Journal of Yeungnam Medical Science

Review article

Home mechanical ventilation in children with chronic respiratory failure: a narrative review: Soyoung Kwak; J Yeungnam Med Sci. 2023;40(2):123-135. Published online May 27, 2022; DOI: https://doi.org/10.12701/jyms.2022.00227

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Advances in perinatal and pediatric intensive care and recent advances in mechanical ventilation during the last two decades have resulted in an exponential increase in the number of children undergoing home mechanical ventilation (HMV) treatment. Although its efficacy in chronic respiratory failure is well established, HMV in children is more complex than that in adults, and there are more considerations. This review outlines clinical considerations for HMV in children. The goal of HMV in children is not only to correct alveolar hypoventilation but also to maximize development as much as possible. The modes of ventilation and ventilator settings, including ventilation masks, tubing, circuits, humidification, and ventilator parameters, should be tailored to the patient’s individual characteristics. To ensure effective HMV, education for the parent and caregiver is important. HMV continues to change the scope of treatment for chronic respiratory failure in children in that it decreases respiratory morbidity and prolongs life spans. Further studies on this topic with larger scale and systemic approach are required to ensure the better outcomes in this population.

Citations

Citations to this article as recorded by

The follow‐up of children on home invasive mechanical ventilation after hospital discharge
Halime Nayır Büyükşahin, Ebru Yalcın
Pediatric Pulmonology.2024; 59(8): 2145. CrossRef
Identifying and managing psychosocial problems in children on home invasive mechanical ventilation
Gizem Özcan, Nazan Çobanoğlu
Pediatric Pulmonology.2024; 59(8): 2149. CrossRef
Management of gastrointestinal and nutritional problems in children on home invasive mechanical ventilation
Ceyda Tuna Kirsaçlioğlu
Pediatric Pulmonology.2024; 59(8): 2170. CrossRef
Indications and practice of home invasive mechanical ventilation in children
Secahattin Bayav, Nazan Çobanoğlu
Pediatric Pulmonology.2024; 59(8): 2210. CrossRef
Rehabilitation in children with home invasive mechanical ventilation
Aysun Genç, Birkan Sonel Tur
Pediatric Pulmonology.2024; 59(8): 2203. CrossRef
Transitioning children using home invasive mechanical ventilation from hospital to home: Discharge criteria, disparities, and ethical considerations
Jennifer Henningfeld, Annie B. Friedrich, Grace Flanagan, Cynthia Griffith, Anna Hughes, Lisa Molkentine, Rebecca Steuart, Stuart Wilkinson, Christopher D. Baker
Pediatric Pulmonology.2024; 59(8): 2113. CrossRef
Mask interfaces and devices for home noninvasive ventilation in children
Sonia Khirani, Vivian Ducrot
Pediatric Pulmonology.2024; 59(6): 1528. CrossRef
Home Mechanical Ventilation in Children: Complications and Benefits—A Two-Year Experience at a Referral Children's Hospital
Majid Keivanfar, Mahnaz Kheiri, Sharareh Babaie, Mohsen Reisi
Iranian Journal of Pediatrics.2024;[Epub] CrossRef

Case report

Anesthetic management during whole-lung lavage using lung ultrasound in a patient with pulmonary alveolar proteinosis: a case report: Jae Wan Jung, Hyunho Lee, Jimi Oh; Yeungnam Univ J Med. 2021;38(4):374-380. Published online September 6, 2021; DOI: https://doi.org/10.12701/yujm.2021.01284

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Abstract PDF

Pulmonary alveolar proteinosis (PAP) is an uncommon disease characterized by progressive accumulation of lipoprotein material in the lungs due to impaired surfactant clearance. Whole-lung lavage (WLL) is the current standard treatment and consists of sequential lavage of each lung to mechanically remove the residual material from the alveoli. Although WLL is considered safe, unexpected complications can occur. Moreover, due to the rarity of the disease itself, this procedure is unknown to many physicians, and management of intraoperative complications can be challenging for anesthesiologists. Lung ultrasound (LUS) provides reliable and valuable information for detecting perioperative pulmonary complications and, in particular, quantitation of lung water content. There have been reports on monitoring the different stages of controlled deaeration of the non-ventilated lung during WLL using LUS. However, it has been limited to non-ventilated lungs. Therefore, we report the use of LUS in WLL to proactively detect pulmonary edema in the ventilated lung and implement a safe and effective anesthesia strategy. Given the limited diagnostic tools available to anesthesiologists in the operating room, LUS is a reliable, fast, and noninvasive method for identifying perioperative pulmonary complications in patients with PAP undergoing WLL.

