Aims of this study were to assess the maximum displacement of tracheal tube tip during head-neck movement in children, and to evaluate the appropriateness of the intubation depth marks on the ...Microcuff Paediatric Endotracheal Tube regarding the risk of inadvertent extubation and endobronchial intubation.
We studied children, aged from birth to adolescence, undergoing cardiac catheterization. The patients’ tracheas were orally intubated and the tracheal tubes positioned with the intubation depth mark at the level of the vocal cords. The tracheal tube tip-to-carina distances were fluoroscopically assessed with the patient supine and the head-neck in 30° flexion, 0° neutral position and 30° extension.
One hundred children aged between 0.02 and 16.4 yr (median 5.1 yr) were studied. Maximum tracheal tube-tip displacement after head-neck 30° extension and 30° flexion demonstrated a linear relationship to age maximal upward tube movement (mm)=0 0.71×age (yr)+9.9 (R2=0.893); maximal downward tube movement (mm)=0.83×age (yr)+9.3 (R2=0.949). Maximal tracheal tube-tip downward displacement because of head-neck flexion was more pronounced than upward displacement because of head-neck extension.
The intubation depth marks were appropriate to avoid inadvertent tracheal extubation and endobronchial intubation during head-neck movement in all patients. However, during head-neck extension the tracheal tube cuff may become positioned in the subglottic region and should be re-adjusted when the patient remains in this position for a longer time.
We compared cardiac output (CO) measurements by the non-invasive electrical velocimetry (Aesculon®) monitor with the pulmonary artery catheter (PAC) thermodilution method in children.
CO values using ...the Aesculon® monitor and PAC thermodilution were simultaneously recorded during cardiac catheterization in children. Measurements were performed under general anaesthesia. To compare, three consecutive measurements for each patient within 3 min were obtained. The means of the three values were compared using simple regression and Bland–Altman analysis. Data were presented as mean (sd). A mean percentage of <30% was defined to indicate clinical useful reliability of the Aesculon® monitor.
A total of 50 patients with a median (range) age of 7.5 (0.5–16.5) yr were enrolled in the study. Mean CO values were 3.7 (1.5) litre min−1 (PAC thermodilution) and 3.1 (1.7) litre min−1 (Aesculon® monitor). Analysis for CO measurement showed a good correlation between the two methods (r=0.894; P<0.0001). The bias between the two methods was 0.66 litre min−1 with a precision of 1.49 litre min−1. The mean percentage error for CO measurements was 48.9% for the Aesculon® monitor when compared with PAC thermodilution.
Electrical velocimetry using the Aesculon® monitor did not provide reliable CO values when compared with PAC thermodilution. Whether the Aesculon® monitor can be used as a CO trend monitor has to be assessed by further investigations in patients with changing haemodynamics.
Purpose: To evaluate whether regional cerebral oxygenation (rSO2) by near‐infrared spectroscopy correlates with central venous (SvO2) or internal jugular (SjO2) oxygen saturation, and whether changes ...over time (Δ) in rSO2 (ΔrSO2) predict changes in SvO2 (ΔSvO2) and SjO2 (ΔSjO2).
Methods: The rSO2 values were measured using the INVOS 5100 cerebral oximeter in children undergoing interventional cardiac catheterization and were compared with the oxygen saturation of analysed central venous and internal jugular blood samples. Changes over time (Δ) were calculated as the difference between the values before and after catheter intervention for rSO2·(ΔrSO2), SvO2·(ΔSvO2) and SjO2·(ΔSjO2). Simple regression and Bland–Altman analysis were performed. Data are presented as median (range).
Results: Sixty patients aged 4.3 (0.2–16.0) years were investigated. A closer correlation was found between rSO2 and SvO2 (r=0.728, P<0.0001) than between rSO2 and SjO2 (r=0.665, P<0.0001). The bias between rSO2 and SvO2·(SjO2) was 0.17% (−0.60%), with limits of agreement from −15.5% to 15. 9% (−18.6–17.4%). The sensitivity/specificity for ΔrSO2 to indicate a fall in SvO2 or in SjO2 was 70.3%/65.2% and 68.6%/60.0%, respectively.
