"Percussive" orbital trauma from wooden drumstick.
Ontology highlight
ABSTRACT:
SUBMITTER: Garcia GA
PROVIDER: S-EPMC8363944 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:IntroductionAlthough intra-orbital foreign bodies (IOrFBs) are commonly seen in daily ophthalmology practice, rarely, they can have very unusual clinical presentations, especially nonmetallic FBs.Presentation of caseA 33-year-old male presented with sudden onset right lower lid swelling and tearing. He was initially tolerating the symptoms, however, it got progressively worse, so he came two weeks after the initiation of symptoms. His eye vitals were within normal limit, including the visual acuity of 6/6 OU. Additionally, slit lamp and fundus examinations were benign. Concern was for infectious etiology with unclear source. After a lengthy conversation, he recalled falling on the ground with face down about 16 months ago. However, he stated that he had remained asymptomatic and never went for treatment after the incident. Non-contrast CT of head and orbit showed hyperdense tract in medial aspect of right eye adjacent to the globe, piercing across the bilateral ethmoidal sinuses. Thus, a diagnosis of retained IOrbFB was made. He underwent surgery where a 5cm rotten wood was extracted. Post-surgical course was uncomplicated. Not all penetrating intra-orbital foreign bodies present immediately after the incident. In our case the patient remained asymptomatic for 16 months.ConclusionTherefore, when dealing with an ocular infection of unclear source, clinicians should ask about distant histories of ocular or facial injuries to assess intraocular foreign bodies.
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Project description:BackgroundHigh-frequency percussive ventilation (HFPV) is an alternative mode of mechanical ventilation that has been shown to improve gas exchange in subjects with severe respiratory failure. We hypothesized that HFPV use would improve ventilation and oxygenation in intubated children with acute bronchiolitis.MethodsIn this single-center prospective cohort study we included mechanically ventilated children in the pediatric ICU with bronchiolitis 1-24 months old who were transitioned to HFPV from conventional invasive mechanical ventilation from November 2018-April 2020. Patients with congenital heart disease, on extracorporeal membrane oxygenation (ECMO), and with HFPV duration < 12 h were excluded. Subject gas exchange metrics and ventilator parameters were compared before and after HFPV initiation.ResultsForty-one of 192 (21%) patients intubated with bronchiolitis underwent HFPV, and 35 met inclusion criteria. Median age of cohort was 4 months, and 60% were previously healthy. All subjects with available oxygenation saturation index (OSI) measurements pre-HFPV met pediatric ARDS criteria (31/35, 89%). Mean CO2 decreased from 65.4 in the 24 h pre-HFPV to 51 (P < .001) in the 24 h post initiation. SpO2 /FIO2 was significantly improved at 24 h post-HFPV (153.3 to 209.7, P = .001), whereas the decrease in mean OSI at 24 h did not meet statistical significance (11.9 to 10.2, P = .15). The mean peak inspiratory pressure (PIP) decreased post-HFPV from 29.7 to 25.0 at 24 h (P < .001). No subjects developed an air leak or hemodynamic instability secondary to HFPV. Two subjects required ECMO, and of these, one subject died.ConclusionsHFPV was associated with significant improvement in ventilation and decreased exposure to high PIPs for mechanically ventilated children with bronchiolitis in our cohort and had a potential association with improved oxygenation. Our study shows that HFPV may be an effective alternative mode of ventilation in patients with bronchiolitis who have poor gas exchange on conventional invasive mechanical ventilation.
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Project description:ObjectiveHigh frequency percussive ventilation (HFPV) is used in acute respiratory failure, but is poorly described in pediatrics. We aimed to describe the clinical characteristics, ventilator settings, and outcomes of a large pediatric cohort, and to determine predictors of who would benefit from HFPV.HypothesisGas exchange 2 h after HFPV initiation predicts success.DesignSingle center retrospective cohort study testing association between gas exchange 2 h after HFPV initiation with success, defined a priori.PatientsIntubated children on HFPV for ≥2 h from 2012 to 2018.MethodsWe described indications, ventilator settings, and gas exchange immediately before, 2 h after, and at termination of HFPV. Univariate and multivariate regression tested association of oxygenation and ventilation after HFPV initiation with success. Areas under the receiver operating characteristic (AUROC) curve and adjusted odds ratios (aORs) were computed.ResultsWe performed 237 courses of HFPV in 193 children (22% non-survivors), of which 162 (68%) were successful. In univariate analysis, pH (AUROC, 0.65) and PCO2 (AUROC, 0.66) 2 h after HFPV predicted success. In multivariate analysis, pH (aOR: 1.67 per 1 SD; 95% confidence interval [CI]: 1.19-2.35), PCO2 (aOR: 0.49 per 1 SD; 95% CI: 0.31-0.79), and oxygenation index (aOR: 0.66 per 1 SD; 95% CI: 0.44-0.97) 2 h after HFPV initiation were associated with success.ConclusionWe describe the largest cohort of HFPV to date, with detailed description of indications and settings. Gas exchange after 2 h of HFPV was independently associated with success.
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