Compression In Infants Research Articles

Pulmonary artery sling: Uncommon cause of airway compression in infants.

Pulmonary artery sling: Uncommon cause of airway compression in infants.

Rationale, design, and methods of a randomized, controlled, open-label clinical trial with open-label extension to investigate the safety of vosoritide in infants, and young children with achondroplasia at risk of requiring cervicomedullary decompression surgery.

Achondroplasia causes narrowing of the foramen magnum and the spinal canal leading to increased mortality due to cervicomedullary compression in infants and significant morbidity due to spinal stenosis later in adulthood. Vosoritide is a C-natriuretic peptide analogue that has been shown to improve endochondral ossification in children with achondroplasia. The objective of this trial is to evaluate the safety of vosoritide and whether vosoritide can improve the growth of the foramen magnum and spinal canal in children that may require decompression surgery. An Achondroplasia Foramen Magnum Score will be used to identify infants at risk of requiring decompression surgery. This is a 2-year open label randomized controlled trial of vosoritide in infants with achondroplasia ages 0 to ≤12 months. Approximately 20 infants will be randomized 1:1 to either open label once daily subcutaneous vosoritide combined with standard of care or standard of care alone. The primary and secondary aims of the study are to evaluate the safety and efficacy of vosoritide in children with cervicomedullary compression at risk of requiring decompression surgery. The trial will be carried out in specialized skeletal dysplasia treatment centers with well established multidisciplinary care pathways and standardized approaches to the neurosurgical management of cervicomedually compression. After 2 years, infants randomized to standard of care alone will be eligible to switch to vosoritide plus standard of care for an additional 3 years. This pioneering trial hopes to address the important question as to whether treatment with vosoritide at an early age in infants at risk of requiring cervicomedullary decompression surgery is safe, and can improve growth at the foramen magnum and spinal canal alleviating stenosis. This in turn may reduce compression of surrounding structures including the neuraxis and spinal cord, which could alleviate future morbidity and mortality.Trial registrations: ClinicalTrials.gov, NCT04554940; EudraCT number, 2020-001055-40.

Cervical spinal cord compression in infants with achondroplasia: should neuroimaging be routine?

PurposeTo examine results of magnetic resonance imaging (MRI), polysomnograms (PSG), and patient outcomes in patients with achondroplasia in light of recent screening recommendations for infants with achondroplasia. MethodsWe reviewed medical records of 49 patients with achondroplasia followed at our institution between September 1997 and January 2017, including physical exams, MRIs, PSGs (when available), and surgical histories. Appropriate PSG data were available for 39 of these patients. ResultsTwenty-seven of 49 patients had cervical cord compression on MRI, and 20 of those patients required surgery. Central apnea was detected in 2/23 patients with cervical cord compression in whom PSG data was available. Physical exam revealed depressed deep-tendon reflexes in two patients with cord compression and one patient without cord compression. Besides hypotonia in some, the neurological exams of these patients were unremarkable. ConclusionsCervical cord compression is a common occurrence in infants with achondroplasia and necessitates surgical intervention in some patients. Physical exam and PSG are poor predictors of the presence of cord compression or the need for surgery. All infants with achondroplasia should have MRIs of the craniocervical junction in the first 6 months of life.

The role of posterior aortopexy in the treatment of left mainstem bronchus compression.

We reviewed the role of posterior aortopexy for left mainstem bronchus compression in infants and children. Eighteen children with respiratory symptoms were enrolled between 2005 and 2015 for surgical decompression of the left mainstem bronchus. The children were managed from diagnosis to follow-up by a dedicated tracheal team. Primary outcomes were the complete relief of symptoms or improvement with respect to preoperative clinical status. The median age was 4 years (0.3-15.4) and the median weight was 13.2 kg (3, 1-40). Symptoms or indications for bronchoscopy included difficult weaning from mechanical ventilation (n = 3, 17%), difficult weaning from tracheotomy (n = 4, 22%), recurrent pneumonia (n = 4, 22%), wheezing (n = 3, 17%), atelectasis (n = 1, 5.5%), bitonal cough (n = 1, 5.5%) and stridor (n = 2, 11%). Associated malformations were present in 88.7%. The diagnosis was made by bronchoscopy and computed tomography. Indication for surgery was the presence of pulsations and reduction in the diameter of the left mainstem bronchus compression of more than 70%. Surgery was performed by left posterolateral thoracotomy. Aortopexy was done under bronchoscopic control. No early or late deaths were observed, nor were reoperations necessary. Residual malacia was observed in 8 children (44%). Median follow-up was 4.1 years (0.1-7.1). At last follow-up, 17/18 (94.4%) children showed adequate airway patency. The intrathoracic location of the left mainstem bronchus predisposes it to compression. Vascular anomalies represent the most frequent causes. Aortopexy has been advocated as a safe and useful method to relieve the compression, and our results confirmed these findings. Management of these patients is challenging and requires a multidisciplinary team.

