Screening for Pericardial Effusions Possible Using Pulse-Oximetry Waveforms
Tamburro RF, Ring JC, Womback K. Detection of pulsus paradoxus associated with large pericardial effusions in pediatric patients by analysis of the pulse-oximetry waveform. Pediatrics. 2002;109(4):673-677.
Identifying children who develop pericardial effusions as the result of complications of infections or cardiac disease is difficult. These effusions, if not discovered early and treated with pericardiocentesis (removal of the fluid), can lead to death. This research investigated whether the use of pulse-oximetry waveform data can help screen children for the development of pericardial effusions making the identification of this problem easier.
The researchers conducted a retrospective chart review of 8 children who had the confirmed diagnosis of pericardial effusions. These children were diagnosed by echocardiogram and had pericardiocentesis performed to alleviate the fluid overload. At the same time, these children had been monitored for the heart rate, blood pressure, and respirations using cardiac and pulse oximeter monitors.
The printouts of the data on the vital signs showed that pulse oximeter readings dipped during inspiration in children who had pericardial effusions. This was indicative of pulsus paradoxus, which is known to be an indicator of the effusions. After pericardiocentesis was performed, the pulsus paradoxus was eliminated, and the readings were normalized.
Therefore, the researchers postulated that using the pulse oximeter readings could be a screening tool to detect the cardiac complications. Then, if the child had these data occurrences, an echocardiogram could be performed to verify the findings. If positive, this would lead to more rapid treatment of the effusions. Hopefully this would prevent the pericardial effusion from escalating into full-blown cardiac tamponade. Further research is needed to substantiate these findings in a larger sample.
Janet T. Ihlenfeld RN, PhD
Professor of Nursing, D'Youville College, Buffalo, NY.
Concurrent RSV and Bacterial Infections Are Rare in Children
Purcell K, Fergie J. Concurrent serious bacterial infections in 2,396 infants and children hospitalized with respiratory syncytial virus lower respiratory tract infections. Archives of Pediatrics and Adolescent Medicine. 2002;156(4):322-324.
Many children are admitted to hospitals every year with respiratory syncytial virus (RSV). In children with other health problems, notably prematurity and congenital defects, this infection can be dangerous. RSV is treated by the antiviral drug ribavirin. However, many physicians also prescribe broad-spectrum antibiotics such as cephalosporins for these children as well. This study investigated whether the use of antibiotics to prevent or treat a presumed concurrent bacterial infection was necessary for these children.
The sample for this study included 2,396 infants and children who had been diagnosed with RSV during 7 consecutive RSV seasons. The charts of these children were reviewed for the RSV infection, the use of ribavirin and antibiotics, and for the results of their sepsis workups.
The data showed that 95.3% of the children were younger than 2 years of age and that 8.3% had illness severe enough to warrant admission to the intensive care unit. When the data on the sepsis workup results were analyzed, it was found that only 39 had positive blood or urine cultures. The organisms that were found in the cultures were Staphylococcus epidermidis, Staphylococcus warneri, or Bacillus species. The researchers considered that each of these microorganisms were contaminants, and not true infections.
Therefore, the findings from this study showed that there were no cases of concurrent bacterial infection in this large sample of children with RSV, meaning that the administration of the antibiotics for bacteria was unnecessary. The researchers also concluded that the sepsis workups were not necessary for these infants. Considering that these workups included blood cultures, urine cultures, and lumbar punctures, these tests were painful for the children, distressful for the parents, and expensive.
The researchers recommended that routine sepsis workups on children with laboratory-diagnosed RSV are unnecessary in children without other signs of significant disease. In addition, the use of antibiotics is also unnecessary and should be reserved only for confirmed bacterial infections, the researchers noted.
Janet T. Ihlenfeld RN, PhD
Professor of Nursing, D'Youville College, Buffalo, NY.