Our objective was to characterize our experience with 8 patients with Rett syndrome undergoing scoliosis surgery in regard to rates of respiratory failure and rates of ventilator-acquired pneumonia in comparison to patients with neurologic scoliosis and adolescent idiopathic scoliosis. This study was a retrospective chart review of patients undergoing scoliosis surgery at a tertiary children's hospital. Patients were divided into 3 groups: (1) adolescent idiopathic scoliosis, (2) neurologic scoliosis, and (3) Rett syndrome. There were 133 patients with adolescent idiopathic scoliosis, 48 patients with neurologic scoliosis, and 8 patients with Rett syndrome. We found that patients with Rett syndrome undergoing scoliosis surgery have higher rates of respiratory failure and longer ventilation times in the postoperative period when compared with both adolescent idiopathic scoliosis and neurologic scoliosis patients. There is insufficient evidence to suggest a difference in the incidence of ventilator-acquired pneumonia between the Rett syndrome and the neurologic scoliosis group. We believe our findings are the first in the literature to show a statistically significant difference between these 3 groups in regard to incidence of respiratory failure.
in P:F ratio after drainage. Secondary endpoint was associated hemodynamic changes. Results: 101 thoracenteses were performed. 44 patients had appropriate datasets for analysis. Significant improvements in P:F ratios (mean±SD) were seen in patients with ARDS(+50.4 ± 38.5, p= 0.001,n=13) and ALI(+90.6 ± 16 1.8,p=0.022,n=16), but not in Normal (-19.7 ± 139.4,p=.15,n=15). Volumes of fluid removed were 873 ± 108ml, 764 ± 96ml, 875 ± 128ml for the groups. P:F ratio improvements did not demonstrate correlation with the volumes of fluid removed ARDS(r=0.28, p=0.35), ALI(r=-0.05,p=0.86), Normal(r=0.32,p=0.25). Statistically significant improvement was observed in pO2 values ARDS patients in pO2 values (+31.1, p=0.005), and in O2 saturation (+4.1,p<0.001), as was worsening in Normal patients' O2 saturations (-0.9, p=0.005). No other significant changes were seen in heart rate, systolic blood pressure, mean blood pressure, pressor requirements, respiratory rate, peak inspiratory pressures, plateau pressures, mean airway pressures, FiO2, arterial pH, pO2, pCO2, HCO3, base excess, or O2 saturations in any other groups. An additional two Normal patients were successfully extubated immediately after drainage(not included). There was one death associated with an aspiration event during a procedure, no pneumothoraces were observed. Conclusions: Only patients with ARDS and ALI demonstrated an improvement in their P:F ratios. Thoracentesis failed to improve respiratory or cardiovascular function in intubated non-ARDS/ALI patients. The data supports the role of therapeutic thoracentesis for patients with ARDS or ALI, but not for patients with normal P:F ratios. With its potential for complications, its role in this group needs to be carefully considered. Introduction:The objective of this study was to identify and describe variables associated with extubation failure among mechanically ventilated children in a pediatric intensive care unit (PICU). Methods: We prospectively collected data on all children extubated in our 20-bed level I PICU over a one-year period. Extubation failure was defined as reintubation within 72 hours. Data collected on patients and compared between extubation failures and successes included: age; diagnosis; PaO2/FiO2 (P/F) ratio prior to extubation; intubation duration; duration of ICU stay; day and timing of extubation; etiology of failure; use of medications including dexmedetomidine, steroids and racemic epinephrine; degree of secretions (graded as none, mild, moderate, or copious); and respiratory support to which they were extubated (room air, face mask, nasal cannula, high-flow nasal cannula, CPAP, bi-level PAP, non-invasive mechanical ventilation). Mann-Whitney U test, chi-square, and Fisher's exact test were performed and where appropriate odds ratio (OR) with 95% confidence intervals (CI) were assessed. Results: Of the 214 patients, 33 (15%) failed extubation. Mean age was 5.6 years; median (interquartile range) was 1 year (0.5, 11). Mean duration of ICU stay was 22 days; median was 9 days (4, 22)...
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