Comparison of CPAP with Humidifie, Blender, and T-piece on the Outcome of Weaning in Patients with Neurological Disorders

How to Cite This Article: Bilan N, Ganji Sh. Comparison of CPAP with Humidifie, Blender, and T-piece on the Outcome of Weaning in Patients with Neurological Disorders. Iran J Child Neurol. Spring 2015;9(2):42-45. AbstractObjective The procedure for weaning from mechanical ventilation in many patients is a difficult and long process and increases the time of mechanical ventilation. There are numerous ways to achieve weaning. One common method is the use of CPAP. Considering the lower price of a humidifier, blender, and T-piece compared with CPAP and in light of the limited number of studies in this field the current study purposed to compare these two procedures.Materials & MethodsFifty-one patients with neurological disorders who were under mechanical ventilation and ready to wean were allocated randomly into two groups: the CPAP group and the humidifier, blender, and T-piece group. Duration of hospital and PICU stay, number of days under mechanical ventilation, frequency of re-intubation, and mortality rate among patients were documented.ResultsThe patients were 33 males and 18 females (64.7% and 35.3%, respectively) with an average age of 22.5 ± 4.5 months.The main indication for intubation was impending respiratory failure.Hospital stay was 22±15 and 21±13 days for the humidifier and CPAP groups, respectively.PICU stay was 13±11 and 21±13 days for the humidifier and CPAP groups, respectively. Re-intubation rates were 17.2% and 45.5% for the humidifier and CPAP groups, respectively.Mortality rates were 3.4% and 22.5% for the humidifier and CPAP groups, respectively.ConclusionConsidering no statistically significant difference between the two groups, using the humidifier, blender, and T-piece is recommended.

The Role of Chest Physiotherapy in Prevention of Postextubation Atelectasis in Pediatric Patients with Neuromuscular Diseases

How to Cite This Article: Bilan N, Poorshiri B.The Role of Chest Physiotherapy in Prevention of Postextubation Atelectasis in Pediatric Patients with Neuromuscular Diseases. Iran J Child Neurol. 2013 Winter; 7 (1):21-24. ObjectiveThere are controversial findings in the literature on the effects of chest physiotherapy on postextubation lung collapse in pediatric age group. Therefore, we aimed to investigate the efficacy of chest physiotherapy in prevention of postextubation atelectasis in pediatric patients. Materials & Methods In a case-control study from March 2007 to March 2011, two groups of patients (35 patients in each group) susceptible to lung collapse were enrolled in the study. The studied patients had neuromuscular diseases such as spinal muscular atrophy, Guillain-Barre syndrome, critical illness polyneuropathy/myopathy, and cerebral palsy. The patients were randomly divided into two groups (case and control); The case group underwent daily chest physiotherapy through vibrator and chest percussion and the control group was under supervision. In the latter group, the underlying disease was treated and the lung collapse was managed, if occurred. Results The frequency of atelectasis was lower in the case group who received prophylactic chest physiotherapy compared to the control group (16.6% vs. 40%). Conclusion Chest physiotherapy as well as appropriate and regular change of position can considerably reduce the rate of pulmonary collapse in pediatric patients.References Jorgensen J, Wei JL, Sykes KJ, Klem SA, Weatherly RA, Bruegger DE, Latz AD, Nicklaus PJ. Incidence of and risk factors for airway complications following endotracheal intubation for bronchiolitis. Otolaryngol Head Neck Surg 2007;137(3):394-9.Flenady VJ, Gray PH. Chest physiotherapy for preventing morbidity in babies being extubated from mechanical ventilation. Cochrane Database Syst Rev 2002;(2):CD000283.Odita JC, Kayyali M, Ammari A. Post-extubation atelectasis in ventilated newborn infants. Pediatr Radiol 1993;23(3):183-5.Balachandran A, Shivbalan S, Thangavelu S. Chest physiotherapy in pediatric practice. Indian Pediatr 2005;42(6):559-68.Finer NN, Moriartey RR, Boyd J, Phillips HJ, Stewart AR, Ulan O. Postextubation atelectasis: a retrospective review and a prospective controlled study. J Pediatr 1979;94(1):110-3.Al-Alaiyan S, Dyer D, Khan B. Chest physiotherapy and post-extubation atelectasis in infants. Pediatr Pulmonol. 1996;21(4):227-30.Bloomfield FH, Teele RL, Voss M, Knight DB, Harding JE. The role of neonatal chest physiotherapy in preventing postentubation atelectasis. J pediatr 1998;133(2):269-71.Bagley CE, Gray PH, Tudehope DI, Flenady V, Shearman AD, Lamont A. Routine neonatal postextubation chest physiotherapy: a randomized controlled trial. J Paediatr Child Health 2005;41(11):592-7.Vivian-Beresford A, King C, Macauley H. Neonatal post-extubation complications: the preventive role of physiotherapy. Physiother Can 1987;39:184-90.Bagley C, Flenady V, Tudehope D, Gray P. The role of postextubation chest physiotherapy: A randomised controlled trial. Proceedings of the Perinatal Society of Australia and New Zealand 4th Annual Congress. Brisbane: 1999.Reines HD, Sade RM, Bradford BF, Marshall J. Chest physiotherapy fails to prevent postoperative atelectasis in children after cardiac surgery. Ann Surg 1982;195(4):451-5. Cavenaghi S, Moura SC, Silva TH, Venturinelli TD, Marino LH, Lamari NM. Importance of pre- and postoperative physiotherapy in pediatric cardiac surgery. Rev Bras Cir Cardiovasc 2009;24(3):397-400.Deakins K, Chatburn RL. A comparison of intrapulmonary percussive ventilation and conventional chest physiotherapy for the treatment of atelectasis in the pediatric patient. Respir Care 2002;47(10):1162-7