Gum-Elastic Bougie Efficacy for Tracheal Intubation During Continuous Chest Compression in Infants—A Crossover Simulation Trial

BackgroundRecent guidelines for infant cardiopulmonary resuscitation emphasize that all rescuers should minimize interruption of chest compression, even for endotracheal intubation. ObjectiveWe compared the utility of application of a gum-elastic bougie (GEB) plus Miller laryngoscope (Mil) with the Mil alone during chest compression on an infant mannequin. MethodsSixteen anesthesiologists with more than 2 years of experience performed tracheal intubation on an infant mannequin using the Mil or Mil plus 6Fr GEB, with or without chest compression. Intubation success rate, intubation time, and subjective difficulty scores of laryngoscopy and tube passage through the glottis were measured. ResultsIn Mil trials, none of the participants failed without compression, whereas four failed with compression (p = 0.03). In Mil-plus-GEB trials, all participants succeeded regardless of chest compression. Intubation time was significantly longer with chest compression in both Mil and Mil-plus-GEB trials (p < 0.001). The intubation time during chest compression was significantly longer in Mil than in Mil-plus-GEB trials (p < 0.001). Difficulty of operation on a visual analog scale (VAS) for laryngoscopy did not significantly differ between Mil and Mil-plus-GEB trials during chest compression, whereas the VAS for tube passage through the glottis was significantly higher in Mil than in Mil-plus-GEB trials. ConclusionsGEB use shortened the intubation time and improved the success rate of infant tracheal intubation during chest compression by anesthesiologists in simulations.

Akute Fremdkörperverlegung der Atemwege bei Kindern

BackgroundAcute airway obstruction by a foreign body in children is a life-threatening emergency respiratory condition. Respiratory foreign body aspiration mostly occurs in children up to 3 years of age. Food and in particular nuts are the most commonly ingested respiratory foreign bodies. Acute airway obstruction is present with a laryngeal or tracheal position of the foreign body.DiagnosisAcute, sudden and severe coughing and/or choking sometimes accompanied by stridor and dyspnea are characteristic of a respiratory foreign body aspiration. Foreign bodies with a laryngeal or tracheal position may rapidly lead to respiratory insufficiency, decreased levels of consciousness and circulatory arrest. Severe bronchial obstruction, infectious or allergic upper airway obstruction or airway obstruction caused by a large esophageal foreign body should be excluded.ManagementChildren with acute airway obstruction by a foreign body with or without dyspnea and danger of suffocation but still with effective coughing and breathing have to be transferred by an emergency physician to a pediatric bronchoscopy unit without undertaking any external maneuvers at the scene. In awake children with inefficient coughing back slapping and thoracic compression in infants or abdominal compression in children aged less than 1 year old have to be performed to help the child to expel or to move the obstructing object to a more advantageous position. In children with asphyxia and loss of consciousness artificial ventilation should be started and if there is no reaction with ventilation, extrathoracic cardiac compression or cardiopulmonary resuscitation must be started. Experienced first aiders should inspect the larynx by direct laryngoscopy to remove or push a foreign body down into a main stem bronchus and ventilate the other lung using an endotracheal tube. Every child suffering from acute severe coughing or choking, even without symptoms must undergo bronchoscopic control to exclude or remove a residual foreign body, which can potentially cause secondary airway obstruction or poststenotic complications.

