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Biomedical subjects

Q Mok

Publications and source records attributed to Q Mok.

36 records · Page 2Linked to original sources
PubMed1998

Use of tracheobronchography as a diagnostic tool in ventilator-dependent infants.

OBJECTIVE: Comparison of investigations of the airway in ventilator-dependent infants. DESIGN: Consecutive infants with suspected upper airway abnormalities were investigated using rigid bronchoscopy and tracheobronchography. SETTING: Tertiary pediatric and neonatal intensive care units. PATIENTS: Eight infants with suspected airway abnormalities. INTERVENTIONS: Rigid bronchoscopy and tracheobronchography. MEASUREMENTS AND MAIN RESULTS: Structural abnormalities, segmental narrowing of the airways and the effect of various levels of positive-end expiratory pressures on the narrowings were documented. In six of the eight cases, additional airway abnormalities were diagnosed with tracheobronchography compared with rigid bronchoscopy. CONCLUSIONS: In cases of suspected abnormalities of the upper airway in small infants unable to be weaned from ventilatory support, tracheobronchography may be a more reliable investigation method than rigid bronchoscopy. The ability to assess the structural and dynamic components of the airway accurately and safely allows a correct and long-term treatment plan to be established in this group of patients.

Airway Obstruction↗
PubMed1998

Prolonged mechanical ventilation as a consequence of acute illness.

OBJECTIVE: To determine why acutely ill children become dependent upon mechanical ventilation and what happens to them. METHODS: A retrospective medical record study of all patients aged between 1 month and 16 years from 1983 to 1996 who required ventilation for more than 28 days. RESULTS: Forty children were ventilated for between 36 and 180 days before discharge or death. Before their presenting illness, 13 (33%) were normal, 15 (37%) had documented predisposing conditions such as bronchopulmonary dysplasia, and the remaining 12 (30%) had diagnoses made after admission. The cause of respiratory failure was central in four patients (10%), spinal cord in eight (20%), neuromuscular in 11 (28%), and pulmonary in 17 (42%). Severe nosocomial infection requiring treatment with intravenous antibiotics occurred in 22. To date, 16 children (40%) have died, and 10 (25%) remain ventilator dependent. Of the 24 survivors, seven (29%) have severe residual neurological deficit. CONCLUSIONS: Increasingly, children are surviving intensive care only to remain ventilator dependent and at risk of significant comorbidity. This study should inform further debate on why such children remain ventilator dependent, and how and where they are managed.

Acute Disease↗
PubMed1997

Tracheobronchomalacia in preterm infants with chronic lung disease.

Tracheobronchomalacia is a treatable cause of persisting ventilatory requirements in the preterm neonate, and warrants a high index of suspicion. Five preterm infants with persisting ventilatory requirements with evidence of tracheobronchomalacia are reported. Four were diagnosed by tracheobronchogram and one by flexible endoscopy. All were successfully managed by continuous positive airway pressure (CPAP) via a tracheostomy. One infant died of unrelated causes. The oldest child in this series at the age of 2 years requires no further ventilatory support. Tracheobronchial anomalies should be considered in all preterm infants with persisting ventilatory requirements.

Bronchi↗
PubMed1996

The outcome of children admitted to intensive care with meningococcal septicaemia.

OBJECTIVE: To review our experience of children with meningococcal septicaemia, and to validate, in our group, severity scores used in different populations to predict outcome. DESIGN: Retrospective review of case notes and charts. PATIENTS: A total of 35 children were admitted to the paediatric intensive care unit (ICU) in the Royal Children's Hospital (RCH) in the 8 years between January 1985 and December 1992 with proven meningococcal septicaemia. RESULTS: Ages ranged from 4 months to 16 years, with a median age of 20 months. The median meningococcal score was 4 and the median PRISM score was 20, with scores above these being significantly associated with death (P < 0.0001). Thirty-two children (91%) received infusions of colloid for hypovolaemia and twenty-nine (83%) received one or more inotropic drugs. Twenty-one children (60%) required mechanical ventilation for a median of 16.5 h (range 7-574). Seven children (20%) underwent plasmapheresis. Six children (17%) underwent haemofiltration and two (6%), peritoneal dialysis. One patient received extracorporeal membrane oxygenation (ECMO) because of circulatory failure. Twenty-one children (60%) developed disseminated intravascular coagulation, renal failure and/or skin or limb necrosis. The overall survival was 66%, and all survivors are functionally normal. CONCLUSION: The mortality from the disease remains at 34% despite the technological advances in intensive care. The PRISM and meningococcal scores are useful in predicting outcome. Novel methods of treatment (e.g., plasmapheresis or ECMO) may be valuable.

