improve the survival rate of preterm infants with pulmonary hemorrhage, but the incidence of intracranial hemorrhage and bronchopulmonary dysplasia is also increased.</p>

Effect of High-frequency Chest Wall Oscillatory on Lung Function in Patient After Single Port Video-assisted Thoracoscopic Surgery Lobectomy / 中国肺癌杂志

BACKGROUND@#It has been confirmed that high-frequency chest wall oscillatory (HFCWO) is a new type of auxiliary sputum discharge device. However, up to now, the specific therapeutic effect of HFCWO is still uncertain. This study aimed to compare the changes of the sputum volume before and after the treatment of HFCWO, and to investigate the effect of HFCWO on lung function and arterial blood gas analysis after single port video-assisted thoracoscopic surgery lobectomy (S-VATS).@*METHODS@#A total of 90 patients with S-VATS lobectomy were collected in the Second Affiliated Hospital of Soochow University from January 2017 to December 2017, which were randomly divided into the experimental group with HFCWO (n=45) and the control group (n=45) with routine clapping, respectively. The sputum volume of the two groups was measured 5 days before operation. Lung function and arterial blood gas analysis was measured before and 7th days after surgery.@*RESULTS@#The sputum volume was higher in the experimental group than that of the control group after surgery, there was statistically significant difference for the first three days (P0.05); Compared with those before surgery, FEV₁, FVC and PaO₂ decreased in both groups after surgery (P0.05).@*CONCLUSIONS@#HFCWO can significantly increase the amount of sputum excretion, improve lung function and alleviate hypoxia status after S-VATS lobectomy. This study provides a promising approach for HFCWO toward hypoxia status after S-VATS lobectomy.
.

Clinical efficacy of nasal high-frequency ventilation in treatment of neonatal respiratory distress syndrome: a Meta analysis / 中国当代儿科杂志

OBJECTIVE@#To systematically evaluate the clinical efficacy of nasal high-frequency ventilation (nHFV) in the treatment of neonatal respiratory distress syndrome (NRDS).@*METHODS@#A literature search was performed in PubMed, Cochrane Library, EMBase (Ovid), Chinese Biomedical Literature Database, Chinese Journal Full-text Database, Wanfang Data, and Weipu Data to collect the randomized controlled trials (RCTs) that compared the clinical efficacy of nHFV and nasal continuous positive airway pressure (nCPAP) in the treatment of NRDS. A Meta analysis was performed on the included RCTs using Rev Man 5.3 software after data extraction and quality evaluation by Cochrane 5.1.0.@*RESULTS@#A total of 4 RCTs involving 218 patients were included. The Meta analysis showed that compared with the nCPAP group, the nHFV group had a significantly better treatment outcome (RR=1.73, 95%CI: 1.39-2.15, P<0.00001). There were no significant differences in the incidence rates of intraventricular hemorrhage, periventricular leukomalacia, bronchopulmonary dysplasia, necrotizing enterocolitis, pneumothorax and retinopathy of prematurity.@*CONCLUSIONS@#Compared with nCPAP, nHFV has better clinical efficacy in the treatment of NRDS, without increasing the risk of related complications.

Effective Tidal Volume for Normocapnia in Very-Low-Birth-Weight Infants Using High-Frequency Oscillatory Ventilation

PURPOSE: Removal of CO₂ is much efficient during high-frequency oscillatory ventilation (HFOV) for preterm infants. However, an optimal carbon dioxide diffusion coefficient (DCO₂) and tidal volume (VT) have not yet been established due to much individual variance. This study aimed to analyze DCO₂ values, VT, and minute volume in very-low-birth-weight (VLBW) infants using HFOV and correlates with plasma CO₂ (pCO₂). MATERIALS AND METHODS: Daily respiratory mechanics and ventilator settings from twenty VLBW infants and their two hundred seventeen results of blood gas analysis were collected. Patients were treated with the Dräger Babylog VN500 ventilator (Drägerwerk Ag & Co.) in HFOV mode. The normocapnia was indicated as pCO₂ ranging from 45 mm Hg to 55 mm Hg. RESULTS: The measured VT was 1.7 mL/kg, minute volume was 0.7 mL/kg, and DCO₂ was 43.5 mL²/s. Mean results of the blood gas test were as follows: pH, 7.31; pCO₂, 52.6 mm Hg; and SpO₂, 90.5%. In normocapnic state, the mean VT was significantly higher than in hypercapnic state (2.1±0.5 mL/kg vs. 1.6±0.3 mL/kg), and the mean DCO₂ showed significant difference (68.4±32.7 mL²/s vs. 32.4±15.7 mL²/s). The DCO₂ was significantly correlated with the pCO₂ (p=0.024). In the receiver operating curve analysis, the estimated optimal cut-off point to predict the remaining normocapnic status was a VT of 1.75 mL/kg (sensitivity 73%, specificity 80%). CONCLUSION: In VLBW infants treated with HFOV, VT of 1.75 mL/kg is recommended for maintaining proper ventilation.

