Persistent pulmonary hypertension of the newborn (PPHN) is a syndrome of high pulmonary vascular resistance (PVR) commonly seen all over the world in the immediate newborn period. Several case reports from India have recently described severe pulmonary hypertension among infants in the postneonatal period. These cases typically present with respiratory distress in 1–6-month-old infants, breastfed by mothers on a polished rice-based diet. Predisposing factors include respiratory tract infection such as acute laryngotracheobronchitis with change in voice, leading to pulmonary hypertension, right atrial and ventricular dilation, pulmonary edema and hepatomegaly. Mortality is high without specific therapy. Respiratory support, pulmonary vasodilator therapy, inotropes, diuretics and thiamine infusion have improved the outcome of these infants. This review outlines four typical patients with thiamine-responsive acute pulmonary hypertension of early infancy (TRAPHEI) due to thiamine deficiency and discusses pathophysiology, clinical features, diagnostic criteria and therapeutic options.
Left atrial (LA) function has been associated with adverse outcomes in patients after acute myocardial infarction. The purpose of the current study was to evaluate LA function in patients with non-ST-segment elevation myocardial infarction (NSTEMI) by two-dimensional speckle tracking echocardiography (2D STE). Fifty-one patients with NSTEMI and 40 age-matched normal control individuals were enrolled in this study. Conventional echocardiographic parameters and global longitudinal strain rate (GLSR) were measured at left ventricular (LV) and LA segments. Compared with healthy subjects, patients with NSTEMI had significantly increased LA volumes but significantly decreased LA emptying fraction and GLSR. LA-GLSR had significant correlations with the 2D Doppler echocardiographic parameters of LA function. In particular, global LA peak negative strain rate during early ventricular diastole (LA-GLSRe) was significantly correlated with both LA 2D Doppler echocardiographic parameters and LV contractile function. This could be suggested as a better indicator to evaluate LA function as a preferred parameter of STE.
Introduction of a justification form before prescribing antimicrobials or at the time of deferring de-escalation can be useful in restricting usage of antimicrobials.
A
bstract
Objective
To study if protocolized monitoring of endotracheal tube (ETT) cuff pressure every 6 hours is better than adjusting endotracheal tube cuff inflation by the only bedside clinical assessment.
Materials and methods
This was a single-center prospective randomized controlled study done between July 1, 2017 and March 31, 2019. Children between 1 month and 18 years, intubated with cuffed ETT by our trained doctors were included. After obtaining consent, patients were randomized into two groups, standard group (SG) and cuff pressure monitoring group (MG). Sample size was calculated with 80 patients in each group with a power of 80%, significance level (alpha 0.05 and beta 0.2). In the SG, ETT cuff inflation was adjusted by clinical assessment (bedside minimal leak technique and monitoring the percentage of leak displayed on ventilator display) at 6 hours interval. In the MG, cuff pressures were monitored by the device every 6 hours to maintain between 20 and 25 mm Hg.
Results
Out of 543 mechanically ventilated children during the study period, 266 were eligible and randomized for study. During the study, 89 patients died and 17 were left against medical advice, leaving 80 patients in each group. Incidence of post-extubation stridor (PES), re-intubation rate, ventilator-associated pneumonia (VAP) rate, ventilator days, and length of pediatric intensive care unit (PICU) stay were analyzed and found no advantage of protocolized monitoring of cuff pressures in the reduction of any of the above variables.
Conclusion
Our findings if confirmed by large multicentric studies can bring an end to routine ETT cuff pressure measurements and emphasize more on clinical assessment. Clinical trial registry (CTRI/2019/05/019098).
Indian Journal of Critical Care Medicine (2021): 10.5005/jp-journals-10071-23737
How to cite this article
Shaikh F, Janaapureddy YR, Mohanty S, Reddy PK, Sachane K, Dekate PS,
et al.
Utility of Endotracheal Tube Cuff Pressure Monitoring in Mechanically Ventilated (MV) Children in Preventing Post-extubation Stridor (PES). Indian J Crit Care Med 2021;25(2):181–184.
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