Therapeutic effect of insulin in reduction of critical illness polyneuropathy and Myopathy in pediatric intensive care unit

How to Cite this Article: Fayyazi A, Karimzadeh P, Torabian S, Damadi S, Khaje A. Comparison of Intravenous Midazolam Drip with Intermittent Intravenous Diazepam in The Treatment of Refractory Serial Seizures in Children. Iran J Child Neurol 2012; 6(3): 15-19.ObjectiveHyperglycemia may occur in the patients affected by any kind of critical illness.This complication makes an adverse effect on the clinical outcome of thesepatients by causing polyneuropathy and myopathy. It has been recently shownthat treatment of hyperglycemia with insulin administration significantly reducesthe prevalence of critical illness polyneuropathy and myopathy (CIPNM) andon the other hand reduces the demand for long-term mechanical ventilation inthe patients admitted to the ICU for more than 1 week. The aim of this studywas to determine the therapeutic effect of insulin in reducing the incidence ofCIPNM in the pediatric intensive care unit (PICU).Materials & MethodsIn this study, we recruited 30 patients admitted to the PICU of Tabriz PediatricHospital. The incidence of CIPNM following hyperglycemia was evaluated inthese patients. The patients were categorized into two groups. In the case group,blood sugar was controlled in the range of 140-180mg/dl by administration of0.05 unit per kilogram body weight of insulin as drip protocol in an hour and inthe control group, placebo was used. Consequently, the incidence of CIPNM,duration of PICU and duration of mechanical ventilation were comparedbetween the two groups.ResultsThe incidence of CIPNM and duration of PICU stay and mechanical ventilationwere significantly reduced in the patients treated with insulin compared to thecontrol group.ConclusionThis study shows that blood sugar control decreases the incidence of CIPNM.ReferencesVan den Berghe G. Insulin therapy in critical illness. Can J Diabetes. 2004;28(1):43-9.Bolton CF, Gilbert JJ, Hahn AF, Sibbald WJ.Polyneuropathy in critically ill patients. J Neurol Neurosurg Psychiatry. 1984 Nov;47(11):1223-31.Vondracek P, Bednarik J. Critical and electrophysiological findings and long-term outcomes in pediatric patients with critical illness polyneuropathy. Eur J Pediatr Neurol 2006 Jul;10(4):176-81.Witt NJ, Zochodne DW, Bolton CF, Grand’Maison F, Wells G, Young GB et al. Peripheral nerve functionin sepsis and multiple organ failure. Chest 1991 Jan;99(1):176-84.5. Marino PL. The ICU book. 2nd ed. Philadelphia:Lippincott Williams and Wilkins; 1998. p. 800-1.Hermans G, De Jonghe B, Bruyninckx F, Van den BergheG. Clinical review: Critical illness polyneuropathy and myopathy. Crit Care 2008;12(6): 238.Wiener RS, Wiener DC, Larson RJ. Benefits and risks of tight glucose control in critically ill adults: a meta analysis.JAMA 2008 Aug;300(8):933-44.8. Griesdale DE, de Souza RJ, van Dam RM, Heyland DK,Cook DJ, Malhotra A et al. Intensive insulin therapy and mortality among critically ill patients: a meta-analysis including NICE-SUGAR study data. CMAJ 2009 Apr;180(8):821-7.Mraovic B. Continuous glucose monitoring during intensive insulin therapy. J iabetes Sci Technol 2009 Jul;3(4):960-3.De Jonghe B, Bastuji-Garin S, Sharshar T, Outina,H, Brochard L. Does ICU-acquired paresis lengthen weaning from mechanical ventilation? Intensive Care Med 2004 Jun;30(6):1117-21.Garnacho-Mantero J, Amaya-Villar R, García-Garmendía JL, Madrazo-Osuna J, Ortiz-Leyba C. Effects of criticallillness polyneuropathy on the withdrawal from mechanical ventilation and the length of stay in septic patients. CritCare Med 2005 Feb;33(2):349-54

