Current opinion in pediatrics
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Curr. Opin. Pediatr. · Aug 2002
ReviewSupport of respiratory failure in 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 in the understanding of ventilator-induced lung injury and in optimizing the supportive use of conventional ventilation strategies. ⋯ This review will focus on recent laboratory and clinical data regarding the techniques of lung protective ventilator strategies, inhaled nitric oxide, liquid ventilation, and extracorporeal life support (ECLS, ECMO). Some of these modalities are commonplace, while others may have much to offer the pediatric clinician if their benefit is clearly demonstrated in future clinical trials.
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The pediatric metabolic response to injury and operation is proportional to the degree of stress and causes an increase in the turnover of proteins, fats, and carbohydrates. Thereby, substrates are made readily available for the immune response and wound healing. Because this process requires energy, the resting energy expenditure of ill patients increases. ⋯ An appropriately designed mixed fuel system of nutritional support replete in protein does not quell this metabolic response but can result in anabolism and continued growth in ill children. In addition, the use of adequate analgesia and anesthesia is a readily available and proven means of reducing the magnitude of the catabolism associated with operation and injury. Finally, as hormonal- and cytokine-mediated metabolic alterations are better understood, therapeutic interventions may become available to directly modulate the metabolic response to illness, thus potentially further improving clinical outcome in pediatric surgical patients.