Browsing by Author "Dai, Zen-Kong"

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Combined Noninvasive Ventilation and Mechanical In-Exsufflator in the Treatment of Pediatric Acute Neuromuscular Respiratory Failure
(2014-06-01)
Chen, Tai-Heng
;
Hsu, Jong-Hau
;
Wu, Jiunn-Ren
;
Dai, Zen-Kong
;
Chen, I-Chen
ObjectivesThe present study aims to evaluate the efficacy and complications of combined noninvasive ventilation (NIV) and assisted coughing by mechanical in-exsufflator (MIE) for acute respiratory failure (ARF) in children with neuromuscular disease (NMD). MethodsA prospective study was conducted in the pediatric intensive care unit. Children with NMD and ARF treated by combined NIV and MIE were included. Treatment success was defined as freedom from tracheal intubation during the hospital stay. Physiologic indices including PaO2, PaCO2, pH, and PaO2/FiO(2) were recorded before and 12, 24hr after the use of NIV/MIE. ResultsCombined NIV/MIE was used in 15 NMD children (mean: 8.1 years, range: 3 months to 18 years) with 16 cases of ARF. There was no mortality in this cohort. Treatment success was achieved in 12 cases (75%), including six cases (38%) demanding Do Not Intubate. ARF was due to pneumonia, with a mean baseline PaCO2 of 73.219.0mmHg. In the success group, hypercarbia and acidosis improved after use of NIV/MIE for 24hr (PaCO2: 71.7 +/- 18.6mmHg vs. 55.8 +/- 11.6mmHg, P<0.01; pH: 7.29 +/- 0.07 vs. 7.38 +/- 0.05, P<0.01). All patients tolerated NIV/MIE well despite transient skin pressure sores in five cases. ConclusionsCombined NIV/MIE is a safe and effective approach to rapidly improve physiologic indices and decrease the need for intubation in NMD children with ARF. NIV/MIE provides a good alternative for those refusing intubation. Pediatr Pulmonol. 2014; 49:589-596. (c) 2013 Wiley Periodicals, Inc.
Life-threatening Dilated Cardiomyopathy Induced by Late-onset Neonatal Hypocalcemia
(2016-12-01)
Chou, Po-Ching
;
Lin, Lung-Chang
;
Hsu, Jong-Hau
;
Yang, Rei-Cheng
;
Jong, Yuh-Jyh
Neonatal seizures caused by hypocalcemia may be associated with cardiopulmonary dysfunction and may require specific management other than calcium supplementation. Severe dilated cardiomyopathy is an extremely rare complication in neonatal hypocalcemia and often results in high morbidity and mortality. We report here a 14-day-old neonate presenting with a gradually increasing frequency of tonic seizures. After admission, arterial desaturation was found despite supplying oxygen (4 L/min) through nasal prongs and the patient developed life-threatening respiratory distress and heart failure secondary to dilated cardiomyopathy. His critical cardiopulmonary derangements rapidly improved after respiratory support, the administration of diuretic and inotropic drugs, and the correction of his hypocalcemia and hypomagnesemia. The patient responded to treatment and was well during the 1-year follow-up period. We present this unique case history of seizure, respiratory distress, and heart failure induced by transient hypocalcemia to remind clinicians about the importance of this rare, life-threatening, but reversible, disorder. Copyright (C) 2014, Taiwan Pediatric Association. Published by Elsevier Taiwan LLC. All rights reserved.