Pediatric Tracheotomy: A Relatively Rare Indication Limited to Pediatric Intensive Care Subjects?

Objective:To evaluate indications, underlying conditions and outcome in pediatric tracheotomy subjects.Methods:Between January 2004 and September 2013, pediatric subjects who underwent a tracheotomy operation were included for study. All subjects were under the age of 14. Subjects’ primary diseases, indication of tracheotomy, age, gender and type of complications were recorded.Results:Forty five subjects were identified. The mean age of subjects was 26.3 months (range between 2 to 140 months). Twenty one (46.6%) subjects were under the age of 1 year. In 34 (75.5%) out of 45 subjects, tracheotomy indication was prolonged intubation. In the remaining 11 (24.4%) subjects, tracheotomy indication was upper respiratory tract obstruction. Thirteen (n=13- 28.8%) out of 45 experienced early complications and 2 (n=2-4.5%) out of 45 subjects experienced late complications. One tracheotomy related death occurred in the immediate period. Eight (18.1%) of subjects died during the study period from underlying conditions. Decannulation was successfully performed in 13 (36.1%) subjects. In the remaining 23 (63.8%) subjects, decannulation could not be done.Conclusion:All tracheotomies in this report were performed on pediatric intensive care subjects on an elective basis. No tracheotomy was performed for acute upper airway obstruction. Even when planned and elective tracheotomy is performed it still has significant mortality and morbidity

Sex difference and intra-operative tidal volume: Insights from the LAS VEGAS study

BACKGROUND: One key element of lung-protective ventilation is the use of a low tidal volume (VT). A sex difference in use of low tidal volume ventilation (LTVV) has been described in critically ill ICU patients.OBJECTIVES: The aim of this study was to determine whether a sex difference in use of LTVV also exists in operating room patients, and if present what factors drive this difference.DESIGN, PATIENTS AND SETTING: This is a posthoc analysis of LAS VEGAS, a 1-week worldwide observational study in adults requiring intra-operative ventilation during general anaesthesia for surgery in 146 hospitals in 29 countries.MAIN OUTCOME MEASURES: Women and men were compared with respect to use of LTVV, defined as VT of 8 ml kg-1 or less predicted bodyweight (PBW). A VT was deemed 'default' if the set VT was a round number. A mediation analysis assessed which factors may explain the sex difference in use of LTVV during intra-operative ventilation.RESULTS: This analysis includes 9864 patients, of whom 5425 (55%) were women. A default VT was often set, both in women and men; mode VT was 500 ml. Median [IQR] VT was higher in women than in men (8.6 [7.7 to 9.6] vs. 7.6 [6.8 to 8.4] ml kg-1 PBW, P < 0.001). Compared with men, women were twice as likely not to receive LTVV [68.8 vs. 36.0%; relative risk ratio 2.1 (95% CI 1.9 to 2.1), P < 0.001]. In the mediation analysis, patients' height and actual body weight (ABW) explained 81 and 18% of the sex difference in use of LTVV, respectively; it was not explained by the use of a default VT.CONCLUSION: In this worldwide cohort of patients receiving intra-operative ventilation during general anaesthesia for surgery, women received a higher VT than men during intra-operative ventilation. The risk for a female not to receive LTVV during surgery was double that of males. Height and ABW were the two mediators of the sex difference in use of LTVV.TRIAL REGISTRATION: The study was registered at Clinicaltrials.gov, NCT01601223

Acoustical characteristics of Izmir Sephardic synagogues

Acoustical environment, which is one of the basic elements of human perception of architectural spaces, is one of the most important issues of conserving and sustaining the architectural heritage. In this context, acoustical performance of the four synagogue buildings of Izmir, having the same space characteristics, are aimed to be documented, the documentation data is synthesized in the research. As the case studies, Shalom, Sinyora Giveret, Algaze and Bikur Holim Synagogues, which are in use at Kemeralti, Izmir, are chosen. RT, T30, EDT, D50, STI and RASTI parameters are measured and the results are evaluated by comparing each other