Conclusion: Neither absolute values nor changes in rSO2 using the INVOS 5100 allowed reliable estimation of SvO2 or SjO2 and their trends.
The minimally invasive CardioQP oesophageal Doppler probe estimates cardiac output by measuring blood flow velocity in the descending aorta. Individual variables to enter are patient's age, weight ...and height. We measured cardiac output simultaneously with CardioQP and pulmonary artery catheter thermodilution techniques during heart catheterisation in 40 paediatric patients with congenital heart defects. Median range age was 8.2 years 0.5-16.7 years, cardiac output values measured by thermodilution and CardioQP were 3.6 l.min(-1) 1.2-7.1 l.min(-1) and 3.0 l.min(-1) 0.7-6.7 l.min(-1), respectively. These values showed only moderate correlation (r = 0.809; p < 0.0001). Bias and precision were 0.66 l.min(-1) and 1.79 l.min(-1) (95% limits of agreement: -1.13 to +2.45 l.min(-1)). Based on our preliminary experience, cardiac output values measured by CardioQP in children do not reliably represent cardiac output values compared with the thermodilution technique. We suggest measurement of individual aortic diameter to improve performance of the CardioQP.
Acquired syphilis has re-emerged in many Western European countries. In contrast to international guidelines, screening for syphilis in pregnancy is not generally recommended in Switzerland. There ...has been an increase in the incidence of laboratory syphilis notifications in recent years, regardless of gender and age.
We conducted a retrospective study, evaluating the total numbers of pregnant women with positive syphilis serology (Treponema pallidum Particle Agglutination assay, TPPA) from 2000 to 2009, and evaluated the clinical management and outcome of their offspring. In addition, we sought to determine cases of infectious syphilis (primary, secondary, and early latent syphilis) reported to the Swiss Federal Office of Public Health in women of childbearing age, which has previously been shown to precede changes in the incidence of congenital syphilis within a population.
Out of 13,833 women who gave birth at our institution, positive syphilis serology was found in 9 pregnant women during the 10 years studied. A total of 6 pregnant women were diagnosed having syphilis infection during pregnancy. Regarding their offspring, 8 of the 9 newborns were tested serologically. One neonate experienced congenital syphilis because the adequately treated mother developed re-infection after treatment. Within the Swiss population, infectious syphilis cases in women of childbearing age increased substantially from 2006 to 2009.
The epidemiologic data suggest that congenital syphilis could become a medical problem in Switzerland due to the rise of infectious syphilis cases in women of childbearing age that have been shown to be followed by changes in the congenital syphilis incidence. The persistence of congenital syphilis in Switzerland along with this rise of infectious syphilis in women of childbearing age suggests a potential for improvement of prenatal care and syphilis control programmes.
The risk of mortality in children admitted to the paediatric intensive care unit (PICU) after haematopoietic stem cell transplantation is felt to be very high. Life‐threatening complications leading ...to PICU admission are due to organ toxicity caused by conditioning regimes and graft‐versus‐host disease (GVHD), systemic infections and other organ dysfunctions. Data collected between October 1998 and December 2001 of paediatric patients undergoing haematopoietic stem cell transplantation and thereafter admitted to the PICU were retrospectively analysed in order to reveal the possible causes and risk factors related to death while in the PICU. Twenty‐six PICU admissions were recorded. We found a mortality rate of 57·7% and a 6‐month survival rate of 23·1%. Univariate analysis identified an oncological paediatric risk of mortality (O‐PRISM) score above 10 points, sustained renal failure and a failed negative fluid balance as significant predictors to non‐survival.
Background
This study aimed to evaluate the cardiac outcome for children with microdeletion 22q11.2 and congenital heart defect (CHD).
Methods
A total of 49 consecutive children with 22q11.2 and CHD ...were retrospectively identified. The CHD consisted of tetralogy of Fallot and variances (
n
= 22), interrupted aortic arch (
n
= 10), ventricular septal defect (
n
= 8), truncus arteriosus (
n
= 6), and double aortic arch (
n
= 1). Extracardiac anomalies were present in 46 of 47 children.
