I have many younger babies with very significant changes in CT scan, significant recurrence of infections that I put on azithromycin and I have seen in first person in the last several years, there's a significant clinical improvement in this patient population.
The difficulty with this patient is that you have aspiration, you have airway obstruction, you have airway clearance limitations, you have recurrent infections and sometimes whatever you do to fix one thing, mess the other one.
QUAD #24: CHARGE Syndrome, Pulmonary Considerations with Dr. Cherie Torres-Silva
▶Ep 5 · 0:37
clinicalPatient required endotracheal intubation 12 times due to acute respiratory failure↗
▶Ep 5 · 0:37
clinicalPatient had more than 12 pneumonias in her lifetime↗
▶Ep 5 · 0:37
clinicalAt baseline, no positive pressure support was needed↗
▶Ep 5 · 1:30
clinicalCT scan showed consolidation and changes especially on the right upper posterior lobe with mild early bronchiectatic cylindrical changes in central lobes bilaterally↗
▶Ep 5 · 2:00
clinicalSwallow study showed absent swallow onset, severe impairment in management of oral secretions with penetration and silent aspiration↗
▶Ep 5 · 2:30
clinicalBronchoalveolar lavage showed elevated lipid laden macrophages of 30% and increased number of squamous cells↗
▶Ep 5 · 3:00
clinicalPatient had chronic and active infection that was both bacterial and fungal↗
▶Ep 5 · 3:15
clinicalUpper airway obstruction fell into severe category with AHI above 10↗
▶Ep 5 · 3:30
quoteThe difficulty with this patient is that you have aspiration, you have airway obstruction, you have airway clearance limitations, you have recurrent infections and sometimes whatever you do to fix one thing, mess the other one.↗
▶Ep 5 · 3:30
clinicalPatient had abnormality in right upper lobe bronchus with very cephalic takeoff and collapse in anterior posterior diameter, contributing to mucus clearance limitation↗
▶Ep 5 · 4:00
clinicalThere is correlation between how deep we're sleeping and the frequency of swallowing - in deeper parts of sleep, we swallow less↗
▶Ep 5 · 4:00
clinicalThere is increased risk of aspiration in patients that have obstructive sleep apnea and gastroesophageal reflux↗
▶Ep 5 · 4:00
clinicalIn deeper sleep, patients have higher number of obstruction events↗
▶Ep 5 · 5:20
clinicalPatients with thoracotomies or progressive scoliosis develop restrictive lung disease that interferes with airway clearance↗
▶Ep 5 · 6:00
clinicalHuff cough mobilizes secretions from peripheral airways to center, making clearance easier↗
▶Ep 5 · 6:20
epidemiologicalDental decay is directly associated with increased frequency of respiratory infections in patients that have aspiration↗
▶Ep 5 · 6:20
quoteThe number one thing I want you to take home is do not forget dental hygiene and dental decay.↗
▶Ep 5 · 6:35
quoteOne of the things that has been proven beyond doubt is that dental decay is directly associated with increased frequency of respiratory infections in patients that have aspiration.↗
▶Ep 5 · 6:50
clinicalAcid reflux is more injurious for these patients than non-acid reflux↗
▶Ep 5 · 7:10
opinionAzithromycin shows significant clinical improvement in younger babies with significant CT scan changes and recurrent infections↗
▶Ep 5 · 7:10
quoteI have many younger babies with very significant changes in CT scan, significant recurrence of infections that I put on azithromycin and I have seen in first person in the last several years, there's a significant clinical improvement in this patient population.↗
▶Ep 5 · 7:40
opinionDr. Torres-Silva always gets an EKG before starting patients on long-term azithromycin↗
▶Ep 5 · 7:40
clinicalStudies showed that patients can have further prolongation of QT interval on azithromycin↗
▶Ep 5 · 8:00
quoteHere's a tricky part because of course, the more aggressive you are with antibiotics, the more likelihood you will contribute to the development of a very resistant flora, and then you're technically chasing your tail.↗
▶Ep 5 · 8:00
clinicalThe more aggressive you are with antibiotics, the more likelihood you will contribute to development of very resistant flora↗
▶Ep 5 · 8:20
clinicalInhaled antibiotics are used to decrease systemic effects of antibiotics↗
▶Ep 5 · 8:20
opinion14-day antibiotic cycles are used because many babies cannot be 28 days without antibiotics↗
▶Ep 5 · 8:20
opinionTobramycin inhaled is the go-to medication for prophylactic antibiotics, with colistin as second line↗
