BACKGROUND: The aim of this study was to evaluate if an effective and noninvasive treatment of sleep-disordered breathing may decrease the frequency of nocturnal enuresis in children presenting both the aforesaid clinical conditions. METHODS: The study was carried out within our pediatric outpatient clinic in Campus Bio-Medico University Hospital of Rome, enrolling a total of 90 children, aged between 5 and 15 years, presenting nocturnal enuresis and sleep-disordered breathing. After clinical evaluation, children were randomized in two different treatment groups: group 1, desmopressin with or without oxybutynin, dietary and lifestyle recommendations and myofunctional therapy; group 2, desmopressin with or without oxybutynin, and dietary and lifestyle recommendations. All patients were treated for 3 months. RESULTS: After 3 months of therapy and 3 months of follow-up, the response rate distribution was 85.7% for the group 1 and 56.2% for the group 2. The results were statistically significant (P<0.05). This study was conducted in accordance with the regulatory standards of Good Clinical Practice and the Declaration of Helsinki. CONCLUSIONS: A higher response rate was achieved by the group treated with the combination of pharmacological and myofunctional therapy.
BACKGROUND: Predicting successful weaning of critically ill patients from MV can be very challenging. Therefore, the aim of this study was to evaluate diagnostic accuracy of N-terminal pro brain natriuretic peptide (pro-BNP) to predict weaning failure. METHODS: Thirty ICU patients at Fayoum University Hospital were included. Variables measured at start of MV and during spontaneous breathing trial (SBT) static respiratory compliance at the start of MV, PaO2/FIO2, RSBI, ABG and N-terminal pro-BNP. RESULTS: According to the study outcomes, Survivor group N.=23: 76.7%, non-survivor group N.=7: 23.3%. N-terminal pro BNP increased significantly during SBT with mean +/- SD 15275 +/- 6667.7ng/L (SD) versus 1599.7 +/- 1448.7ng/L (SD) ng/L at start of MV. At start of MV, N-terminal pro-BNP showed no statistically significance correlations with static compliance and ABG, while highly significant positive correlation with RSBI. During SBT it showed no statistically significance correlations with RSBI and static compliance, while significant positive correlation with PO2. BNP, at start of MV cutoff point = 1765 ng/L with sensitivity 78.3% and specificity 57.1% and during SBT cutoff point = 18500 ng/L with sensitivity 87% and specificity 57.1%. BNP in non-survivor at start of MV was 2764.3 ng/L and 20178.6 ng/L during SBT while among survivor at start of MV was 1245.2 ng/L and 13782.6ng/L during SBT. CONCLUSIONS: Serum NT-pro-BNP appears promising to detect weaning-induced cardiovascular dysfunction as it is difficult to apply echocardiography as a routine monitor in the ICU. Further investigation is required to assess the utility of this test as a complement of the standard clinical monitoring of the weaning trial.
