Objective:To describe the efficacy and safety of chloral hydrate sedation in infants for pulmonary function tests.Methods:All sedation attempts for pulmonary function tests in infants carried out between June 2007 and August 2014 were evaluated. Obstructive sleep apnea and heart disease were contraindications to the exams. Anthropometric data, exam indication, used dose, outcomes of sedation and clinical events were recorded and described.Results:The sedation attempts in 277 infants (165 boys) with a median age of 51.5 weeks of life (14-182 weeks) were evaluated. The main indication for the tests was recurrent wheezing (56%) and the chloral hydrate dose ranged from 50 to 80mg/kg (orally). Eighteen (6.5%) infants had some type of clinical complication, with the most frequent being cough and/or airway secretion (1.8%); respiratory distress (1.4%) and vomiting (1.1%). A preterm infant had bradycardia for approximately 15 minutes, which was responsive to tactile stimulation. All observed adverse effects were transient and there was no need for resuscitation or use of injectable medications.Conclusions:The data demonstrated that chloral hydrate at the employed doses is a safe and effective medicament for sedation during short procedures in infants, such as pulmonary function tests. Because of the possibility of severe adverse events, recommendations on doses and contraindications should be strictly followed and infants should be monitored by trained staff.
Background Prolonged slow expiration (PSE) is a manual chest physical therapy technique routinely performed in clinical practice. However, the reliability and agreement of the technique have not been tested. Objective The objective of this study was to assess reliability and agreement between physical therapists during the application of PSE in infants with wheezing. Design This was a cross-sectional study. Methods Infants with a mean age of 59 weeks (SD = 26 weeks) were included in this study. Two physical therapists (physical therapist 1 and physical therapist 2) randomly performed 3 PSE sequences (A, B, and C). The expiratory reserve volume (ERV) was measured with a pneumotachograph connected to a face mask. ERV was used to evaluate the reproducibility of the technique between sequences and between physical therapist 1 and physical therapist 2. Results The mean ERV of the infants was 63 mL (SD = 21 mL). There was no statistically significant difference between the ERV values in the 3 sequences for physical therapist 1 (A: mean = 46.6 mL [SD = 17.8 mL]; B: mean = 45.7 mL [SD = 19.9 mL]; C: mean = 53.3 mL [SD = 26.3 mL]) and physical therapist 2 (A: mean = 43.5 mL [SD = 15.4 mL]; B: mean = 43.2 mL [SD = 18.3 mL]; C: mean = 44.8 mL [SD = 25.0 mL]). There was excellent reliability between the sequences for physical therapist 1 (ICC = 0.88 [95% CI = 0.63–0.95]) and physical therapist 2 (ICC = 0.82 [95% CI = 0.48–0.93]). Moderate agreement was observed between physical therapist 1 and physical therapist 2 (ICC = 0.67 [95% CI = 0.01–0.88]). According to Bland-Altman analysis, the mean difference between physical therapist 1 and physical therapist 2 was 4.1 mL (95% CI = −38.5 to 46.5 mL). Limitations The data were collected in infants with wheezing who were not in crisis. This decreased lung mucus; however, it also reduced evaluation risks. Conclusions PSE was a reproducible chest physical therapy technique between physical therapists.
Objective:To describe the efficacy and safety of chloral hydrate sedation in infants for pulmonary function tests.Methods:All sedation attempts for pulmonary function tests in infants carried out between June 2007 and August 2014 were evaluated. Obstructive sleep apnea and heart disease were contraindications to the exams. Anthropometric data, exam indication, used dose, outcomes of sedation and clinical events were recorded and described.Results:The sedation attempts in 277 infants (165 boys) with a median age of 51.5 weeks of life (14-182 weeks) were evaluated. The main indication for the tests was recurrent wheezing (56%) and the chloral hydrate dose ranged from 50 to 80mg/kg (orally). Eighteen (6.5%) infants had some type of clinical complication, with the most frequent being cough and/or airway secretion (1.8%); respiratory distress (1.4%) and vomiting (1.1%). A preterm infant had bradycardia for approximately 15 minutes, which was responsive to tactile stimulation. All observed adverse effects were transient and there was no need for resuscitation or use of injectable medications.Conclusions:The data demonstrated that chloral hydrate at the employed doses is a safe and effective medicament for sedation during short procedures in infants, such as pulmonary function tests. Because of the possibility of severe adverse events, recommendations on doses and contraindications should be strictly followed and infants should be monitored by trained staff.
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