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Soong WJ, Chen CH, Lin CH, Yang CF, Lee YS, Tsao PC, Sung YH, Dhochak N. Sustained pharyngeal inflation on upper airway effects in children-Flexible bronchoscopy measurement. Pediatr Pulmonol 2021; 56:3293-3300. [PMID: 34407326 DOI: 10.1002/ppul.25608] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 06/12/2021] [Accepted: 07/20/2021] [Indexed: 11/05/2022]
Abstract
OBJECTIVE Sustained pharyngeal inflation (SPI) with pharyngeal oxygen and nose-closure (PhO2 -NC) can create positive peak inflation pressure (PIP) inside the pharyngolaryngeal space (PLS). This study measured and compared the effects of four different SPI durations in the PLS. METHODS A prospective study, 20 consecutive children aged between 6 months and 3 years old, scheduled for elective flexible bronchoscopy (FB) suspected positive PLS findings were enrolled. SPI was performed twice in four different durations (0, 1, 3, and 5 s) sequentially in each infant. PIP was measured for each SPI in the pharynx, while simultaneously record images at two locations of the oropharynx and supra-larynx. Patient demographic details, PIP levels, lumen expansion scores, and images of PLS were measured and analyzed. RESULTS Twenty patients with 40 measurements were collected. The mean (SD) age and weight were 11.6 (9.1) months and 6.8 (2.4) kg, respectively. The measured mean (SD) pharyngeal PIPs were 4.1 (3.3), 21.9 (7.0), 42.2 (12.3), and 65.5 (18.5) cmH2 O at SPI duration of 0, 1, 3, and 5 s, respectively, indicating significant (p<.001) positive correlation. At assigned locations, corresponding PLS images also displayed a significant increase in lumen expansion scores and a number of detected lesions with an increase in SPI duration (p < .004). The mean (SD) procedural time was 5.7 (1.2) min. No study-related complication was noted. CONCLUSIONS FB utilizing PhO2 -NC as SPI of 1-3 s is a simple, less invasive, and valuable ventilation modality. It provides an adequate PIP level to expand the PLS and improve FB performance in children.
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Affiliation(s)
- Wen-Jue Soong
- Division of Pediatric Pulmonology, Children's Hospital, China Medical University, Taichung, Taiwan.,Department of Pediatrics, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Pediatrics, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Chieh-Ho Chen
- Division of Pediatric Pulmonology, Children's Hospital, China Medical University, Taichung, Taiwan
| | - Chien-Heng Lin
- Division of Pediatric Pulmonology, Children's Hospital, China Medical University, Taichung, Taiwan
| | - Chia-Fang Yang
- Department of Pediatrics, Taipei Veterans General Hospital, Taipei, Taiwan.,College of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Yu-Sheng Lee
- Department of Pediatrics, Taipei Veterans General Hospital, Taipei, Taiwan.,College of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Pei-Chen Tsao
- Department of Pediatrics, Taipei Veterans General Hospital, Taipei, Taiwan.,College of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Yi-Hung Sung
- Department of Medical Education, MacKay Memorial Hospital, Taipei, Taiwan
| | - Nitin Dhochak
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
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Hsieh KH, Chou YL, Soong WJ, Lee YS, Tsao PC. Long-term management and outcomes of tracheobronchial stent by flexible bronchoscopy in infants <5 kg: A 13-year single-center experience. J Chin Med Assoc 2019; 82:727-731. [PMID: 30893261 DOI: 10.1097/jcma.0000000000000048] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Tracheobronchial (TB) lumen narrowing may require prolonged positive-pressure ventilation, endotracheal tube intubation or even surgical interventions. Therapeutic flexible bronchoscopy (TFB) of balloon-expandable metallic stent (BEMS) placement and subsequent forceps, laser and balloon dilatation management might be less invasive and helpful. This study aimed to analyse the placement, follow-up management with TFB and long-term outcomes in small infants with BEMS. METHODS This retrospective study reviewed the medical records and associated TFB videos of infants with a maximum body weight (BW) of 5.0 kg who had TB BEMS placement from January 2005 to December 2017 at our institution. All TFB procedures were supported with a novel noninvasive ventilation, nasopharyngeal oxygen with intermittent nose closure and abdominal compression. RESULTS Forty-one BEMSs were placed in 24 infants. The mean BW and mean age were 4.0 ± 0.7 kg and 4.9 ± 2.4 months, respectively. There were 20, 8 and 13 stents located in trachea, carina and main-stem bronchi, respectively. Seven infants with 13 stents died without obvious stent-related mortality. Seven stents in five infants were successfully retrieved by rigid endoscopy (RE). At placement, the diameters of 28 tracheal and 21 bronchial stents were 7.5 ± 1.1 (4-10) and 5.4 ± 0.9 (4-8) mm, respectively. These implanted BEMSs could be gradually and significantly (p < 0.01) expanded. At the end of the follow-up period, all the remaining 21 stents in 12 infants were functional. The diameters of the 14 remaining tracheal and 13 remaining bronchial stents were 9.6 ± 2.0 (8-14) and 7.2 ± 1.4 (4-10) mm, respectively. CONCLUSION BEMSs are practical and effective in selected small infants with benign TB narrowing and can be safely implanted and managed with TFB, and finally retrieved by RE.
