Articles: apnea-diagnosis.
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The Journal of pediatrics · Jul 1994
Prolonged cardiorespiratory monitoring of children more than twelve months of age: characterization of events and approach to discontinuation.
We assessed children referred to our apnea program who were > or = 12 months of age, beyond the at-risk period for sudden infant death syndrome (SIDS), but for whom home cardiorespiratory monitoring had continued. Our objectives were to (1) determine reasons for initiation and continuation of monitoring, (2) apply documented monitoring of transthoracic impedance, electrocardiographic signals, and, in a subset of patients, pulse oximetry, to determine the types of cardiorespiratory events that these children experienced, and (3) describe how documented monitoring was applied for eventual discontinuation of monitoring. Among 45 patients (median age, 22 months), 263 disks were collected, representing 2982 monitor days. ⋯ By extension of the audible apnea alarm to 25 or 30 seconds, lowering of the cutoff point for bradycardia alarm, or lowering of the cutoff point for the oximetry alarm, a recommendation to discontinue monitoring could be made for 41 patients. Of these, no child had a recurrence of cardiorespiratory events or died of SIDS. Documented monitoring proved to be a useful clinical tool for investigation of the clinical and physiologic importance of these cardiorespiratory events in children beyond the at-risk period for SIDS; recommendations about discontinuation of monitoring could be made knowledgeably and safely.
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Munchausen syndrome by proxy (MSP) is recognized in the differential diagnosis of apparent life-threatening events, but the early signs and the full spectrum of this presentation are not well recognized. We aim to describe MSP presenting with apnea to illustrate this spectrum and the evolution in our management over a period of 10 years. ⋯ MSP is part of child abuse, and it needs to be recognized by all physicians. Family assessment is required and the development of a team interested in MSP facilitates assessment and management.
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To assess the efficacy of bulk diffusion in maintaining oxygenation during apnea testing for brain death. ⋯ The bulk diffusion technique has several advantages, including ease of performance over other methods of supplying oxygen during apnea testing, but this method does not prevent hypoxemia in patients with lung disease.
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To evaluate the clinical use of a cardiorespiratory rate monitor in patients receiving epidural opioids following major surgery. ⋯ The cardiorespiratory rate monitor is useful in patients at risk for bradypnea following surgery.