Atelectasis In Children Research Articles

"A prospective comparative study to evaluate the utility of lung ultrasonography to improve the accuracy of traditional clinical methods to confirm position of left sided double lumen tube in elective thoracic surgeries".

Sir, I read the article written by Parab et al. on the utility of lung ultrasonography to improve the accuracy of traditional clinical methods to confirm position of left sided double lumen tube in elective thoracic surgeries, with great interest.[1] I congratulate them for their magnificent work. I would like to make a few comments. First, in their article, Parab et al. assert “lung ultrasonography (LU) does not detect selective lobar atelectasis. Hence, patients with right-sided double lumen tube (DLT) or with bronchial blocker were not included in this study.” Acosta et al. have tested the accuracy of transthoracic LU for diagnosing anaesthesia-induced atelectasis in children undergoing magnetic resonance imaging studies while breathing spontaneously, under sevoflurane anaesthesia. They reported that small anaesthesia-induced atelectasis was represented by juxtapleural consolidations associated with static air bronchograms, absence of A-lines and presence of B-lines. In large atelectatic areas, the absence of lung sliding (LS) and presence of lung pulse sign (LP) could be seen.[2] In critically ill patients, dynamic air bronchogram and LP are two sonographic signs which can be used to distinguish atelectasis from pneumonia. In 2014, Ponsonnard et al. described the value of LU to control right DLT location in 23 patients.[3] They found that for a diagnosis of left lung isolation, sensitivity (S), specificity (E) and negative and positive predictive values (NPV and PPV) of sonography were 100%. The S of sonographic diagnosis of the right upper lobe (RUL) isolation was 91.67%, E was 100%, NPV and PPV were 91.67% and 100%, respectively. According to them, an isolated RUL cannot be detected when high tidal volumes are used. The hyper insufflation of the lung can reveal LS when actually, it does not exist. Another condition of false positivity (FP) was described by Kaldirim et al.[4] They reported how LS might be a cause of of FP in an oesophageal intubation. They attributed it to a high thoracic pressure induced by increased air in the stomach. LS depends on pulmonary compliance and tidal volume. To solve that problem, one can use a power colour Doppler technique by power slide sign. However, this is time-consuming and it requires some technical skill.[5] On the other hand, LP sign is more commonly seen on the left hemithorax than the right due to the proximity of the heart. For these reasons, one can use a combination between diaphragmatic motion, LS and LP to improve the accuracy of LU to confirm the position of any kind of endotracheal tube.[6] Second, bronchial blockers should be placed under visual guidance of fibreoptic bronchoscope, as a suggestion made by manufacturers and medical literature. To sum up, more studies are needed to determine the role of LU for detecting acute selective lobar atelectasis in thoracic anaesthesia.