Comparison of air-Q® and Soft Seal® laryngeal mask for airway management by novice doctors during infant chest compression: A manikin study

BackgroundRecent resuscitation guidelines for infant cardiopulmonary resuscitation (CPR) emphasise that rescuers should minimise the interruption of chest compressions. To that end, supraglottic devices such as laryngeal mask airways (LMAs) are suggested as a backup for airway management during infant CPR. We therefore compared the utility of the air-Q® LMA (air-Q) with that of the Soft Seal® LMA (Soft Seal) for infant CPR in an infant manikin. MethodsTwenty-four novice doctors in the anaesthesia department performed insertion and ventilation with air-Q and Soft Seal on an infant manikin with or without chest compression. ResultsTwo doctors failed to insert the Soft Seal without chest compression, while nine failed during chest compression (P<0.05). However, only one doctor failed to insert the air-Q without chest compression, and two doctors failed during chest compression. Insertion time was not significantly increased with chest compression using either device. Insertion time during chest compression was significantly shorter for the air-Q than for the Soft Seal (P<0.05). The visual analogue scale (VAS) was used to evaluate difficulty of use (0mm (extremely easy) to 100mm (extremely difficult)). VAS scores did not change significantly by the addition of chest compression with either device; however, VAS scores during chest compression were significantly higher with Soft Seal than with the air-Q device. ConclusionWe conclude that novice doctors find the air-Q easier to use than Soft Seal for emergency airway management during chest compression in infants, in an infant manikin.

The physiology behind resuscitation guidelines

Abstract The guidelines for paediatric resuscitation have been made by international consensus, following a review of the available research data, but evidence is limited. In children, respiratory arrest usually precedes cardiac arrest, so there is an emphasis on respiratory support in this age group. In older children and adults, the underlying pathology may be different, and emergency medical service activation should immediately be sought. Pulse checks for lay rescuers have been omitted because of inherent difficulty for the inexperienced. The preferred method of cardiac compression in infants is with two apposed thumbs and hands encircling the chest. Two-finger compressions continue to be recommended for lay rescuers. Automated external defibrillators are not currently suitable for use in infants and young children, although manufacturers are developing such instruments. High-dose epinephrine is no longer routinely recommended in cardiac arrest as there are significant adverse effects. Amiodarone is used for the treatment of ventricular tachyarrhythmias in place of lignocaine.

The physiology behind resuscitation guidelines

The guidelines for paediatric resuscitation have been made by international consensus, following a review of the available research data, but evidence is limited. In children, respiratory arrest usually precedes cardiac arrest, so there is an emphasis on respiratory support in this age group. In older children and adults, the underlying pathology may be different, and emergency medical service activation should immediately be sought. Pulse checks for lay rescuers have been omitted because of inherent difficulty for the inexperienced. The preferred method of cardiac compression in infants is with two apposed thumbs and hands encircling the chest. Two-finger compressions continue to be recommended for lay rescuers. Automated external defibrillators are not currently suitable for use in infants and young children, although manufacturers are developing such instruments. High-dose epinephrine is no longer routinely recommended in cardiac arrest as there are significant adverse effects. Amiodarone is used for the treatment of ventricular tachyarrhythmias in place of lignocaine.

A novel non-invasive technique for measuring the residual lung volume by nitrogen washout with rapid thoracoabdominal compression in infants

BACKGROUNDThe functional residual capacity (FRC), the only lung volume to be routinely measured in infants, is an unreliable volume landmark. In addition to FRC, the residual volume (RV) was measured...

Unusual forms of tracheobronchial compression in infants with congenital heart disease

Three groups of unusual forms of tracheobronchial compression caused by vascular anomalies are presented. Three patients had an encircling right aortic arch with a left-sided descending aorta and ligamentum arteriosum (group 1), two patients had airway compression caused by a pincer effect between a malposed and enlarged ascending aorta and the descending aorta (group 2), and three patients had airway compression after an arterial switch operation for transposition of the great arteries (group 3). Symptoms developed in all patients before the age of 4 months, and six of them had multiple failed attempts at extubation before the surgical intervention directed at relieving the airway compression. Fiberoptic endoscopy was used in all patients as a first-line diagnostic tool and was 100% accurate in establishing the diagnosis. The operations performed were aortic uncrossing in group 1, dissection and aortopexy of the right or left main bronchus in group 2, and dissection of the left main bronchus and lysis of adhesions in group 3. In group 1 there was one early death, resulting from aspiration, and one late death 4 years later, resulting from an unrelated cause. In this group, bronchomalacia was noted after the operation and resolved gradually in the year after the intervention. In group 2, one patient died of an aortobronchial fistula after placement of a bronchial stent. Group 3 patients had good postoperative results. Two of them are completely symptom-free and one has residual bronchomalacia and may need placement of a bronchial stent. (J T horac C ardiovasc S urg 1996;112:415-23)

Intracranial compliance in infants: evaluation with Doppler US.

