Paired inspiratory–expiratory thin-section CT findings in patients with small airway disease

The objective of this study was to evaluate minimal small airway disease (SAD) as reflected on paired inspiratory–expiratory CT findings. Seventy-two subjects, 34 with SAD, 11 with normal lung function, and 27 with chronic obstructive pulmonary diseases (COPD), underwent thin-section CT during deep inspiration and expiration at upper, middle, and lower lung levels. Evaluation of CT measurement was performed between inspiratory and expiratory CT attenuation of lung parenchyma, in non-dependent and dependent lung at each of the three levels. Visual assessment of mosaic patterns and attenuation differences was also performed using the inspiratory and expiratory images. Patients with SAD were differentiated from those with COPD, by visual assessment and from the CT measurements. Visual assessment failed to differentiate between the SAD and normal groups. However, one measurement, an inspiratory–expiratory attenuation difference in the dependent lower lung, was different between SAD and normal group. Early small airway disease may be indicated by an inspiratory–expiratory attenuation difference in the dependent lower lung using the simple method of a paired inspiratory–expiratory CT. Received: 10 April 2000 Revised: 7 June 2000 Accepted: 8 June 2000     

儿童闭塞性细支气管炎42例临床分析

目的 探讨儿童闭塞性细支气管炎的临床特点.方法对北京儿童医院2001年4月-2007年8月诊断闭塞性细支气管炎的42例患儿进行分析,内容包括患儿年龄、性别、临床表现、病因、肺功能改变、影像学改变、治疗及随访预后等方面.结果 42例患儿(男31例,女11例)诊断时年龄最小的7个月,最大的12岁2个月,均以持续咳嗽、喘息为主要表现.肺部体征有喘鸣音及湿性啰音.病因为感染后32例(76.2%),其中考虑为腺病毒肺炎者8例(占感染后闭塞性细支气管炎的25%),考虑为麻疹肺炎者7例(占感染后闭塞性细支气管炎的21.9%),考虑为呼吸道合胞病毒感染者2例(占感染后闭塞性细支气管炎的6.2%).病因为Steven-Johnson综合征的4例(9.5%).骨髓移植后1例(2.4%).肺功能表现为小气道阻塞性通气功能障碍35例(89.7%),混合性通气功能障碍4例(10.3%).肺CT有典型的马赛克灌注征者34例(81.0%),支气管扩张14例(33.3%),支气管壁增厚14例(33.3%),肺不张4例(9.5%),合并Swyer-James综合征2例(4.8%).所有患儿均予皮质醇激素、小剂量红霉素或阿奇霉素口服治疗,辅以糖皮质激素和支气管扩张剂吸入,或白三烯受体拮抗剂口服治疗.随访1个月至5年,除2例临床表现及影像检查、肺功能有一定程度好转外,其余患儿均有不同程度的加重,死亡1例.结论儿童闭塞性细支气管炎多为感染后起病,其特征性的临床、影像学和肺功能表现基本可以确定诊断.该病预后不佳.     

博利康尼、普米克令舒、沐舒坦雾化吸入佐治毛细支气管炎疗效观察

目的 探讨博利康尼、普米克令舒、沐舒坦雾化吸入佐治毛细支气管炎的疗效。方法将54例毛细支气管炎惠儿随机分成治疗组和对照组，2组均采用综合治疗，治疗组加用博利康尼、普米克令舒、沐舒坦空气压缩泵雾化吸入治疗。对治疗后症状、体征改善时间进行比较。结果治疗组治愈率93．3％，对照组治愈率62．5％，2组疗效比较（P〈0．05～0．01），差异有统计学意义。2组症状、体征持续时间及病程上比较（P〈0.01），差异也有统计学意义。结论博利康尼、普米克令舒、沐舒坦雾化吸入能改善毛细支气管炎的治愈过程，起效快，副作用小，疗效满意。     

