Guillaume Mortamet

Sleep study as a diagnostic tool for unexplained respiratory failure in infants hospitalized in the PICU

Purpose: The aim of the study was to analyze the diagnostic and therapeutic value of a polygraphy (PG) in infants hospitalized for unexplained respiratory failure or life‐threatening events in the PICU. Material and methods: The PG of 13 infants (4 girls), mean age 6.8 ± 7.7 months, were analyzed. Results: Eight infants were admitted for unexplained respiratory failure and 5 for life‐threatening events. PG showed features suggestive of respiratory muscle weakness in 5 infants whose final diagnoses were nemaline rod myopathy (n = 2), congenital myasthenia (n = 2), and diaphragmatic dysfunction (n = 1). Four of these patients were successfully treated with noninvasive ventilation (NIV). PG was suggestive of brainstem dysfunction in 4 infants; 2 were treated successfully with NIV and another with caffeine. PG showed obstructive sleep apnea in 3 infants; 2 were treated successfully with NIV and one patient was lost during follow up. A typical pattern of congenital central hypoventilation syndrome was observed in the last patient who was treated successfully with invasive ventilation. One patient with diaphragmatic dysfunction and one with brain stem dysfunction died. Conclusions: PG may assist the diagnosis and guide the management of unexplained respiratory failure or life‐threatening events in infants hospitalized in the PICU.

Parental perceptions of clown care in paediatric intensive care units: Clowns in paediatric intensive care unit

The objective of this study was to report family satisfaction with regards to the presence of clowns in the paediatric intensive care unit (PICU).

Disaster preparedness in French paediatric hospitals 2 years after terrorist attacks of 2015

Objective We aimed to determine paediatric hospital preparedness for a mass casualty disaster involving children in both prehospital and hospital settings. The study findings will serve to generate recommendations, guidelines and training objectives. Design and setting The AMAVI-PED study is a cross-sectional survey. An electronic questionnaire was sent to French physicians with key roles in specialised paediatric acute care. Results In total, 81% (26 of 32) of French University Hospitals were represented in the study. A disaster plan AMAVI with a specific paediatric emphasis was established in all the paediatric centres. In case of a mass casualty event, paediatric victims would be initially admitted to the paediatric emergency department for most centres (n=21; 75%). Paediatric anaesthesiologists, paediatric surgeons and paediatric radiologists were in-house in 20 (71%), 5 (18%) and 12 (43%) centres, respectively. Twenty-three (82%) hospitals had a paediatric specialised mobile intensive care unit and seven (25%) of these could provide a prehospital emergency response. Didactic teaching and simulation exercises were implemented in 20 (71%) and 22 (79%) centres, respectively. Overall, physician participants rated the level of readiness of their hospital as 6 (IQR: 5–7) on a 10-point readiness scale. Conclusion Paediatric preparedness is very heterogeneous between the centres. Based on the study findings, we suggest that a national programme must be defined and guidelines generated.

Diaphragm electrical activity monitoring as a breakpoint in the management of a tetraplegic child

Over the last decade, new technology has been developed to continuously record the electrical activity of the diaphragm (EAdi) at the bedside [1]. EAdi monitoring has been shown to be useful in assessing the patient’s ventilatory drive, in adjusting ventilatory support, and in detecting patient–ventilator asynchrony [2–4]. In the present case, we highlight how monitoring EAdi could be a sensitive diagnostic tool to detect spontaneous respiratory cycles in a mechanically ventilated child with tetraplegia. An 8-year-old girl was admitted to our pediatric intensive care unit (PICU) for a rapidly progressive right hemiparesis. The CT scan revealed a large C3–C4 medullary arteriovenous malformation predominantly. An urgent embolization was attempted, but severe edema and hemorrhagic transformation of venous thrombosis developed, leading to tetraplegia with dysautonomia. She underwent tracheostomy on day 12 due to the absence of spontaneous breathing. Three months later, an MRI scan showed extensive cervical cord fibrosis and atrophy at C2–C3–C4 levels (Fig. 1). On day 90, a phrenic nerve stimulation test was conducted to assess the potential for diaphragmatic pacing. No esophageal pressure deflection was induced by the stimulation. However, after a few respiratory pauses applied for the stimulation, we noted some spontaneous cycles on the EAdi recordings (about 5 μV) associated with esophageal pressure deflections (5–10 cmH2O). Continuous monitoring of EAdi was performed while decreasing the level of ventilator support, thereby confirming an intermittent and small respiratory drive (Fig. 2). Weaning using NAVA was started in order to favor the patient’s own respiratory drive, which gradually increased over time (Fig. 2). She was progressively and successfully weaned from the ventilator during daytime on day 162 and the patient was discharged home on day 374.