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Affiliation(s)
- Kao-Hsian Hsieh
- Department of Pediatrics, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC
| | - Ya-Ling Chou
- Department of Pediatrics, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC
| | - Wen-Jue Soong
- Department of Pediatrics, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC
- Department of Pediatrics, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Institute of Emergency and Critical Care Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
- Department of Pediatrics, National Yang-Ming University, School of Medicine, Taipei, Taiwan, ROC
- Children's Hospital, China Medical University, Taichung, Taiwan, ROC
| | - Yu-Sheng Lee
- Department of Pediatrics, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Institute of Emergency and Critical Care Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
- Department of Pediatrics, National Yang-Ming University, School of Medicine, Taipei, Taiwan, ROC
| | - Pei-Chen Tsao
- Department of Pediatrics, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Institute of Emergency and Critical Care Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
- Department of Pediatrics, National Yang-Ming University, School of Medicine, Taipei, Taiwan, ROC
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Soong WJ, Tsao PC, Lee YS, Yang CF. Flexible endoscopy for pediatric tracheobronchial metallic stent placement, maintenance and long-term outcomes. PLoS One 2018; 13:e0192557. [PMID: 29420596 PMCID: PMC5805307 DOI: 10.1371/journal.pone.0192557] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Accepted: 01/25/2018] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES To assess the placement, surveillance management and long-term outcomes of the tracheobronchial (TB) balloon expandable metallic stent (BEMS) managed by therapeutic flexible endoscopy (TFE). METHODS This is a retrospective review and analysis of all computerized medical records and related flexible endoscopy videos of pediatric patients who received TB BEMS during 20 years period, from January 1997 to December 2016. TFE techniques with forceps debridement, balloon dilatation and laser ablation were used to implant stents, perform regular surveillance, maintain their functions, and expand the diameters of BEMS. Short-length (30cm-36cm) endoscopes of OD 3.2mm to 5.0mm coupled with the noninvasive ventilation, without ventilation bag, mask or airway tube, supported the whole procedures. RESULTS 146 BEMS were implanted in 87 consecutive children, including 84 tracheal, 15 carinal and 47 bronchial stents. At the time of placement, the mean age was 35.6 ± 54.6 month-old (range 0.3-228) and the mean body weight was 13.9 ± 10.6 kg (range 2.2-60). Surveillance period was 9.4 ± 6.7 years (range, 0.3-18.0). Satisfactory clinical improvements were noted immediately in all but two patients. Seventy-two (82.8%) patients were still alive with stable respiratory status, except two patients necessitating TFE management every two months. Fifty-one stents, including 35 tracheal and 16 bronchial ones, were successfully retrieved mainly with rigid endoscopy. Implanted stents could be significantly (< .001) further expanded for growing TB lumens. The final stent diameters were positively correlated to the implanted duration. Altogether, 33 stents expired (15 patients), 51 were retrieved (40 patients), and 62 remained and functioning well (38 patients), with their mean duration of 7.4 ± 9.5, 34.9 ± 36.3 and 82.3 ± 62.5 months, respectively. CONCLUSION In pediatric patients, TFE with short-length scopes coupled with this NIV support has provided a safe, feasible and effective modality in placing and subsequently managing TB BEMS with acceptable long-term outcomes.
