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Ding X, Li S, Liu X, Zhan X, Wang Z, Wang M, Wu G. Study on the Correlation Between the Expression of NF-Ƙb in the Alveolar Lavage Fluid of Children with Severe Mycoplasma Pneumoniae Pneumonia, Its Clinical Characteristics, and Cellular Immunity. Infect Drug Resist 2024; 17:2469-2484. [PMID: 38915319 PMCID: PMC11194830 DOI: 10.2147/idr.s411361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 06/01/2023] [Indexed: 06/26/2024] Open
Abstract
Objective This study explored the level of nuclear factor-ƙB (NF-ƙB) in the bronchoalveolar lavage fluid (BALF) of children with severe Mycoplasma Pneumoniae pneumonia (SMPP) and the correlation between NF-ƙB, cellular immunity, and clinical characteristics. Methods A total of 41 hospitalized children diagnosed with SMPP were selected and included in the SMPP group, and 13 bronchial foreign bodies (FB) without infection during the same period were included in the FB group. The NF-ƙB in the BALF of participants was detected by enzyme-linked immunosorbent assay. The correlation between NF-ƙB and laboratory findings, cellular immunity, and the clinical features in children with SMPP was analyzed. The differences in chest imaging and bronchoscopy in children with SMPP were observed. Results The levels of NF-ƙB were significantly increased in the SMPP group compared with the FB group (P < 0.001). There were correlations between different NF-ƙB pairs in the SMPP group (P < 0.01). Nuclear factor-ƙB (NF-ƙB) correlated with IL-6, the mycoplasma load in BALF, fever peak, length of hospital stay, and sputum suppository (P < 0.05). The higher the intracellular NF-ƙB level in BALF, the lower the CD3+ CD4+ value in peripheral blood (P < 0.05). Intracellular NF-ƙB and total NF-ƙB correlated with pleural effusion, pericardial effusion, and extrapulmonary complications (P < 0.05). Conclusion NF-ƙB is involved in airway inflammation changes in children with SMPP. The higher the level of NF-ƙB in the airway, the more severe the clinical manifestations, and the longer the length of hospital stay is likely to be.
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Affiliation(s)
- Xinyao Ding
- Department of Paediatrics, Luohe Yancheng District People’s Hospital, Luohe, Henan, 462300, People’s Republic of China
| | - Shujun Li
- Department of Pediatrics, The First Affiliated Hospital of Xinxiang Medical University, Weihui, Henan, 453100, People’s Republic of China
| | - Xue Liu
- Department of Pediatrics, The First Affiliated Hospital of Xinxiang Medical University, Weihui, Henan, 453100, People’s Republic of China
| | - Xiaowen Zhan
- Department of Pediatrics, The First Affiliated Hospital of Xinxiang Medical University, Weihui, Henan, 453100, People’s Republic of China
| | - Zhiyuan Wang
- Department of Pediatrics, The First Affiliated Hospital of Xinxiang Medical University, Weihui, Henan, 453100, People’s Republic of China
| | - Mengzhu Wang
- Department of Pediatrics, The First Affiliated Hospital of Xinxiang Medical University, Weihui, Henan, 453100, People’s Republic of China
| | - Guannan Wu
- Department of ICU, The First Affiliated Hospital of Xinxiang Medical University, Weihui, Henan, 453100, People’s Republic of China
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Lu W, Wu X, Xu Y, Wang T, Xiao A, Guo X, Xu Y, Li D, Li S. Predictive value of bronchoscopy combined with CT score for refractory mycoplasma pneumoniae pneumonia in children. BMC Pulm Med 2024; 24:251. [PMID: 38778338 PMCID: PMC11110382 DOI: 10.1186/s12890-024-02996-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 04/04/2024] [Indexed: 05/25/2024] Open
Abstract
INTRODUCTION Mycoplasma pneumoniae pneumonia (MPP) is prevalent in paediatric patients and can progress to refractory mycoplasma pneumoniae pneumonia (RMPP). OBJECTIVE To assess the predictive value of bronchoscopy combined with computed tomography (CT) score in identifying RMPP in children. METHODS A retrospective analysis was conducted on 244 paediatric patients with MP, categorising them into RMPP and general mycoplasma pneumoniae pneumonia (GMPP) groups. A paired t-test compared the bronchitis score (BS) and CT score before and after treatment, supplemented by receiver operating characteristic (ROC) analysis. RESULTS The RMPP group showed higher incidences of extrapulmonary complications and pleural effusion (58.10% and 40%, respectively) compared with the GMPP group (44.60%, p = 0.037 and 18.71%, p < 0.001, respectively). The CT scores for each lung lobe were statistically significant between the groups, except for the right upper lobe (p < 0.05). Correlation analysis between the total CT score and total BS yielded r = 0.346 and p < 0.001. The ROC for BS combined with CT score, including area under the curve, sensitivity, specificity, and cut-off values, were 0.82, 0.89, 0.64, and 0.53, respectively. CONCLUSION The combined BS and CT score method is highly valuable in identifying RMPP in children.
