Ischemic Injury and Necrotizing Tracheobronchitis FREE

THOMAS E. WISWELL, MD

Am J Dis Child. 1989;143(11):1259-1260. doi:10.1001/archpedi.1989.02150230017005.

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ABSTRACT

ABSTRACT | REFERENCES

Sir.—The article by Hanson et all in the October 1988 issue of AJDC somewhat supported a personal belief that ischemic injury is involved in the propagation of necrotizing tracheobronchitis (NTB). However, I do not believe that their data justify a causal relationship, as the title of the article would imply. Although 58 infants with NTB had either profound hypotension or low 5-minute Apgar scores (the "ischemia" factors that differentiated them from the controls), the remaining 64 affected infants (54%) had neither of these factors. Furthermore, the authors state that their data were analyzed with "a two-tailed t test."¹ I suspect that they actually meant that X² analysis was used. Simplistically, the t distribution is a method of com= paring two group means, while the X² statistic compares rates or frequencies of discrete findings. The P values presented in the tables are actually those that one would

REFERENCES

ABSTRACT | REFERENCES

Hanson JB, Waldstein G, Hernandez JA, Fan LL. Necrotizing tracheobronchitis: an ischemic lesion . AJDC . 1988;;142:1094-1098.

Joshi VV, Mandavia MB, Stern L, Wigglesworth FW Acute lesions induced by endotracheal intubation . AJDC . 1972;;124:646-649.

Wiswell TE. Airway injury with mechanical ventilation . J Pediatr . 1988;;113:615-616.

Clark RH, Wiswell TE, Null DM, deLemos RA, Coalson JJ. Tracheal and bronchial injury in high-frequency oscillatory ventilation compared with conventional positive pressure ventilation . J Pediatr . 1987;;111:114-118.

Wiswell TE, Clark RH, Null DM, deLemos RA, Coalson JJ. Tracheal and bronchial injury in high-frequency oscillatory ventilation and high-frequency flow interruption compared with conventional positive pressure ventilation . J Pediatr . 1988;;112:249-256.

Wiswell TE, Turner BS, Bley JA, Hunt RE, Fritz DL. Determinants of tracheobronchial histologic alterations during conventional mechanical ventilation. Pediatrics. In press.

deLemos RA, Gerstmann DR, Clark RH, et al. High frequency ventilation: the relationship between ventilator design and clinical strategy in the treatment of hyaline membrane disease and its complications: a brief review . Pediatr Pulmonol . 1987;;3:370-372.

Wiswell TE, Clark RH. The effect of 100% oxygen on the propagation of tracheobronchial injury during high frequency and conventional ventilation . Pediatr Res . 1988;;23:530.

Mammel MC, Ophoven JP, Lewallen PK, Gordon MJ, Sutton MC, Boros SJ. High-frequency ventilation and tracheal injuries . Pediatrics . 1986;;77:608-613.

Fox WW, Spitzer AR, Smith D, Musci M, Beatty JR, Myerberg DA. Tracheal secretion impaction during hyperventilation for persistent pulmonary hypertension of the neonate . Pediatr Res . 1984;;19:323.

Mimouni F, Ballard JL, Ballard ET, Cotton RT. Necrotizing tracheobronchitis: case report . Pediatrics . 1986;;77:366-368.

Pietsch JB, Nagaraj HS, Groff DB, Yacoub UAH, Roberts JL. Necrotizing trancheobronchitis: a new indication for emergency bronchoscopy in the neonate . J Pediatr Surg . 1985;;20:391-393.

Mammel MC, Boros SJ. Airway damage and mechanical ventilation: a review and commentary . Pediatr Pulmonol . 1987;;3:443-447.

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