Cardiac indexes determined by Fick, C-TDCi, and R-TDCi were equivalent in children. Saline at room temperature can be used as an alternative to cold saline to avoid potential drop in body temperature of these patients.
The more recent group of patients undergoing Fontan operations, all of whom received VP perioperatively, had less chest tube output and shorter duration of chest tube drainage after the Fontan operation relative to the earlier patient group whose perioperative management did not include VP. They also experienced less positive fluid balance in the early postoperative period and shorter hospital length of stay than the patients from the earlier era.
Rationale: Gastric aspiration is a known complication of pediatric asthmatic patients during an acute attack and has been shown to propagate chronic pulmonary disease in these patients. Pepsin and lipid-laden macrophages (LLM) have been studied and used as markers of gastric aspiration and inflammation on bronchoalveolar lavage (BAL). Objective: Our aim was to determine if asthmatic patients, who were not having an acute attack, underwent fiberoptic bronchoscopy (FOB) with BAL had pepsin activity and/or increased LLM on BAL to suggest pulmonary aspiration. Method: Prospective study, over a 8-month period, of 25 pediatric patients with uncontrolled asthma, not in acute exacerbation, undergoing FOB and BAL. There were 11 female and 14 male patients. The ages ranged from 15 months to 14 years of age. Results:: 2 (8%) had positive pepsin levels. One of the patients had a diagnosis of asthma and allergic rhinitis. The In evaluation of pepsin pepsin level was 105.2. The other patient had a diagnosis of neuromuscular disease adn asthma. The pepsin level was 93.4. In evaluation of : 9 patients (36%) had a positive LLM. Of those 9 patients: 4 patients (44%) had +1 LLM; 5 patients (56%) had a +2 LLM. There were no LLM patients with +3 or +4 LLM. 14 (56%) had negative pepsin and LLM. Conclusion: According to our study in patients with uncontrolled asthma, undergoing fiberoptic bronchoscopy, BAL was not associated with gastric reflux as measured by pepsin. LLM was elevated in 36% of patients, ranging from 0 to +2, signifing inflammation or reflux. Two of our patients had elevated pepsin, one of which had a neuromuscular syndrome.
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