Effect of upper respiratory infection on anaesthesia induced atelectasis in paediatric patients

An Unusual Case of Severe Atelectasis: Mucus Impaction in a Young Obese Female

Atelectasis is defined as the the loss of lung volume due to collapse of lung tissue and is usually associated with symptoms of respiratory distress, including increased work of breathing and increased oxygen requirements. It is common in hospitalized patients with limited mobility and in patients with underlying lung conditions. Treatment is largely supportive when no underlying condition is identified. It is rare to occur in otherwise healthy individuals. The patient in this case presented to the emergency department with complaints of progressive shortness of breath, productive cough, chest tightness, subjective fever, chills, and nasal congestion for two weeks. Physical exam revealed decreased breath sounds on the left side, raising the suspicion for atelectasis or pneumothorax. Chest X-ray revealed complete white-out of the left lung. Bronchoscopy was performed and revealed mucus impaction in the left mainstem bronchus, which was removed. Repeat chest X-ray revealed resolution of atelectasis. The patient's symptoms improved, and she was discharged with outpatient pulmonary follow-up. The case described below illustrates that even in young patients with no underlying comorbidities, other than obesity, atelectasis as a cause of respiratory complaints should always be considered.

Association between preoperative respiratory symptoms and perioperative respiratory adverse events in pediatric patients with positive viral testing

STUDY OBJECTIVE

To determine the association between the presence of upper respiratory tract viral infection symptoms and occurrence of perioperative respiratory adverse events (PRAE) in children with positive viral screening, and to analyze the risk of PRAE in children with SARS-CoV-2 compared to non-SARS-CoV-2 infection.

DESIGN

A prospective cohort study.

SETTING

A tertiary, freestanding pediatric hospital in Dallas, Texas.

PATIENTS

Children <18 years of age with positive respiratory viral testing who underwent general anesthesia.

INTERVENTION

Measurement of incidence of PRAE and severe adverse events during the first 7 postoperative days.

MEASUREMENTS

The primary outcome was a composite of PRAE: oxygen saturation < 90% for >5 min, supplemental oxygen for >2 h after anesthesia, laryngospasm, and bronchospasm. The secondary outcome was severe adverse events: high flow nasal cannula >6 l of oxygen per minute, admission to the ICU for escalation of respiratory support post-anesthetic, acute respiratory distress syndrome, postoperative pneumonia, cardiovascular arrest, extracorporeal life support, and death.

MAIN RESULTS

In this convenience sample of 196 children, 83 were symptomatic and 113 were asymptomatic. The risk of PRAE was similar in children with active viral symptoms and asymptomatic children (risk difference: -1.9%; 95% CI: -10.9, 7.9%), but higher among children with documented fever within 48 h of the anesthetic (risk difference: 20.8%; 95% CI: 5.3, 39.7%). The multivariable adjusted odds ratio of PRAE was 0.68 (95% CI: 0.25, 1.85) for symptomatic compared to asymptomatic patients, and 0.46 (95% CI: 0.14, 1.44) for patients with SARS-CoV-2 compared to non-SARS-CoV-2 infection.

CONCLUSIONS

There was no significant difference in the incidence of PRAE between symptomatic and asymptomatic children with laboratory confirmed viral respiratory infection, and between children with the Omicron variant of SARS-CoV-2 compared to non-SARS-CoV-2 respiratory viruses. However, the risk was increased in children with recent fever.