Current opinion in pediatrics
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Curr. Opin. Pediatr. · Jun 2006
ReviewVentilatory management of sleep-disordered breathing in children.
The purpose of this review is to summarize the current management of continuous positive airway pressure and noninvasive positive pressure ventilation in children with sleep-disordered breathing. ⋯ Continuous positive airway pressure is a useful second-line treatment for children with sleep-disordered breathing. Strategies to improve adherence are needed. Equipment manufacturers should be encouraged to develop equipment that better meets children's needs.
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Curr. Opin. Pediatr. · Jun 2006
ReviewEmergency and critical care pediatrics: use of medical simulation for training in acute pediatric emergencies.
Recent data suggest that pediatric trainees receive insufficient training to manage acute pediatric emergencies. This review addresses the use of medical simulation as a way for medical learners to acquire and maintain skills needed to manage pediatric resuscitations. ⋯ Medical simulation holds great promise to enhance existing pediatric training curricula by increasing skills and expertise in resuscitation. Future research is needed to identify best methods of pediatric simulation-based training.
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Assistance with airway clearance is critical for reducing morbidity and mortality in children with neuromuscular weakness. Several techniques and devices are available to enhance airway clearance in patients with neuromuscular disease. Only recently, however, has assessment of their effectiveness included children. This review highlights the rationale for use of both secretion extraction and mucus mobilization techniques and devices, emphasizing findings in pediatric patients whenever possible. ⋯ Secretion extraction and mobilization techniques are safe, even in infants who require airway clearance assistance. To date, however, criteria specific for children are lacking to determine when such modalities should be used and which ones are most effective.
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Sepsis requires prompt recognition and aggressive therapy; early goal-directed therapy decreases morbidity and mortality. Recommendations on the specific management of pediatric sepsis have historically been extrapolated from adult literature and from expert/consensus opinion. This review serves to appraise recent recommendations and determine the applicability of newly promoted adult guidelines for pediatric sepsis. ⋯ Prompt recognition, institution of appropriate therapy, and continual assessment for children with sepsis and shock are essential for improved outcomes. The emerging new literature on early goal-directed therapy is most applicable to care in the emergency department.
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Curr. Opin. Pediatr. · Jun 2006
ReviewUpdate on the acute management of status epilepticus in children.
Status epilepticus is the most common neurologic emergency in children. The understanding of its less recognizable forms, its pharmacologic management, the role of electroencephalography and the long-term morbidity and mortality as a result of status epilepticus are consistently evolving. This review frames the current understanding of several issues as they apply to acute management in the emergency department. ⋯ The understanding of different types of status epilepticus, the options for pharmacologic treatment, the tools for diagnosis and the morbidity and mortality of the disease are still evolving. As a result, several areas for further research remain that will help clinicians in their approach to this complex condition.