Scarce studies about spontaneous pneumomediastinum (SPM) in pediatric patients are published because of lower incidence in a child than an adult. This article is a literature review of pediatric SPM, discussing about aspects of incidence rate, epidemiology, pathophysiology, diagnosis, management, and prognosis about pediatric SPM. In conclusion, SPM is usually a benign disease and treatable with only supportive care. However, poorer prognosis is noted; if it is complicated with other underlying diseases or complications, then aggressive treatment might be needed.
{"title":"Spontaneous pneumomediastinum in children","authors":"Yen-Jhih Liao, Y. Huang, Bao-Ren Nong","doi":"10.4103/prcm.prcm_13_21","DOIUrl":"https://doi.org/10.4103/prcm.prcm_13_21","url":null,"abstract":"Scarce studies about spontaneous pneumomediastinum (SPM) in pediatric patients are published because of lower incidence in a child than an adult. This article is a literature review of pediatric SPM, discussing about aspects of incidence rate, epidemiology, pathophysiology, diagnosis, management, and prognosis about pediatric SPM. In conclusion, SPM is usually a benign disease and treatable with only supportive care. However, poorer prognosis is noted; if it is complicated with other underlying diseases or complications, then aggressive treatment might be needed.","PeriodicalId":273845,"journal":{"name":"Pediatric Respirology and Critical Care Medicine","volume":"13 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129901012","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Brigitte Fung, Mei-yee Lau, Shuk-yu Leung, R. Wong, K. Kwok, D. Ng
Objective: To evaluate the relationship between the percentage of total sleep time with mouth breathing (SMBP) and post-adeno-tonsillectomy apnea-hypopnea index (AHI) in non-obese children. Materials and Methods: Non-obese obstructive sleep apnea (OSA) children with pre- and post- TandA PSG done between August 2011 and February 2019 were reviewed and mouth breathing during sleep was manually scored. Percentage of total sleep time with mouth breathing (SMBP) was calculated. Its correlation with post-operative AHI >1.5/h was studied. Results: Fifty-nine children were included in the analysis and 47 of the study group (79.7%) were male. The mean age at pre-operative PSG was 9.2+/-3.1 years. The mean AHI dropped from 8.3+/-19.8 to 4.1+/-11.6 (P < 0.001). Thirty-one (50.8%) were cured of OSA defined as AHI<=1.5/h. There was a statistically significant positive correlation between post-operative log-transformed AHI and log-transformed SMBP (r=0.265, P = 0.044). The optimal SMBP for detecting residual OSA was 10.5%. The sensitivity, specificity, positive predictive value, negative predictive value and Youden Index were 0.86, 0.37, 0.57, 0.73 and 0.23, respectively. Post-operative children with SMBP >10.5% had higher risk for residual OSA (OR 4.2, 95%CI: 1.2–15.0, P = 0.029). Conclusion: Obstructive sleep apnea children with mouth breathing for more than 10.5% of total sleep time are more likely to have residual OSA after TandA.
{"title":"Mouth breathing during sleep and persistence of OSA after adeno-tonsillectomy in non-obese children","authors":"Brigitte Fung, Mei-yee Lau, Shuk-yu Leung, R. Wong, K. Kwok, D. Ng","doi":"10.4103/prcm.prcm_17_21","DOIUrl":"https://doi.org/10.4103/prcm.prcm_17_21","url":null,"abstract":"Objective: To evaluate the relationship between the percentage of total sleep time with mouth breathing (SMBP) and post-adeno-tonsillectomy apnea-hypopnea index (AHI) in non-obese children. Materials and Methods: Non-obese obstructive sleep apnea (OSA) children with pre- and post- TandA PSG done between August 2011 and February 2019 were reviewed and mouth breathing during sleep was manually scored. Percentage of total sleep time with mouth breathing (SMBP) was calculated. Its correlation with post-operative AHI >1.5/h was studied. Results: Fifty-nine children were included in the analysis and 47 of the study group (79.7%) were male. The mean age at pre-operative PSG was 9.2+/-3.1 years. The mean AHI dropped from 8.3+/-19.8 to 4.1+/-11.6 (P < 0.001). Thirty-one (50.8%) were cured of OSA defined as AHI<=1.5/h. There was a statistically significant positive correlation between post-operative log-transformed AHI and log-transformed SMBP (r=0.265, P = 0.044). The optimal SMBP for detecting residual OSA was 10.5%. The sensitivity, specificity, positive predictive value, negative predictive value and Youden Index were 0.86, 0.37, 0.57, 0.73 and 0.23, respectively. Post-operative children with SMBP >10.5% had higher risk for residual OSA (OR 4.2, 95%CI: 1.2–15.0, P = 0.029). Conclusion: Obstructive sleep apnea children with mouth breathing for more than 10.5% of total sleep time are more likely to have residual OSA after TandA.","PeriodicalId":273845,"journal":{"name":"Pediatric Respirology and Critical Care Medicine","volume":"42 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130030505","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"The last mile of COVID-19?","authors":"Yu-Tsun Su","doi":"10.4103/prcm.prcm_9_22","DOIUrl":"https://doi.org/10.4103/prcm.prcm_9_22","url":null,"abstract":"","PeriodicalId":273845,"journal":{"name":"Pediatric Respirology and Critical Care Medicine","volume":"18 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129971486","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Beginning of the End","authors":"Daniel Ng","doi":"10.4103/prcm.prcm_8_22","DOIUrl":"https://doi.org/10.4103/prcm.prcm_8_22","url":null,"abstract":"","PeriodicalId":273845,"journal":{"name":"Pediatric Respirology and Critical Care