Citations

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Anesthetic management of broncho- alveolar lavage in pulmonary alveolar proteinosis: A case report
Abinav Sarvesh S P S, Sucheta Gaiwal, Nimitha Prasad
Indian Journal of Clinical Anaesthesia.2024; 11(2): 251. CrossRef

Original Articles

Effects of small tidal volume and positive end-expiratory pressure on oxygenation in pressure-controlled ventilation-volume guaranteed mode during one-lung ventilation: Sung Hye Byun, So Young Lee, Jin Yong Jung; Yeungnam Univ J Med. 2018;35(2):165-170. Published online December 20, 2018; DOI: https://doi.org/10.12701/yujm.2018.35.2.165

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Abstract PDF

Background
The purpose of this study was to investigate whether tidal volume (TV) of 8 mL/kg without positive end-expiratory pressure (PEEP) and TV of 6 mL/kg with or without PEEP in pressure-controlled ventilation-volume guaranteed (PCV-VG) mode can maintain arterial oxygenation and decrease inspiratory airway pressure effectively during one-lung ventilation (OLV).
Methods
The study enrolled 27 patients undergoing thoracic surgery. All patients were ventilated with PCVVG mode. During OLV, patients were initially ventilated with TV 8 mL/kg (group TV8) without PEEP. Ventilation was subsequently changed to TV 6 mL/kg with PEEP (5 cmH2O; group TV6+PEEP) or without (group TV6) in random sequence. Peak inspiratory pressure (Ppeak), mean airway pressure (Pmean), and arterial blood gas analysis were measured 30 min after changing ventilator settings. Ventilation was then changed once more to add or eliminate PEEP (5 cmH2O), while maintaining TV 6 mL/kg. Thirty min after changing ventilator settings, the same parameters were measured once more.
Results
The Ppeak was significantly lower in group TV6 (19.3±3.3 cmH2O) than in group TV8 (21.8±3.1 cmH2O) and group TV6+PEEP (20.1±3.4 cmH2O). PaO2 was significantly higher in group TV8 (242.5±111.4 mmHg) than in group TV6 (202.1±101.3 mmHg) (p=0.044). There was no significant difference in PaO2 between group TV8 and group TV6+PEEP (226.8±121.1 mmHg). However, three patients in group TV6 were dropped from the study because PaO2 was lower than 80 mmHg after ventilation.
Conclusion
It is postulated that TV 8 mL/kg without PEEP or TV 6 mL/kg with 5 cmH2O PEEP in PCV-VG mode during OLV can safely maintain adequate oxygenation.

Citations

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Pressure-Controlled Ventilation-Volume Guaranteed Mode Combined with an Open-Lung Approach Improves Lung Mechanics, Oxygenation Parameters, and the Inflammatory Response during One-Lung Ventilation: A Randomized Controlled Trial
Jianli Li, Baogui Cai, Dongdong Yu, Meinv Liu, Xiaoqian Wu, Junfang Rong
BioMed Research International.2020; 2020: 1. CrossRef

Risk factors for persistent otitis media with effusion in children: a case-control study: Ju Yeon Lee, Se-Hyung Kim, Chan Il Song, Young Ree Kim, Yoon-Joo Kim, Jae Hong Choi; Yeungnam Univ J Med. 2018;35(1):70-75. Published online June 30, 2018; DOI: https://doi.org/10.12701/yujm.2018.35.1.70