Risk Factors for the Development of Critical Illness Polyneuropathy and Myopathy in a Pediatric Intensive Care Unit

ObjectiveCritical illness polyneuropathy and myopathy (CIPNM) is a major complication of severe critical illness. Previous studies have suggested that many risk factors such as sepsis, multiorgan failure, and neuromuscular blocking agents play a role in CIPNM pathogenesis. The aim of this study was to evaluate possible risk factors in the development of CIPNM in a pediatric intensive care unit (PICU). Materials & MethodsIn this observational study, we recruited 57 patients admitted in the PICU of the Tabriz Pediatric Hospital. CIPNM was diagnosed in 13 (22.8%) patients on the basis of the clinical and electrodiagnostic findings. Different variables such as age, sex, the pediatric risk of mortality (PRISM) score, duration of mechanical ventilation and PICU stay, accompanying pathologic conditions, medications, and in-hospital outcome were compared between the CIPNM and non-CIPNM groups.ResultsCompared to the non-CIPNM patients, the CIPNM patients showed significantly more frequent sepsis (6.8% vs. 38.5%, odds ratio [OR] = 8.5, 95% confidence interval [CI] = 1.7-43.1) and multiorgan dysfunction (43.2% vs. 76.9%, OR = 4.4, 95% CI = 1.1-18.2). Midazolam was administered more frequently in the non-CIPNM group than in the CIPNM group (88.6% vs. 53.8%, OR =0.2, 95% CI = 0.0-0.6). There was no significant difference between the 2 groups withrespect to parameters such as age, sex, PRISM score, duration of mechanical ventilation and PICU stay, other accompanying pathologic conditions, and other medications. The mortality rate was 4.5% in the non-CIPNM group and 15.4% in the CIPNM group.In the multivariable analysis, sepsis and midazolam administration were the only significant contributors to the development of CIPNM.ConclusionSepsis is an independent risk factor for the development of CIPNM. However, midazolam administration seems to be an independent protective factor against CIPNM.Keywords: Critical illness polyneuropathy and Myopathy; pediatric intensive care unit; risk factors  

The Role of Rapid Shallow Breathing Index in Predicting Successful Weaning of Pediatric Patients with Respiratory Failure

Background About 40 to 60% of all patients admitted to pediatric intensive care unitsundergo mechanical ventilation and 10 to 20% will fail to be extubated. We aimed to determine the role of the rapid shallow breathing index (RSBI) in predicting successful weaning of pediatric patients with respiratory failure.   Materials and Methods: This cross-sectional study, was performed on 72 mechanically ventilated children (36 in the lung failure group and 36 in the pump failure group) who were admitted in Tabriz children’s hospital in pediatric intensive care unit (PICU), Tabriz city, Iran. In order to spontaneous breathing trial (SBT) criteria, the patients who had FiO2 less than 40%, PEEP less than or equal to 5 cmH2O and PaO2 higher than 60 mmHg, was placed on spontaneous ventilation mode (PSV+CPAP) to maintain a PEEP of less than or equal to 5 cmH2O, PS of less than or equal to 8 cmH2O and FiO2 of less than or equal to 40%. After 2 hours, measured tidal volume and respiratory rate to calculate the RSBI then the patient was extubated. Results: From 72 patients were enrolled in this study, 26 patients failed in extubation. The total RSBI threshold was 6.7 breath/min/ml/kg (AUC = 0.739, 95%CI = 0.618 – 0.861; p = 0.001)) with a sensitivity of 73.1% and a specificity of 80.4% for success of extubation. Patients successfully extubated had significantly lower RSBI 4.65 ± 3.03 breath/min/ml/kg compared to extubation failuregroup. Conclusion Based on the result of this study, the rapid shallow breathing index with a threshold of 6.7 breath/min/ml/kg was considered to be an acceptable and practical criterion for predicting the outcome of weaning in children

Positive Expiratory Pressure (PEP) versus Conventional Chest Physiotherapy in Pediatric Patients with Acute Exacerbation of Cystic Fibrosis

Background Pulmonary involvement is the main cause of mortality in cystic fibrosis (CF). Airway clearance techniques are non-pharmacological complement options for CF patients. The aim of this study was to evaluate the short-term outcome of airway cleaning treatment in patients with cystic fibrosis in a children's hospital. Materials and Methods This clinical trial study conducted on 40 CF patients referring to the specialized lung clinic of Tabriz Pediatric Center in Tabriz, Iran from April 2016 to April 2017. Patients were randomly divided into two equal case (PEP), and control (conventional) groups. The basic spirometry parameters were measured on the European Respiratory Society criteria. After therapeutic intervention, the patients were followed for the next six months and the number of hospital admissions were recorded. Results The mean of FEV1, FEV1/FVC and FEF25%-75% in the control group after treatment were 62.60±20.39, 86.70±19.39 and 55.20±32.78, respectively. Comparison of the control group means of FEV1, FEV1/FVC, and FEF25%-75% in the case group after intervention (57.52±14.62, 76.80±21.83 and 59.8±28.71, respectively) showed significant differences (