Medicine","volume":"3 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126804789","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The pathophysiology of obstructive sleep apnoea (OSA) is well studied in the adult population, but not in the paediatric population, although it can be generally classified into anatomical, functional, and pathological factors, with the most common aetiology being adenotonsillar hypertrophy and a reduced neuromuscular tone of the upper airway (UA) muscles. It is vital to understand the pathophysiology behind paediatric OSA, so that treatment can be optimized. Although the first-line treatment remains to be adenotonsillectomy (AT), this is not always effective, as indicated by the complex pathophysiology of OSA, leading to residual OSA post-AT. Myofunctional therapy (MFT), a newer non-invasive method focusing on re-educating, strengthening, and stimulating UA muscles, improves neuromuscular tone and prevents airway collapse, as supported by multiple randomized controlled trials (RCTs). Outcomes after 2 months to 2 years of therapy have also been positive, with children experiencing improved sleep quality, reduced emotional distress and mood swings, and reduced daytime problems, whereas polysomnogram (PSG) results revealed a clinically significant reduced apnoea–hypopnoea index post-therapy. Major limitations include poor compliance for active MFT and the short duration of the studies with small sample sizes. Given the high prevalence rates of childhood OSA, it is essential that more high-quality studies and RCTs are performed to assess the effectiveness of this treatment method, with a specific emphasis on its long-term impacts, risks, and optimal treatment duration.
{"title":"Paediatric obstructive sleep apnoea: Pathophysiology and the role of myofunctional therapy","authors":"Yan Li","doi":"10.4103/prcm.prcm_21_21","DOIUrl":"https://doi.org/10.4103/prcm.prcm_21_21","url":null,"abstract":"The pathophysiology of obstructive sleep apnoea (OSA) is well studied in the adult population, but not in the paediatric population, although it can be generally classified into anatomical, functional, and pathological factors, with the most common aetiology being adenotonsillar hypertrophy and a reduced neuromuscular tone of the upper airway (UA) muscles. It is vital to understand the pathophysiology behind paediatric OSA, so that treatment can be optimized. Although the first-line treatment remains to be adenotonsillectomy (AT), this is not always effective, as indicated by the complex pathophysiology of OSA, leading to residual OSA post-AT. Myofunctional therapy (MFT), a newer non-invasive method focusing on re-educating, strengthening, and stimulating UA muscles, improves neuromuscular tone and prevents airway collapse, as supported by multiple randomized controlled trials (RCTs). Outcomes after 2 months to 2 years of therapy have also been positive, with children experiencing improved sleep quality, reduced emotional distress and mood swings, and reduced daytime problems, whereas polysomnogram (PSG) results revealed a clinically significant reduced apnoea–hypopnoea index post-therapy. Major limitations include poor compliance for active MFT and the short duration of the studies with small sample sizes. Given the high prevalence rates of childhood OSA, it is essential that more high-quality studies and RCTs are performed to assess the effectiveness of this treatment method, with a specific emphasis on its long-term impacts, risks, and optimal treatment duration.","PeriodicalId":273845,"journal":{"name":"Pediatric Respirology and Critical Care Medicine","volume":"17 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122276225","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Drug-induced sleep endoscopy (DISE) is an objective assessment and diagnostic procedure of the upper airway obstruction (UAO) under sedation. Findings of DISE in Hong Kong pediatric group patients with obstructive sleep apnea (OSA) are limited. Materials and Methods: This is a single-center retrospective chart review study on DISE findings in pediatric patients with OSA documented by polysomnography (PSG). We used the DISE scoring system proposed by Chan 2014, Fishman 2013 together as our internal practice. A standard sedation protocol was conducted. Endoscopic findings were recorded and evaluated the level of obstruction, severity, and correlation with PSG parameters. Results: A total of 124 patients who underwent DISE were reviewed in our study. Multiple levels of obstruction had been observed in all patients. Forty-five (36.6%) patients suffered from severe obstruction in more than one level. Tongue base was the most common level being severely obstructed. DISE total score is positively correlated with obstructive apnea-hypopnea index (oAHI, r = 0.35, P = <0.001), negatively correlated with oxygen nadir (SpO2 nadir, r = –0.32, P = <0.001), and positively correlated with desaturation index (DI, r = 0.34, P < 0.001). In the subgroup analysis of the post-adenotonsillectomy (AT) group, scores in nostrils, tongue base, and supraglottic showed significantly increased. None of the subjects had complications from sedation or the endoscopy procedure. Conclusion: In our study, DISE was shown to be a safe, feasible, and informative assessment tool for pediatric OSA patients. In particular, multiple levels of obstruction were common in children and we observed a significant correlation between the severity of UAO measured by DISE in children with OSA and PSG parameters. Changes in UAO sites were observed when preoperative patients underwent surgical treatment.
