Browsing by Author "Jovicic, Nevena (57204552756)"

Background/Objectives: Prediction of a difficult airway during pre-anesthetic evaluation is of great importance because it enables an adequate anesthetic approach and airway management. As there is a scarcity of prospective studies evaluating the role of anthropometric measures of the face and neck in predicting difficult airways in infants with an apparently normal airway, we aimed to identify the aforementioned predictors of difficult facemask ventilation and intubation in infants. Methods: A prospective, observational study that included 97 infants requiring general endotracheal anesthesia was conducted. Anthropometric and specific facial measurements were obtained before ventilation and intubation. Results: The incidence of difficult facemask ventilation was 15.5% and 38.1% for difficult intubation. SMD (sternomental distance), TMA (tragus-to-mouth angle distance), NL (neck length) and mouth opening were significantly lower in the difficult facemask ventilation group. HMDn (hyomental distance in neutral head position), HMDe (hyomental distance in neck extension), TMD (thyromental distance), SMD, mandibular development and mouth opening were significantly different in the intubation difficulty group compared to the non-difficult group. HMDn and HMDe showed significantly greater specificities for difficult intubation (83.8% and 76.7%, respectively), while higher sensitivities were observed in TMD, SMD and RHSMD (ratio of height to SMD) (89.2%, 75.7%, and 70.3%, respectively). Regarding difficult facemask ventilation, TMA showed greater sensitivity (86.7%) and SMD showed greater specificity (80%) compared to other anthropometric parameters. In a multivariate model, BMI (body mass index), COPUR (Colorado Pediatric Airway Score), BOV (best oropharyngeal view) and TMA were found to be independent predictors of difficult intubation, while BMI, ASA (The American Society Physical Status Classification System), CL (Cormack–Lehane Score), TMA and SMD predicted difficult facemask ventilation. Conclusions: Preoperative airway assessment is of great importance for ventilation and intubation. Patient’s overall condition and facial measurements can be used as predictors of difficult intubation and ventilation. © 2024 by the authors.

Home noninvasive ventilation (NIV) is expanding worldwide for pediatrics and is mainly indicated to treat nocturnal alveolar hypoventilation. Nasal mask is the most common interface used in children, but oronasal mask may be indicated in case of excessive mouth leaks or facial weakness. Obstructive events caused by the oronasal mask have been reported in a few studies on adult patients, but never in pediatrics. Some strategies to prevent their occurrence have been proposed, such as the increase of expiratory positive airway pressure (EPAP), the use of automatic adjusted EPAP or the switch to a nasal mask. We report here the cases of 2 adolescents with neuromuscular diseases, who experienced upper airway obstructive events by an oronasal mask. The management of these patients to improve NIV efficacy is described and discussed in line with the adult literature. © 2024 Elsevier B.V.

Introduction: The Asthma Control Questionnaire (ACQ) is a seven-item questionnaire assessing symptoms that asthma clinicians consider to be most important for evaluating the adequacy of asthma control. An online version of the ACQ may be able to indicate whether a visit to the physician is warranted to modify therapy to achieve better control of their asthma, ultimately reducing the number of unnecessary visits, particularly during the pandemic. The aim of our study is to compare the paper and online ACQ to validate the online version for use in real-life settings. Methods: Our study included 28 patients who completed both paper and the online ACQ on the same day when they came home. The online version of the questionnaire was prepared to look similar to the paper form, with the same sentences and answers. Results: The correlation between paper and online ACQ questionnaires was very high (r = 0.935; p < 0.001). When comparing each individual item, correlation coefficients ranged from 0.672 to 0.935. The lowest correlation is obtained in activity limitations, while the next one is 0.767, others higher than 0.8. The online form gave small and insignificantly higher scores compared to paper form with mean difference between −0.07 and 0.21. Mean difference of 0.01 (p = 0.986) between paper ACQ and online ACQ is obtained. Conclusion: The online version of the ACQ can be used for asthma control monitoring in pediatric patients in order to minimize unnecessary social contacts as well as hospital patient load, but retain adequate surveillance of disease symptoms by their physician. © 2023 Taylor & Francis Group, LLC.