Current opinion in pediatrics
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Curr. Opin. Pediatr. · Jun 2004
ReviewApproaches in the management of acute respiratory failure in children.
Acute lung injury (ALI) and acute respiratory distress syndrome (ARDS) are conditions that are associated with significant morbidity and mortality in children. There have been no advances in preventing ARDS, but this review highlights strategies directed at minimizing ventilator-induced lung injury and other new adjunctive therapies in the care of these patients. ⋯ It is likely that a combination of these therapies will maximize treatment and clinical outcomes in the future, but the only way that will be proven is through large controlled clinical trials in pediatric patients.
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Continuous positive airway pressure is increasingly being used in the care of premature infants. The purpose of this review is to highlight the current controversies in the use of neonatal continuous positive airway pressure. ⋯ Existing evidence suggests that short binasal prongs are most effective, nasal intermittent positive pressure ventilation is a useful way of augmenting neonatal continuous positive airway pressure and that very premature infants can be managed with neonatal continuous positive airway pressure in the delivery room as part of the resuscitation. Further research is required to determine whether important outcomes are improved with the use of nasal continuous positive airway pressure rather than endotracheal intubation and, if so, whether surfactant should be given to infants so managed. Definition of optimal levels of continuous positive airway pressure for infants at varying stages of their disease also requires further research.
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To review the current literature describing drug-induced hyperthermia and its treatment. Specifically, five syndromes will be discussed: malignant hyperthermia, neuroleptic malignant syndrome, anticholinergic poisoning, sympathomimetic poisoning, and serotonin syndrome. ⋯ Although the recognition of causative agents is increasing, the treatment of drug-induced hyperthermia remains unchanged and continues to be primarily supportive.
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Curr. Opin. Pediatr. · Dec 2003
ReviewUnraveling the Hallervorden-Spatz syndrome: pantothenate kinase-associated neurodegeneration is the name.
After the recent discovery of the major genetic defect in neurodegeneration with brain iron accumulation (NBIA, formerly Hallervorden-Spatz syndrome), this heterogeneous group of disorders can now be differentiated by clinical, radiographic, and molecular features. ⋯ Recent insight into the biochemical basis of PKAN has led to novel ideas for rational therapies. Investigations are under way to enable testing of promising compounds, first in animal models of disease and then in human patients. Identification of the genetic basis for the major form of NBIA has allowed more accurate clinical delineation of the specific diseases that compose this group, a new molecular diagnostic test for PKAN, and hypotheses for treatment of this neurodegenerative disorder.
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The field of cardiac intensive care is rapidly evolving with nearly simultaneous advances in surgical techniques and adjunctive therapies, respiratory care, intensive care technology and monitoring, pharmacologic research and development, and computing and electronics. The focus of care has now shifted toward reducing morbidity and improving "quality of life" while the survival of infants and children with congenital heart defects, including those with univentricular hearts has dramatically improved during the last three decades. ⋯ This article focuses on early identification and aggressive treatment of the low cardiac output syndrome peculiar to these patients. The authors also briefly review the recent advances in the treatment of pulmonary hypertension, mechanical support, and neurologic surveillance after cardiac surgery.