Follicular Bronchiolitis in a Child With 1p36 Deletion Syndrome

SESSION TITLE: Lung Pathology Student/Resident Case Report Posters SESSION TYPE: Student/Resident Case Report Poster PRESENTED ON: Tuesday, October 27, 2015 at 01:30 PM - 02:30 PM INTRODUCTION: The rarity of pulmonary manifestations in children with chromosome 1p36 deletion syndrome makes a diagnosis of follicular bronchiolitis (FB) a unique challenge. CASE PRESENTATION: A one year old female was diagnosed with a chromosome 1p36 deletion after birth. She has hypotonia, developmental delay, visual abnormalities, growth and feeding related problems, which are common features of this disorder. She presented with tachypnea, several months of productive cough and wheezing that were unresponsive to antibiotics, albuterol, and corticosteroids. On exam, she was dysmorphic, hypotonic, with increased respiratory distress, and mild splenomegaly. A chest CT showed compression of the right upper lobe (RUL) bronchus and an ill-defined soft tissue fullness in right hilum. She was admitted with concern for neuroblastoma and immunodeficiency. An extensive autoimmune, infectious, and immunodeficiency work-up was negative, except for a low CD4/CD8 ratio. She was found to have elevated metanephrines; however, her MIBG did not show evidence of an avid lesion. Flexible bronchoscopy disclosed compression of the RUL bronchus. Lung biopsy revealed findings consistent with follicular bronchiolitis, whereas lymph node biopsy showed reactive follicular and interfollicular hyperplasia. She was treated with IV steroids and did not have any recurrence. DISCUSSION: Notably, our patient has a complex chromosomal anomaly that does not typically present with pulmonary problems; however, deletions in chromosome 1p36 have been linked to reactive lymphoid hyperplasia and follicular lymphoma. FB is a rare disease in children. In adults, most cases are associated with collagen vascular diseases, immunodeficiency, or hypersensitivity reaction.1 This disease is characterized by bronchiolar narrowing by external compression due to lymphoid hyperplasia, which is seen in our patient.2 Affected children may present with tachypnea, respiratory distress and failure to thrive. Lung biopsy is necessary for confirmation of diagnosis. There are no well-established guidelines for the treatment of this condition, but macrolides and steroids have been suggested to have a benefit.3 Immunosuppressive agents are generally reserved for refractory cases. CONCLUSIONS: To our knowledge, this is the first case of FB reported on a child with chromosome 1p36 deletion. The etiology of this disease in children is unknown; however, diagnosis should be considered in a child with chronic bronchial obstruction. Reference #1: Yousem S.A., et al. Follicular bronchitis/bronchiolitis. Hum Pathol. 1985 Jul;16(7):700-706. Reference #2: Kinane B.T., et al. FB in the Pediatric Population. Chest. 1993; 104:1183-1186. Reference #3: Dias A., et al. FB: A Rare Cause of Persistent Atelectasis in Children. Respiratory Medicine Case Reports. 2013; 10:7-9. DISCLOSURE: The following authors have nothing to disclose: Marissa Love, Jane Taylor, Wendy Estrellado No Product/Research Disclosure Information

Long-term results and prognostic factors of underlay myringoplasty in pars tensa atelectasis in children.

Pars tensa retraction is a frequent condition in chronic otitis media, and there is a large diversity of opinions regarding its management. To report the long-term results and prognostic factors of myringoplasty in pediatric patients with grade 5 pars tensa atelectasis. This was an observational, retrospective case review, conducted at a referral university hospital, of children undergoing surgical intervention for dry tympanic disruption after a clinical history of tensa retraction with a transcanal or postauricular approach under general anesthesia. Underlay myringoplasty with temporalis fascia or tragal perichondrium by transcanal or postauricular approach under general anesthesia. Anatomical results are reported with a minimum follow-up of 5 years analyzing perforation or retraction of the neotympanum. Age; sex; side, position, and size of the eardrum disruption; surgical approach; graft material; and presence of contralateral disease were correlated with anatomical failure. The population included 33 girls and 28 boys undergoing 65 interventions; the age varied from 4 to 16 years (mean [SD], 10 [3.2] years). An intact tympanic membrane was obtained in 58 cases (89.2%) with a follow-up varying from 5 to 14 years (mean follow-up, 9 years). None of the variables analyzed significantly predisposed patients to tympanic perforation after surgical repair. There were no new progressive retractions. Tensa retraction resulting in a tympanic disruption can be cured by underlay myringoplasty with perichondrium or temporalis fascia with results similar to those of simple tympanic perforations without recurrent retraction even in the long-term period.

Diagnostic and management effect of bronchoscopy on mycoplasma pneumonia with pulmonary atelectasis in children

Objective To explore the clinical characteristics of mycoplasma pneumonia with pulmonary atelectasis and lavage interventional effect through fiberoptic bronchoscopy in children. Methods During Jun 2012 to Apr 2013, fifty-three children diagnosed of mycoplasma pneumonia with pulmonary atelectasis who received fiberoptic bronchoscopy were enrolled as the experimental group. Thirty-five children diagnosed of mycoplasma pneumonia without pulmonary atelectasis were chosen as control group. According to the lavage interventional time of fiberoptic bronchoscopy, we divided the patients in the experimental group into two groups, the early group and late group. Clinical data and laboratory finds were collected and analyzed. Results The duration of fever, hospital stay and C-reactive protein (CRP) of the experimental group were significantly higher than those of the control group (P< 0.05). The location of pulmonary atelectasis in the experimental group were usually in the right middle lobe (18 cases, 33.9%). Under fiberoptic bronchoscope, all patients had obviously bronchial mucosa congestive edema. Some of them had follicular hyperplasia (9 cases, 17.0%), mucosal erosion (3 cases, 5.7%), mucus plug formation (7 cases, 13.2%) and poor ventilation of segmental bronchi (4 cases, 7.5%). Neutrophils (43 cases, 81.1%) increased and phagocytic cells (31 cases, 58.5%) dereased obviously in bronchoalevolar lavage fluid. After treatment in the experimental group, 52 children (98.1%) got complete recruitment of atelectasis. The average duration of fever and hospital stay of the early group were significantly shoter than those of late group (P< 0.05). Conclusion Children diagnosed of mycoplasma pneumonia with pulmonary atelectasis had longer fever duration and higher CRP level. Bronchoscopic interventional therapy promoted the recovery of pulmonary atelectasis. Using bronchoscop early in shorten the duration of fever and hospitalization in children diagnosed of mycoplasm pneumonia with pulmonary atelectasis. Key words: Children; Mycoplasma pneumoniae; Atelectasis; Fiberoptic bronchoscopy