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Abstract PDF

Background
Otitis media with effusion (OME) is defined as middle ear effusion without acute signs of infection. OME usually resolves spontaneously; however, persistent OME may require the insertion of a ventilation tube. This study investigated risk factors for persistent OME in children who undergo ventilation tube insertion.
Methods
Children who were admitted to undergo ventilation tube insertion at Jeju National University Hospital between August 2015 and July 2016 were enrolled as the case group. Healthy children without persistent OME from August 2016 to July 2017 were enrolled as the control group. Baseline characteristics and predisposing factor data were collected using an interview questionnaire. Middle ear fluids were collected from the case group.
Results
A total of 31 patients underwent ventilation tube insertion. The mean age of the case group was 4.53 years, with a male-to-female ratio of 21:10. Twenty-nine (93.5%) children attended a daycare center, and 21 (67.7%) had experience with bottle feeding. Fifteen (48.4%) children in the case group and 3 (9.7%) in the control group first attended a daycare center at <1 year of age (odds ratio=9.96; 95% confidence interval=2.44-39.70; p=0.001). No bacteria were found in middle ear fluid collected from the 31 operated children. Nasopharyngeal bacterial colonization was found in 13 (41.9%) and 17 (54.8%) children in the case and control groups, respectively.
Conclusion
Earlier attendance at a daycare center was the only predisposing factor for ventilation tube insertion in our study. The aseptic nature of middle ear fluids found in children with OME highlights the efficacy of antimicrobial use.

Citations

Citations to this article as recorded by

Otitis Media With Effusion After the COVID‐19 Pandemic: Return to the Past and New Lessons
Mirko Aldè, Paola Marchisio, Francesco Folino, Umberto Ambrosetti, Federica Di Berardino, Stefania Barozzi, Diego Zanetti, Lorenzo Pignataro, Giovanna Cantarella
Otolaryngology–Head and Neck Surgery.2024;[Epub] CrossRef
Impact of COVID-19 on nationwide pediatric otolaryngology: Otitis media and myringotomy tube trends
David Z. Allen, Sai Challapalli, Sean McKee, Kyung Hyun Lee, Cynthia S. Bell, Soham Roy, Sarah Bowe, Karthik Balakrishnan, C.W. David Chang, Zhen Huang
American Journal of Otolaryngology.2022; 43(2): 103369. CrossRef
Special Considerations for Tympanoplasty Type I in the Oncological Pediatric Population: A Case-Control Study
Celine Richard, Emily Baker, Joshua Wood
Frontiers in Surgery.2022;[Epub] CrossRef

Case Reports

Contralateral Tension Pneumothorax during One Lung Ventilation by a Univent(R) Tube.: Min Young No, Sung Ha Moon, Hyun Soo Kim; Yeungnam Univ J Med. 2012;29(1):31-34. Published online June 30, 2012; DOI: https://doi.org/10.12701/yujm.2012.29.1.31

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Abstract PDF

Tension pneumothorax during one-lung ventilation (OLV) is a rare but life-threatening complication. A 79-year-old male patient who was diagnosed with lung cancer underwent Univent(R) Tube (Fuji Systems Corporation, Tokyo) intubation for left upper lobectomy. Two hours after the initiation of OLV, the patient could not tolerate it. Thus, oneand two-lung ventilation were alternatively applied to continue the operation. After the operation, an emergent chest radiograph was taken, and pneumothorax was found at the right (dependent) lung field.

Citations

Citations to this article as recorded by

Mechanical ventilation-associated pneumothorax presenting with paroxysmal supraventricular tachycardia in patients with acute respiratory failure
Jeong Ho Eom, Myung Goo Lee, Chang Youl Lee, Kyong Min Kwak, Won Jae Shin, Jung Wook Lee, Seong Hoon Kim, Sang Hyeon Choi, So Young Park
Yeungnam University Journal of Medicine.2015; 32(2): 106. CrossRef

Ventilation Impairment During Anesthesia in Patients with Anterior Mediastinal Mass.: Kibum Bum Park, Sang Jin Park, Dae Lim Jee, Bo Hyun Lee; Yeungnam Univ J Med. 2005;22(1):104-112. Published online June 30, 2005; DOI: https://doi.org/10.12701/yujm.2005.22.1.104

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Abstract PDF: Because of location, a mediastinal mass may cause complications such as a major airway obstruction, a superior vena caval obstruction, and cardiac compression during general anesthesia. The patient's condition need to be assessed by several methods to predict the risks associated with general anesthesia. The authors took computed tomographs for a preoperative evaluation of two patients with an anterior mediastinal mass, and the risk of perioperative complications was predicted by measuring the tracheal area. The patients were managed according to the preoperative evaluation but severe ventilation impairments were encountered during anesthesia. In one patient, stable ventilation could not be maintained until spontaneous breathing appeared. The operation was cancelled and the patient was brought into the ICU. In the other patient, a tracheal tube was inserted deeper in an attempt to pass the narrowed tracheal portion due to mediastinal tumor compression resulting in improved ventilation

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