Chest
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Comparative Study
Routine chest radiographs following repositioning of endotracheal tubes are necessary to assess correct position in pediatric patients.
Attempts to correctly reposition endotracheal tubes (ETTs) are not always successful in pediatric patients, even when chest radiographs (CXRs) are measured to determine the distance that the ETT deviates from the correct position. We determined the frequency of continued ETT malposition after repositioning in a pediatric intensive care unit (PICU). Forty children with malpositioned ETTs were identified during a 4-month period. ⋯ Despite repositioning based on measurements taken from a CXR, a large percentage of pediatric patients had continued ETT malposition. However, after radiographic documentation of correct position, we demonstrated that significant movement was uncommon. Routine confirmation of ETT position by CXRs should be considered after repositioning ETTs in pediatric patients.
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To assess the effect of cardiopulmonary bypass (CPB) on muscle blood flow (MBF) when measured in the forearm by venous occlusion plethysmography. ⋯ These findings indicate that the increase in MBF seen during warm and the post-CPB periods is only a recovery toward normal blood flow. The role of this change in the low SVR that usually accompanies CPB is equivocal.
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A miniature flexible fiberoptic bronchoscope (FFB) (Olympus BF-N20) (2.2 mm diameter) was applied to 53 children (20 female subjects) ranging in age from 3 months to 15 years (mean, 4.19 years). Most common indications for bronchoscopy included stridor or weak cry and persistent wheezing or cough unresponsive to inhaled bronchodilators, chest physiotherapy, steroids, and antimicrobial agents. There were no complications. ⋯ It was of limited value when excessive bronchial secretions obstructed the view of the working field for which a bronchoscope with a built-in suction channel was needed. It is concluded that this miniature FFB is a useful diagnostic tool in infants and children particularly for obstructed upper airways but has limited applications in children with peripheral airway disease. The 2.2-mm bronchoscope may have its greatest advantage in preterm neonates and intubated infants, where the small glottic or endotracheal tube size renders the 3.5-mm bronchoscope useless.
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The present study was designed to evaluate if continuous positive airway pressure (CPAP) augments the effect of nitric oxide (NO) inhalation on matching between ventilation and perfusion (VA/Q) during acute lung injury. ⋯ Although pulmonary vascular resistance can be lowered with NO inhalation alone, recruitment of gas exchange units with CPAP is necessary to produce a beneficial effect of NO inhalation on VA/Q matching and oxygenation. When recruitment of gas exchange units with CPAP brings gaseous NO in contact with enough pulmonary blood vessels, NO-induced vasodilation will augment VA/Q matching by a steal mechanism.