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Affiliation(s)
- Weihong Lu
- Department of Pediatrics, the First Affiliated Hospital of Xinxiang Medical University, No. 88 of Jiankang Road, Weihui, Henan province, 453100, China
| | - Xiangtao Wu
- Department of Pediatrics, the First Affiliated Hospital of Xinxiang Medical University, No. 88 of Jiankang Road, Weihui, Henan province, 453100, China
| | - Yali Xu
- Department of Pediatrics, the First Affiliated Hospital of Xinxiang Medical University, No. 88 of Jiankang Road, Weihui, Henan province, 453100, China
| | - Tuanjie Wang
- Department of Pediatrics, the First Affiliated Hospital of Xinxiang Medical University, No. 88 of Jiankang Road, Weihui, Henan province, 453100, China
| | - Aiju Xiao
- Department of Pediatrics, the First Affiliated Hospital of Xinxiang Medical University, No. 88 of Jiankang Road, Weihui, Henan province, 453100, China
| | - Xixia Guo
- Department of Pediatrics, the First Affiliated Hospital of Xinxiang Medical University, No. 88 of Jiankang Road, Weihui, Henan province, 453100, China
| | - Yuping Xu
- Department of Pediatrics, the First Affiliated Hospital of Xinxiang Medical University, No. 88 of Jiankang Road, Weihui, Henan province, 453100, China
| | - Duoduo Li
- Department of Pediatrics, the First Affiliated Hospital of Xinxiang Medical University, No. 88 of Jiankang Road, Weihui, Henan province, 453100, China
| | - Shujun Li
- Department of Pediatrics, the First Affiliated Hospital of Xinxiang Medical University, No. 88 of Jiankang Road, Weihui, Henan province, 453100, China.
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Wu X, Lu W, Wang T, Xiao A, Guo X, Xu Y, Li S, Liu X, Zeng H, He S, Zhang X. Optimization strategy for the early timing of bronchoalveolar lavage treatment for children with severe mycoplasma pneumoniae pneumonia. BMC Infect Dis 2023; 23:661. [PMID: 37798699 PMCID: PMC10557288 DOI: 10.1186/s12879-023-08619-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 09/18/2023] [Indexed: 10/07/2023] Open
Abstract
BACKGROUND Early evaluation of severe mycoplasma pneumoniae pneumonia (SMPP) and the prompt utilization of fiberoptic bronchoscopic manipulation can effectively alleviate complications and restrict the progression of sequelae. This study aim to establish a nomogram forecasting model for SMPP in children and explore an optimal early therapeutic bronchoalveolar lavage (TBAL) treatment strategy. METHODS This retrospective study included children with mycoplasma pneumoniae pneumonia (MPP) from January 2019 to December 2021. Multivariate logistic regression analysis was used to screen independent risk factors for SMPP and establish a nomogram model. The bootstrap method was employed and a receiver operator characteristic (ROC) curve was drawn to evaluate the accuracy and robustness of the model. Kaplan-Meier analysis was used to assess the effect of lavage and hospitalization times. RESULTS A total of 244 cases were enrolled in the study, among whom 68 with SMPP and 176 with non-SMPP (NSMPP). A prediction model with five independent risk factors: left upper lobe computed tomography (CT) score, sequential organ failure assessment (SOFA) score, acute physiology and chronic health assessment (APACHE) II score, bronchitis score (BS), and c-reactive protein (CRP) was established based on the multivariate logistic regression analysis. The ROC curve of the prediction model showed the area under ROC curve (AUC) was 0.985 (95% confidence interval (CI) 0.972-0.997). The Hosmer-Lemeshow goodness-of-fit test results showed that the nomogram model predicted the risk of SMPP well (χ2 = 2.127, P = 0.977). The log-rank result suggested that an early BAL treatment could shorten MPP hospitalization time (P = 0.0057). CONCLUSION This nomogram model, based on the left upper lobe CT score, SOFA score, APACHE II score, BS, and CRP level, represents a valuable tool to predict the risk of SMPP in children and optimize the timing of TBAL.