To test graded fontanelle compression during Doppler ultrasound (US) scanning to identify and monitor infants with altered cranial compliance. An ophthalmodynamometer exerted pressure on the anterior fontanelle during Doppler US scanning of the middle cerebral artery. Sixty examinations were performed in 43 infants--13 full-term and 11 premature healthy control subjects, 10 with increased intracranial volume, and nine with suspected abnormal cranial compliance but without increased intracranial volume. Resistive index (RI) and angle-corrected time-averaged mean velocities (TAV) of blood flow were compared at three different pressures. Baseline RI values in healthy full-term infants were significantly lower than in healthy premature infants and infants with abnormal compliance (P < .05). Values for healthy premature infants and infants with abnormal compliance were indistinguishable (P > .5). Neither RI nor TAV changed significantly in healthy infants, but both changed significantly with compression in infants with abnormal cranial compliance. This procedure may be more useful than measurement of RI of the anterior cerebral artery alone to evaluate infants with altered cranial compliance.

Echocardiography in the preoperative evaluation of vascular rings

Vascular rings may produce tracheal and/or esophageal compression in infants and children. Traditionally recognized fluoroscopically, the exact anatomy of the ring and appropriate surgical correction are determined intraoperatively. The role of preoperative echocardiography was examined. Twenty patients with symptomatic vascular rings were evaluated preoperatively with echocardiography at this institution. Their ages ranged from 10 days to 11 years (mean, 17 months). There were 9 boys and 11 girls. Most ( 17 20 ) presented with respiratory symptoms in the first year of life, although in 3 patients dysphagia was the primary complaint (at birth, 4 months, 9 years). All underwent initial evaluation with a barium esophagogram prior to the echocardiogram. Surgical correction was subsequently performed and the exact anatomy identified. All barium esophagograms were interpreted prospectively as demonstrating a “vascular ring.” Although often suspected fluoroscopically, the actual type of ring was correctly identified by echocardiogram in all cases including determination of the dominant arch and associated anomalies. The types of vascular rings included double aortic arch (10), right aortic arch with left ligamentum arteriosum and/or aberrant left subclavian artery (6); aberrant right subclavian artery (2), and pulmonary artery sling (2). Barium esophagogram remains the best screening test for children in whom a vascular ring is suspected. However, echocardiography is a useful noninvasive complementary examination to confirm the diagnosis, clarify anatomy, and exclude other major intracardiac pathology prior to surgical correction.

Closed Chest Cardiac Massage in the Newborn Infant

The recommended techniques for external cardiac compression during cardiopulmonary resuscitation of the newborn are reviewed. The American Heart Association advises the rescuer to depress the infant's midsternum with the index and forefingers. An alternative recommendation is to encircle the chest with both hands and appose the thumbs on the midsternum. The cases reported here prove the superiority of the latter maneuver over the former in improving cardiac output and systemic blood pressures. The history of external cardiac compression in infants and children is briefly reviewed, further supporting the conclusion that the technique of encircling the chest with thumbs at midsternum is more efficacious and hence the preferred approach to closed chest cardiac massage in the newborn.

Promoting better health

A case of tracheal compression in an infant after repair of a tracheo-oesophageal fistula and oesophageal atresia is reported. Tracheopexy completely relieved the symptoms of apnoeic attacks, cyanosis, and convulsions. We suggest that tracheal compression in infants and children with repaired oesophgeal atresia can not only cause life-threatening attacks but also be responsible for recurrent chest infections. All infants and children with signs and symptoms of tracheal compression as shown by the presence of a barking type of cough, recurrent chest infections, or persistent mild respiratory symptoms should be referred for thorough investigation of the tracheobronchial tree.

