No abstract

Noninvasive ventilation is effective in respiratory failure from various etiologies. This study aimed to analyze the efficacy of noninvasive positive pressure ventilation (NPPV) in pediatric cardiac patients. NPPV was used (1) as an alternative means of respiratory support in patients with hypoxemic or hypercarbic respiratory failure or with signs of respiratory distress that were considered to require intubation; or (2) as a preventive measure in patients with high risk for extubation failure. Between 2008 and 2011, there were 107 episodes of NPPV use in 82 patients. Their median age was 57 days (range 1 day to 18 years), and weight was 4.1 kg (range 1.7-68). Within the first hour of NPPV, partial pressure of carbon dioxide/fraction of inspired oxygen (PaO2/FiO2) was significantly increased, and arterial pCO2, and respiratory rate were decreased. This decrease in respiratory rate and increase in PaO 2/FiO2 continued during the first 24 h of therapy, and pCO2 was decreased during the first 6 h. In 59.8% of cases, NPPV was successfully used without the need for tracheal intubation. The Aristotle Basic Complexity score, presence of infection, residual cardiac defect, and pH <7.36 in the first hour were independent predictors of NPPV failure. We conclude that NPPV improved oxygenation and decreased respiratory effort in pediatric cardiac patients, 59.8% of whom eventually did not receive intubation. A high-complexity surgical score, presence of infection, residual cardiac defect, and pH <7.36 in the first hour are predictors of NPPV failure, which occurs in most patients >24 h after the onset of therapy.

We present the case histories of two children having respiratory failure due to bilateral diaphragm paralysis after cardiac surgery. In both children non-invasive positive pressure ventilation alleviated respiratory distress, improved gas exchange, and prevented the need for endotracheal intubation. Following unilateral recovery of diaphragmatic function both children were successfully weaned from non-invasive positive pressure ventilation.

AIM: To analyse the fi ndings in a newborn (36 gestational weeks, birth weight: 4,030 grams, birth length: 48 cm, Apgar score 7/8/8 points) with prenatal suspicion of intestinal obstruction at the duodenum/jejunum level. The patient required urgent surgery on the fi rst day of life. RESULTS: Examination of the abdominal cavity confi rmed the presence of a cystic mass with a volume of approximately 800 ml, which was located at the site of jejunal atresia. As part of the surgical solution, the cystic formation and the atretic segment of the intestine were resected with subsequent end-to-end jejunojejunal anastomosis and Bishop-Koop ileostomy. The histological examination of 3 samples collected confi rmed the presence of mucous membrane and smooth muscle. CONCLUSION: The cyst anatomically communicated with the aboral section of the jejunum, but the lumen of the jejunum was functionally obturated by solid whitish masses. The histological examination confi rmed the diagnostic features of a cyst of intestinal origin. The ileum and colon were patent throughout, but of smaller diameter, so a Bishop-Koop relieving anastomosis was indicated. The condition of the child at the age of 9 months was stabilised and surgical closure of the stoma was carried out (Tab. 1, Fig. 8, Ref. 21).