Lung Function In Pediatric Patients Research Articles

Use of Asthma Medications in African American Children With Sickle Cell Disease: A Single Center Experience.

To investigate use of asthma controller medications and their effect on lung function in pediatric patients with sickle cell disease (SCD). Retrospective study in pediatric patients who self-identified as African American with SCD treated at Phoenix Children's between 2014 and 2021. Associations of asthma controller medications with changes in lung symptoms (cough, wheeze, chest pain, shortness of breath with exercise, sleep disturbance), Acute Chest Syndrome (ACS), and percent predicted probabilities (FEV1, FVC, FEV1/FVC, FEF25%-75%)) were examined (Fisher exact, Wilcoxon rank sum) in SCD patients overall, and by physician-diagnosed asthma. Of the total 98 SCD patients, 28 (29%) had an asthma diagnosis and 76 (78%) were treatment naïve. During study follow-up, asthma controller medications were used by 57 (58%) patients (35 new prescriptions, 13 continued prescriptions and 9 with prescription escalation), with 41 patients remaining treatment naïve. Medication use vs non-use during follow-up improved cough (33% vs 7%, p = 0.002), chest pain (12% vs 5%, p = 0.03) and shortness of breath with exercise (32% vs 10%, p = 0.01) among all SCD patients. Medications also improved the mean relative percent change FEV1 (12.3 vs -3.6; p < 0.0001), FVC (10.5 vs -1.3; p < 0.0001), and FEF25%-75%, (20.6 vs -8.8; p < 0.0001), overall and in both asthmatics and non-asthmatics. These findings demonstrate improved lung function and respiratory symptoms with asthma controller medications in pediatric patients with SCD, irrespective of an asthma diagnosis, and hold great promise for this undertreated population.

Uncomplicated SARS-CoV-2 Infections with Preserved Lung Function in Pediatric Patients with Cystic Fibrosis: A Three-Year Single-Centre Experience.

Background/Objectives: Patients with chronic lung diseases, such as cystic fibrosis, were considered a risk group for a severe course of coronavirus disease 2019 at the beginning of the pandemic. However, mounting evidence suggests that this group may not face an elevated risk for a severe SARS-CoV-2 infection. Methods: Here, we present data on the incidence and clinical course of SARS-CoV-2 infections in a single pediatric CF centre in Austria. Clinical variables were analyzed for their potential impact on disease acquisition and severity. A total of 135 young people with CF were assessed from February 2020 until December 2022. Results: Eighty-four patients were infected with SARS-CoV-2, out of which nine patients reported re-infection, resulting in 93 SARS-CoV-2 infections. Most infections, 76/93 (82%), occurred during the period of omicron variant predominance. Higher body mass index and respiratory colonization with Haemophilus influenzae before the beginning of the pandemic were significantly associated with the risk of acquiring SARS-CoV-2 infection. All patients had an uncomplicated COVID-19 course, regardless of the SARS-CoV-2 variant and COVID-19 vaccine status at infection. The most frequent symptoms were rhinitis (53%), fatigue (49%), cephalea (43%), and fever (38%). Neither oxygen therapy nor hospitalization were needed for any of the patients. Lung function parameters (FEV1, FVC, FEF50, LCI), both in the early post-viral as well as late post-viral stages, were not significantly impacted by SARS-CoV-2 infections. No long-term post-COVID-19 effects were reported. Conclusions: Our single-centre experience suggests that the course of SARS-CoV-2 infections in children and adolescents with CF is primarily mild and uncomplicated.

Decortication in Chronic Pleural Empyema and Its Effect on Lung Function in Pediatric patients

