Prospective Evaluation of the Safety and Efficacy of THRIVE for Children Undergoing Airway Evaluation
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Transnasal Humidified Rapid-Insufflation Ventilatory Exchange (THRIVE) is a humidified high-flow nasal cannula capable of extending apneic time. Although THRIVE is assumed to stent upper airway soft tissues, this has not been objectively evaluated. Also, there are no prior studies providing safety and efficacy data for those patients undergoing upper airway evaluation using THRIVE.This report is a prospective study of the safety and efficacy of THRIVE in pediatric patients younger than 18 years old undergoing drug-induced sleep endoscopy. We positioned a flexible laryngoscope to view the larynx, and photographs were taken with no THRIVE flow (control) and with THRIVE flow at 10 and 20 liters per minute (LPM). Upper airway patency was measured using epiglottis to posterior pharynx distance, laryngeal inlet area, and modified Cormack-Lehane score at the trialed parameters. Vomiting and aspiration were our primary safety endpoints.Eleven patients (6 women) with a mean age of 5.3 ± 2.1 years (2-8 years; SD, 2.05) were enrolled. Measurements of upper airway patency showed a significant THRIVE flow-associated increase in epiglottis to posterior pharynx distance (105 ± 54 at 10 L/min and 199 ± 67 at 20 L/min; P = 0.007) and nonsignificant increase of laryngeal inlet area (206 ± 148 at 10 L/min and 361 ± 190 at 20 L/min; P = 0.07). Cormack-Lehane score improved significantly at higher THRIVE volumes (P = 0.006).THRIVE appears to safely improve upper airway patency during sleep endoscopy in the pediatric patient. In this study, we objectively document the flow-dependent increase in laryngeal patency associated with THRIVE.Keywords:
Failure to Thrive
Epiglottis
Feeding tube
Nasal cannula
A case of mixed tumor of the epiglottis, which was treated surgically, is presented. Delay in diagnosis contributed to the patient's death. This case represents the second reported case of mixed tumor of the epiglottis.
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Objective To explore the effect of MedtrnicXPS3000 in the excision of huge Epiglottis Cysts.Method 23 cases,of which 14 cases were suffering from dyspnes in degree I-Ⅱ had their huge epiglottis cysts removed by MedtrnicXPS3000 under local anesthesia.Results 23 cases were cured by one operation.No complications were found,and no relapse was found during a follow-up of 6 months.Conclusion MedtrnicXPS3000 is feasible for the excision of huge epiglottis cysts.
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The Mallampatti test was devised as a simple bedside examination to predict the likelihood of difficult intubation. We would like to report a case of unusual anatomy seen when performing this test. The on-call anaesthetist was requested to provide anaesthesia for an otherwise healthy 33-year-old woman requiring an urgent Caesarean section. A Mallampatti test was performed as part of the pre-operative assessment and a 2-cm mass was immediately evident protruding from the base of the tongue. Closer inspection revealed this to be the patient's epiglottis (Figure). The patient received a general anaesthetic for the operation and was noted to be an extremely easy intubation. There were no intra- or postoperative complications. In their paper describing what has now come to be known as the Mallampatti test, Mallampatti et al. [1] printed an illustration of a Mallampatti Class 1 patient in whom the faucial pillars, soft palate and uvula are visible. The illustration also shows a small part of the epiglottis seen at the base of the tongue, although no mention is made of this in the text. We have been unable to find any case in the literature where an epiglottis is visible on performing a Mallampatti test, although there is a case report of an elongated epiglottis with an unusual angle causing a difficult intubation [2].
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One of major functions of the epiglottis is thought to protect the lower respiratory tract, covering the glottis in phase of swallowing. It is most likely that the epiglottis might play an important role to make food channels bilaterally cooperating with hypopharyngeal structures in swallowing.On the other hand, the epiglottis should stand up forward and upward in inspiratory phase in order to let the air pass the glottis smoothly.If the epiglottis falls down backward and downward, in inspiration, dyspnea might be caused.We have recently experienced such a patient with dyspnea. The laryngeal mirror examination revealed that the epiglottis was sucked down toward the glottis in phase of inspiration. The fluorocinematography was very useful to obtain an exact diagnosis. The epiglottis was thought to be longer than a usual one we observe clinically.We succeeded in releasing the patient from dyspnea by partial resection of the epiglottis by use of laser under microlaryngoscopical procedure.In this paper, the whole clinical course was reported and the merit of laser surgery for resection of the epiglottis through the direct laryngoscope was emphasized. The result was discussed from the viewpoint of anatomy of the epiglottis.
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Optimal nutrition in early infancy is the success behind good health, growth, and development of children. This article presents an overview of failure to thrive in children younger than 2 years of age. This article reviews normal growth, growth indices, common etiology, and an approach to evaluation and management of failure to thrive.
