OBJECTIVES

The current study aimed to evaluate the impact of an interprofessional simulation-based training program on providers' perception, knowledge, and confidence in proning of pregnant patients with Acute Respiratory Distress Syndrome due to COVID -19 or other causes.

METHODS

A total of 124 healthcare workers who took part in the management of patients in COVID wards and ICUs participated in the study. The simulation workshop was conducted on May 2022 and the participants were divided into interprofessional teams. Standardized patients and mannequins were used to simulate patients with ARDS. Standardized checklists for proning were used. The participants were debriefed after. The participants completed pre- and post-simulation questionnaires.

RESULTS

After the simulation workshop, the participants’ perception on the benefit of prone position in the ventilation of patients with ARDS, level of confidence in handling proning of pregnant patients, comfort in speaking to patient and next of kin regarding prone ventilation, and knowledge on proning significantly improved. Subgroup analysis
showed statistically significant improvements in knowledge scores among registered nurses, resident physicians, and participants with varying degrees of experience managing COVID-19 patients and proning pregnant patients. Majority of participants deemed it was easy to turn patients in the prone position using the supportive pillow as well as expressed confidence in doing the procedure.

CONCLUSION

Interprofessional simulation-based training of healthcare workers improved providers' knowledge and confidence in proning pregnant patients. Simulation based training also improved the comfort of the healthcare professional in advising the patient and next of kin on the benefits of proning.
Human ; World Health Organization ; Respiratory Insufficiency ; Handling (psychology) ; Occupational Groups ; Knowledge

Drug-induced sleep endoscopy (DISE) is used for directly visualizing sites of obstruction among patients with obstructive sleep apnea (OSA). Owing to the scarcity of data, there is still no consensus on the anesthetic regimen for conducting pediatric DISE.

This paper presents a 5-year-old patient who underwent DISE using an opioid-sparing regimen with dexmedetomidine and propofol infusion.

Simultaneous dexmedetomidine and propofol infusion is a promising opioid-sparing regimen for pediatric DISE.

Human ; Male ; Child Preschool: 2-5 Yrs Old ; Endoscopy ; Propofol ; Dexmedetomidine ; Sleep Apnea, Obstructive ; Anesthetics ; Apnea ; Consensus ; Paper ; Patients ; Pharmaceutical Preparations ; Research Report ; Sleep ; Sleep Apnea Syndromes ; World Health Organization

Drug-induced sleep endoscopy (DISE) is used for directly visualizing sites of obstruction among patients with obstructive sleep apnea (OSA). Owing to the scarcity of data, there is still no consensus on the anesthetic regimen for conducting pediatric DISE.

This paper presents a 5-year-old patient who underwent DISE using an opioid-sparing regimen with dexmedetomidine and propofol infusion.

Simultaneous dexmedetomidine and propofol infusion is a promising opioid-sparing regimen for pediatric DISE.

Human ; Male ; Child Preschool: 2-5 Yrs Old ; Endoscopy ; Propofol ; Dexmedetomidine ; Sleep Apnea, Obstructive

Objective:The variability of the apnea-hypopnea index（AHI） measured in the first and second halves of the night is significant in patients with obstructive sleep apnea hypopnea syndrome（OSAHS）. This variation may be related to fluid redistribution caused by the supine position during sleep. Methods:Eighty-nine adult subjects were enrolled. Circumferences（neck, chest, waist, and calf） were measured before sleep onset and upon awakening. Polysomnography（PSG） was performed, and the night was divided into two halves based on the midpoint of total sleep time to calculate AHI for each half. The correlation between changes in AHI and changes in circumferences was analyzed. Results:Twenty simple snorers and sixty-nine OSAHS patients were included, with a median AHI of 22.6（11.8, 47.3） events/hour. Compared to pre-sleep measurements, there was no significant change in neck circumference upon awakening in the control group（P=0.073）, while reductions were observed in the other three measurements（P=0.006, P=0.038, P<0.001）. In the OSAHS group, neck circumference increased（P<0.001）, and reductions were noted in the other three measurements（P<0.001 for all）, with the most significant change observed in calf circumference 40.0（37.1, 42.0） cm to 38.0（35.8, 40.5） cm. Compared to the first half of the night, total AHI, supine AHI, and NREM AHI significantly decreased in the second half（P=0.010, P=0.031, P=0.001）, while no significant changes were observed in lateral AHI and REM AHI（P=0.988, P=0.530）. Further analysis revealed a significant relationship between increased chest circumference and decreases in NREM AHI, supine AHI, and supine NREM AHI（P=0.036, P=0.072, P=0.034）, as well as between decreased lateral position AHI and increased waist circumference（P=0.048）. Additionally, this study found a negative correlation between changes in calf circumference and changes in AHI（R=-0.24, P=0.048）, while neck circumference changes positively correlated with changes in AHI（R=0.26, P=0.03）. Conclusion:In OSAHS patients during the second half of sleep compared to before sleeping, chest circumference, waist circumference, and calf circumference decrease while neck circumference increases; total AHI, supine position AHI, and NREM period AHI decrease; increases in chest circumference are associated with decreases in NREM period AHI, supine position AHI, supine position NREM period AHI. There is nocturnal variability in AHI among OSAHS patients that may be associated with fluid shifts during sleep.
Humans ; Sleep Apnea, Obstructive/physiopathology* ; Male ; Female ; Polysomnography ; Fluid Shifts/physiology* ; Adult ; Middle Aged ; Neck ; Severity of Illness Index ; Sleep/physiology* ; Snoring/physiopathology*