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Affiliation(s)
- Xiangtao Wu
- Department of Pediatrics, the First Affiliated Hospital of Xinxiang Medical University, Weihui, 453100, China
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, 510260, China
- Department of Neonatology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, 510080, China
| | - Weihong Lu
- Department of Pediatrics, the First Affiliated Hospital of Xinxiang Medical University, Weihui, 453100, China
| | - Tuanjie Wang
- Department of Pediatrics, the First Affiliated Hospital of Xinxiang Medical University, Weihui, 453100, China
| | - Aiju Xiao
- Department of Pediatrics, the First Affiliated Hospital of Xinxiang Medical University, Weihui, 453100, China
| | - Xixia Guo
- Department of Pediatrics, the First Affiliated Hospital of Xinxiang Medical University, Weihui, 453100, China
| | - Yali Xu
- Department of Pediatrics, the First Affiliated Hospital of Xinxiang Medical University, Weihui, 453100, China
| | - Shujun Li
- Department of Pediatrics, the First Affiliated Hospital of Xinxiang Medical University, Weihui, 453100, China.
| | - Xue Liu
- Department of Pediatrics, the First Affiliated Hospital of Xinxiang Medical University, Weihui, 453100, China
| | - Hanshi Zeng
- Department of Neonatology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, 510080, China
| | - Shaoru He
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, 510260, China
- Department of Neonatology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, 510080, China
| | - Xingliang Zhang
- Department of Pediatrics, the First Affiliated Hospital of Xinxiang Medical University, Weihui, 453100, China.
- Department of Respiratory Medicine, Institute of Pediatrics, Shenzhen Children's Hospital, Shenzhen, 518038, China.
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Wu M, Liu D, Zhu F, Yu Y, Ye Z, Xu J. Diagnostic Value of Immunological Biomarkers in Children with Asthmatic Bronchitis and Asthma. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1765. [PMID: 37893483 PMCID: PMC10608232 DOI: 10.3390/medicina59101765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 09/18/2023] [Accepted: 09/28/2023] [Indexed: 10/29/2023]
Abstract
Background and Objectives: This study aimed to investigate the diagnostic value of immunological biomarkers in children with asthmatic bronchitis and asthma and to develop a machine learning (ML) model for rapid differential diagnosis of these two diseases. Materials and Methods: Immunological biomarkers in peripheral blood were detected using flow cytometry and immunoturbidimetry. The importance of characteristic variables was ranked and screened using random forest and extra trees algorithms. Models were constructed and tested using the Scikit-learn ML library. K-fold cross-validation and Brier scores were used to evaluate and screen models. Results: Children with asthmatic bronchitis and asthma exhibit distinct degrees of immune dysregulation characterized by divergent patterns of humoral and cellular immune responses. CD8+ T cells and B cells were more dominant in differentiating the two diseases among many immunological biomarkers. Random forest showed a comprehensive high performance compared with other models in learning and training the dataset of immunological biomarkers. Conclusions: This study developed a prediction model for early differential diagnosis of asthmatic bronchitis and asthma using immunological biomarkers. Evaluation of the immune status of patients may provide additional clinical information for those children transforming from asthmatic bronchitis to asthma under recurrent attacks.