Results
The median follow-up time was 8.5 years (range, 3 months to 23.5 years). Cardiac surgical repair was performed for 35 children, whereas 5 had palliative surgery, and 9 never underwent cardiac surgery. The median age at repair was 7.5 months (range, 2 days to 5 years). The mean hospital stay was 35 days (range, 7–204 days), and the intensive care unit stay was 15 days (range, 3–194 days). Significant postoperative complications occurred for 26 children (74%), and surgery for extracardiac malformations was required for 21 patients (43%). The overall mortality rate was 22% (11/49), with 1-year survival for 86% and 5-year survival for 80% of the patients. A total of 27 cardiac reinterventions were performed for 16 patients (46%) including 15 reoperations and 12 interventional catheterizations. Residual cardiac findings were present in 25 patients (71%) at the end of the follow-up period.
Conclusions
Children with microdeletion 22q11.2 and CHD are at high risk for mortality and morbidity, as determined by both the severity of the cardiac lesions and the extracardiac anomalies associated with the microdeletion.
Background: In this study, we evaluated the ratio of the cuff diameters of the Microcuff paediatric tracheal tube (Microcuff PET, Weinheim, Germany) to fluoroscopically measured internal transverse ...tracheal diameters in children from birth to adolescence.
Methods: With Institutional Ethics Committee approval and parental consent, we measured the internal transverse tracheal diameters from fluoroscopy images in children undergoing cardiac catheterization requiring general anaesthesia with oro‐tracheal intubation. Minimal tracheal sealing pressures were assessed at standardized respirator settings. Internal transverse tracheal diameters were compared with cuff diameters at 20 cmH2O cuff pressure. Linear regression analysis was employed to assess the correlation of tracheal diameters with age, height and weight, and to assess the correlation of the cuff/tracheal diameter ratio with sealing pressures. For all tests, P < 0.05 was considered to be statistically significant.
Results: One hundred and forty‐five patients were studied (62 girls; 83 boys). Transverse tracheal diameters correlated well with age (r = 0.890; P < 0.0001), height (r = 0.900; P < 0.0001) and weight (r = 0.882; P < 0.0001). Tracheal sealing pressures ranged from 4 to 18 cmH2O. The ratio of the tracheal tube cuff diameter to the internal transverse tracheal diameter ranged from 1.06 in tubes with internal diameters of 6.0 and 4.5 mm to 2.01 in a tube with an internal diameter of 3.5 mm (median, 1.43), and did not correlate with tracheal sealing pressures (r = 0.021, P = 0.7999).
Conclusions: The residual diameters of the Microcuff paediatric tracheal tube cuffs were sufficient to cover the measured internal transverse tracheal diameters of children from birth to adolescence. This allowed the internal tracheal mucosal surface to be draped and the trachea to be sealed at very low cuff pressures.
Summary
The minimally invasive CardioQPTM oesophageal Doppler probe estimates cardiac output by measuring blood flow velocity in the descending aorta. Individual variables to enter are patient’s age, ...weight and height. We measured cardiac output simultaneously with CardioQP and pulmonary artery catheter thermodilution techniques during heart catheterisation in 40 paediatric patients with congenital heart defects. Median range age was 8.2 years 0.5–16.7 years, cardiac output values measured by thermodilution and CardioQP were 3.6 l.min−1 1.2–7.1 l.min−1 and 3.0 l.min−1 0.7–6.7 l.min−1, respectively. These values showed only moderate correlation (r = 0.809; p < 0.0001). Bias and precision were 0.66 l.min−1 and 1.79 l.min−1 (95% limits of agreement: −1.13 to +2.45 l.min−1). Based on our preliminary experience, cardiac output values measured by CardioQP in children do not reliably represent cardiac output values compared with the thermodilution technique. We suggest measurement of individual aortic diameter to improve performance of the CardioQP.
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