Objective:To investigate the safety and efficacy of submucous radiofrequency ablation of the inferior turbinate, and to provide a clinical basis for the surgical treatment of allergic rhinitis in children. Methods:Patients with obstructive sleep apnea syndrome and allergic rhinitis who were admitted to the Department of Otolaryngology Head and Neck Surgery of Shanghai Children's Hospital from January 2021 to December 2023 and underwent bilateral submucous radiofrequency ablation of the inferior turbinate and radiofrequency ablation of the adenoid tonsil were included in the study. Observational and statistical indexes were used to evaluate the curative effect. Results:A total of 51 cases were included in this study, and 43 cases were followed up for half a year. Submucous radiofrequency ablation of the inferior turbinate plus radiofrequency ablation of the adenoid tonsil achieved a good effect （total effective rate 93%）, and there was a statistically significant difference in the preoperative and postoperative symptoms of the children（P<0.05）. There were no complications such as bleeding, Eustachian tube injury, nasal adhesion, or nasal dryness. Conclusion:Under the premise of strict control of surgical indications, children with allergic rhinitis can be treated surgically. Inferior turbinate submucous radiofrequency ablation is more minimally invasive, effective, and safe, and can be used in clinical practice.
Humans ; Turbinates/surgery* ; Rhinitis, Allergic/surgery* ; Radiofrequency Ablation/methods* ; Child ; Male ; Female ; Sleep Apnea, Obstructive/surgery* ; Treatment Outcome ; Catheter Ablation ; Adolescent

Objective:To explore the causes and preventive measures of respiratory arrest following general anesthesia in children with obstructive sleep apnea （OSA）, in order to enhance the safety of OSA surgeries under general anesthesia. Methods:A retrospective analysis was conducted on the clinical and follow-up data of four pediatric cases that experienced respiratory arrest after general anesthesia for OSA at Shenzhen Hospital of Southern Medical University from March 2020 to March 2022. Results:All four children exhibited varying degrees of decreased blood oxygen saturation, cyanosis, and loss of consciousness after OSA surgery under general anesthesia, with one case experiencing respiratory and cardiac arrest. Through emergency rescue measures such as oxygen supplementation, suctioning, positive pressure ventilation, awakening, and cardiopulmonary resuscitation, all four children were stabilized. Follow-up after 2 to 6 months showed no complications. The main reasons for the occurrence are analyzed as: residual anesthetic drugs, characteristics of the OSA disease, and the unique aspects of the pediatric population. Conclusion:Children undergoing general anesthesia for OSA should be closely monitored for vital signs after surgery. If respiratory suppression occurs, active rescue measures should be taken to avoid serious consequences.
Humans ; Sleep Apnea, Obstructive/surgery* ; Anesthesia, General/adverse effects* ; Retrospective Studies ; Child ; Postoperative Complications/prevention & control* ; Male ; Female ; Child, Preschool

This case report outlines the treatment of an 11-year-old female who underwent adenotonsillectomy six years ago for snoring but experienced postoperative inefficacy. Her symptoms worsened two weeks before readmission, with increased snoring and sleep apnea, disabling her from lying down to sleep. She was readmitted on December 1, 2023, and diagnosed with severe obstructive sleep apnea hypopnea syndrome and hypercapnia. Automatic BiPAP alleviated her symptoms, with sleep breathing parameters normalizing during treatment. Follow-up at one month showed significant acceleration in her growth and resolution of her hypersomnolence issue.
Humans ; Female ; Child ; Hypercapnia/complications* ; Sleep Apnea, Obstructive/complications* ; Positive-Pressure Respiration ; Noninvasive Ventilation

