Current opinion in pediatrics
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Curr. Opin. Pediatr. · Jun 1998
ReviewInhaled nitric oxide in the treatment of hypoxemic respiratory failure.
Inhaled nitric oxide (iNO) is a pulmonary vasodilator that recruits blood flow to well-ventilated lung areas in the presence of lung disease. iNO may improve oxygenation by decreasing intrapulmonary shunt or may worsen oxygenation by reversing hypoxic pulmonary vasoconstriction, therapy increasing ventilation-perfusion mismatch. Recent studies have examined the mechanisms for gas exchange alterations with iNO. ⋯ The potential benefit of iNO therapy must be weighed against the potential risks of inactivating surfactant and platelet function as well as influencing endogenous pulmonary vasoregulation. Well-designed studies will be important to determine whether the improvement in oxygenation outweighs these as well as unknown risks.
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Curr. Opin. Pediatr. · Jun 1998
ReviewUse of high-frequency and nonconventional ventilation for respiratory failure.
Over the past several years, many new strategies have evolved for improving the care of patients with acute lung injury and respiratory failure. Although many of these new modalities remain unproven, some show much promise for decreasing the morbidity and mortality seen in critically ill patients who need assisted ventilation. In this review, we discuss recent data concerning four of these modalities: high frequency ventilation, prone positioning, tracheal gas insufflation, and partial liquid ventilation.
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Pathologic alterations in cerebral blood flow and metabolism commonly occur following a variety of insults to the brain. An understanding of blood flow and metabolic abnormalities and the ability to monitor and manipulate cerebral blood flow and metabolism may improve outcome following brain injury. ⋯ The method utilized is dependent upon the clinical situation, the type of information needed, and the availability of the technique. This review provides an overview of the theory and application of the techniques that have been used to evaluate cerebral blood flow in children.
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Curr. Opin. Pediatr. · Jun 1998
ReviewInhaled nitric oxide therapy for pulmonary disease in pediatrics.
Inhaled nitric oxide (iNO) therapy improves gas exchange and lowers pulmonary vascular resistance in neonates and children with diverse cardiac and pulmonary disorders. Recent multicenter studies have shown that iNO reduces the need for rescue therapy with extracorporeal membrane oxygenation in term neonates with severe hypoxemic respiratory failure. ⋯ Acute iNO treatment can improve oxygenation in nearly 70% of older infants and children with acute respiratory distress syndrome, but multicenter studies have yet to demonstrate that prolonged iNO therapy can improve outcome in these patients. Further studies are needed to better identify the exact role for iNO therapy in cardiopulmonary diseases associated with hypoxemia or pulmonary hypertension.
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Despite increasing understanding of the cellular and molecular mechanisms that cause pathology in children who suffer traumatic brain injury, few advances have been made in developing new effective therapies for such injury. In the past, clinicians treated some neurologically injured patients with the sustained application of systemic hypothermia. This practice was largely abandoned when patients experienced complications; however, interest has been renewed in treatment with milder forms of hypothermia. ⋯ Promising results from two clinical trials are presented. Moreover, evidence is discussed in support of the notion that some children with traumatic brain injury, more so than adults, may benefit from hypothermic therapy. Lastly, putative mechanisms for the effects of hypothermia, including attenuation of injury caused by inflammation, excitotoxic amino acids, nitric oxide, and free radicals, are discussed.