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Affiliation(s)
| | | | | | | | | | - Jin Xu
- Department of Clinical Laboratory, Children’s Hospital of Fudan University, National Children’s Medical Center, Shanghai 201102, China; (M.W.); (D.L.); (F.Z.); (Y.Y.); (Z.Y.)
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Krasaelap A, Duncan DR, Sabe RMM, Bhardwaj V, Lerner DG, Gold BD, Boesch RP, Faure C, von Allmen D, Williams D, Chiou E, DeBoer E, Hysinger E, Maybee J, Khlevner J, Larson K, Morris K, Jalali L, McSweeney M, Brigger MT, Greifer M, Rutter M, Williams N, Subramanyan RK, Ryan MJ, Acra S, Pentiuk S, Friedlander J, Sobol SE, Kaul A, Dorfman L, Darbari A, Prager JD, Rosen R, Cocjin JT, Mousa H. Pediatric Aerodigestive Medicine: Advancing Collaborative Care for Children With Oropharyngeal Dysphagia. J Pediatr Gastroenterol Nutr 2023; 77:460-467. [PMID: 37438891 DOI: 10.1097/mpg.0000000000003882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/14/2023]
Abstract
OBJECTIVES Aerodigestive disorders encompass various pathological conditions affecting the lungs, upper airway, and gastrointestinal tract in children. While advanced care has primarily occurred in specialty centers, many children first present to general pediatric gastroenterologists with aerodigestive symptoms necessitating awareness of these conditions. At the 2021 Annual North American Society for Pediatric Gastroenterology, Hepatology and Nutrition meeting, the aerodigestive Special Interest Group held a full-day symposium entitled, Pediatric Aerodigestive Medicine: Advancing Collaborative Care of Children with Aerodigestive Disorders. The symposium aimed to underline the significance of a multidisciplinary approach to achieve better outcomes for these complex patients. METHODS The symposium brought together leading experts to highlight the growing aerodigestive field, promote new scientific and therapeutic strategies, share the structure and benefits of a multidisciplinary approach in diagnosing common and rare aerodigestive disorders, and foster multidisciplinary discussion of complex cases while highlighting the range of therapeutic and diagnostic options. In this article, we showcase the diagnostic and therapeutic approach to oropharyngeal dysphagia (OPD), one of the most common aerodigestive conditions, emphasizing the role of a collaborative model. CONCLUSIONS The aerodigestive field has made significant progress and continues to grow due to a unique multidisciplinary, collaborative model of care for these conditions. Despite diagnostic and therapeutic challenges, the multidisciplinary approach has enabled and greatly improved efficient, high-quality, and evidence-based care for patients, including those with OPD.
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Affiliation(s)
- Amornluck Krasaelap
- From the Division of Pediatric Gastroenterology, Hepatology and Nutrition, Children's Mercy Kansas City, Kansas City, MO
| | - Daniel R Duncan
- the Aerodigestive Center, Division of Gastroenterology, Hepatology and Nutrition, Boston Children's Hospital, Harvard Medical School, Boston, MA
| | - Ramy M M Sabe
- the Department of Pediatric Gastroenterology, Hepatology and Nutrition, University Hospitals Rainbow Babies and Children's Hospital, Cleveland, OH
| | - Vrinda Bhardwaj
- the Division of Gastroenterology, Hepatology and Nutrition, Children's Hospital Los Angeles, Keck School of Medicine of the University of Southern California, Los Angeles, CA
| | - Diana G Lerner
- the Division of Pediatric Gastroenterology, Hepatology and Nutrition, Medical College of Wisconsin, Milwaukee, WI
| | - Benjamin D Gold
- the Children's Center for Digestive Health Care, LLC, GI Care for Kids, LLC, Aerodigestive Center and Program, Children's Healthcare of Atlanta, Atlanta, GA
| | - Richard Paul Boesch
- the Division of Pediatric Pulmonology, Department of Pediatrics and Adolescent Medicine, Mayo Clinic Children's Center, Rochester, MN
| | - Christophe Faure
- the Division of Pediatric Gastroenterology, Sainte-Justine University Health Center, Université de Montréal, Montréal, QC, Canada