普米克令舒雾化吸入辅助治疗小儿毛细支气管炎临床疗效观察

目的探讨普米克令舒辅助治疗毛细支气管炎的疗效及安全性。方法2003年2月—2007年2月，内蒙古医学院附属人民医院收治的85例毛细支气管炎患儿，分为治疗组和对照组。2组均采用综合治疗（抗感染、抗病毒、吸氧、镇静、补液等）；治疗组加用普米克令舒雾化吸入治疗。用法为每次1ml（含布地奈德0．5mg），加生理盐水二三毫升，由空气压缩泵雾化吸入，每日2次，每次吸入10～15min，疗程为5～7d。对2组咳嗽、呼吸困难、肺部啰音消失时间、平均治疗天数进行对照评价。结果治疗组治愈率明显提高，肺部啰音、咳嗽消失时间及住院时间明显缩短，与对照组比较，差异有统计学意义（P〈0．05或P〈0．01）。结论在常规治疗的基础上加用普米克令舒雾化吸入，可明显缩短病程，提高治愈率，疗效确切，使用安全。     

The effect of passive smoking on the development of respiratory syncytial virus bronchiolitis

In spite of the increasing evidence that passive smoking increases the incidence of respiratory infections and bronchial hyper-responsiveness, the information about whether exposure to sudden heavy smoke enhances the development of acute respiratory infections in children remains inadequate. In this study, to quantitate the level of exposure to environmental tobacco smoke, in 28 children (age ranging 2–18 months) with respiratory syncytial virus (RSV) bronchiolitis and in 30 children (age ranging between 2–15 months) with non-respiratory symptoms, the serum levels of cotinine, the major metabolite of nicotine, were measured at admission to the emergency department. Parents were asked to fill in a questionnaire about the housing conditions and their smoking habits. Serum samples were taken again from the children with RSV bronchiolitis at their second visit at 1 month after discharge from the hospital. The children with RSV bronchiolitis had higher levels of serum cotinine (mean of 10.8 ng/ml) in the acute stage, compared with post-bronchiolitis stage (mean of 7.4 ng/ml). Moreover, patients admitted with non-respiratory symptoms had significantly lower levels of serum cotinine (mean of 3.9 ng/ml) than both phases of patients with RSV bronchiolitis. Children with RSV bronchiolitis were found to have higher levels of cotinine when either the mother or both of the parents smoked, than the children with non-smoker parents. In conclusion, children admitted to the hospital with RSV bronchiolitis were shown to be acutely exposed to more cigarette smoke after 1 month and much more than the children admitted for non-respiratory diseases. These findings may imply that sudden heavy cigarette smoke exposure may predispose to an acute respiratory infection.     

Severe respiratory syncytial virus bronchiolitis in children: from short mechanical ventilation to extracorporeal membrane oxygenation

The objective of this study was to describe the characteristics of children who required mechanical ventilation (MV) or extracorporeal membrane oxygenation (ECMO) support for respiratory syncytial virus (RSV) bronchiolitis, and to identify risk factors associated with disease severity assessed by duration of MV, mortality and need for ECMO. Ventilated children under 1 year of age admitted for bronchiolitis were retrospectively studied over the 8-year period 1996–2003. The study population included 151 children. Of these, 38.4% were born prematurely and 8.6% had bronchopulmonary dysplasia (BPD). The mean age at initiation of MV was 61 days (±63 days). Infants were ventilated for a mean of 7.8 days (±7.5 days). Multivariate analysis revealed that prolonged duration of MV (>6 days, median value) was significantly associated with low gestational age ( P =0.02 for the group <32 weeks), requirement of neonatal oxygen supplementation ( P =0.03), BPD ( P =0.02) and positive tracheal aspiration culture ( P =0.004), in particular for Haemophilus influenzae ( P =0.03). Fourteen infants required ECMO with a mean period of MV before ECMO of 3.9 days (±4.5 days). Amongst these infants, the frequency of BPD was significantly higher as compared with the others ( P =0.001). Four infants died (survival rate 71.4%). The mean duration of ECMO for survivors was 12.1 days (±3.3 days). Conclusion:The data suggest that gestational age, requirement of neonatal oxygen supplementation, bronchopulmonary dysplasia and tracheal colonisation with Haemophilus influenzae are correlated with prolonged mechanical ventilation in children with bronchiolitis. Only bronchopulmonary dysplasia was associated with a need for extracorporeal membrane oxygenation that may provide lifesaving support in infants refractory to conventional management.     