Drug-induced sleep endoscopy （DISE） is an endoscopic examination performed under conditions similar to human physiological sleep induced by drugs. In recent years, its clinical application has become increasingly widespread. This article reviews the research progress on the indications, anesthesia, and outcome determination of pediatric DISE, providing a basis for the application of pediatric DISE.
Humans ; Child ; Sleep Apnea, Obstructive/diagnosis* ; Endoscopy/methods* ; Sleep

Objective:To investigate the incidence of collateral circulation in high-risk patients with sleep apnea and stroke treated by continuous positive airway pressure （CPAP） ventilation and to analyze the influencing factors. Methods:A total of 152 patients diagnosed with obstructive sleep apnea-hypopnea syndrome （OSAHS） combined with acute ischemic stroke （AIS） who were admitted to our hospital from January 2020 to June 2022 were selected for this study. Based on the apnea-hypopnea index （AHI）, the patients were divided into three groups: mild （n=44）, moderate （n=72）, and severe （n=36）. After treatment, the patients were further classified into a group without collateral circulation （n=30） and a group with collateral circulation （n=26）, which included those with moderate collateral circulation （n=69） and good collateral circulation （n=27）. Clinical data across the different groups were compared, and multiple factor analysis was performed to identify factors affecting the occurrence of collateral circulation. Results:The AHI and IL-6 levels in the severe group were significantly higher than those in the mild and moderate groups, while the levels of NO and PO2 were significantly lower in the severe group compared to the mild and moderate groups, with statistically significant differences among the three groups （P<0.05）. After treatment, all groups showed improvement, and the proportion of patients with collateral circulation was 84.09% in the mild group, 81.94% in the moderate group, and 72.22% in the severe group. Significant differences in age, AHI, NIHSS, NO, MoCA, and MMSE scores were observed between the groups with and without collateral circulation （P<0.05）. In the group with collateral circulation, the scores for age, AHI, and NIHSS in the good collateral circulation subgroup were significantly lower than those in the poor collateral circulation and moderate collateral circulation subgroups, while the scores for NO, MoCA, and MMSE were significantly higher in the good collateral circulation subgroup. Multi-factor analysis revealed that age, AHI, and NIHSS were independent risk factors for collateral circulation, whereas NO, MoCA, and MMSE served as protective factors that were negatively correlated with collateral circulation. Classification tree model results indicated that AHI had the greatest influence on the occurrence of collateral circulation among the five influencing factors, demonstrating good predictive capability. Conclusion:Most high-risk patients with sleep apnea and stroke are likely to develop collateral circulation following continuous positive airway pressure ventilation. Factors such as age, AHI, NIHSS, NO, MoCA, and MMSE are important determinants affecting the occurrence of collateral circulation.
Humans ; Collateral Circulation ; Continuous Positive Airway Pressure ; Stroke/physiopathology* ; Sleep Apnea, Obstructive/physiopathology* ; Risk Factors ; Male ; Incidence ; Female ; Middle Aged ; Aged ; Sleep Apnea Syndromes/physiopathology* ; Interleukin-6/blood*

Objective:This study aims to explore the clinical effectiveness of a novel treatment method for refractory laryngeal contact granuloma, involving CO2 laser excision with local pedicled mucosal flap transfer combined with type A botulinum toxin injection. Methods:A retrospective analysis was conducted on 18 patients with refractory laryngeal contact granuloma who visited Department of Otolaryngology Head and Neck Surgery, Nanjing Tongren Hospital, School of Medicine, Southeast University from January 2021 to June 2023. These patients underwent CO2 laser excision of the granuloma with local pedicled mucosal flap transfer combined with type A botulinum toxin injection. During follow-up, electronic laryngoscopy were performed at 1, 3, 6, and 12 months postoperatively, and local laryngeal mucosa, voice quality, and pharyngeal discomfort symptoms were evaluated. Results:Postoperative electronic laryngoscopy revealed the disappearance of granulomas in all 18 patients. Symptoms such as hoarseness, foreign body sensation in the throat, and cough were significantly improved. No complications were observed systemically or locally. No recurrence was observed during one-year follow-up. Conclusion:CO2 laser excision of granuloma with local pedicled mucosal flap transfer combined with type A botulinum toxin injection could eliminate the lesion, restore the integrity of the vocal fold lining, preserve the perichondrium, and provide a time window for mucosal flap recovery. This approach adheres to the principle of preserving normal mucosa, achieves a high cure rate, and is therefore worthy of widespread promotion and application in clinical practice.
Humans ; Retrospective Studies ; Surgical Flaps ; Botulinum Toxins, Type A/administration & dosage* ; Male ; Female ; Granuloma/therapy* ; Adult ; Middle Aged ; Granuloma, Laryngeal/therapy* ; Laryngeal Diseases/therapy* ; Lasers, Gas/therapeutic use* ; Laryngoscopy ; Laser Therapy ; Treatment Outcome