| | - Daniel von Allmen
- the Division of Pediatric Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Dana Williams
- the Department of Pediatric Gastroenterology and Nutrition, Phoenix Children's Hospital, Phoenix, AZ
| | - Eric Chiou
- the Division of Pediatric Gastroenterology, Hepatology & Nutrition, Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, TX
| | - Emily DeBoer
- the Department of Pediatrics, Section of Pulmonary and Sleep Medicine, Children's Hospital Colorado Breathing Institute, University of Colorado Denver, Aurora, CO
| | - Erik Hysinger
- Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Jennifer Maybee
- Children's Hospital Colorado, University of Colorado, Aurora, CO
| | - Julie Khlevner
- the Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons and NewYork-Presbyterian, New York, NY
| | - Kara Larson
- the Division of Otolaryngology, Boston Children's Hospital, Boston, MA
| | - Kimberly Morris
- the Department of Speech Pathology, Rady Children's Hospital, San Diego, CA
| | - Lauren Jalali
- the Aerodigestive Center, Division of Gastroenterology, Hepatology and Nutrition, Boston Children's Hospital, Harvard Medical School, Boston, MA
| | - Maireade McSweeney
- the Aerodigestive Center, Division of Gastroenterology, Hepatology and Nutrition, Boston Children's Hospital, Harvard Medical School, Boston, MA
| | - Matthew T Brigger
- the Division of Pediatric Otolaryngology, Department of Surgery, Rady Children's Hospital San Diego, University of California San Diego, San Diego, CA
| | - Melanie Greifer
- the Department of Pediatrics, Division of Pediatric Gastroenterology, New York University Grossman School of Medicine, New York, NY
| | - Michael Rutter
- the Division of Pediatric Otolaryngology, Aerodigestive and Esophageal Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Nina Williams
- the Center for Airway Disorders, Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, MA
| | - Ram Kumar Subramanyan
- the University of Nebraska Medical Center, Children's Hospital and Medical Center, Omaha, NE
| | - Matthew J Ryan
- the Division of Gastroenterology, Hepatology and Nutrition, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Sari Acra
- the Division of Pediatric Gastroenterology, Hepatology and Nutrition, Vanderbilt University Medical Center, Nashville, TN
| | - Scott Pentiuk
- the Division of Gastroenterology, Hepatology and Nutrition, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | | | - Steven E Sobol
- the Division of Otolaryngology, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Ajay Kaul
- the Division of Gastroenterology, Hepatology and Nutrition, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Lev Dorfman
- the Division of Gastroenterology, Hepatology and Nutrition, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Anil Darbari
- Children's National Hospital, George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Jeremy D Prager
- the Department of Otolaryngology, University of Colorado School of Medicine; Pediatric Otolaryngology, Children's Hospital Colorado, Aurora, CO
| | - Rachel Rosen
- the Aerodigestive Center, Division of Gastroenterology, Hepatology and Nutrition, Boston Children's Hospital, Harvard Medical School, Boston, MA
| | - Jose T Cocjin
- the Division of Pediatric Gastroenterology, Sainte-Justine University Health Center, Université de Montréal, Montréal, QC, Canada
| | - Hayat Mousa
- the Division of Gastroenterology, Hepatology and Nutrition, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
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Wu X, Lu W, Sang X, Xu Y, Wang T, Zhan X, Hao J, Ren R, Zeng H, Li S. Timing of bronchoscopy and application of scoring tools in children with severe pneumonia. Ital J Pediatr 2023; 49:44. [PMID: 37024936 PMCID: PMC10079491 DOI: 10.1186/s13052-023-01446-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Accepted: 03/20/2023] [Indexed: 04/08/2023] Open
Abstract