Background: Chronic pleural empyema, a condition marked by ongoing pleural infection and the development of a fibrous sheath around the lungs, severely impacts lung function and overall well-being in pediatric patients. Decortication is a surgical procedure aimed at removing this fibrous layer to restore normal lung mechanics. This study investigates the impact of decortication surgery on lung function in children with chronic pleural empyema and evaluates how factors such as malnutrition, obesity, and cardiovascular conditions influence surgical outcomes. Methods: This prospective cohort study included 80 children aged 5 to 15 years diagnosed with chronic pleural empyema who underwent decortication. Clinical and demographic data, including age, sex, nutritional status, and comorbidities, were collected. Lung function was evaluated through spirometry before and after surgery, focusing on parameters such as FEV1 and FVC. Postoperative complications, including bleeding, infections, and air leaks, were recorded along with hospital stay duration. Paired t-tests assessed changes in lung function, while subgroup analyses explored the effects of malnutrition and other comorbidities on recovery. Results: The participants had an average age of 10.2 ± 2.8 years, with males accounting for 60% of the cohort. Post-surgical lung function showed significant improvement, with FEV1 rising from 1.2 ± 0.3 L to 1.7 ± 0.4 L (p &lt; 0.001) and FVC increasing from 1.6 ± 0.4 L to 2.3 ± 0.5 L (p &lt; 0.001). Common complications included bleeding (10%), infections (12%), and prolonged air leaks (15%). Malnutrition was associated with slower recovery and a higher rate of complications. The average hospital stay was 10 ± 3 days. Conclusion: Decortication is highly effective in improving lung function in children with chronic pleural empyema. Even in patients with malnutrition and comorbidities, this intervention demonstrates significant benefits. These findings underscore the value of timely surgery and individualized perioperative care in improving outcomes for this vulnerable group.

Optimizing perioperative lung protection strategies for reducing postoperative respiratory complications in pediatric patients: a narrative review.

Despite significant advancements in the safe delivery of anesthesia and improvements in surgical techniques, postoperative respiratory complications (PRCs) remain a serious concern. PRCs can lead to increased length of hospital stay, worsened patient outcomes, and higher hospital and postoperative costs. Perioperative lung injury and PRCs are more common in children than in adults owing to children's unique physiology and anatomical characteristics. Studies have shown that lung-protective ventilation (LPV) strategies can improve lung function and minimize the risk of PRCs in adults. However, individualized LPV in children remains underexplored. This narrative review provides an overview of the various perioperative pulmonary protection strategies and their effect on pediatric PRCs. We searched PubMed for articles published from 2000 to 2024, setting our inclusion criteria to include studies that involved pediatric patients, addressed LPV strategies, and reported data on PRCs. Non-English language studies, case reports, editorials, conference abstracts, and non-full text published literatures were excluded. We utilized the following keyword strategy: (((lung protective ventilation) OR (PEEP)) OR (recruitment maneuver)) OR (low tidal volume) AND (2000:2024[pdat])) AND (pediatric) filters. In total, 1,106 articles were retrieved, with only 23 being deemed relevant to the review. Data extraction and analysis were conducted by two independent researchers to ensure accuracy and consistency. We conducted descriptive statistical analysis for quantitative data and thematic analysis for qualitative data. The key content are an overview of risk factors for PRCs in children including the patients themselves, anesthesia, and surgery, as well as the effectiveness of LPV strategies in pediatric surgery, including low tidal volume (TV), positive end-expiratory pressure (PEEP), ultrasound-guided pulmonary recruitment maneuver (RM), low fraction of inspired oxygen (FiO2), pressure-controlled ventilation (PCV), as well as fluids, pain, and high-flow nasal cannula (HFNC). We found that age, mechanical ventilation with general anesthesia, and thoracic surgery increased the risk of PRCs in children. The application of LPV strategies in pediatric surgery had positive effect, including low TV combined with titrated PEEP, age- and physiologically appropriate FiO2, ultrasound-guided RM, target directed fluid infusion, adequate analgesia, and the use of HFNC in special circumstances. However, we also found that the application of LPV has certain potential risks and therefore needs to be implemented according to the patient's actual age and physical condition. Perioperative LPV strategies show potential benefits in reducing lung injury and PRCs in pediatric patients. These strategies, including low TV, appropriate individualized PEEP, lung RM, and avoidance of high FiO2, appear to be effective methods for protecting lung function in pediatric patients. Additionally, perioperative fluid management and effective pain control are crucial for lung protection. The emerging use of HFNC therapy shows promise, but further research is needed to fully understand its benefits.

