Chairul Yoel
Department of Child Health, University of Sumatera Utara Medical School/H. Adam Malik General Hospital, Medan, North Sumatera

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Comparison of ventilation parameters and blood gas analysis in mechanically-ventilated children who received chest physiotherapy and suctioning vs. suctioning alone Monalisa Elizabeth; Chairul Yoel; Muhammad Ali; M. Sjabroeddin Loebis; Hasanul Arifin; Pertin Sianturi
Paediatrica Indonesiana Vol 56 No 5 (2016): September 2016
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (867.979 KB) | DOI: 10.14238/pi56.5.2016.285-90

Abstract

Background Chest physiotherapy and suctioning are routine methods for airway clearance in mechanically-ventilated children. However, chest physiotherapy has not been confirmed to affect ventilation parameters, such as tidal volume (TV), peak inflation pressure (PIP), peak inspiratory flow (PIF), and peak expiratory flow (PEF), as well as blood gas analysis (BGA) values in pediatric intensive care unit (PICU) patients.Objective To determine the efficacy of chest physiotherapy and suctioning vs. suctioning alone for improving the mechanical ventilation parameters and BGA.Methods This randomized, single-blind, clinical trial was conducted from November 2012 to June 2013 in the PICU at Haji Adam Malik Hospital, Medan. A total of 40 mechanically-ventilated pediatric patients were enrolled and divided into either the chest physiotherapy and suctioning group (24 subjects) or the suctioning alone group (16 subjects). Subjects underwent treatment, followed by monitoring of their ventilation parameters and blood gas analyses. Data were analyzed by independent t-test and Mann-Whitney test.Results Subjects comprised of 23 boys and 17 girls, with an age range of 1–204 months. After the respective treatments (chest physiotherapy and suctioning vs. suctioning alone), the ventilation parameters were as follows: median TV (60.0 vs. 56.5 mL, respectively; P=0.838), median PEF (10.4 vs. 10.8 I/s, respectively; P=0.838), median PIF (7.4 vs. 8.2 I/s, respectively; P=0.469), and mean PIP (17.3 vs. 15.6 cmH2O, respectively; P=0.23). The BGA values were: median pH (7.4 vs. 7.3, respectively; P=0.838), median pCO2 (38.4 vs. 36.2 mmHg, respectively; P=1.000), mean pO2 (136.6 vs. 139.2 mmHg, respectively; P=0.834), median HCO3 (20.4 vs. 22.7 mmol/L, respectively; P=0.594), median TCO2 (22.0 vs. 23.7 mmol/L, respectively; P=0.672), mean BE (-4.3 vs. -3.1 mmol/L, respectively; P=0.629), and median O2 saturation  (98.5 vs. 98.3 %, respectively; P=0.967).Conclusion In mechanically-ventilated children in the PICU, ventilation parameters and BGA values are not significantly different between subjects who received both chest physiotherapy and suctioning and those who received suctioning alone.
Comparison of SpO2/FiO2 and PaO2/FiO2 ratios as markers of acute lung injury Dewi Shandi Laila; Chairul Yoel; Hakimi Hakimi; Munar Lubis
Paediatrica Indonesiana Vol 57 No 1 (2017): January 2017
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (21.685 KB) | DOI: 10.14238/pi57.1.2017.30-4

Abstract

Background One of the diagnostic criteria for acute lung injury (ALI) is the PaO2/FiO2 (P/F) ratio. This measurement is obtained by blood gas analysis, which involves an invasive procedure (arterial blood draw). In order to reduce invasive procedures on critically ill patients, an alternative non-invasive marker for ALI is needed. The SpO2/FiO2 (S/F) ratio attained by pulse oximetry may be a suitable alternative.Objective To investigate for a correlation between S/F ratio and P/F ratio, in order to find an alternative non-invasive marker of ALI.Methods A cross-sectional study was conducted in the pediatric intensive care unit (PICU) at Haji Adam Malik Hospital, Medan from August 2012 to June 2013. Subjects (children aged 1 month – 18 years) underwent blood gas analysis when their pulse oximetry showed saturation of 80-97% within 24 hours of ventilator use. We measured PaO2, SpO2, and FiO2 and calculated S/F and P/F ratios. Data were analyzed by Spearman’s correlation and linear regression tests.Results Of 69 PICU patients, 39 children fulfilled the criteria for ALI. The S/F ratio and P/F ratio had a weak correlation (r=0.2; P=0.18). The linear regression equation was S/F ratio = 129.67 + 0.11 (P/F), with S/F ratio values of 162.67 and 151.67 correlating to P/F ratio values of 300 and 200, respectively.Conclusion  The S/F ratio has a weak correlation with P/F ratio for ALI in children. Â