背景:药物诱导睡眠内镜(Drug-induced sleep endoscopy，简称DISE)是一种对镇静状态下上呼吸道梗阻(UAO)进行客观评估和诊断的方法。DISE在香港儿童组阻塞性睡眠呼吸暂停(OSA)患者中的发现是有限的。材料和方法:这是一项单中心回顾性图表综述研究，通过多导睡眠图(PSG)记录了儿童OSA患者的DISE结果。我们采用了Chan 2014和Fishman 2013共同提出的DISE评分系统作为我们的内部实践。采用标准镇静方案。记录内镜检查结果并评估梗阻程度、严重程度以及与PSG参数的相关性。结果:我们的研究共回顾了124例接受了DISE的患者。所有患者均有不同程度的梗阻。45例(36.6%)患者出现严重的一级以上梗阻。舌根是最常见的严重阻塞水平。DISE总分与阻塞性呼吸暂停低通气指数(oAHI, r = 0.35, P = <0.001)正相关，与氧最低点(SpO2最低点，r = -0.32, P = <0.001)负相关，与去饱和指数(DI, r = 0.34, P <0.001)正相关。在腺扁桃体切除术(AT)组的亚组分析中，鼻孔、舌根和声门上的评分明显增加。所有受试者均未出现镇静或内窥镜检查的并发症。结论:在我们的研究中，DISE被证明是一种安全、可行和信息丰富的儿童OSA患者评估工具。特别是，多种程度的梗阻在儿童中很常见，我们观察到，在患有OSA的儿童中，DISE测量的UAO严重程度与PSG参数之间存在显著相关性。术前患者接受手术治疗时观察到UAO部位的变化。
{"title":"Review findings of drug-induced sleep endoscopy (DISE) in children with obstructive sleep apnea (OSA)","authors":"G. Yeung, Shuk-yu Leung, K. Kwok","doi":"10.4103/prcm.prcm_5_22","DOIUrl":"https://doi.org/10.4103/prcm.prcm_5_22","url":null,"abstract":"Background: Drug-induced sleep endoscopy (DISE) is an objective assessment and diagnostic procedure of the upper airway obstruction (UAO) under sedation. Findings of DISE in Hong Kong pediatric group patients with obstructive sleep apnea (OSA) are limited. Materials and Methods: This is a single-center retrospective chart review study on DISE findings in pediatric patients with OSA documented by polysomnography (PSG). We used the DISE scoring system proposed by Chan 2014, Fishman 2013 together as our internal practice. A standard sedation protocol was conducted. Endoscopic findings were recorded and evaluated the level of obstruction, severity, and correlation with PSG parameters. Results: A total of 124 patients who underwent DISE were reviewed in our study. Multiple levels of obstruction had been observed in all patients. Forty-five (36.6%) patients suffered from severe obstruction in more than one level. Tongue base was the most common level being severely obstructed. DISE total score is positively correlated with obstructive apnea-hypopnea index (oAHI, r = 0.35, P = <0.001), negatively correlated with oxygen nadir (SpO2 nadir, r = –0.32, P = <0.001), and positively correlated with desaturation index (DI, r = 0.34, P < 0.001). In the subgroup analysis of the post-adenotonsillectomy (AT) group, scores in nostrils, tongue base, and supraglottic showed significantly increased. None of the subjects had complications from sedation or the endoscopy procedure. Conclusion: In our study, DISE was shown to be a safe, feasible, and informative assessment tool for pediatric OSA patients. In particular, multiple levels of obstruction were common in children and we observed a significant correlation between the severity of UAO measured by DISE in children with OSA and PSG parameters. Changes in UAO sites were observed when preoperative patients underwent surgical treatment.","PeriodicalId":273845,"journal":{"name":"Pediatric Respirology and Critical Care Medicine","volume":"20 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125230792","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
High-flow nasal cannula (HFNC) provides conditioned high-flow oxygen through an open system with high pressure and high velocity. HFNC has been widely used in neonatal patients with comparable benefit to CPAP; however, the use in pediatric patients has not been well evaluated. In pediatric patients, a regular nasal cannula is widely used as oxygen therapy, but the flow provided is limited because the humidity is not optimal. While HFNC as noninvasive oxygen therapy can deliver heated, humidified gas, via nasal cannula. High-velocity HFNC makes oxygen-rich gases occupy the dead space of the nasopharynx, increasing FiO2, and improving alveolar ventilation. The use of HFNC in children begins with bronchiolitis patients, also considered effective in various respiratory disorders including cases of hypoxemic respiratory failure. HFNC has been shown to have a better patient tolerance, less nose damage, and less work for the staff than CPAP and noninvasive ventilators (NIV). HFNC can be used in the emergency department and even the patient ward, while CPAP and NIV require intensive care unit facility as it needs close monitoring. HFNC is considered safe with mild side effects such as epistaxis and skin irritation that have been reported. While serious side effects such as pneumothorax are rarely reported because open system HFNC can prevent a sudden increase in airway pressure.