Comparison of the tidal volume by the recruitment maneuver combined with positive end-expiratory pressure for mechanically ventilated children

The recruitment maneuver (RM) combined with PEEP to prevent atelectasis have beneficial effects. However, the change in tidal volume (VT) due to RM combined with PEEP in pediatric patients during the induction of general anesthesia is unknown. Therefore, we assessed the effects of RM combined with PEEP on VT. Pediatric patients were divided into three groups: infants, preschool children, and school children. The RM was performed by maintaining pressure control continuous mandatory ventilation (PC-CMV) with a 15 cmH2O and PEEP increase of 5 cmH2O. VT, respiratory function and hemodynamics were monitored before and after RM combined with PEEP. VT (mL) /ideal body weight (kg) before vs. after RM combined with PEEP were 9 vs 12 mL/kg (p < 0.05) in the infants, 9 vs 11 mL/kg (p < 0.05) in the preschool children, 8 vs 10 mL/kg (p < 0.05) in the school children, respectively. HR and BP before and after RM combined with PEEP increased by 2–3% and decreased by 4–7% in all groups. RM combined with PEEP resulted in an increase in VT per ideal body weight (1.1–1.2%). Therefore, this RM combined with PEEP method might improve the lung function in pediatric patients.

Evaluation of the factors affecting lung function in pediatric patients with asthma

Purpose This study aimed to analyze the risk factors affecting lung function in children with asthma based on clinical data to advice on clinical treatment and prognosis. Methods This study included newly diagnosed patients with asthma admitted to the Respiratory Department of Chengdu Women’s and Children’s Central Hospital in Sichuan from July 2020 to June 2021. The factors associated with lung function were analyzed using univariate and multivariate linear regression with the forward method, while factors affecting lung ventilation function were analyzed using multivariate logistic regression. Results Sixty percent of the patients had normal lung function. Age was significantly negatively correlated with forced vital capacity (FVC)/FVCpredicted (B = –1.385, p = 0.001), FEV1/FEV1predicted (B = –2.092, p < 0.001), and FEV1%/FEV1%predicted (B = –0.834, p = 0.001). Body mass index (BMI) for age Z score (B = 1.661, p = 0.045) and cesarean delivery (B = 4.471, p = 0.013) were significantly positively correlated with FVC/FVCpredicted. Birth weight was significantly positively correlated with FEV1/FEV1predicted (B = 4.593, p = 0.027). Multivariate logistic regression analysis revealed that age ≥6 years and cough variant asthma (CVA) were risk factors for abnormal lung function. Conclusions Age, BMI for age Z score, mode of delivery, and birth weight were significantly correlated with lung function in children with asthma. Furthermore, children with asthma and normal lung function were more likely to be overlooked. More attention should be given to children with asthma and normal lung function, and CVA.

Correlation of digital flow peak with spirometry in children with and without asthma

Introduction Spirometry and peak expiratory flow measurement (PEF) are combined during functional respiratory assessments. The new digital peak flow meter (DPM) evaluates the forced expiratory volume in the first second (FEV1) and PEF. Objective To compare lung function measurements using spirometry and DPM. Methods This cross-sectional analytical study assessed FEV1 and PEF in children with and without asthma. Statistical analysis was performed to assess the agreement between the measures using the intraclass correlation coefficient (ICC), Bland–Altman, and survival agreement plot. Results 125 (3–12 y) and 196 (6–18 y) children without and with asthma, respectively, were studied. In children without asthma, the ICC for FEV1 and PEF were 0.89 and 0.86, respectively, while the corresponding values were 0.87 and 0.79, respectively, in patients with asthma. The Bland–Altman method showed a difference of −0.4 to 0.5 for FEV1 in patients without asthma, with a tendency to increase as the FEV1 increased to a certain extent. In patients with asthma, the pattern was similar for FEV1, and the PEF had a greater dispersion than among those without asthma; however, a good agreement pattern was maintained. In the survival agreement plot, when accepting a tolerance of 0.150 mL for FEV1, there was an agreement of close to 55% in both groups. Likewise, when accepting a tolerance of 0.5 L/s for PEF, an agreement of close to 60% and 50% was observed in patients without and with asthma, respectively. Conclusion DPM was effective as a measure of lung function in pediatric patients with and without asthma.