Role of serum Immunoglobulin E level in diagnosis of severity of cough variant asthma

Introduction: Cough variant asthma (CVA) is known by airway Hyper responsiveness and nonproductive chronic cough without wheezing for a minimum duration of 8 weeks. It is less common form of asthma. This study was conducted aiming to diagnose the role of serum Immunoglobulin E (IgE) in diagnosis of cough variant form of the disease. Methods: In this cross sectional study, 80 patients with an age range of 5-14 years were included with clinical criteria for CVA who referred to pulmonology clinic of Tabriz Children Hospital, Tabriz, Iran. Serum IgE level was measured and severity of CVA based on Global Initiative for Asthma (GINA) classification was determined, finally the relationship between serum IgE level and severity of CVA was evaluated. Results: In patients with CVA without history of allergic disease, mean serum titer of IgE was 138.2 ± 17.5. Significant difference of serum IgE level in different severities of CVA was detected (P = 0.001). Conclusion: Serum IgE level in patients with CVA is a reliable marker for diagnosis and evaluation of the severity of disease

The Effects of Triggers’ Modifying on Adolescent Self-Efficacy with Asthma: A Randomized Controlled Clinical Trial

Introduction: The management of asthma during adolescence has specific challenges and is likely influenced, to some extent, by the patient's belief in their ability to affect change, their self-efficacy. Bolstering self-efficacy could potentially improve an adolescent’s ability to self-manage their asthma. The aim of this study was to examine the effects of a triggers’ educational-modifying intervention on self-efficacy among adolescents diagnosed with asthma living in Iran. Methods: Sixty adolescents, aged 12 to 18 years, diagnosed with asthma participated in this randomized clinical trial. Participants randomly assigned to the control group received standard care while those assigned to the experimental group participated in a 5 week, nurse led, triggers modifying educational intervention in specialized clinics of lung in Tabriz, Iran. The self-efficacy scale developed by Bursh et al., was used for data collection. Results: The level of self- efficacy in two groups before intervention was not statistically significant, while the post intervention measures were statistically significant. Intervention was effective in improving adolescents’ self-efficacy. Conclusion: Since this type of intervention has the potential to improve Self- efficacy in adolescents with asthma, it is suggested that adolescence directly education about asthma triggers along with modulating triggers will be of value and parent‐centered could be diminished. The need for such interventions emphasizes in clinic and outpatient clinics

The Role of Inflammatory Biomarkers in the Management of Children with Asthma

Background Making decision on asthma as an inflammatory disease is done mostly on the airways function and the patient symptoms which most of them are nonspecific and subjective. Also, the children are not able to express their signs and collaboration in examination of the lungs function. Evaluation of serum level inflammatory biomarkers can be useful in assessment of the response to treatment and severity of asthma. In this regard, we aimed to examine the changes of serum levels of biomarkers which may occur as a result of treatment in children with asthma. Materials and Methods This study was conducted in 2017 and 54 children who referring to the respiratory clinic of Tabriz University of Medical Sciences, Tabriz city (Iran), were studied by convenience sampling method. To evaluate the changes of biomarkers (Immunoglobulin E, Eosinophil, Periostin and Eosinophil Cationic Protein), 5ml peripheral blood samples were drawn before and after the treatment period of six-month. They were measured by ELISA method. The data were analyzed by SPSS software ver.16.0 using descriptive statistics and Paired Sample t test. Results The mean age of the children was 6.27±2.25 years. There was a significant difference between the studied biomarkers before and after treatment (P>0.05) and the serum level of Immunoglobulin E, Eosinophil, Periostin and Eosinophil Cationic Protein was reduced after receiving the treatment. Conclusion The biomarkers serum levels in the children was reduced after the end of the treatment period. Thus, in this study, the role of selective biomarkers in asthma management was confirmed. The physicians could decide about the stop or continuation of the treatment by measuring their serum levels

Rhabdomyosarcoma Arising within Congenital Cystic Adenomatoid Malformation; a Case Report

This case report describes a 30-month-old child with primary pulmonary rhabdomyosarcoma with a congenital cystic adenomatoid malformation (CCAM). In the current literature, primary pulmonary neoplasms have been reported for similar cases. The tumor was located in the anterior-basal segment of the left lower lobe with a thin-walled cystic appearance and lobulated margins. A histology examination showed rhabdomyosarcoma origin with an embryonal subtype. Postoperative systemic chemotherapy was carried out. After a 6-month follow-up, the patient had no residual or recurrent disease