Comparação entre ventilação mecânica convencional protetora e ventilação oscilatória de alta frequência associada à posição prona / Comparison between conventional protective mechanical ventilation and high-frequency oscillatory ventilation associated with the prone position

RESUMO Objetivo: Comparar os efeitos da ventilação oscilatória de alta frequência e da ventilação mecânica convencional protetora associadas à posição prona quanto à oxigenação, à histologia e ao dano oxidativo pulmonar em modelo experimental de lesão pulmonar aguda. Métodos: Foram instrumentados com traqueostomia, acessos vasculares e ventilados mecanicamente 45 coelhos. A lesão pulmonar aguda foi induzida por infusão traqueal de salina aquecida. Foram formados três grupos experimentais: animais sadios + ventilação mecânica convencional protetora, em posição supina (Grupo Controle; n = 15); animais com lesão pulmonar aguda + ventilação mecânica convencional protetora, posição prona (GVMC; n = 15); animais com lesão pulmonar aguda + ventilação oscilatória de alta frequência, posição prona (GVAF; n = 15). Após 10 minutos do início da ventilação específica de cada grupo, foi coletada gasometria arterial, sendo este momento denominado tempo zero, após o qual o animal foi colocado em posição prona, permanecendo assim por 4 horas. O estresse oxidativo foi avaliado pelo método de capacidade antioxidante total. A lesão tecidual pulmonar foi determinada por escore histopatológico. O nível de significância adotado foi de 5%. Resultados: Ambos os grupos com lesão pulmonar aguda apresentaram piora da oxigenação após a indução da lesão comparados ao Grupo Controle. Após 4 horas, houve melhora significante da oxigenação no grupo GVAF comparado ao GVMC. A análise da capacidade antioxidante total no plasma mostrou maior proteção no GVAF. O GVAF apresentou menor escore de lesão histopatológica no tecido pulmonar que o GVMC. Conclusão: A ventilação oscilatória de alta frequência, associada à posição prona, melhora a oxigenação, e atenua o dano oxidativo e a lesão pulmonar histopatológica, comparada com ventilação mecânica convencional protetora.

ABSTRACT Objective: To compare the effects of high-frequency oscillatory ventilation and conventional protective mechanical ventilation associated with the prone position on oxygenation, histology and pulmonary oxidative damage in an experimental model of acute lung injury. Methods: Forty-five rabbits with tracheostomy and vascular access were underwent mechanical ventilation. Acute lung injury was induced by tracheal infusion of warm saline. Three experimental groups were formed: healthy animals + conventional protective mechanical ventilation, supine position (Control Group; n = 15); animals with acute lung injury + conventional protective mechanical ventilation, prone position (CMVG; n = 15); and animals with acute lung injury + high-frequency oscillatory ventilation, prone position (HFOG; n = 15). Ten minutes after the beginning of the specific ventilation of each group, arterial gasometry was collected, with this timepoint being called time zero, after which the animal was placed in prone position and remained in this position for 4 hours. Oxidative stress was evaluated by the total antioxidant performance assay. Pulmonary tissue injury was determined by histopathological score. The level of significance was 5%. Results: Both groups with acute lung injury showed worsening of oxygenation after induction of injury compared with the Control Group. After 4 hours, there was a significant improvement in oxygenation in the HFOG group compared with CMVG. Analysis of total antioxidant performance in plasma showed greater protection in HFOG. HFOG had a lower histopathological lesion score in lung tissue than CMVG. Conclusion: High-frequency oscillatory ventilation, associated with prone position, improves oxygenation and attenuates oxidative damage and histopathological lung injury compared with conventional protective mechanical ventilation.

The value of high-flow nasal cannula oxygen therapy after extubation in patients with acute respiratory failure

OBJECTIVE: To investigate the value of high-flow nasal cannula oxygen therapy after extubation in patients with acute respiratory failure. METHODS: A single-center, prospective, randomized, controlled pilot trial was conducted between January 2013 and December 2014. Sixty enrolled patients were randomized immediately after extubation into either a high-flow nasal cannula group (n=30) or an air entrainment mask group (n=30) at a fixed inspired oxygen fraction (40%). The success rate of oxygen therapy, respiratory and hemodynamic parameters and subjective discomfort (using a visual analogue scale) were assessed at 24h after extubation. RESULTS: The two groups were comparable at extubation. A total of 46 patients were successfully treated including 27 patients in the high-flow nasal cannula group and 19 patients in the air entrainment mask group. Compared to the air entrainment mask group, the success rate of oxygen therapy and the partial pressure of arterial oxygen were significantly higher and the respiratory rate was lower in the high-flow nasal cannula group. In addition, less discomfort related to interface displacement and airway dryness was observed in the high-flow nasal cannula group than in the air entrainment mask group. CONCLUSIONS: At a fixed inspired oxygen fraction, the application of a high-flow nasal cannula after extubation achieves a higher success rate of oxygen therapy and less discomfort at 24h than an air entrainment mask in patients with acute respiratory failure.