Incidence of hyponatraemia and hyponatraemic seizures in severe respiratory syncytial virus bronchiolitis

AIM: To document the incidence and early evolution of hyponatraemia (serum sodium < 136 mmol l(-1)) associated with respiratory syncytial virus (RSV) bronchiolitis in infants requiring intensive care. METHODS: In a retrospective review over two winter seasons, 130 infants were admitted with confirmed RSV infection, of whom 39 were excluded because of either pre-existing risk factors for hyponatraemia: diuretic therapy (n = 14), cardiac disease (n = 10), renal disease (n = 2) or lack of admission sodium data (n = 13). RESULTS: The incidence of admission hyponatraemia in the remaining infants (median age 6 wk) was 33% (30/91), with 11% (10/91) exhibiting a serum sodium less than 130 mmol l(-1) . Hyponatraemic and normonatraemic infants were of a similar age (median 6 vs 7 wk, p = 0.82). With fluid restriction and diuretic therapy, the incidence of hyponatraemia at 48 h had decreased to 3.3%, odds ratio 0.07 (95% confidence interval 0.02-0.24, p < 0.001). Four infants (4%) suffered hyponatraemic seizures at admission (sodium 114-123 mmol l(-1)); three had received hypotonic intravenous fluids at 100-150 ml kg(-1) d(-1) before referral to intensive care. All four were managed successfully with hypertonic (3%) saline, followed by fluid restriction, resulting in immediate termination of seizure activity and normalization of serum sodium values over 48 h. CONCLUSION: Hyponatraemia is common among infants with RSV bronchiolitis presenting to intensive care. Neurological complications may occur and fluid therapy in vulnerable infants should be tailored to reduce this risk.     

甲泼尼龙联合顺尔宁治疗重症毛细支气管炎的临床和诱导痰细胞学研究

目的 研究甲泼尼龙(MP)联合顺尔宁治疗重症毛细支气管炎(毛支)的疗效和治疗前后诱导痰细胞学的变化.方法 将64例重症毛细支气管炎患儿随机分为两组,治疗组32例联用MP和顺尔宁治疗,对照组32例用地塞米松治疗.分别观察两组的喘憋消失时间、肺部体征消失时间和住院天数.同时分析治疗组用MP和顺尔宁联合治疗前后的诱导痰细胞学变化.结果 与对照组相比,治疗组的喘憋消失时间、肺部体征消失时间和住院天数均明显缩短(P均＜0.01).经MP和顺尔宁联合治疗后,治疗组的嗜酸性粒细胞和肥大细胞的比例明显下降(P均＜0.001).结论 MP和顺尔宁联合治疗重症毛支的疗效优于常规治疗方法,同时对其诱导痰细胞学有显著影响.     

A case series of paediatric high flow nasal cannula therapy

IntroductionHigh flow nasal cannula is an emerging treatment option in Paediatric Intensive Care Units for paediatric patients in acute respiratory distress. Yet there is a paucity of literature describing its clinical application in various presenting pathophysiologies.AimTo describe three cases with differing underlying pathophysiologies and their response to high flow nasal cannula oxygen therapy.MethodPatients admitted to the Paediatric Intensive Care Unit with bronchiolitis, asthma and cardiomyopathy, and treated with high flow nasal cannula therapy were searched in the Paediatric Intensive Care database. The most representative cases were chosen to review.ResultsOne infant and two children were reviewed. All were commenced on high flow nasal cannula therapy in the Paediatric Intensive Care Unit and all demonstrated an improvement in their work of breathing. There was also a substantial improvement in their haemodynamic status. No patient required escalation to other forms of respiratory therapy.ConclusionHigh flow nasal cannula therapy is a viable treatment option for a range of patients presenting to the Paediatric Intensive Care Unit with acute respiratory distress. More invasive methods of respiratory support may be avoided by the use of high flow nasal cannula therapy.