Jornal de pediatria
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To review the current support and treatment strategies of the acute respiratory distress syndrome. ⋯ The last decade was marked by significant advances, such as the concept of protective ventilation for acute respiratory distress syndrome. The benefit of alternative strategies, such as high-frequency oscillatory ventilation, the use of surfactant and immunomodulators continue to be the target of study.
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To describe the current knowledge and indications for use of hypertonic saline solutions in pediatrics patients. ⋯ Resuscitation by means of hypertonic saline solutions associated or not with colloid solutions is one of the most innovative concepts for primary resuscitation from trauma and shock established in the past decade. Currently, the spectrum of potential indications involves not only prehospital trauma care, but also perioperative and intensive care therapy. However, additional randomized double-blind studies are required with both children and adult patients to confirm the advantages of the method in terms of survival.
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To review the criteria for diagnosing and treating adrenal insufficiency in patients with septic shock. ⋯ The existing data, although controversial, already provides a basis to determine when to begin hormone replacement therapy, the serum level of cortisol accepted as adequate, and the choice of corticotropin doses for performing the adrenal stimulation test and diagnosing occult or relative adrenal insufficiency in patients with septic shock.
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To review the steps involved in safe airway management in critically ill children. ⋯ Training, knowledge, and skill in airway management are of fundamental importance for pediatric intensive caregivers and are vital for the adequate treatment of critically ill children. We present an objective and dynamic text aimed at offering a theoretical basis for the generation of new protocols, to be implemented according to the strengths and difficulties of each service.
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To present a critical and updated review about sepsis, focusing especially on diagnosis and treatment. ⋯ In comparison to the advances of the past few years, little has been achieved in terms of decreasing sepsis-related mortality due to the complexity of the pathogen-host relationships. The individual regulation of host reactions did not have the expected effects. The benefits of some known strategies were confirmed. Other types of treatment, such as corticosteroids and activated protein C therapies, are emerging as promising alternatives. Research indicates that the combination of immune modulator therapies is probably the best choice to improve outcomes in sepsis.