BACKGROUND There is still a lack of effective scoring criteria for assessing the severity of pulmonary infection associated with changes in the endobronchial lining of the bronchus in children. This study aimed to ascertain the timing and value of endoscopic scoring of fibreoptic bronchoscopy (FOB) and bronchoalveolar lavage (BAL) in children with severe pneumonia. METHOD The clinical data of 229 children with severe pneumonia treated with BAL in the Pediatric Intensive Care Unit of the First Affiliated Hospital of Xinxiang Medical University between November 2018 and December 2021 were collected. According to the severity of the disease, patients were divided into an invasive ventilation group and a non-invasive ventilation group, as well as an early BAL group (receiving BAL within 1 day of admission) and a late BAL group (receiving BAL 2 days after admission). A Student's t-test, Chi-square test, receiver operating characteristic (ROC) curve and survival curve were used to analyse the bronchitis score, aetiology of BAL fluid and survival data. RESULTS The scores of endoscopic mucosal oedema, erythema and pallor and the total score in the invasive ventilation group were higher than those in the non-invasive ventilation group (P < 0.05), and they were consistent with the Sequential Organ Failure Assessment (SOFA) scores. The secretion colour score was lower in the early BAL group than in the late BAL group (P < 0.05). On the bronchitis scores, which were evaluated using a ROC curve, the difference in the mucosal erythema, pallor, oedema and total score of the invasive and non-invasive groups was statistically significant (P < 0.05), which was consistent with the area under the ROC of the SOFA scores. Acute Physiology and Chronic Health Assessment II and SOFA scores after FOB were lower than those before treatment (P < 0.05). In terms of ICU hospitalisation days and total hospitalisation days, the time of the early FOB patients was shorter than that of the late FOB patients (P < 0.05). A total of 22 patients (9.61%) died. The Kaplan-Meier analysis and log-rank test showed that the survival rate of the non-invasive ventilation group was higher than that of the invasive ventilation group (P < 0.05). CONCLUSION This study found that FOB combined with BAL is an important method for the diagnosis and treatment of severe pneumonia. Early BAL can reduce hospitalisation and ICU time; however, it cannot improve the survival rate. The endoscopic score has a certain role to play in assessing the severity of pulmonary inflammation, but studies with a large sample are still needed to confirm this.
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Affiliation(s)
- Xiangtao Wu
- Department of Pediatrics, the First Affiliated Hospital of Xinxiang Medical University, No. 88 of Jiankang Road, Weihui, 453100, Henan province, China
| | - Weihong Lu
- Department of Pediatrics, the First Affiliated Hospital of Xinxiang Medical University, No. 88 of Jiankang Road, Weihui, 453100, Henan province, China
| | - Xinquan Sang
- Department of Pediatrics, the First Affiliated Hospital of Xinxiang Medical University, No. 88 of Jiankang Road, Weihui, 453100, Henan province, China
| | - Yali Xu
- Department of Pediatrics, the First Affiliated Hospital of Xinxiang Medical University, No. 88 of Jiankang Road, Weihui, 453100, Henan province, China
| | - Tuanjie Wang
- Department of Pediatrics, the First Affiliated Hospital of Xinxiang Medical University, No. 88 of Jiankang Road, Weihui, 453100, Henan province, China
| | - Xiaowen Zhan
- Department of Pediatrics, the First Affiliated Hospital of Xinxiang Medical University, No. 88 of Jiankang Road, Weihui, 453100, Henan province, China
| | - Jie Hao
- Department of Pediatrics, the First Affiliated Hospital of Xinxiang Medical University, Weihui, 453100, China
| | - Ruijuan Ren
- Department of Pediatrics, the First Affiliated Hospital of Xinxiang Medical University, No. 88 of Jiankang Road, Weihui, 453100, Henan province, China
| | - Hanshi Zeng
- Department of Pediatrics, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510000, China
| | - Shujun Li
- Department of Pediatrics, the First Affiliated Hospital of Xinxiang Medical University, No. 88 of Jiankang Road, Weihui, 453100, Henan province, China.
