LETTERS to the EDITOR

Manual chest compression for total bronchospasm

These European Resuscitation Council (ERC) Cardiac Arrest in Special Circumstances guidelines are based on the 2020 International Consensus on Cardiopulmonary Resuscitation Science with Treatment Recommendations. This section provides guidelines on the modifications required to basic and advanced life support for the prevention and treatment of cardiac arrest in special circumstances; specifically special causes (hypoxia, trauma, anaphylaxis, sepsis, hypo/hyperkalaemia and other electrolyte disorders, hypothermia, avalanche, hyperthermia and malignant hyperthermia, pulmonary embolism, coronary thrombosis, cardiac tamponade, tension pneumothorax, toxic agents), special settings (operating room, cardiac surgery, catheter laboratory, dialysis unit, dental clinics, transportation (in-flight, cruise ships), sport, drowning, mass casualty incidents), and special patient groups (asthma and COPD, neurological disease, obesity, pregnancy).

Asthma is a preventable and relatively common cause of death in young people. Under-estimating the severity of the condition and failure to anticipate subsequent relapses can contribute to poor outcomes. The management of life-threatening asthma according to international guidelines is discussed alongside expert opinion where there is an absence of high-quality data from clinical trials.

Tracheal tube placement during infant resuscitation is essential for definite airway protection. Accidental extubation due to tracheal tube displacement is a rare event, but it results in severe complications, especially in infants.

The present study evaluated how infant tracheal tube displacement is affected by tape vs. tube holder fixation using a manikin.

A tracheal tube with internal diameter of 3.5 mm was placed 10 cm from the gum ridge in an advanced life support (ALS) Baby^® simulator (Laerdal, Stavanger, Norway). In the first trial, cuff pressure was set at 15, 20, and 25 cmH₂O and trials were performed at each setting with no fixation, Durapore^® (3M, St Paul, MN) tape fixation, Multipore^® (3M) tape fixation, and Thomas^® Tube Holder (Laerdal) fixation. After 5 min of chest compression, the tracheal tube shift was measured. In the second trial, we compared the tube shift by chest compression with or without cuff in the same way.

Relative to no fixation, tracheal tube shift was significantly less in the Durapore, Multipore, and tube holder groups (p < 0.05) at all cuff settings. Of the three fixation methods, the tube holder showed significantly less shift (p < 0.05) relative to tape, regardless of the initial cuff pressure. The positional shift after chest compressions was significantly larger in the trials with cuff than in those without cuff in Durapore or Multipore fixation (p < 0.05), but did not in tube holder fixation.

There is less tracheal tube displacement with tube holder fixation than with tape during continuous infant chest compression simulation. The tube cuff can contribute to the positional shift of the tube during infant chest compression.

Critical status asthmaticus resulting in respiratory failure is frequently encountered by the pediatric intensivist. This article discusses the prerequisites and contributing causes of critical status asthmaticus, updates routine therapies, and discusses newer therapies available in the pediatric intensive care unit setting.