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). Fifteen children with American Society of Anesthesiology's physical status classification I and aged 1 to 7 yr old were studied. Sevoflurane anesthesia was performed with the patients breathing spontaneously during the study period. After taking the reference lung MRI images, LUS was carried out using a linear probe of 6 to 12 MHz. Atelectasis was documented in MRI and LUS segmenting the chest into 12 similar anatomical regions. Images were analyzed by four blinded radiologists, two for LUS and two for MRI. The level of agreement for the diagnosis of atelectasis among observers was tested using the κ reliability index. Fourteen patients developed atelectasis mainly in the most dependent parts of the lungs. LUS showed 88% of sensitivity (95% CI, 74 to 96%), 89% of specificity (95% CI, 83 to 94%), and 88% of accuracy (95% CI, 83 to 92%) for the diagnosis of atelectasis taking MRI as reference. The agreement between the two radiologists for diagnosing atelectasis by MRI was very good (κ, 0.87; 95% CI, 0.72 to 1; P < 0.0001) as was the agreement between the two radiologists for detecting atelectasis by LUS (κ, 0.90; 95% CI, 0.75 to 1; P < 0.0001). MRI and LUS also showed good agreement when data from the four radiologists were pooled and examined together (κ, 0.75; 95% CI, 0.69 to 0.81; P < 0.0001). LUS is an accurate, safe, and simple bedside method for diagnosing anesthesia-induced atelectasis in children.

Anesthesia-induced atelectasis assessed by lung sonography

Background Atelectasis and poorly ventilated lung areas are negative consequences of general anesthesia observed in adult as well as in children. The reported incidence of this anesthesia-induced atelectasis in children is high and comes from 83 % to almost 100 %. The diagnosis of this entity is difficult to do at the bedside; they are commonly small and mostly invisible to standard chest X-ray images. More complex diagnosing techniques like CT scan or magnetic resonance imaging (MRI) can easily diagnose atelectasis although they are strategically impractical. Ultrasound is a bedside, rapid, noninvasive and radiation-free technique. Lung ultrasound (LUS) has an important role for diagnosing pulmonary diseases in children although it role for detecting anesthesia-induced atelectasis has not been determined yet.

Early Respiratory Therapy Reduces Postoperative Atelectasis in Children Undergoing Lung Resection

Early physiotherapy reduces pulmonary complications after lung resection in adult patients. However, the effectiveness and the techniques used in postoperative physiotherapy in children undergoing lung resection have not been well described. Therefore, the standardization of a physiotherapeutic attendance after lung resection in children is necessary. This was a retrospective and prospective, interventional, descriptive, and quantitative study. We evaluated 123 pediatric subjects undergoing lung resection. Fifty-two children were prospectively submitted to a standardized physiotherapy protocol that included a mask with a positive expiratory pressure of 10 cm H2O, expiratory rib cage compression, coughing, lifting the upper limbs, and ambulation, starting within the first 4 hours after surgery and continuing 3 times each day. A historical control group of 71 subjects received physiotherapeutic techniques without specific standardization and with variability in the start date and number of days attended. We recorded the presence of postoperative complications, prolonged air leak, postoperative bronchoscopy, the time of chest tube removal, and hospital stay following surgery. The group that received a standardized protocol of physiotherapy had fewer instances of atelectasis than the control group (15.4% vs 7.6%, P = .01). Subjects in the control group were more likely than those in the intervention group to require fiberoptic bronchoscopy for bronchial toilet (n = 14 [19.7%] vs n = 5 [9.6%], P ≤ .001). There was no difference in the time of drainage or hospital stay between the groups. Implementation of a standardized physiotherapeutic protocol after lung resection in children decreases atelectasis but does not reduce the time of chest tube removal or the duration of hospital stay.

