Aim
To define the impact of demographics on the incidence, aetiology and clinical course of viral bronchiolitis in infants younger than 2 years of age.
Methods
Retrospective case review of all viral bronchiolitis admissions for patients aged younger than 2 years old from January 1 2014 to 31 December 2015 at Wellington Regional Hospital, New Zealand. Demographic data, second‐hand smoke exposure (SHSE) and presence of predisposing conditions were collected, along with outcome data including use of respiratory support and intensive care unit (ICU) admission. This was compared to background rates calculated from regional census data.
Results
There were 556 admissions included (11% of paediatric medical admissions); 49% tested positive for respiratory syncytial virus (RSV) (84% tested), and 40% of admissions received positive pressure respiratory support and 10% ICU admission. Admission rates ranged from 9.6 to 77 per 1000/year, with higher rates seen in those from areas of high deprivation. Admission rates by deprivation varied according to aetiology. RSV‐positive admission rates increased from 9.7 per 1000/year to 24.6 per 1000/year in the least to most deprived areas, whereas non‐RSV admissions showed even greater disparity, increasing from 10.1 per 1000/year to 37.5 per 1000/year (both P < 0.0001).
Conclusions
This study further reinforces that material deprivation contributes significantly to poor health outcomes that are apparent in infancy. SHSE is a potent risk factor for adverse respiratory outcomes in this patient population. Ongoing efforts to eradicate smoking and reduce material inequality need to continue.
The Ventrain provided stable oxygenation and effective ventilation at low airway pressures during emergency PTV in critically obstructed airways. The Manujet provided effective temporizing oxygenation in this situation with hypoventilation necessary to minimize barotrauma risk. The nature and extent of airway obstruction may not be known in a CICO emergency but an understanding of device differences may help inform optimal ventilation device and method selection.
The relationships between blood pressure variability (BPV) and cerebral blood flow variability (CFV) are poorly understood. This study sought to characterize the interindividual characteristics between spontaneous BPV and CFV across individuals with intact cerebrovascular control. We analyzed blood pressure and flow velocity data from 105 healthy subjects. Spontaneously occurring fluctuations in mean arterial blood pressure (MAP) and middle cerebral artery flow velocity (MCAvmean; Transcranial Doppler ultrasound) were characterized using power spectral and transfer function analysis in the very low‐ (0.02‐0.07 Hz), low‐ (0.07‐0.20 Hz), and high‐frequency (0.20‐0.40 Hz) ranges. Across our study sample, MAP was a positive predictor of MCAvmean to varying degrees in all three frequency ranges (Very Low Frequency (R2= 0.088, P< 0.01) Low Frequency (R2= 0.47, P< 0.01), High Frequency (R2 = 0.55, P< 0.01)). The increased predictive power of MAP for MCAvmean in higher frequencies demonstrates that BPV is a determinant of CFV. However, factors other than BPV are influential, especially in the very low frequencies. These results demonstrate that intermittent blood pressure, a clinical measurement predominantly representative of very low frequency BPV content, is an inadequate surrogate of cerebral perfusion variability.
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