{"title":"High-flow Nasal Cannula in Pediatric Patients","authors":"N. Puspaningtyas, R. Dewi, A. Pudjiadi","doi":"10.4103/prcm.prcm_1_21","DOIUrl":"https://doi.org/10.4103/prcm.prcm_1_21","url":null,"abstract":"High-flow nasal cannula (HFNC) provides conditioned high-flow oxygen through an open system with high pressure and high velocity. HFNC has been widely used in neonatal patients with comparable benefit to CPAP; however, the use in pediatric patients has not been well evaluated. In pediatric patients, a regular nasal cannula is widely used as oxygen therapy, but the flow provided is limited because the humidity is not optimal. While HFNC as noninvasive oxygen therapy can deliver heated, humidified gas, via nasal cannula. High-velocity HFNC makes oxygen-rich gases occupy the dead space of the nasopharynx, increasing FiO2, and improving alveolar ventilation. The use of HFNC in children begins with bronchiolitis patients, also considered effective in various respiratory disorders including cases of hypoxemic respiratory failure. HFNC has been shown to have a better patient tolerance, less nose damage, and less work for the staff than CPAP and noninvasive ventilators (NIV). HFNC can be used in the emergency department and even the patient ward, while CPAP and NIV require intensive care unit facility as it needs close monitoring. HFNC is considered safe with mild side effects such as epistaxis and skin irritation that have been reported. While serious side effects such as pneumothorax are rarely reported because open system HFNC can prevent a sudden increase in airway pressure.","PeriodicalId":273845,"journal":{"name":"Pediatric Respirology and Critical Care Medicine","volume":"15 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133979123","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pandemics of the coronavirus SARS-Cov-2 has been circulating the world since the beginning of 2020 in several waves leaving behind many millions of affected individuals and very many fatalities. In children, the course of the disease has generally been milder that in adults; however, there was a wide range of possible serious complications observed including the pediatric fatalities. In this article, we review possible complications of COVID-19 in children and also focus on the role of pediatric primary care practitioners in the diagnosis and management of this serious disease.
{"title":"Complications of COVID-19 in children and the approach to the affected children in pediatric primary care","authors":"P. Pohunek","doi":"10.4103/prcm.prcm_15_21","DOIUrl":"https://doi.org/10.4103/prcm.prcm_15_21","url":null,"abstract":"Pandemics of the coronavirus SARS-Cov-2 has been circulating the world since the beginning of 2020 in several waves leaving behind many millions of affected individuals and very many fatalities. In children, the course of the disease has generally been milder that in adults; however, there was a wide range of possible serious complications observed including the pediatric fatalities. In this article, we review possible complications of COVID-19 in children and also focus on the role of pediatric primary care practitioners in the diagnosis and management of this serious disease.","PeriodicalId":273845,"journal":{"name":"Pediatric Respirology and Critical Care Medicine","volume":"30 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114873382","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"After COVID - where now?","authors":"Andrew Bush","doi":"10.4103/prcm.prcm_14_21","DOIUrl":"https://doi.org/10.4103/prcm.prcm_14_21","url":null,"abstract":"","PeriodicalId":273845,"journal":{"name":"Pediatric Respirology and Critical Care Medicine","volume":"41 5 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128220174","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"To help the Fight","authors":"Daniel Ng","doi":"10.4103/prcm.prcm_20_21","DOIUrl":"https://doi.org/10.4103/prcm.prcm_20_21","url":null,"abstract":"","PeriodicalId":273845,"journal":{"name":"Pediatric Respirology and Critical Care Medicine","volume":"81 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125176168","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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