Optimum Position for External Cardiac Compression in Infants and Young Children

Ninety-seven pediatric patients (age 67%) in all cases at all ages. Ten pediatric patients (between 1 month and 3 years of age) who sustained cardiac arrest while in the Pediatric and Surgical Intensive Care Unit and who had arterial pressure monitoring lines already in place were monitored with a two- or four-channel strip-chart recorder during external cardiac compression (ECC) performed by staff members who were blinded from the results of the strip-chart recording. The ECC performers were instructed to perform ECC at either the midsternum at the level of the victim's nipples or at the lower one-third of the sternum 1.5 to 2 cm above the tip of the xiphoid, and then to switch on command. In every instance in which the patients served as their own controls (ECC performed at both the midsternum and lower one-third of the sternum in random sequence), the performance of ECC over the lower one-third of the sternum resulted in significantly better systolic and mean arterial blood pressures ( P

Optimum position for external cardiac compression in infants and young children

Ninety-seven pediatric patients (age less than 17 years) undergoing routine upright chest roentgenograms in the posteroanterior projection and 90 children undergoing supine anteroposterior chest roentgenograms had lead markers placed at the suprasternal notch and xiphoid prior to taking the roentgenograms. The position of the geometric center of the cardiac silhouette in relation to the sternum was recorded as a percentage of the distance along the sternum. The heart lies under the lower one-third of the sternum (greater than 67%) in all cases at all ages. Ten pediatric patients (between 1 month and 3 years of age) who sustained cardiac arrest while in the Pediatric and Surgical Intensive Care Unit and who had arterial pressure monitoring lines already in place were monitored with a two- or four-channel strip-chart recorder during external cardiac compression (ECC) performed by staff members who were blinded from the results of the strip-chart recording. The ECC performers were instructed to perform ECC at either the midsternum at the level of the victim's nipples or at the lower one-third of the sternum 1.5 to 2 cm above the tip of the xiphoid, and then to switch on command. In every instance in which the patients served as their own controls (ECC performed at both the midsternum and lower one-third of the sternum in random sequence), the performance of ECC over the lower one-third of the sternum resulted in significantly better systolic and mean arterial blood pressures (P less than .001).(ABSTRACT TRUNCATED AT 250 WORDS)

Mechanisms of blood flow during CPR.

HomeCirculationVol. 62, No. 5Mechanisms of blood flow during CPR. Free AccessAbstractPDF/EPUBAboutView PDFSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessAbstractPDF/EPUBMechanisms of blood flow during CPR. J P Orlowski J P OrlowskiJ P Orlowski Search for more papers by this author Originally published21 Mar 2018https://doi.org/10.1161/circ.62.5.7418168Circulation. 1980;62:1141"Mechanisms of blood flow during CPR.." Circulation, 62(5), p. 1141 Previous Back to top Next FiguresReferencesRelatedDetailsCited By Meaney P, Nadkarni V, Cook E, Testa M, Helfaer M, Kaye W, Larkin G and Berg R (2006) Higher Survival Rates Among Younger Patients After Pediatric Intensive Care Unit Cardiac Arrests, Pediatrics, 10.1542/peds.2006-1724, 118:6, (2424-2433), Online publication date: 1-Dec-2006. Orlowski J (1986) Optimum position for external cardiac compression in infants and young children, Annals of Emergency Medicine, 10.1016/S0196-0644(86)80423-1, 15:6, (667-673), Online publication date: 1-Jun-1986. November 1, 1980Vol 62, Issue 5 Advertisement Article InformationMetrics Copyright © 1980 by American Heart Associationhttps://doi.org/10.1161/circ.62.5.7418168PMID: 7418168 Originally publishedMarch 21, 2018 PDF download Advertisement

Vascular rings and tracheobronchial compression in infants: H. H. Keith. Pediatr Ann 92:540–549 (August), 1977

Vascular rings and tracheobronchial compression in infants: H. H. Keith. Pediatr Ann 92:540–549 (August), 1977

Vascular Rings and Tracheobronchial Compression in Infants

Five common types of vascular anomalies have been reviewed. The entities should be kept in mind when a child has stridor, respiratory distress, recurrent croup, or pulmonary infections. Use of the plain radiography, barium esophagram, bronchoscopy, and angiography has been discussed in the diagnostic workup of vascular rings. Treatment of true encircling or compressive rings is surgical.