Adolescent↗
PubMed1996

Steroids for intubated croup masking airway haemangioma.

Recently, the beneficial role of steroids for acute laryngotracheobronchitis has been more clearly defined for both intubated and unintubated patients. However, corticosteroids also improve the clinical signs of airway haemangiomata. Two patients are described who illustrate how this can be a source of diagnostic confusion.

Airway Obstruction↗
PubMed1992

Negative extrathoracic pressure ventilation for phrenic nerve palsy after paediatric cardiac surgery.

OBJECTIVE: To investigate the feasibility of negative extrathoracic pressure ventilation as a respiratory support following phrenic nerve palsy after cardiac surgery. DESIGN: An uncontrolled pilot study. PATIENTS: 14 patients aged one week to 30 months (median 5.3 months) with phrenic nerve palsy diagnosed by phrenic nerve conduction tests and diaphragmatic electromyograms. Four had bilateral and 10 unilateral palsy. Before treatment all required oxygen and 10 were receiving positive pressure ventilation. One of the patients with bilateral and four of the patients with unilateral palsies had undergone a plication before negative pressure ventilation was started. INTERVENTION: Treatment was started 6-65 days (median 23) after operation with a newly designed system which included a Perspex chamber, which gave easy access to the child, and an elastic latex neck seal. Continuous negative pressure was used in conjunction with intermittent positive pressure ventilation while continuous or intermittent negative pressure ventilation was used in extubated infants. RESULTS: All four patients with bilateral palsy survived with long-term intermittent negative pressure ventilation and did not require further surgery. Of the 10 with unilateral lesions, seven required no further surgery, two underwent plication, and one had a re-plication. Three patients with unilateral palsy died of non-respiratory causes. The duration of positive pressure ventilation after starting negative pressure ranged from 0 to 23 days (median 6). Treatment with negative pressure lasted for 3-241 days (median 32) and was predominantly administered off the intensive care unit, including at home. CONCLUSIONS: Negative pressure ventilation may be an alternative to positive airway pressure ventilation in the management of phrenic nerve palsy. A multicentre randomised controlled trial is now required to assess further the role of negative pressure ventilation in phrenic nerve palsy.

Child, Preschool↗
PubMed1991

Temperature instability during nursing procedures in preterm neonates.

The temperature changes associated with total care nursing procedures were studied on 249 occasions during the first week of life in 25 preterm infants weighing less than 1500 g, 16 of whom weighed less than 1100 g. Large drops in both central and peripheral temperature occurred, with widening of the central-peripheral temperature gap. Recovery of the temperature after the total care procedure took up to two hours. These routine nursing procedures are carried out every four to six hours. They cause an important alteration in the environmental temperature with consequent thermal stress to the infants that may influence ultimate outcome.

Body Temperature Regulation↗
PubMed1991

Phrenic nerve injury in infants and children undergoing cardiac surgery.

Fifty infants and 50 children less than 15 years undergoing palliative or corrective cardiac surgery in the Brompton Hospital between March and October 1988 had direct percutaneous stimulation of the phrenic nerve before and after operation. Ten patients, six under 1 year of age and four over, developed unilateral phrenic nerve injury. In those aged less than 1 year recovery after operation was prolonged because their diaphragmatic palsy made it difficult to wean them from the ventilator. Older children had symptoms but their rate of recovery did not seem to be affected by the phrenic nerve injury. Phrenic nerve damage was no more frequent after a lateral thoracotomy than after a median sternotomy. There was no significant association with the type of operation performed, the experience of the surgeon, the use of bypass or topical ice, the duration of bypass, circulatory arrest or aortic cross clamping, or the age of the patient at the time of operation. In patients who had cardiopulmonary bypass the risk of injury was significantly higher in those who had undergone previous operation. The 10% frequency of phrenic nerve injury determined in this prospective study was higher than that seen in earlier retrospective reports. Direct percutaneous stimulation of the phrenic nerve can be used at the bedside in infants and children to facilitate early and accurate diagnosis of phrenic nerve palsy, and the results may influence early management.