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Atag E, Unal F, Yazan H, Girit S, Uyan ZS, Ergenekon AP, Yayla E, Merttürk E, Telhan L, Meral Ö, Kucuk HB, Gunduz M, Gokdemir Y, Erdem Eralp E, Kiyan G, Cakir E, Ersu R, Karakoc F, Oktem S. Pediatric flexible bronchoscopy in the intensive care unit: A multicenter study. Pediatr Pulmonol 2021; 56:2925-2931. [PMID: 34236776 DOI: 10.1002/ppul.25566] [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: 04/16/2021] [Revised: 06/10/2021] [Accepted: 07/01/2021] [Indexed: 11/06/2022]
Abstract
INTRODUCTION Flexible bronchoscopy (FB) is frequently used for assessment and treatment of patients with respiratory diseases. Our aim was to investigate the contribution of FB to diagnosis and therapy in children admitted to the intensive care units (ICU) and to evaluate the safety of FB in this vulnerable population. METHODS Children less than 18 years of age who underwent FB in the five neonatal and pediatric ICUs in Istanbul between July 1st, 2015 and July 1st, 2020 were included to the study. Demographic and clinical data including bronchoscopy indications, findings, complications, and the contribution of bronchoscopy to the management were retrospectively reviewed. RESULTS One hundred and ninety-six patients were included to the study. The median age was 5 months (range 0.3-205 months). The most common indication of FB was extubation failure (38.3%), followed by suspected airway disease. Bronchoscopic assessments revealed at least one abnormality in 90.8% patients. The most common findings were airway malacia and the presence of excessive airway secretions (47.4% and 35.7%, respectively). Positive contribution of FB was identified in 87.2% of the patients. FB had greater than 1 positive contribution in 138 patients and 80.6% of the patients received a new diagnosis. Medical therapy was modified after the procedure in 39.8% and surgical interventions were pursued in 40% of the patients. Therapeutic lavage was achieved in 18.9%. There were no major complications. CONCLUSION Flexible bronchoscopy is a valuable diagnostic and therapeutic tool in neonatal and pediatric ICUs and is not associated with major complications.
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Affiliation(s)
- Emine Atag
- Division of Pediatric Pulmonology, Faculty of Medicine, Medipol University, Istanbul, Turkey
| | - Fusun Unal
- Department of Pediatrics, Faculty of Medicine, Medipol University, Istanbul, Turkey
| | - Hakan Yazan
- Division of Pediatric Pulmonology, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey
| | - Saniye Girit
- Division of Pediatric Pulmonology, Faculty of Medicine, Medeniyet University, Istanbul, Turkey
| | - Zeynep Seda Uyan
- Division of Pediatric Pulmonology, Faculty of Medicine, Koc University, Istanbul, Turkey
| | - Almala Pınar Ergenekon
- Division of Pediatric Pulmonology, Faculty of Medicine, Marmara University, Istanbul, Turkey
| | - Esra Yayla
- Department of Pediatrics, Faculty of Medicine, Medipol University, Istanbul, Turkey
| | - Edanur Merttürk
- Department of Pediatrics, Faculty of Medicine, Medipol University, Istanbul, Turkey
| | - Leyla Telhan
- Department of Pediatrics, Faculty of Medicine, Medipol University, Istanbul, Turkey
| | - Özge Meral
- Division of Pediatric Pulmonology, Faculty of Medicine, Medipol University, Istanbul, Turkey
| | - Hanife Busra Kucuk
- Department of Pediatrics, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey
| | - Mehmet Gunduz
- Division of Neonatalogy, Faculty of Medicine, Medipol University, Istanbul, Turkey
| | - Yasemin Gokdemir
- Division of Pediatric Pulmonology, Faculty of Medicine Istanbul, Marmara University, Istanbul, Turkey
| | - Ela Erdem Eralp
- Division of Pediatric Pulmonology, Faculty of Medicine Istanbul, Marmara University, Istanbul, Turkey
| | - Gursu Kiyan
- Department of Pediatric Surgery, Faculty of Medicine, Marmara University, Istanbul, Turkey
| | - Erkan Cakir
- Division of Pediatric Pulmonology, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey
| | - Refika Ersu
- Division of Pediatric Pulmonology, Faculty of Medicine Istanbul, Marmara University, Istanbul, Turkey
| | - Fazilet Karakoc
- Division of Pediatric Pulmonology, Faculty of Medicine, Marmara University, Istanbul, Turkey
| | - Sedat Oktem
- Division of Pediatric Pulmonology, Faculty of Medicine, Medipol University, Istanbul, Turkey
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