Usefulness of flexible bronchoscopy in treatment of atelectasis in children

Usefulness of flexible bronchoscopy in treatment of atelectasis in children

Inflammatory myofibroblastic tumor of the lung: a rare cause of atelectasis in children

Although rare, inflammatory myofibroblastic tumor is the most common primary lung mass in children. We report the case of an 11-year-old boy investigated for persistent cough and dyspnea with complete left lung atelectasis mimicking pneumonia. CT and MRI showed an endobronchial mass of the left main bronchus. The boy underwent endoscopic resection of the tumor and histology was in favor of an inflammatory myofibroblastic tumor of the lung. This diagnosis should be suspected in children with recurrent pneumonia. The prognosis is good after complete resection.

Complications of mechanical ventilation in the pediatric population

Mechanical ventilation (MV) strategies are continuously evolving in an effort to minimize adverse events. The objective of this study was to determine the complications associated with MV in children. Prospective observational study. Over a period of 10 consecutive months, 150 patients (median age 0.8 years, IQR 4.4, 59% male) were enrolled in this study. The median duration of MV was 3.1 days (IQR 3.9). A total of 85 complications were observed in 60 (40%) patients (114 complications per 1,000 ventilation days). 16.7% of patients developed atelectasis, 13.3% post-extubation stridor, 9.3% failed extubation, 2.0% pneumothorax, 3.3% accidental extubation, 2.7% nasal or perioral tissue damage and 1.9% ventilator associated pneumonia. Atelectasis occurred most often in the left lower lobe (36%) or in the right upper lobe (26%). The incidence of atelectasis in children <1 year of age was 12% (31 episodes per 1,000 days of ventilation) compared to 18% (57 episodes per 1,000 days of ventilation) in children ≥ 1 year of age (P < 0.05). Patients that failed extubation were ventilated for a median of 8.5 (IQR 8.8) days compared to 2.9 days (IQR, 3.8) in patients that were successfully extubated (P < 0.01). The absence of an air leak prior to extubation did not correlate with failed extubation. Accidental extubation was limited to orally intubated patients. MV complications occurred in 40% of patients and most often consisted of atelectasis and post-extubation stridor. Further studies are needed to examine associated risk factors and strategies to reduce their occurrence.

Recombinant Human Deoxyribonuclease Improves Atelectasis in Mechanically Ventilated Children with Cardiac Disease

To investigate whether a mucolytic agent, recombinant human deoxyribonuclease (rhDNase), improves atelectasis in children with cardiac illness requiring mechanical ventilation. A retrospective cohort study on consecutive patients receiving short-term (< or =14 days) rhDNase therapy for atelectasis in the cardiac intensive care unit from January 2005 through February 2007 was carried out. Data relating to patient characteristics, gas exchange, ventilatory parameters, and chest radiographs were collected and analyzed. The effectiveness of rhDNase therapy in the presence of neutrophils and/or bacteria in the pre-rhDNase therapy tracheal aspirates was also investigated. rhDNase was effective in significantly improving established atelectasis without any major changes in gas exchange and ventilatory parameters. Therapeutic effect of rhDNase is most effective in ameliorating atelectasis in the lungs within 10 doses. rhDNase was more effective in improving chest radiographic atelectasis score in patients who had > moderate amounts of polymophonuclear neutrophils (P value = 0.0008), or bacteria (P value = 0.007) or both (P value = 0.004) present in their pre-rhDNase therapy trachea aspirate. No adverse effects were seen with rhDNase administration in the study cohort. rhDNase can be safely and effectively used to improve atelectasis in mechanically ventilated children with cardiac disease especially in the presence of bacteria and/or moderate amounts of polymophonuclear neutrophils in the pre-rhDNase therapy tracheal aspirate.

