Expert review of respiratory medicine
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Expert Rev Respir Med · Jun 2009
Identifying and relieving asynchrony during mechanical ventilation.
Patient-ventilator asynchrony refers to the uncoupling between the mechanically delivered breath and the patient's respiratory effort. It is common during assisted mechanical ventilation and may affect the morbidity of critically ill patients. Close inspection of pressure, volume and flow waveforms - displayed by modern ventilators - may help the physician to recognize and act appropriately to minimize patient-ventilator asynchrony. During the last two decades new modes of assisted mechanical ventilation have been introduced, aiming to improve patient ventilator synchrony by modulating the triggering function and the variables that control the flow delivery and the cycling off.
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Expert Rev Respir Med · Jun 2009
Advances in therapies for pediatric pulmonary arterial hypertension.
Pulmonary arterial hypertension (PAH) is a life-threatening disease characterized by progressive obliteration of the pulmonary vasculature, leading to right heart failure and death if left untreated. Prior to the current treatment era, pulmonary hypertension carried a poor prognosis with a high mortality rate, but its prognosis has changed over the past decades in relation to new therapeutic agents. Nevertheless, pulmonary hypertension continues to be a serious condition, which is extremely challenging to manage. ⋯ While none of these new therapeutic agents have been specifically approved for children, there is evidence that each can appropriately benefit the PAH child. We review the current understanding of pediatric pulmonary hypertension, classification, diagnostic evaluation and available treatment. A description of targeted pharmacological therapy and new treatments in children is outlined.