Impact of vitamin D status on CF and non-CF bronchiectasis outcomes

BackgroundVitamin D deficiency occurs frequently in cystic fibrosis (CF) and non-CF bronchiectasis patients. Yet, few studies have assessed the impact of vitamin D status on the clinical outcomes in pediatric bronchiectasis. This study is designed to assess vitamin D level and determine its effect on exacerbations, bacterial colonization, and lung function in pediatric patients with CF and non-CF bronchiectasis.ResultsThis cross-sectional case-control study assessing vitamin D level was performed in a total of sixty cases under the age of 18 years—forty cases with CF and non-CF bronchiectasis and twenty age- and sex-matched healthy controls. Associations between serum vitamin D and clinical and laboratory parameters were assessed in the patient groups. Vitamin D deficiency was more prevalent among CF and non-CF bronchiectasis patients (75%, 45%) compared to controls (10%) (P < 0.001). In addition, vitamin D deficiency was associated with more frequent and severe pulmonary exacerbations (66.7%, 46.7%) (P=0.033, < 0.001), chronic Pseudomonas infection (80%) (P=0.060) among CF patients, and with lower FEV1 (66%) (P= 0.071) among non-CF bronchiectasis. Moreover, a cutoff value of vitamin D level equal or less than 22.5 ng/ml was accurate in differentiating moderate from mild pulmonary exacerbations in both patients’ groups (AUC=0.809) (p=0.004).ConclusionsVitamin D deficiency is not uncommon in both CF and non-CF bronchiectasis. In this population, vitamin D deficiency is associated with more frequent pulmonary exacerbations, chronic Pseudomonas infection, and worse lung function.

Correlation of Iron Levels with Asthma and Lung Function in Pediatric Patients with Sickle Cell Anemia

Correlation of Iron Levels with Asthma and Lung Function in Pediatric Patients with Sickle Cell Anemia

Restrictive lung function in pediatric patients with structural congenital heart disease

Restrictive lung function in pediatric patients with structural congenital heart disease

Changes in body composition after lung transplantation in children

Changes in body composition after lung transplantation in children

Respiratory and hemodynamic effects of a stepwise lung recruitment maneuver in pediatric ARDS: A feasibility study

Little is known about the efficacy and safety of recruitment maneuvers (RMs) in pediatric patients with acute respiratory distress syndrome (ARDS). We therefore assessed the effects on gas exchange and lung mechanics and the possible detrimental effects of a sequential lung RMs and decremental positive end-expiratory pressure (PEEP) titration in pediatric ARDS patients. We enrolled patients <15 years of age with ARDS, progressive hypoxemia, <72 hr of mechanical ventilation, and hemodynamic stability. A step-wise RM and decremental PEEP trial were performed. Safety was evaluated as the occurrence of hypotension and low pulse oxymeter oxygen saturation during the maneuver and development of airleaks after. Efficacy was evaluated as changes in lung compliance (Cdyn ) and gas exchange 1, 12, and 24 hr after the RM. We included 25 patients, of median age 5 (1-16) months, median weight 7.0 (4.1-9.2) kg, median PaO2 /FIO2 117 (96-139), and median Cdyn 0.48 (0.41-0.68) ml/cmH2 O/kg at baseline. Thirty RM were performed, with all completed successfully. No airleaks developed. Mild hypotension was detected during four procedures. Following RM, Cdyn , and PaO2 /FIO2 increased significantly (P < 0.01 each), without changes in PaCO2 (P = 0.4). A >25% improvement in lung function (Cdyn or PaO2 /FIO2 ) was observed after 90% of the RM procedures. Gas exchange worsening over the next 24 hr resulted in HFOV use in 36% of patients, while the remaining subjects sustained improvements in oxygenation at 12 and 24 hr. The 28-day mortality rate was 16%. Sequential RMs were safe and well tolerated in hemodynamically stable children with ARDS. RMs and a decremental PEEP trial may improve lung function in pediatric patients with ARDS and severe hypoxemia.

Effects of breviscapine on pulmonary inflammatory response and lung injury in children undergoing open heart surgery

This study examined the effects of breviscapine (1) on pulmonary inflammatory response and lung function in pediatric patients undergoing open heart surgery. Forty-five children (ASA II or III, aged 2–72 months) were randomly assigned to control group (saline, Group C), low dose 1 group (0.5 mg/kg, Group Bre0.5), and high dose 1 group (1.0 mg/kg, Group Bre1.0), 15 cases each group. Plasma concentrations of procalcitonin (PCT) and neutrophil elastase (NE) were measured and compared at different time points. Plasma concentrations of PCT and NE were increased after cardiopulmonary bypass (CPB) induction, and the concentrations were lower in 1-treated groups. The present results indicated that continuous infusion of 1 before the CPB suppressed the production of PCT and NE attenuated systemic inflammatory response, which could result in lung protective effect in children undergoing open heart surgery.

The Use of Impulse Oscillometry Percent of Predicted Value to Determine Abnormal Lung Function in Pediatric Patients

The Use of Impulse Oscillometry Percent of Predicted Value to Determine Abnormal Lung Function in Pediatric Patients