Effect of bronchoalveolar lavage in therapy of mycoplasmal pneumonia with atelectasis in children

Effect of bronchoalveolar lavage in therapy of mycoplasmal pneumonia with atelectasis in children

Pulmonary Atelectasis in Children Anesthetized for Cardiothoracic MR

To systematically assess the frequency and risk factors for atelectasis in children anesthetized for cardiothoracic magnetic resonance (MR). We retrospectively identified 58 consecutive children (age range, 6 days to 21 years) who underwent cardiothoracic MR from January 2001 to December 2004 whose imaging and medical charts were available. One certificate of added qualification pediatric radiologist and 1 of 2 cardiothoracic radiologists, in consensus, evaluated the first and last set of axial images. Images were evaluated for cardiac, vascular and tracheobronchial abnormalities, and degree of atelectasis. Atelectasis was considered significant if the equivalent of 3 or more segments were involved. Patients received 1 or more of 7 anesthetic medications (n = 27), chloral hydrate alone (n = 4), or required no anesthesia (n = 27). Significant atelectasis developed only in those receiving anesthetic medications. Thirty-seven percent (10/27) of anesthetized children developed significant atelectasis in the first and/or last axial sequence. In 90% (9 /10) of patients, it developed in the first axial sequence. Strong risk factors were age younger than 1 year (80%, 8/10, P = 0.029) and MR evidence of tracheobronchial narrowing (50%, 5/10, P = 0.008). In patients with vascular ring, there was a trend toward significance (40%, 4/10, P = 0.09). None of the anesthesia factors were significant, including ventilation mode, anesthesia duration, or American Society of Anesthesiology risk (all P > 0.1). Atelectasis may occur shortly after induction of anesthesia in children younger than 1 year of age or with tracheobronchial narrowing when anesthetized for cardiothoracic MR.

Atelectatic children treated with intrapulmonary percussive ventilation via a face mask: Clinical trial and literature overview

Persistent atelectasis in children is lacking a gold standard treatment. Intrapulmonary percussive ventilation (IPV) is presented as a promising chest physiotherapy technique in the treatment of atelectasis. This study aimed to follow the evolution of atelectasis resolution with noninvasive IPV in young children and to detect eventual adverse effects. Six children were hospitalized for respiratory distress with suspicion of atelectasis. A 15 min IPV treatment was immediately started at D1 twice a day for 5 days. Children were free of any other treatment. Chest X-Ray (CXR) was performed on the second day (D2) and was repeated 3 days later (D5). After the study, CXR were retrospectively reviewed by three specialists who had no knowledge of the clinical observations of the patients. They were asked to assess atelectasis by a score between 4 (complete collapse) and 0 (complete resolution). A clinical score on a maximum of 4 points was assessed by appetite deterioration, dyspnoea, mucus production and cough presence at D1 and D5 (1 point per symptom present). Paired t-test compared D1 and D5 results. All patients returned home after 5 days IPV. SpO2 normalized (93.2 +/- 0.8 to 95.3 +/- 0.8; P = 0.002) and patients all improved clinically (score, 2.8 +/- 0.9 to 0.8 +/- 0.6; P < 0.05). Out of four patients with radiographic evidence of atelectasis, three improved their atelectasis score. No side-effect or adverse effect was observed during IPV treatments. IPV was safe and effective in atelectasis resolution in 3/4 of the cases. Patients all recovered a stable clinical state. CXR improved in 4/5 children. They were all discharged home after 5 days of IPV treatment.

Application of fiberoptic bronchoscopy in the etiological diagnosis and treatment of atelectasis in children

目的 探讨纤维支气管镜在儿童肺不张病因诊断及治疗中的应用价值.方法 回顾分析我院经一般治疗无效而行纤维支气管镜检查的40例肺不张患儿的临床资料.结果 40例中以炎症最多见,共21例,占52.5%;其次为异物10例,占25.0%;支气管扩张3例,占7.5%,居第三位.肺不张发生率右肺高于左肺.炎性肺不张以右中叶最多,占71.4%;异物所致肺不张以下叶为多,且多发生在1～3岁的幼儿;支气管扩张所致肺不张多发生在较大儿童.经支气管肺泡灌洗治疗37例(有异物者予异物取出术),部分或完全复张者31例,复张率达83.8%.结论 小儿肺不张病因中以炎症、异物、支气管扩张最多见;纤维支气管镜检查不仅能最大限度地帮助明确肺不张病因,而且在小儿肺不张的治疗中有重要作用。