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The presence of a defined set of behaviors was examined in 67 hospitalized infants, 3–24 months old; 17 with organic failure-to-thrive (OFTT), 17 with nonorganic failure-to-thrive (NOFTT), and 33 with no signs of failure-to-thrive. The usefulness of assessing these behaviors to distinguish nonorganic from organic failure-to-thrive infants was evaluated. The frequency of behaviors per infant as well as the intensity of behaviors was greater for NOFTT. The order of decreasing frequency of behaviors was similar in both OFTT and NOFTT infants. Four of the 7 most prevalent behaviors occurred significantly more frequently in NOFTT than OFTT infants. The presence of these behaviors does not rule in NOFTT or rule out OFTT. However, when a number of the behaviors are present, particularly if they occur in high intensity, and when no organic disease is found, a diagnosis of NOFTT is suggested. Response to appropriate treatment remains the most reliable confirmation of the correct diagnosis. J Dev Behav Pediatr 8:18–24, 1987. Index terms: failure-to-thrive, infant behavior.
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Failure to thrive is a condition commonly seen by primary care physicians. Prompt diagnosis and intervention are important for preventing malnutrition and developmental sequelae. Medical and social factors often contribute to failure to thrive. Either extreme of parental attention (neglect or hypervigilance) can lead to failure to thrive. About 25 percent of normal infants will shift to a lower growth percentile in the first two years of life and then follow that percentile; this should not be diagnosed as failure to thrive. Infants with Down syndrome, intrauterine growth retardation, or premature birth follow different growth patterns than normal infants. Many infants with failure to thrive are not identified unless careful attention is paid to plotting growth parameters at routine checkups. A thorough history is the best guide to establishing the etiology of the failure to thrive and directing further evaluation and management. All children with failure to thrive need additional calories for catch-up growth (typically 150 percent of the caloric requirement for their expected, not actual, weight). Few need laboratory evaluation. Hospitalization is rarely required and is indicated only for severe failure to thrive and for those whose safety is a concern. A multidisciplinary approach is recommended when failure to thrive persists despite intervention or when it is severe.
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About the Author. List of Epigraphs. Acknowledgements. SECTION I: THE PROBLEM. 1. Introduction. 2. Historical Perspective of Failure to Thrive. 3. Failure to Thrive: Definition, Prevalence, Manifestation, and Effect. 4. Psychosocial Short Stature: Emotional Stunting of Growth. 5. Feeding/Eating Behaviour of Children who Fail to Thrive, and Parental Feeding Styles. 6. Parent-Child Interaction in Failure-to-Thrive Cases. 7. Child-Parent Attachment Behaviour of Children who Fail to Thrive and Parental Responsiveness. 8. Fabricated or Induced Illnesses and Failure to Thrive. SECTION II: THE FRAMEWORK OF ASSESSMENT. 9. A Framework of Assessment of Failure-to-Thrive Cases: Ecological Approach. SECTION III: INTERVENTION AND TREATMENT OF FAILURE-TO-THRIVE CHILDREN AND THEIR FAMILIES. 10. Levels of Intervention. 11. Some Theoretical Approaches to Failure-to-Thrive Intervention. 12. Multidimensional/Integrated Model of Intervention in Failure-to-Thri ve Cases. 13. Approaches to Failure-to-Thrive Intervention Programmes. 14. Considerations Arising from Failure-to-Thrive Intervention Research. Epilogue. References. Index.
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The aim of the study was to determine the prevalence of failure to thrive among children in Bayelsa state and its associated factors. It was a cross-sectional study designed to obtain anthropometric data and history of failure to thrive children and determine associated factors by using a pre-tested questionnaire. A total of 374 failure to thrive children ages 1 to 5 years were investigated from three local government areas of the State; Southern Ijaw (124), Yenagoa (126) and Nembe (124). 185 were males while 189 were females. The Gomez classification and four-week recall approaches were used as criteria to estimate failure to thrive among children. 24.6% (92) of the children were diagnosed to have failure to thrive using the Gomez criteria while 19.8% (18) of the children were said to have failure to thrive using the four weeks’ recall approach. Furthermore, result also showed that majority of the cases of failure to thrive are a mix of organic and non-organic factors with a significant relationship between health status of child at birth using Chi-square (X2) = 14.357, difference (d) = 1, and P-value = 0.000 at 95% confidence interval, thus showing a significant relationship between failure to thrive and child being ill at birth and health status of the mother. Also, there was a significant relationship between failure to thrive and exposure to environmental pollutants with Chi-square (X2) = 11.607, difference (d) = 1, and P-value = 0.001 at 95% confidence interval. The high prevalence of failure to thrive among children under the age of five in Bayelsa State calls for immediate public actions such as promotion of optimum infant and young child nutrition and regular growth monitoring of children and mothers health in the state for improved growth and development and health outcomes of children in the state. Key words: Failure to thrive children, exposure, ill health, Prevalence, Bayelsa State, Gomez criteria, organic factors, non-organic factors.
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Infants commonly present with failure to thrive. Psychosocial and nutritional causes are commonly responsible, but significant organic pathology requires exclusion in all children with failure to thrive.This article discusses an approach to the assessment of infants presenting with failure to thrive, together with information on management and available resources.Close liaison between those involved in the management of infants presenting with failure to thrive--including family, maternal child health nurse, family doctor and paediatrician--should usually allow for appropriate intervention to correct the failure to thrive.
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