Jornal de pediatria
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Jornal de pediatria · May 2007
ReviewEnd-of-life care in children: the Brazilian and the international perspectives.
To analyze the medical practices and the end-of-life care provided to children admitted to pediatric intensive care units in different parts of the globe. ⋯ The adoption of LSL with children in the final phases of irreversible diseases has ethical, moral and legal support. In Brazil, these measures are still being adopted in a timid manner, demanding a change in behavior, especially in the involvement of families in the decision-making process.
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Jornal de pediatria · May 2007
ReviewPharmacologic support of infants and children in septic shock.
Septic shock (SS) is a frequent cause for admission to the pediatric intensive care unit, requiring prompt recognition and intervention to improve outcome. Our aim is to review the relevant literature related to the diagnosis and management of SS and present a sequential management for its treatment. ⋯ Septic shock hemodynamics is a changing process that requires frequent assessment and therapeutic adjustments.
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Jornal de pediatria · May 2007
ReviewAnalgesia and sedation in children: practical approach for the most frequent situations.
To review the most frequent recommendations, doses and routes of administration of sedatives, analgesics, and muscle relaxants in children, as well as the methods for monitoring the level of sedation. ⋯ Sedation should be tailored to each child for each specific situation. Protocols that facilitate the correct selection of drugs, their appropriate administration and careful monitoring improve the quality of sedation and analgesia and avoid their adverse effects.
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To review the various challenges of providing mechanical ventilation to pediatric patients with diseases of increased airway resistance, diseases of abnormal lung compliance or normal lungs. ⋯ The last decade was marked by significant advances in the management of pediatric respiratory failure. The choice of mechanical ventilation strategy can significantly influence the subsequent course of lung injury. Mechanical ventilation can no longer be viewed simply as a harmless support modality that is employed to keep patients alive while disease-specific treatments are used to ameliorate the underlying pathology.
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To assess the use of noninvasive ventilation (NIV) in children and its application in the acute and chronic setting of pediatric respiratory failure. ⋯ Although the use of NIV is increasingly recognized in pediatrics, there are currently still no generally accepted guidelines for its use. In the chronic setting, its use has mainly been proven in obstructive sleep apnea and respiratory failure secondary to neuromuscular disorders. It would appear that the major challenge is ensuring compliance, and this can be enforced by patient/caregiver education, use of a suitable interface, heated humidifiers and by minimizing the side effects of NIV. In the setting of acute respiratory failure, it would appear from available data that success is usually predicted by the rapidity of response. Patients placed on NIV should be monitored closely and this mode of ventilation should be reviewed if there is a lack of response within a few hours after commencement of therapy.