Ventilación de alta frecuencia oscilatoria en pediatría / High frequency oscillatory ventilation in pediatrics

Mechanical ventilation (MV) is a usual therapy for the management of critically ill children. However its inappropriate use can produce lung injury. Today, the evidence recommends protective ventilation such as strategie low tidal volumes (VT) that minimize injury and thus, high frequency oscillatory ventilation (HFOV) would have a theoretical role. HFOV allows gas exchange using low tidal volumes (1 – 2 ml/kg) and supraphysiologic respiratory frequencies. In pediatrics it comprises 3 – 30 percent of mechanically ventilated patients, most of the time as a rescue therapy in refractory respiratory failure cases where conventional mechanical ventilation fails. Many aspects of HFVO in children remain unclear, theoretical benefits has no solid clinical basis, when is the best time to initiate (early vs rescue mode), which are the optimal settings, and how to monitor lung mechanics. This review examines HFVO theoretical bases, suggest recommendations for its use and considers the available evidence to understand the aspects that are still unclear.

La ventilación mecánica (VM) constituye un apoyo frecuente en el manejo de niños críticamente enfermos, quienes pueden requerirla por diferentes etiologías, entre ellas el síndrome de dificultad respiratoria aguda (SDRA). Sabemos que a pesar de ser un soporte vital, su uso inapropiado puede producir daño inducido por ventilación mecánica (DIVM). En la actualidad, la evidencia recomienda las estrategias de “ventilación protectora”, bajos volúmenes corrientes, que minimicen este daño y es ahí donde la ventilación de alta frecuencia oscilatoria (VAFO) tendría un rol teórico. La VAFO permite el intercambio gaseoso usando pequeños volúmenes corrientes (VT) 1-2 ml /kg y frecuencias respiratorias supra fisiológicas, con la consiguiente disminución del riesgo de atelectrauma, manteniendo el “pulmón abierto” y en la zona de seguridad de la curva presión-volumen. Su uso en pediatría oscila entre el 3 y el 30 por ciento de los pacientes ventilados, la mayoría de las veces como terapia de rescate frente a la falla de la ventilación convencional (VMC) en insuficiencia respiratoria refractaria. Muchos aspectos de la VAFO en pediatría no han sido totalmente esclarecidos; su efecto protector teórico permanece aún sin bases sólidas en el escenario clínico, quienes se benefician de su uso, cuál es el mejor momento para iniciarla (temprana o rescate), cuales son los valores óptimos del oscilador y como monitorear la mecánica pulmonar en VAFO. La presente revisión pretende repasar los conceptos teóricos de la VAFO, formular recomendaciones para su uso y considerar la evidencia disponible que nos permitan dilucidar las interrogantes antes mencionadas.

Actualización en ventilación de alta frecuencia oscilatoria en pacientes pediátricos con insuficiencia respiratoria aguda / Ventilation update high oscillatory frequency in pediatric patients with Severe respiratory insufficiency

Recientemente un grupo de expertos estableció la definición del síndrome de dificultad respiratoria aguda en niños y las recomendaciones relativas a su tratamiento. La ventilación de alta frecuencia oscilatoria es considerada por este consenso como una alternativa válida a la ventilación mecánica convencional en pacientes con este síndrome e hipoxemia resistente. La incorporación de la ventilación de alta frecuencia oscilatoria en el ámbito clínico data de la década de 1970, su utilización se sustenta en que este modo ventilatorio respeta los objetivos fisiológicos de reclutamiento y protección pulmonar. La literatura alberga numerosas publicaciones referidas a la ventilación de alta frecuencia oscilatoria en niños con síndrome de dificultad respiratoria aguda y su comparación con la ventilación mecánica convencional, la mayoría de los trabajos con diseños limitados, a excepción de dos estudios controlados y aleatorizados que objetivan menor daño inducido y menor enfermedad pulmonar crónica en los pacientes tratados con ventilación de alta frecuencia oscilatoria. A la luz de la evidencia analizada, esta ventilación en pacientes con síndrome de dificultad respiratoria aguda pediátrico sería una terapia aceptable ante el fracaso de las medidas convencionales(AU)

Recently, a group of experts established the definition of pediatric acute respiratory distress syndrome and the recommendations regarding its treatment. High-frequency oscillatory ventilation is considered by this consensus as a valid alternative to conventional mechanical ventilation in children with acute respiratory distress syndrome and refractory hypoxemia. There are numerous publications about high-frequency oscillatory ventilation in pediatric patients with this syndrome and its comparison with the conventional mechanical ventilation, most of the studies with limited designs, except for two randomized controlled studies that reported less induced injury and less chronic lung disease in patients treated with high-frequency oscillatory ventilation. Incorporation of this type of ventilation in the clinical setting dates back to the 70s, its use is supported by the fact that this ventilation mode respects the physiological aims of recruitment and lung protection. In light of the analyzed evidence, high-frequency oscillatory ventilation in children with acute respiratory distress syndrome would be an acceptable therapy when conventional measures fail.(AU)