Negative pressure pulmonary oedema (NPPO) is an anaesthetic complication due to acute obstruction of the upper airway, whose main cause is laryngospasm. The pathophysiology involves a strong negative intrapleural pressure during inspiration against a closed glottis, which triggers excessive pressure in the pulmonary microvasculature. Although its diagnosis can be difficult, its recognition help...

1 Department of Pediatrics, Division Pediatric Critical Care Medicine, Beatrix Children’s Hospital, University Medical Center Groningen, the The Netherlands 2 Care, Anesthesiology, Peri-operative and Emergency medicine (CAPE), *See also p. 474 Dr. Kneyber has received funding from National Institutes Health/National Heart, Lung Blood Institute, ZonMW, Stichting Kinderziekenhuis, Fonds NutsOhra,...

Abstract Background Cuff leak test (CLT) has been used widely to assess upper airway patency before extubation but with low positive predictive value. Aim To the diagnostic accuracy of column width ratio (ACWR) in predicting postextubation stridor (PES). Patients and methods 50 who intubated >24 hours were observed for reintubation. Laryngeal ultrasound was done measure ACW ETT cuff defl...

Stridor following tracheal extubation occurs in approximately 5% of all patients, and approximately 1% of all patients require reintubation for upper-airway obstruction.1 Patients at increased risk for stridor and upper-airway obstruction following extubation include female patients; children,2 particularly those with acute respiratory-tract infections (croup);3 patients who have incurred facia...

EVIDENCE DEFINITIONS  Class I: Prospective randomized controlled trial.  Class II: Prospective clinical study or retrospective analysis of reliable data. Includes observational, cohort, prevalence, or case control studies.  Class III: Retrospective study. Includes database or registry reviews, large series of case reports, expert opinion.  Technology assessment: A technology study which doe...

BACKGROUND The nasopharyngeal tube (NT) is a potential interface for noninvasive ventilation (NIV) available in all health care centers. The aim of the study was to describe our experience in the use of the NT for bi-level NIV in infants and its effectiveness. METHODS Prospective observational study from January 2007 to December 2010, including all patients ≤ 6 months old admitted to the pedi...

To avoid the complications associated with endotracheal intubation, noninvasive positive-pressure ventilation (NPPV) has been proposed in the management of ventilator weaning in patients with acute respiratory failure (ARF) of various etiologies. Several studies have been performed to assess the benefit of NPPV in various weaning strategies, including permitting early extubation in patients who...