Airway compromise was found to be a common problem in children requiring critical care transport to our hospital. This retrospective review of 39 infants and children was undertaken to assess the frequency and degree of airway compromise in these children, to document the management required and to determine who performed it. Ninety-seven per cent of children had airway difficulties associated with their disease, and one-third of these required further airway management on the arrival of the transport team. Airway specialists had not been involved in the care of these children before the arrival of the transport team. This indicates that greater attention should be paid to airway management as soon as children are identified as being sufficiently ill to require transport to a tertiary care facility.
Comment In: Can J Anaesth. 1991 Mar;38(2):151-42021985
Oil tanks containing a mixture of hydrocarbons, including sulphuric compounds, exploded and caught fire in an industrial harbour. This study assesses airway symptoms and lung function in the nearby population 1½ years after the explosion.
A cross-sectional study included individuals =18 years old. Individuals living 20 km away formed a control group. A questionnaire and spirometry tests were completed by 223 exposed individuals (response rate men 70%, women 75%) and 179 control individuals (response rate men 51%, women 65%). Regression analyses included adjustment for smoking, occupational exposure, atopy, infection in the preceding month and age. Analyses of symptoms were also adjusted for stress reactions related to the accident.
Exposed individuals experienced significantly more blocked nose (odds ratio 1.7 [95% confidence interval 1.0, 2.8]), rhinorrhoea (1.6 [1.1, 3.3]), nose irritation (3.4 [2.0, 5.9]), sore throat (3.1 [1.8, 5.5]), morning cough (3.5 [2.0, 5.5]), daily cough (2.2 [1.4, 3.7]), cough >3 months a year (2.9 [1.5, 5.3]) and cough with phlegm (1.9 [1.2, 3.1]) than control individuals. A significantly increasing trend was found for nose symptoms and cough, depending on the proximity of home address to explosion site (daily cough, 3-6km 1.8 [1.0, 3.1],
Sunnybrook Health Science Centre is an adult regional trauma unit serving metropolitan Toronto and environs. We undertook a two-year retrospective review of patients admitted to our institution with blunt thoracic trauma. Three hundred and thirty-three patients with blunt trauma and an injury severity score (ISS) greater than 17 required emergency surgery. Of these, 208 had blunt thoracic injuries while 125 did not have chest injuries. Both groups were similar with respect to age but patients with thoracic trauma had a greater ISS. (P less than 0.05) and greater intraoperative mortality (P less than 0.01). The aetiology of the intraoperative deaths with one exception was exsanguination. Emergency thoracotomy or sternotomy indicated a poor prognosis with a mortality rate of 80%. The most common intraoperative problem was an elevated airway pressure. Awake intubation was undertaken in 77.5% of patients requiring anaesthesia and surgery because of the potentially compromised airways and difficult intubations due to the nature of the associated injuries. Finally, 74% of patients undergoing urgent surgery required mechanical postoperative ventilation. The presence of blunt chest trauma should be considered a marker of the severity of injury sustained by the patient.
The aim of this investigation was to study the relationship between psychologic status and respiratory health. The study comprised 715 persons aged 22 to 44 who participated in the European Commission Respiratory Health Survey. The study included a structural interview, spirometry, methacholine challenge, peak flow diary, skin prick test, and measurement of eosinophil activity in peripheral blood. The psychologic status was assessed by means of the hospital anxiety and depression (HAD) scale questionnaire. A significant correlation was found between anxiety and depression and the report of asthma-related symptoms, such as attacks of breathlessness after activity and waking with attacks of breathlessness (p
In this study, the authors assessed the impact of particulate air pollution on first respiratory hospitalization. Study subjects were children less than 3 years of age living in Vancouver, British Columbia, who had their first hospitalization as a result of any respiratory disease (ICD-9 codes 460-519) during the period from June 1, 1995, to March 31, 1999. The authors used logistic regression to estimate the associations between ambient concentrations of particulate matter (PM) and first hospitalization. The adjusted odds ratios for first respiratory hospitalization associated with mean and maximal PM10-2.5 with a lag of 3 days were 1.12 (95% confidence interval: 0.98, 1.28) and 1.13 (1.00, 1.27). After adjustment for gaseous pollutants, the corresponding odds ratios were 1.22 (1.02, 1.48) and 1.14 (0.99, 1.32). The data indicated the possibility of harmful effects from coarse PM on first hospitalization for respiratory disease in early childhood.