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Affiliation(s)
- Wen-Jue Soong
- Department of Pediatrics, Taipei Veterans General Hospital, Taipei, Taiwan
- Institute of Emergency and Critical Care Medicines, School of Medicine, National Yang-Ming University, Taipei, Taiwan
- Department of Pediatrics, Tri-service General Hospital, National Defense Medical Center, Taipei, Taiwan
- * E-mail:
| | - Pei-Chen Tsao
- Department of Pediatrics, Taipei Veterans General Hospital, Taipei, Taiwan
- Institute of Emergency and Critical Care Medicines, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Yu-Sheng Lee
- Department of Pediatrics, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chia-Feng Yang
- Department of Pediatrics, Taipei Veterans General Hospital, Taipei, Taiwan
- Institute of Emergency and Critical Care Medicines, School of Medicine, National Yang-Ming University, Taipei, Taiwan
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Hsieh KH, Soong WJ, Jeng MJ, Lee YS, Tsao PC, Chou YL. Flexible endoscopic diagnosis and treatment of esophageal stenosis in children with noninvasive ventilation support. Pediatr Neonatol 2018; 59:31-34. [PMID: 28587747 DOI: 10.1016/j.pedneo.2016.11.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2016] [Revised: 10/27/2016] [Accepted: 11/09/2016] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Esophageal stenosis (ES) is characterized by dysphagia, failure to thrive, and long-term disability. It requires repeated management because it is refractory. Traditionally, these procedures are performed under general anesthesia with airway intubation. PURPOSE This study investigated the safety and efficacy of the management of interventional flexible endoscopy (IFE) performed with a novel noninvasive ventilation (NIV) support. METHODS Use of a short-length flexible endoscope with NIV of pharyngeal oxygen, nose closure, and abdominal compression during IFE was investigated. Medical charts of patients aged ≤10 years with a diagnosis of ES in our hospital between 1990 and 2014 were reviewed and analyzed. The outcome measurement included the number of IFE with balloon dilatation (BD), laser therapy (LT), stent placement, procedural complications, and the success rate. RESULTS Ten patients were enrolled. The most common etiologies were esophageal atresia with/without tracheoesophageal fistula (n = 6), followed by caustic injury (n = 2), and unknown etiology (n = 2). Nine patients who were considered successfully managed received an average of 2.8 BD sessions and 1.6 LT sessions. The complication rate of IFE in this study was 1.08% (1/93). One esophageal perforation developed after BD (1/63) and none after LT (0/30). CONCLUSION In this study, IFE with this NIV support is a safe, feasible and valuable modality which could rapidly examine and manage ES.
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Affiliation(s)
- Kao-Hsian Hsieh
- Department of Pediatrics, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan; Children's Medical Center, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Wen-Jue Soong
- Children's Medical Center, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Emergency and Critical Care Medicines, School of Medicine, National Yang-Ming University, Taipei, Taiwan.
| | - Mei-Jy Jeng
- Children's Medical Center, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Emergency and Critical Care Medicines, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Yu-Sheng Lee
- Children's Medical Center, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Pei-Chen Tsao
- Children's Medical Center, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Emergency and Critical Care Medicines, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Ya-Ling Chou
- Department of Pediatrics, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
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Soong WJ, Tsao PC, Lee YS, Yang CF. Therapeutic flexible airway endoscopy of small children in a tertiary referral center-11 years' experience. PLoS One 2017; 12:e0183078. [PMID: 28817604 PMCID: PMC5560590 DOI: 10.1371/journal.pone.0183078] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Accepted: 07/28/2017] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES Use of therapeutic flexible airway endoscopy (TFAE) is very limited in pediatrics. We report our clinical experiences and long term outcomes of TFAE in small children from a single tertiary referral center. METHODS This is a retrospective cohort study. Small children with their body weight no more than 5.0 kg who had received TFAE between 2005 and 2015 were enrolled. Demographic information and outcomes were reviewed and analyzed from medical charts and TFAE videos. RESULTS A total of 313 TFAE were performed in 225 children. The mean age was 3.50 ± 0.24 (0.01-19.2) months old; the mean body weight was 3.52 ± 0.65 (0.57-5.0) kg. A noninvasive ventilation technique, without mask or artificial airway, was applied to support all the procedures. TFAE included laser therapy (39.6%), balloon dilatation plasty (25.6%), tracheal intubation (24.3%) and metallic stent placement (6.4%). Short-length endoscopes of 30-35 cm were used in 96%. All TFAE were successfully completed without serious adverse events or mortality. Mean procedural time was 27.6 ± 16.1 minutes. TFAE resulted in successful extubation immediately in 67.2% (45/67) and 62.8% (118/188) were able to wean off their positive pressure ventilation support in 7 days after procedures. By the end of this study, these TFAE averted the originally suggested airway surgeries in 93.8% (61/65), as benefited from laser therapy, stent implantation, and balloon dilatation plasty. CONCLUSIONS The TFAE modality of using short-length endoscopes as supported with this noninvasive ventilation and ICU support is a viable, instant and effective management in small children. It has resulted in rapid weaning of respiratory supports and averted more invasive rigid endoscopy or airway surgeries.
