Pediatric pulmonology
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Pediatric pulmonology · Jun 2013
Bronchoscopy and airway management in patients with mucopolysaccharidoses (MPS).
Mucopolysaccharidoses (MPS) are a group of lysosomal storage disorders characterized by tissue deposition of glycosaminoglycans (GAG). Their musculoskeletal abnormalities and the GAG storage in the airway result in increased risk for patients undergoing anesthesia. This study evaluates a multi-disciplinary airway management approach and reports upper and lower airway findings of flexible bronchoscopy performed during these procedures. ⋯ Our experience demonstrates that a multidisciplinary approach and combined surgeries in MPS provides for safe airway management and allows diagnostic assessments for further patient care without added risks. Significant, multi-factorial airway compromise may occur already in early childhood including upper and lower airway GAG deposits.
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Pediatric pulmonology · Jun 2013
Nocturnal phenotypical features of obstructive sleep apnea (OSA) in asthmatic children.
Asthma and obstructive sleep apnea (OSA) often coexists during childhood. To delineate this clinical association, we investigated the phenotypical features of OSA in asthmatic children. Specifically, we hypothesized that asthmatic children have a distinct OSA phenotype that involves a higher prevalence of Rapid-Eye-Movement (REM)-related breathing abnormalities relative to children with OSA alone. ⋯ These results demonstrate that asthma is associated with REM-related breathing abnormalities in children with moderate-severe OSA. The link between asthma and REM-related OSA is independent of asthma control and obesity. Further research is needed to delineate the REM-sleep biological mechanisms that modulate the phenotypical expression of OSA in asthmatic children.
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Pediatric pulmonology · Jun 2013
Fraction of exhaled nitric oxide and wheezing phenotypes in preschool children.
Asthma is a chronic lower airway inflammatory disease. Nitric oxide is an inflammatory mediator produced endogenously in the airway. Previous studies have demonstrated that the fractional concentration of exhaled nitric oxide (FeNO) is increased in asthma. ⋯ FeNO may be a better marker for asthma phenotypes in preschool children than AHR and PFT results.
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Pediatric pulmonology · May 2013
Effect of HFNC flow rate, cannula size, and nares diameter on generated airway pressures: an in vitro study.
Increased use of non-invasive forms of respiratory support such as CPAP and HFNC in premature infants has generated a need for further investigation of the pulmonary effects of such therapies. In a series of in vitro tests, we measured delivered proximal airway pressures from a HFNC system while varying both the cannula flow and the ratio of nasal prong to simulated nares diameters. Neonatal and infant sized nasal prongs (3.0 and 3.7 mm O. ⋯ At 6 L/min HFNC flow with mouth open, airway pressures remained <1.7 cm H₂O for all ratios; and <10 cm H₂O with mouth closed for ratios <0.9. For ratios >0.9 and 50% mouth leak, airway pressures rapidly increased to 18 cm H₂O at 2 L/min HFNC flow followed by a pressure relief valve limited increase to 24 cm H₂O at 6 L/min. Safe and effective use of HFNC requires careful selection of an appropriate nasal prong-to-nares ratio even with an integrated pressure relief valve.