Current opinion in pediatrics
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Curr. Opin. Pediatr. · Jun 1999
ReviewHyperbaric oxygen therapy in childhood carbon monoxide poisoning.
Hyperbaric oxygen therapy is the administration of 100% oxygen at pressures two to three times ambient pressure, and it significantly increases dissolved oxygen content. Although it has been used successfully to treat decompression illness and arterial air embolism, its role in the treatment of carbon monoxide poisoning remains somewhat controversial. ⋯ This review focuses on the unique aspects of carbon monoxide poisoning and hyperbaric oxygen therapy in the fetus, the newborn, the infant, and the child. In addition, it discusses general indications for and special and practical considerations in the use of hyperbaric oxygen therapy in children.
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The element mercury exists as inorganic, elemental, or organic species. Routes of exposure and toxicity in humans vary according to the species of mercury involved. ⋯ Although dimercaprol is contraindicated in organic mercury exposures, meso-2,3-dimercaptosuccinic acid and sodium 2,3-dimercapto-1-propanesulfonate may be used to chelate all species of mercury. Recent evidence suggests that their efficacy in organic mercury poisoning is uncertain.
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Ethylene glycol is a serious toxin that children frequently ingest. Diagnosis and treatment of this poisoning are challenging and frequently involve the use of novel therapies. In the past year, fomepizole (4-methylpyrazole) has been approved for use as an antidote in the treatment of ethylene glycol poisoning in adults, and the first article reporting the use of fomepizole in a pediatric ethylene glycol exposure was published. As a result, the therapy of ethylene glycol poisoning in children is likely to change from the traditional approach of ethanol administration coupled with hemodialysis to the administration of fomepizole with or without hemodialysis.
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Curr. Opin. Pediatr. · Jun 1999
ReviewHypoxic-ischemic brain injury: advancements in the understanding of mechanisms and potential avenues for therapy.
Hypoxic-ischemic brain injury occurs frequently in infancy and childhood. Events such as perinatal asphyxia, near drowning, respiratory arrest, and near sudden infant death syndrome cause significant mortality and morbidity. Despite current critical care practices, the outcomes from such injuries may be life-long neurologic deficits. ⋯ The development of new therapies for hypoxic-ischemic brain injury depends on such understanding. To date, the results of preclinical therapeutic trials have not demonstrated a "magic bullet." Nevertheless, the understanding of injury mechanisms has uncovered potential avenues for new therapies, particularly combination therapies or single interventions that have multiple effects. Clinical trials, using these strategies, are planned or have been recently begun and offer hope for advancements in treatment.
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Curr. Opin. Pediatr. · Jun 1999
ReviewAdvances in ventilatory support of the pediatric surgical patient.
Severe respiratory failure in newborn and pediatric patients is associated with significant morbidity and mortality. Basic science laboratory investigation has led to advances both in our understanding of ventilator-induced lung injury and in optimizing the supportive use of conventional ventilation strategies. ⋯ This review focuses on recent laboratory and clinical data detailing the techniques of permissive hypercapnia, high frequency oscillatory ventilation, inhaled nitric oxide, intratracheal pulmonary ventilation, and liquid ventilation. Some of these modalities are becoming commonplace, and others may have much to offer the clinician if their benefit is clearly demonstrated in future clinical trials.