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Affiliation(s)
- Wen-Jue Soong
- Department of Pediatrics, Taipei Veterans General Hospital, Taipei, Taiwan
- Institute of Emergency and Critical Care Medicines, School of Medicine, National Yang-Ming University, Taipei, Taiwan
- * E-mail:
| | - Pei-Chen Tsao
- Department of Pediatrics, Taipei Veterans General Hospital, Taipei, Taiwan
- Institute of Emergency and Critical Care Medicines, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Yu-Sheng Lee
- Department of Pediatrics, Taipei Veterans General Hospital, Taipei, Taiwan
- Institute of Emergency and Critical Care Medicines, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Chia-Feng Yang
- Department of Pediatrics, Taipei Veterans General Hospital, Taipei, Taiwan
- Institute of Emergency and Critical Care Medicines, School of Medicine, National Yang-Ming University, Taipei, Taiwan
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Retrieval of tracheobronchial foreign bodies by short flexible endoscopy in children. Int J Pediatr Otorhinolaryngol 2017; 95:109-113. [PMID: 28576517 DOI: 10.1016/j.ijporl.2017.01.033] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Revised: 01/27/2017] [Accepted: 01/28/2017] [Indexed: 11/22/2022]
Abstract
OBJECTIVES Flexible endoscopy (FE) is frequently used to diagnose tracheobronchial foreign bodies (TBFB). However, it is still controversial for retrieval of TBFB in pediatric field. This study aims at reporting and evaluating our experiences of using short-length FE with a non-invasive ventilation (NIV) technique and intensive care unit (ICU) support in retrieving pediatric TBFB. METHODS A retrospective review of the hospital database and FE videos of pediatric patients aged less than 18 year-old who were diagnosed of TBFB and managed in our hospital over a 17-year period (1999-2015). The demographic data were collected and analyzed. A NIV technique of providing nasopharyngeal oxygen with intermittent nose closure and abdominal compression was routinely performed in procedural sedated patients throughout the whole FE procedures. RESULTS Sixty-six consecutive patients with 76 TBFB were enrolled. Among them, 72 (94.7%) TBFB in 64 patients were successfully retrieved at the first attempt of FE immediately after the diagnosis was made. There were 13 iatrogenic TBFB in patients who already had coexisting airway problems. The median age was 16 months (range 1.5 months-17 years) and the median body weight was 10.5 kg (range 3.5-48.5 kg). Seventy (70/72, 97.2%) TBFB were retrieved by short-length FE and among them, 55 procedures (55/72, 76.4%) used FE with no working channel. No significant acute or late adverse effects were noted. The mean retrieval procedural time was 23.6 ± 15.1 min. CONCLUSION Using short-length FE with this NIV technique, appropriate sedation and ICU support is a safe, simple and effective modality for the retrieval of TBFB immediately after confirming the diagnosis in pediatric patients.
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Solevåg AL, Cheung PY, Lie H, O’Reilly M, Aziz K, Nakstad B, Schmölzer GM. Chest compressions in newborn animal models: A review. Resuscitation 2015; 96:151-5. [DOI: 10.1016/j.resuscitation.2015.08.001] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Revised: 07/22/2015] [Accepted: 08/02/2015] [Indexed: 11/25/2022]
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Soong WJ, Tsao PC, Lee YS, Yang CF, Liao J, Jeng MJ. Retrieving difficult aspirated pen caps by balloon catheter with short working-length flexible endoscopy and noninvasive ventilation support in intensive care unit. Int J Pediatr Otorhinolaryngol 2015; 79:1484-9. [PMID: 26188901 DOI: 10.1016/j.ijporl.2015.06.033] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Revised: 06/21/2015] [Accepted: 06/24/2015] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Aspirated pen cap (APC) is a clinical challenging issue in children because of the difficulty in both making diagnosis and performing extraction. In case of failed retrieval by rigid endoscopy (RE), more invasive surgical approaches are recommended. The objective of this study is to introduce a new retrieval technique of APC by using laser and balloon catheter (BC) guided with flexible endoscopy (FE) and supported by a novel non-invasive ventilation (NIV) in the intensive care unit (ICU) setting. METHODS We retrospectively review the charts and FE video records of our pediatric cases with the diagnosis of APC in the past decade, 2004-2014. RESULTS Four consecutive cases with bronchial APC which had failed extraction with RE were transferred to our hospital. All of them were under procedural sedation, topical anesthesia, NIV support and ICU monitoring. After FE confirmed the diagnosis and location, a BC parallel to the endoscope was manipulated to pass through the cap hole of the APC. Two APCs required laser pretreatment before retrieval: one debulked the entrenched granulation whereas another enlarged the size of cap hole. Guide wires also were required in three cases to assist the BC to pass through the cap hole. All four APCs were successfully retrieved on their first attempts with no significant complications. CONCLUSIONS FE assisted by laser, guide wire and BC, with this NIV support and ICU monitoring is a feasible, safe and effective modality for retrieving those difficult bronchial APCs in pediatric cases.