The concentration of particulate matter in outdoor air, as indicated by daily measures of particulate matter 10 microm in diameter (PM10) in many cities, has been found to be associated with the daily number of deaths and hospital admissions in these cities. To understand this association better, we studied the daily number of hospital admissions for respiratory diseases and the concentrations of eight pollutants in ambient air, during a period of 38 months, in an area with cold winters and air pollution that comes mainly from motor vehicles. We estimated the changes in risk of hospitalization by interquartile increases in pollutant concentrations by Poisson regression analyses. Controlling for periodic trends and weather, the relative risk of hospitalization associated with an interquartile increase of PM10 was 1.038 [95% confidence interval (CI) = 0.991-1.087]. In contrast, the relative risk associated with benzene was 1.105 (95% CI = 1.047-1.166). In a two-pollutant model, the relative risk estimates were 1.014 (95% CI = 0.966-1.063) for PM10 and 1.090 (95% CI = 1.031-1.153) for benzene. We evaluated other two- and three-pollutant models and concluded that pollutants other than PM10 are more strongly associated with hospital admissions for respiratory diseases.
STUDY OBJECTIVE--The aim was to examine whether baseline characteristics from a cross sectional survey provided sufficient information regarding non-response bias in a follow up study when compared with information on hospital admissions in the intervening years. DESIGN--This was an 11 year follow up study of a cohort selected in 1974 with register information on hospital admissions during follow up. SETTING--The study was based on a sample of cement workers from a particular Portland cement factory with suitable controls from other occupations. PARTICIPANTS--A total of 1404 men participated in the first survey in 1974, including a questionnaire and lung function tests. In 1985 1070 men were alive and of these, 928 men (87%) responded to a postal questionnaire. MAIN RESULTS--Non-responders in 1985 did not differ markedly from responders when smoking habits, respiratory symptoms, and lung function were examined in 1974. During follow up, non-responders had twice as high rates of hospital admission due to respiratory diseases as responders. These differences remained present after adjusting for minor differences in age and smoking habits. CONCLUSIONS--Equal distributions of baseline characteristics among responders and non-responders in a follow up study do not preclude non-response bias.
The aim of the study is to investigate the epidemiological situation regarding chronic respiratory diseases in populations that inhabit different climatic-geographical regions of Russia, and to develop targeted programs for prevention of these diseases.
(1) a comparative analysis of the standardized mortality data in Russia and other selected regions of the Russian North using the European standard for respiratory diseases, in a population aged 25-64; and (2) data from a randomized cross-sectional epidemiological study, with subjects from three different climatic-geographical regions of Russia.
(1) the respiratory disease-related mortality rates in the majority of Russian Northern regions were much higher compared to the national average. Although death rates from chronic lower respiratory diseases were higher among the Northern regions and in the whole of Russia relative to the countries of European Union (EU), the cause of death in the populations of the Northern regions tend to be lower respiratory infections and pneumonia; and (2) despite the absence of any significant differences in the prevalence of smoking, the prevalence of chronic respiratory diseases (COPD) is significantly higher in Far North Yakutsk compared to the other two regions in this study-Chelyabinsk and Vologda. The status of hyperborean had the highest chance of a significant contribution to COPD and cardiorespiratory pathology among all other risk factors. The results revealed a need for effective targeted strategies for primary and secondary prevention of chronic respiratory diseases for the populations of the Northern regions of Russia.
The revealed regional distinctions regarding the prevalence of, and mortality from, chronic respiratory diseases should be taken into consideration when designing integrated programs for chronic non-communicable disease prevention in these regions.
Cites: JAMA. 2004 Jun 2;291(21):2616-22 PMID 15173153
Cites: Eur Respir J. 2003 Feb;21(2):347-60 PMID 12608452
Cites: Lancet. 1997 May 24;349(9064):1498-504 PMID 9167458