Atelectasis in children undergoing either propofol infusion or positive pressure ventilation anesthesia for magnetic resonance imaging

Atelectasis because of anesthesia is a recognized problem but may be affected by the anesthetic technique. We compared magnetic resonance images of atelectasis in children undergoing two types of anesthesia. Children requiring anesthesia for magnetic resonance imaging (MRI) had additional lung imaging sequences at the beginning and the end of anesthesia. Children had either i.v. propofol infusion (PI) without an artificial airway (n = 26) or positive pressure ventilation (PPV) via a tracheal tube (n = 20); the technique was chosen for clinical reasons. The extent of atelectasis was scored by two independent radiologists. The median ages (range) for PI and PPV groups were 45 months (1-77 months) and 18 months (2-74 months), respectively. The proportion of children with atelectasis was different in the first lung scan (42% vs 80%), but in the second scan atelectasis was seen frequently in both groups (82% vs 94%) with a greater extent in the PPV group. The atelectasis score was higher in young children, but all children had normal oxygen requirements and saturations. Many factors may influence the development of atelectasis but this study found less extensive atelectasis with PI than PPV. PI allows for sufficient motionlessness, required for high diagnostic image quality in pediatric MRI.

Bronchoscopic Surfactant Administration in Pediatric Patients with Persistent Lobar Atelectasis

Persistent lobar atelectasis in pediatric patients on mechanical ventilation results in impaired gas exchange and lung mechanics and contributes to a further need for mechanical ventilation. The most common types of atelectasis in children are resorption atelectasis following airway obstruction, and atelectasis due to surfactant deficiency or dysfunction. We aimed to determine whether bronchoscopic suctioning and surfactant application to atelectatic lung segments would result in improved oxygenation, ventilation, chest X-ray scoring, and early extubation. Five children with heterogeneous lung diseases (aged between 7 months and 15 years) were treated with a diluted surfactant preparation (Curosurf^TM) in a concentration of 5–10 mg/ml (total dose 120–240 mg) which was instilled into the affected segments. Outcome parameters were gas exchange, radiographic resolution of atelectasis and extubation. All mechanically ventilated patients could be extubated within 24 h following the intervention. Bronchoscopic surfactant application could be carried out without adverse effects and brought improvements in oxygenation, respiratory rate, and partial or complete resolution of atelectases without recurrence.

376-PA11 Etiologic aspects of pneumonia with atelectasis in children under age of three years

376-PA11 Etiologic aspects of pneumonia with atelectasis in children under age of three years

Tracheobronchial Foreign Bodies and Pulmonary Atelectasis in Children

Tracheobronchial Foreign Bodies and Pulmonary Atelectasis in Children

Alterations in gas exchange associated with lobar atelectasis in young piglets

ABSTRACT: Lobar atelectasis is common among infants and children with obstructive lung diseases. However, the effect of lobar collapse in the presence of diffuse lung disease on gas exchange in the pediatric age group has not been described. We developed an infant model of lobar atelectasis using piglets and tested the hypothesis that diffuse alveolar hypoxia increases shunt fraction (Q/QT) associated with lobar atelectasis by redirecting pulmonary blood from the well-ventilated portion of the lung into the collapsed region. Shunt fraction was determined using the multiple inert gas elimination technique. The proportion of pulmonary blood flow perfusing the left lower lobe was measured with microspheres. Q/Qt increased significantly but by a variable amount to an average value (±SD) of 5.9 ± 4.2% following lobar collapse. The percentage of cardiac output perfusing the left lower lobe fell by an average of 70 ± 17% in response to lobar collapse. When animals were ventilated with 12% oxygen, shunt fraction increased to 18.7 ± 7.1% and blood flow to the collapsed left lower lobe increased from 9 ± 3 to 22 ± 3% of cardiac output. Lobar atelectasis in conditions where diffuse alveolar hypoxia is present may be associated with a significantly greater intrapulmonary shunt than lobar atelectasis in children with otherwise normal lungs.