Methemoglobinemia Following Monolinuron Ingestion: A Case Report in a Child.

Case We describe a case report of a 2-year-old boy presenting to the emergency department with cyanosis and agitation. There was no suggestive history of poisoning but parents reported the presence of an aquarium at the family dinner the night before, with an aquarium cleaner beside it. Physical examination at admission revealed central cyanosis without signs of respiratory distress. Oxygen saturation measured by pulse oximetry (SpO2) was at 80% in room air. Plasma level of methemoglobin was measured at 11.8%. After 6 hours, methemoglobin decreased spontaneously to 5% and pulse oximetry saturation reached 98% in room air. Consciousness, weakness, and behavior were concomitantly improved. Because of rapid and spontaneous improvement, no specific treatment such as methylene blue was administered. A mass spectrometry toxicological analysis was performed in a blood sample taken the day of admission. Screening procedure of pesticides based on liquid chromatography coupled with mass spectrometry identified monolinuron, a phenylurea herbicide. Conclusions We recommend considering acquired methemoglobinemia after ingestion of industrial products and drugs in children with cyanosis, mental status alteration, and without respiratory distress symptoms.

Intérêt de la ventilation non invasive en réanimation pédiatrique : doit-on espérer un autre niveau de preuve ? Non-invasive ventilation in children: Do we need more evidence?

Respiratory failure is the leading cause of hospital admissions in the pediatric intensive care unit (PICU) and is associated with significant morbidity and mortality. Mechanical ventilation, preferentially delivered by a non-invasive route (NIV), is currently the first-line treatment for respiratory failure since it is associated with a reduction in the intubation rate. This ventilatory support is increasingly used in the PICU, but its wider use contrasts with the paucity of studies in this field. This review aims to describe the main indications of NIV in acute settings: (i) bronchiolitis; (ii) postextubation respiratory failure; (iii) acute respiratory distress syndrome; (iv) pneumonia; (v) status asthmaticus; (vi) acute chest syndrome; (vii) left heart failure; (viii) exacerbation of chronic respiratory failure; (ix) upper airway obstruction and (x) end-of-life care. Most of these data are based on descriptive studies and expert opinions, and few are from randomized trials. While the benefit of NIV is significant in some indications, such as bronchiolitis, it is more questionable in others. Monitoring these patients for the occurrence of NIV failure markers is crucial.

SFP CO-70 - Etude de la variabilité génétique des virus de la rougeole de génotype D4

Objectif Cette etude a pour but d’analyser la variabilite des genes H et P complets de virus de la rougeole de genotype D4 identifies pendant l’epidemie qui a sevi en France de 2008 a 2011, afin de completer l’analyse du fragment hypervariable du gene N requis pour l’identification du genotype. Materiels et Methode Nous avons selectionne 100 prelevements detectes positifs pour le virus de la rougeole pendant cette epidemie. Soixante-quinze souches de virus de la rougeole ont pu etre amplifiees et sequencees pour les genes complets H et P. Resultats L’alignement et l’analyse phylogenetique des genes H, P et N mettent en evidence une variabilite genetique au sein du genotype D4 et permettent l’identification de plusieurs clusters, dont certains sont retrouves simultanement dans les arbres construits pour les genes H, P et N. L’analyse phylogenomique du pseudogene P/H chez des souches dont la sequence du gene N est identique permet la mise en evidence de plusieurs clusters. Certains regroupent des souches isolees sur une meme periode et avec des origines geographiques differentes. Conclusions cette etude montre un interet a etendre le sequencage aux genes P et H pour affiner la comprehension des mecanismes de diffusion d’une epidemie de rougeole.