Clinical analysis of nine children with acute laryngitis complicated with negative pressure pulmonary edema and changes of inflammatory factors

Abstract

Objective To investigate the clinical characteristics and treatment of children with acute laryngitis complicated with negative pressure pulmonary edema(NPPE), and the changes of inflammatory factors were monitored. Methods Data of 9 cases with acute laryngitis complicated with NPPE in pediatric intensive care unit from August 2010 to March 2015 were analyzed.The levels of TNF-α and IL-6 of 8 cases were detected at admission and checked again forty-eight hours after therapy.Ten children of acute laryngitis without NPPE were selected as disease control group, and ten healthy children as normal control group. Results (1)The onset of NPPE varied from 8 minutes to 2 hours following relief of obstruction, and presented with acute respiratory distress, decreased oxygen saturation, tachycardia, rales on chest auscultation.All these patients received therapeutic measures including mechanical ventilation, limiting the fluid input volume.The disappearance of rales on chest auscultation varied from 6 hours to 30 hours.Duration of mechanical ventilation was less than 48 hours, and all the children were cured.(2)Compared with the children of disease control group and normal control group, in acute phase the plasma levels of TNF-α and IL-6 in children with NPPE were significantly higher(P<0.01). The indicators of NPPE group significantly decreased after 48 hours therapy(P<0.01). Conclusion NPPE is manifested by rapid onset of respiratory distress after relief of the airway obstruction.The symptoms resolve rapidly if early support of breath and limiting the fluid input volume are applied properly.The inflammatory response is one of the possible mechanisms of NPPE. Key words: Acute laryngitis; Negative pressure pulmonary edema; Children