Adolescent↗
PubMed1990

Restrictive dermopathy: a report of three cases.

We report three infants with a rare syndrome of restrictive dermopathy, in which rigidity of the skin at birth is associated with characteristic facial anomalies, generalised arthrogryposis, bony abnormalities, and lung hypoplasia. The skin has a distinctive pathology with compaction of the dermal collagen and fibrosis of the subcutaneous tissue. The inheritance is likely to be autosomal recessive and the condition appears to be fatal in the early neonatal period.

Arthrogryposis↗
PubMed1989

Intradermal hepatitis B vaccine in thalassaemia and sickle cell disease.

Thirty two patients with beta thalassaemia and sickle cell disease who were having regular blood transfusions were selected to test the efficacy and immunogenicity of low dose (2 micrograms or 0.1 ml) intradermal hepatitis B vaccine compared with the standard (20 micrograms or 1 ml) intramuscular dose. There was no significant difference in the rates of seroconversion, seroconversion had occurred in all patients by seven months. There were no significant differences in antibody titres between the intramuscular and intradermal groups at 1, 2, and 6 months. Although the titres were significantly higher in the intramuscular group at seven months and at 12-18 months, the antibody titre in the intradermal group did not fall below 10 IU/l. The results of this study suggest that low dose intradermal hepatitis B vaccination is an effective and economical way of stimulating an immune response in patients with beta thalassaemia and sickle cell disease.

Anemia, Sickle Cell↗
PubMed1987

Survival after balloon atrial septostomy for complete transposition of great arteries.

Mortality before surgery must be taken into account when comparing the surgical mortality of atrial redirection procedures (Mustard's or Senning's operation) and the arterial switch operation for patients with complete transposition. This is because the switch operation is usually performed within the neonatal period or early infancy but Mustard's or Senning's operation usually after 4 months of age. The outcome of balloon atrial septostomy was therefore assessed in all 102 infants with transposition of the great arteries (plus or minus associated anomalies) who underwent the procedure at our hospital in the 10 years from January 1975 to December 1984. We considered the procedure to have been unsuccessful if the patient died from any cause (including other surgical procedures) between the septostomy and subsequent interatrial repair (Mustard's operation) or arterial switch operation. Eighteen patients died, although in only two was this as a direct result of the septostomy. Statistical analysis showed that low weight, presence of a persistent arterial duct, and coarctation of the aorta were significant risk factors. Early survival of infants with transposition of the great arteries has been dramatically improved after the introduction of balloon atrial septostomy. Nevertheless, there is considerable attrition before definitive repair, which must be included in the prediction of overall outcome.

Body Weight↗
PubMedDate not supplied

Long-term ventilator-dependent children: a vocal profile analysis.

PURPOSE: Ventilator dependent children need to be able to communicate effectively to be able to re-integrate into society. This study was performed to see if the Vocal Profile Analysis can be used to assess the voice quality produced by speaking aids in ventilated children, and therefore help to direct speech therapy input. METHODS: This study attempted to evaluate vocal function using a perceptual rating scale in four ventilator-dependent children fitted with the Passy-Muir Tracheostomy Speaking Valve. The children were at different stages of speech development and had either intact or abnormal cognitive function. The evaluation was performed independently by three trained speech therapists blinded to the child's underlying diagnosis. RESULTS: Although speaking aids enhanced verbal communication skills, most of the subjects still displayed marked abnormalities of speech. There was significantly greater agreement among the trained observers when assessing children who were cognitively intact at the time of the study. The older child with intact cognitive function achieved near normal speech potential with the speaking valve. CONCLUSIONS: The Vocal Profile Analysis is a useful tool for assessing vocal characteristics in ventilated children with intact cognitive function. Near normal speech can be attained with speaking aids, provided a certain stage of speech development has already been attained.

Child, Preschool↗