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      Effects of positive end-expiratory pressure on pulmonary atelectasis after paediatric laparoscopic surgery as assessed by ultrasound: A randomised controlled study

      , , , ,
      Anaesthesia Critical Care & Pain Medicine
      Elsevier BV

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          Risk assessment for respiratory complications in paediatric anaesthesia: a prospective cohort study.

          Perioperative respiratory adverse events in children are one of the major causes of morbidity and mortality during paediatric anaesthesia. We aimed to identify associations between family history, anaesthesia management, and occurrence of perioperative respiratory adverse events. We prospectively included all children who had general anaesthesia for surgical or medical interventions, elective or urgent procedures at Princess Margaret Hospital for Children, Perth, Australia, from Feb 1, 2007, to Jan 31, 2008. On the day of surgery, anaesthetists in charge of paediatric patients completed an adapted version of the International Study Group for Asthma and Allergies in Childhood questionnaire. We collected data on family medical history of asthma, atopy, allergy, upper respiratory tract infection, and passive smoking. Anaesthesia management and all perioperative respiratory adverse events were recorded. 9297 questionnaires were available for analysis. A positive respiratory history (nocturnal dry cough, wheezing during exercise, wheezing more than three times in the past 12 months, or a history of present or past eczema) was associated with an increased risk for bronchospasm (relative risk [RR] 8.46, 95% CI 6.18-11.59; p<0.0001), laryngospasm (4.13, 3.37-5.08; p<0.0001), and perioperative cough, desaturation, or airway obstruction (3.05, 2.76-3.37; p<0.0001). Upper respiratory tract infection was associated with an increased risk for perioperative respiratory adverse events only when symptoms were present (RR 2.05, 95% CI 1.82-2.31; p<0.0001) or less than 2 weeks before the procedure (2.34, 2.07-2.66; p<0.0001), whereas symptoms of upper respiratory tract infection 2-4 weeks before the procedure significantly lowered the incidence of perioperative respiratory adverse events (0.66, 0.53-0.81; p<0.0001). A history of at least two family members having asthma, atopy, or smoking increased the risk for perioperative respiratory adverse events (all p<0.0001). Risk was lower with intravenous induction compared with inhalational induction (all p<0.0001), inhalational compared with intravenous maintenance of anaesthesia (all p<0.0001), airway management by a specialist paediatric anaesthetist compared with a registrar (all p<0.0001), and use of face mask compared with tracheal intubation (all p<0.0001). Children at high risk for perioperative respiratory adverse events could be systematically identified at the preanaesthetic assessment and thus can benefit from a specifically targeted anaesthesia management. Department of Anaesthesia, Princess Margaret Hospital for Children, Swiss Foundation for Grants in Biology and Medicine, and the Voluntary Academic Society Basel. Copyright 2010 Elsevier Ltd. All rights reserved.
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            The dynamic air bronchogram. A lung ultrasound sign of alveolar consolidation ruling out atelectasis.

            The objective of this study was to identify the relationship between a dynamic lung artifact, the dynamic air bronchogram, within alveolar consolidation and the diagnosis of pneumonia vs resorptive atelectasis. This prospective study was undertaken within the medical ICU of a university-affiliated teaching hospital. The sample comprised 52 patients with proven pneumonia (pneumonia group) and 16 patients with proven resorptive atelectasis (atelectasis group). All patients had alveolar consolidation with air bronchograms on lung ultrasound, were mechanically ventilated, and received fibroscopy and bacteriological tests. The air bronchogram dynamic was analyzed within the ultrasound area of consolidation. The air bronchograms in the pneumonia group yielded the dynamic air bronchogram in 32 patients and a static air bronchogram in 20. In the atelectasis group, air bronchograms yielded a dynamic air bronchogram in 1 out of 16 patients. With regard to pneumonia vs resorptive atelectasis in patients with ultrasound-visible alveolar consolidation with air bronchograms, the dynamic air bronchogram had a specificity of 94% and a positive predictive value of 97%. The sensitivity was 61%, and the negative predictive value 43%. In patients with alveolar consolidation displaying air bronchograms on an ultrasound, the dynamic air bronchogram indicated pneumonia, distinguishing it from resorptive atelectasis. Static air bronchograms were seen in most resorptive atelectases and one third of cases of pneumonia. This finding increases the understanding of the pathophysiology of lung diseases within the clinical context and decreases the need for fibroscopy in practice.
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              Accuracy of transthoracic lung ultrasound for diagnosing anesthesia-induced atelectasis in children.

              The aim of this study was to test the accuracy of lung sonography (LUS) to diagnose anesthesia-induced atelectasis in children undergoing magnetic resonance imaging (MRI).
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                Author and article information

                Contributors
                Journal
                Anaesthesia Critical Care & Pain Medicine
                Anaesthesia Critical Care & Pain Medicine
                Elsevier BV
                23525568
                April 2022
                April 2022
                : 41
                : 2
                : 101034
                Article
                10.1016/j.accpm.2022.101034
                0d754506-19ec-4565-bab5-6a302b1f325e
                © 2022

                https://www.elsevier.com/tdm/userlicense/1.0/

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