Valentine Marchac

Complications of flexible bronchoscopy in children: prospective study of 1,328 procedures

Complications of flexible bronchoscopy (FB) were prospectively evaluated during 1,328 diagnostic procedures in children, not in intensive care units. A total 92.8% of the procedures were performed in conscious patients under sedation and 7.2% under deep sedation. Supplementary oxygen was provided in ∼80% of cases via endoscopic face mask (n=783) or nasal prongs (n=290). At least one complication was recorded in 91 cases (6.9%). Minor complications (n=69; 5.2%) included moderate and transient episodes of desaturation (n=15), isolated excessive coughing (n=22), excessive nausea reflex with coughing (n=20), transient laryngospasm (n=6) and epistaxis (n=6). Major complications (n=22; 1.7%) included oxygen desaturation to <90%, either isolated (n=10) or associated with laryngospasm (n=6), coughing (n=4), bronchospasm (n=1), and pneumothorax (n=1). Major complications involving oxygen desaturation were associated with age <2 yrs (13 of 529 versus 8 of 778) and laryngotracheal abnormalities (7 of 85 versus 14 of 1,222). The overall frequency of complications was similar in conscious (6.7%) but sedated patients and patients under deep (7.3%) sedation. However, the frequency of transient desaturation was significantly higher in children undergoing FB under deep sedation. Transient fever after bronchoalveolar lavage was observed in 52 of 277 cases (18.8%). Flexible bronchoscopy is a safe procedure with <2% major complications. Careful analysis of indications and clinical status for each patient, and proper anaesthesia and monitoring during the examination ensure that the procedure is successful, with a minimum of complications.

Case-control study of Stenotrophomonas maltophilia acquisition in cystic fibrosis patients

The aims of this case-control study were to describe the characteristics of cystic fibrosis (CF) patients who isolated Stenotrophomonas maltophilia in sputum, to determine risk factors for acquisition, to assess persistence of the organism and clinical outcomes postacquisition. Data were collected from 1991–1999. CF patients and controls (who had never isolated S. maltophilia) were matched for age (±1 yr), sex and forced expiratory volume in one second (±10%). Data were collected from the year prior and for 2 yrs postacquisition of S. maltophilia. The prevalence of S. maltophilia increased from 3.3% to 15%. Factors associated with S. maltophilia acquisition were more than two courses of intravenous antibiotics, isolation of Aspergillus fumigatus in sputum and oral steroid use. The effect of A. fumigatus was independent of steroid use. Clinical status did not change postacquisition. The majority of patients cleared the organism from the sputum. Long-term infection or an accelerated deterioration in lung function or nutrition is not likely post-Stenotrophomonas maltophilia acquisition in cystic fibrosis. This is the first documentation of an association between Aspergillus fumigatus isolation and Stenotrophomonas maltophilia acquisition in cystic fibrosis, independently of steroid therapy.

L’enfant siffleur de zéro à trois ans, approche thérapeutique

Resume La population des enfants siffleurs de zero a trois ans est heterogene et comprend les bronchiolites et l’asthme du nourrisson. Le traitement de la bronchiolite repose essentiellement sur la kinesitherapie respiratoire. Le traitement de fond de l’asthme du nourrisson repose surtout sur la corticotherapie inhalee a doses minimales efficaces. La corticotherapie inhalee se justifie par les donnees recentes montrant l’existence d’une inflammation bronchique precoce, chez tous ces enfants, qu’ils aient un facteur de risque (atopie familiale et/ou personnelle) ou non. Les enfants qui spontanement evoluent vers une regression des symptomes sont aussi ameliores cliniquement par la corticotherapie inhalee. L’evolution vers la persistance des symptomes est difficile a prevoir. La corticotherapie inhalee pourrait limiter le remodeling et preserver la fonction respiratoire.

Asthme difficile à traiter de l'enfant, identification et explorations

Severe asthma in children is characterized by the persistence of symptoms or bronchial obstruction in spite of adequate treatment. Side effects of high dose inhaled or repeated courses of systemic corticosteroids must be considered. Therefore, an exact assessment is necessary. First, the observation of the child has to be secured and risk factors eliminated by interrogation and examination (smoking, ENT affection, allergy with persistence of high exposure, gastro-esophageal reflux). An initial thorax-X-ray is essential. After exclusion of differential diagnoses and confirmation of severe asthma, the child must be referred to a specialized department for a diagnostic work-up including a thoracic CT and bronchoscopy. Patient education including treatment can be realized in asthma schools and consultation intervals must be shortened.

Prise en charge infirmière des enfants atteints de coqueluche

Resume La coqueluche est redevenue une maladie dˈactualite. Sa cible principale est desormais le nourrisson de moins de un an, contamine par un adulte de son entourage. Les nourrissons de moins de six mois doivent etre hospitalises et la reanimation prevenue de lˈarrivee de ceux de moins de trois mois. Le risque dˈapnee avec bradycardie est en effet majeur. La surveillance infirmiere (scope, alimentation, nombre de quintes, poids) est essentielle. Lˈextreme contagiosite de la maladie justifie les macrolides chez lˈenfant et lˈentourage proche. La prevention repose sur la vaccination.

Malformaciones vasculares pulmonares en el niño

Resumen Las malformaciones vasculares pulmonares en el nino son excepcionales, y su descubrimiento se debe a los signos pulmonares o cardiacos que las acompanan. Pueden clasificarse en funcion del segmento vascular patologico: malformaciones arteriales (aneurismas, fistulas arterioarteriales), arteriovenosas (fistulas), capilares (hemangiomatosis difusa o localizada), venosas (varices) y linfaticas (linfangiectasias). Consideracion aparte merecen los secuestros pulmonares, en los cuales la vascularizacion de un segmento pulmonar es anormal, y el sindrome hepatopulmonar, en el cual una malformacion vascular hepatica ocasiona una repercusion vascular pulmonar. El diagnostico y el tratamiento de estas malformaciones se ven beneficiados, desde hace unos diez anos, por los grandes progresos de los metodos de diagnostico por imagenes (sobre todo, imagenes prenatales y angiografia mediante imagenes por resonancia magnetica) y las nuevas posibilidades que brinda la radiologia intervencionista (embolizaciones).

Discinesia ciliar primitiva de los bronquios del niño

Resumen La sintomatologia respiratoria del nino afectado de discinesia ciliar primitiva es causada por una anomalia del cilio, la mayoria de las veces estructural. Tal anomalia ocasiona un trastorno de la depuracion mucociliar que explica los cuadros clinicos dominados por la obstruccion y la sobreinfeccion. La malifestacion pulmonar de la enfermedad, cuyas primeras malifestaciones pueden ser neonatales, es una bronconeumopatia obstructiva la cual, si no es tratada, evoluciona hacia la dilatacion de los bronquios. El diagnostico se basa en el analisis de la funcion y la ultraestructura del cilio y podria valerse tambien de la medicion del monoxido de nitrogeno en los gases espirados. La genetica de las discinesias ciliares primarias, compleja debido a la heterogeneidad de las anomalias ciliares, solo ha sido parcialmente dilucidada. Un seguimiento regular, clinico, escanografico y funcional, asi como un tratamiento de por vida basado en la antibioticoterapia y en un drenaje bronquial ininterrumpido, reducen la morbilidad y protegen el capital pulmonar del nino afectado de discinesia ciliar primitiva.