Paediatric Respiratory Reviews最新文献

Introduction

Methods

Results

Conclusion

Objectives

Design

Results

Conclusion

Objective

To review the recent evidence in the literature of various aspects of recurrent/severe wheezing in children under 3 in low-middle income countries [LMICS].

Sources

A non-systematic review including articles in English. We mainly selected publications from the last 5 years. Studies on epidemiology, aetiology, diagnosis, treatment, and prevention were included in the search. We reviewed differential diagnoses of wheezing that focused on LMICS. We also reviewed aspects of prevention.

Summary of the findings

Many epidemiological studies have shown a variable but significant number of wheezy infants [WI] cases in LMICS when compared to other countries.

The differential diagnosis of causes of wheezing in this age group is mandatory, taking into account local facilities.

Few treatment options have been well studied for this age group. In LMICS, a pragmatic approach could be considered, as described in the article.

It is difficult to study primary prevention for WI and secondary prevention (mainly environmental) may have some impact.

A schematic approach for recurrent wheezers is presented, which takes into account settings with limited resources.

Conclusion

Severely or recurrently wheezy children under 3 is a common clinical issue in LMICS. Studies on this age group are needed to reduce the significant morbidity. It may be possible to lower the high burden of wheezing in this age group by selecting the phenotype which may respond to inhaled steroids.

There is increasing use of clinical Simulation Based Education (SBE) in healthcare due to an increased focus on patient safety, the call for a new training model not based solely on apprenticeship, a desire for standardised educational opportunities that are available on-demand, and a need to practice and hone skills in a controlled environment. SBE programs should be evaluated against Kirkpatrick level 3 or 4 criteria to ensure they improve patient or staff outcomes in the real world. SBE programs have been shown to improve outcomes in neonatology – reductions in hypoxic ischaemic encephalopathy, in brachial plexus injury, rates of school age cerebral palsy, reductions in 24hr mortality and improvements in first pass intubation rates. In paediatrics SBE programs have shown improvements in paediatric cardiac arrest survival, PICU survival, reduced PICU admissions, reduced PICU length of stay and reduced time to critical operations. SBE can improve the non-technical tasks of teamwork, leadership and communication (within the team and with patients and carers). Simulation is a useful tool in Quality and Safety and is used to identify latent safety issues that can be addressed by future programs. In high stakes assessment simulation can be a mode of assessment, however, care needs to be taken to ensure the tool is validated carefully.

Pulse oximetry is widely used to non-invasively estimate the oxygen saturation of haemoglobin in arterial blood (SpO₂). It is used widely throughout healthcare and was used extensively during the Covid-19 pandemic to detect and treat hypoxic patients. Research has suggested that pulse oximetry is less accurate in patients with darker skin. This led the US Food and Drug Administration agency (FDA) to issue a safety statement warning that pulse oximeters may be inaccurate when patients have pigmented skin.

Evidence suggests that the oxygen saturation of arterial blood (SaO₂) may be being overestimated by measuring SpO₂ in those with pigmented skin. The degree of overestimation increases as SaO₂ decreases especially when SpO₂ reads below 80%. We review how pulse oximetry works and consider the implications for a patient’s health when interpreting SpO₂ in individuals with pigmented skin.

Spirometry and peak cough flow testing (PCF) are commonly used in the respiratory assessment of children with a neuromuscular disorder (NMD). Testing uses two different machines, increases laboratory time, costs and resource utilisation. No studies have assessed the correlation between peak expiratory flow (PEF) obtained from spirometry and PCF in children with NMD using one device. An audit of children with a NMD managed at the Children’s Hospital at Westmead in 2022–2024 aged < 20 years who performed spirometry and PCF testing on the same device (Vyaire Body Box^TM, Ultrasonic flow meter-based, or Vyaire Pneumotachograph^TM, Pneumotach flow meter-based; Germany) was conducted to assess the correlation between PCF and PEF. Fifty-one sets of testing were identified, and 40 subjects (9F) had reproducible testing and were included. Median (range) age was 14.95 (7.20–19.00) years. Median PEF (L/min) was 4.05 (1.22–10.26) and median PCF (L/min) was 4.29 (1.69–10.82). PEF and PCF had a strong Pearson’s correlation coefficient, (R = 0.97, p = 0.03). The coefficient of determination was 0.93. If laboratory resources permit, spirometry should be the test of choice for children with NMD. On average, spirometry required multiple practices to achieve reproducibility to meet ATS/ERS standards. PCF testing can be utilised for children where performing technically acceptable spirometry is not possible.