761. Pediatric Home Sleep Apnea Testing: Slowly Getting There!
Pediatric OSA can result in significant neurocognitive, behavioral, cardiovascular, and metabolic morbidities. Prompt diagnosis and treatment are, therefore, of paramount importance. The current gold standard for diagnosis of OSA in children is in-laboratory polysomnography (PSG). Home sleep apnea testing has been considered as an alternative as it is potentially more cost effective, convenient, and accessible. This review concentrates mainly on the use of type 2 and 3 portable monitoring devices. The current evidence on the feasibility and diagnostic accuracy of home testing in the diagnosis of pediatric OSA was examined. Overall, the evidence in children is limited. Feasibility studies that have been performed have on the whole shown good results, with several reporting > 90% of their home recordings as meeting predetermined quality criteria regarding signal artifact and minimum recording time. The limited data comparing type 2 studies with in-laboratory PSG have shown no significant differences in respiratory parameters. The results pertaining to diagnostic accuracy of type 3 home sleep apnea testing devices are conflicting. Although more research is needed, home testing with at least a type 3 portable monitor offers a viable alternative in the diagnosis of otherwise healthy children with moderate to severe OSA, particularly in settings where access to polysomnography is scarce or unavailable. Of note, since most studies have been performed in habitually snoring healthy children, home sleep apnea testing may not be applicable to children with other comorbid conditions. In particular, CO2 monitoring is important in children in whom there is concern regarding nocturnal hypoventilation, such as children with neuromuscular disease, underlying lung disease, or obesity hypoventilation, and most home testing devices do not include a transcutaneous or end-tidal CO2 channel.
762. Practice Patterns and Outcomes of Treatments for Atrial Fibrillation During Sepsis: A Propensity-Matched Cohort Study.
作者: Allan J Walkey.;Stephen R Evans.;Michael R Winter.;Emelia J Benjamin.
来源: Chest. 2016年149卷1期74-83页
Atrial fibrillation (AF) during sepsis is associated with increased morbidity and mortality, but practice patterns and outcomes associated with rate- and rhythm-targeted treatments for AF during sepsis are unclear.
763. Circulating microRNAs as Potential Biomarkers of Endothelial Dysfunction in Obese Children.
作者: Abdelnaby Khalyfa.;Leila Kheirandish-Gozal.;Rakesh Bhattacharjee.;Ahamed A Khalyfa.;David Gozal.
来源: Chest. 2016年149卷3期786-800页
Cardiovascular disease (CVD) is a complex disease with multifactorial etiology. The presence of endothelial dysfunction constitutes an early risk factor for CVD in children. Circulating microRNAs (miRNAs) are small noncoding RNAs that regulate gene expression and represent a novel class of biomarkers and therapeutic targets; therefore, we examined whether the presence of endothelial dysfunction is associated with differential expression of plasma miRNAs in otherwise healthy children.
764. Transcriptional Profiling of Endobronchial Ultrasound-Guided Lymph Node Samples Aids Diagnosis of Mediastinal Lymphadenopathy.
作者: Gillian S Tomlinson.;Niclas Thomas.;Benjamin M Chain.;Katharine Best.;Nandi Simpson.;Georgia Hardavella.;James Brown.;Angshu Bhowmik.;Neal Navani.;Samuel M Janes.;Robert F Miller.;Mahdad Noursadeghi.
来源: Chest. 2016年149卷2期535-544页
Endobronchial ultrasound (EBUS)-guided biopsy is the mainstay for investigation of mediastinal lymphadenopathy for laboratory diagnosis of malignancy, sarcoidosis, or TB. However, improved methods for discriminating between TB and sarcoidosis and excluding malignancy are still needed. We sought to evaluate the role of genomewide transcriptional profiling to aid diagnostic processes in this setting.
765. The Association Between Indwelling Arterial Catheters and Mortality in Hemodynamically Stable Patients With Respiratory Failure: A Propensity Score Analysis.
作者: Douglas J Hsu.;Mengling Feng.;Rishi Kothari.;Hufeng Zhou.;Kenneth P Chen.;Leo A Celi.
来源: Chest. 2015年148卷6期1470-1476页
Indwelling arterial catheters (IACs) are used extensively in the ICU for hemodynamic monitoring and for blood gas analysis. IAC use also poses potentially serious risks, including bloodstream infections and vascular complications. The purpose of this study was to assess whether IAC use was associated with mortality in patients who are mechanically ventilated and do not require vasopressor support.
774. Caring for Critically Ill Patients Infected With the Ebola Virus: Logistic and Human Challenges.
作者: Julien Bordes.;Nicolas Gagnon.;Jean Cotte.;Thierry de Greslan.;Claire Rousseaul.;Magali Billhot.;Jean Marie Cournac.;Ludovic Karkowski.;Sophie Moroge.;Sandrine Duron.;Benoit Quentin.;Gilles Cellarier.
来源: Chest. 2015年148卷2期e64-e65页 |