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Affiliation(s)
- Wen-Jue Soong
- Department of Pediatrics, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Emergency and Critical Care Medicines, School of Medicine, National Yang-Ming University, Taipei, Taiwan.
| | - Pei-Chen Tsao
- Department of Pediatrics, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Emergency and Critical Care Medicines, School of Medicine, National Yang-Ming University, Taipei, Taiwan.
| | - Yu-Sheng Lee
- Department of Pediatrics, Taipei Veterans General Hospital, Taipei, Taiwan.
| | - Chia-Feng Yang
- Department of Pediatrics, Taipei Veterans General Hospital, Taipei, Taiwan.
| | - Jessica Liao
- Department of Internal Medicine and Pediatrics, Hoag Hospital Newport Beach, Los Angeles, California, USA.
| | - Mei-Ji Jeng
- Department of Pediatrics, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Emergency and Critical Care Medicines, School of Medicine, National Yang-Ming University, Taipei, Taiwan.
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Soong WJ, Jeng MJ, Lee YS, Tsao PC, Harloff M, Matthew Soong YH. A novel technique of non-invasive ventilation: Pharyngeal oxygen with nose-closure and abdominal-compression--Aid for pediatric flexible bronchoscopy. Pediatr Pulmonol 2015; 50:568-75. [PMID: 24616304 DOI: 10.1002/ppul.23028] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2013] [Accepted: 02/03/2014] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To evaluate the safety, feasibility and efficacy of a novel non-invasive ventilation (NIV) technique--pharyngeal oxygen with nose-closure and abdominal-compression (PhO2 -NC-AC)--to aid pediatric flexible bronchoscopy (FB). DESIGN A prospective 1 year study of patients who received FB. A basic PhO2 flow (0.5-1.0 L/kg/min, maximal 5.0 L/min) was routinely applied. Active NIV was initiated when the heart rate dropped <80 beats/min or desaturation was <80% for >10 sec. It was performed as follows: NC 1 sec for inspiration then released, followed by AC 1 sec for active expiration at a rate of 20-30 cycles/min until vital signs returned to acceptable levels for >10 sec. When the patients were stable, supplementary NIV was optionally given. Cardiopulmonary parameters were collected and analyzed. MEASUREMENTS AND MAIN RESULTS Three hundred thirty-seven FBs, including 188 therapeutic, were conducted in 286 patients with a mean age of 18.3 months (± 14.4, 10 min to 12 years) and a mean body weight of 13.5 kg (± 6.7, 0.5-35 kg). Three hundred thirty-three active NIVs were executed with a mean duration of 87.8 sec (± 40.4, 28-190 sec). A significantly longer FB duration (33.2 ± 16.7 min vs. 7.2 ± 2.8 min, P < 0.001) and a higher application rate of active NIV (1.44/FB vs. 0.42/FB) were noted in the therapeutic compared to the diagnostic group. Vital signs and blood gases (35 cases) improved rapidly and returned to baseline within 3 min. All FBs were safely and successfully completed without significant complications. CONCLUSIONS PhO2 -NC-AC is a simple, safe and effective NIV technique for respiratory support and rescue during various pediatric FB procedures.
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Affiliation(s)
- Wen-Jue Soong
- Children's Medical Center, Taipei Veterans General Hospital, Taiwan, Republic of China.,Institute of Emergency and Critical Care Medicines, School of Medicine, National Yang-Ming University, Taiwan, Republic of China
| | - Mei-Jy Jeng
- Children's Medical Center, Taipei Veterans General Hospital, Taiwan, Republic of China.,Institute of Emergency and Critical Care Medicines, School of Medicine, National Yang-Ming University, Taiwan, Republic of China
| | - Yu-Sheng Lee
- Children's Medical Center, Taipei Veterans General Hospital, Taiwan, Republic of China
| | - Pei-Chen Tsao
- Children's Medical Center, Taipei Veterans General Hospital, Taiwan, Republic of China.,Institute of Emergency and Critical Care Medicines, School of Medicine, National Yang-Ming University, Taiwan, Republic of China
| | - Morgan Harloff
- Children's Medical Center, Taipei Veterans General Hospital, Taiwan, Republic of China
| | - Yen-Hui Matthew Soong
- Department of Medicine, Los Angeles County + USC Medical Center, Los Angeles, California
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