Current opinion in pediatrics
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Curr. Opin. Pediatr. · Jun 1994
ReviewInhalation-based therapies in the treatment of cystic fibrosis.
As most of the morbidity seen in cystic fibrosis (CF) is related to pulmonary complications, new therapies are being developed that seek to ameliorate these debilitating sequelae. Recently, there has been intense effort into the development of new aerosol-based therapies for CF. This review summarizes much of this recent investigation, with particular emphasis on therapies described in the literature within the past year. ⋯ The effects of tobramycin delivered via nebulizer in a cohort of stable CF patients is reported. Recombinant human DNase and distearoyl phosphatidylglycerol liposomes, agents that alter the adhesiveness of CF mucus, are outlined as possible strategies for CF treatment. Finally, antiprotease therapy is considered as a possible addition to the CF armamentarium.
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Support of oxygen delivery (DO2) is central to the care of the critically ill. Whether through interventions designed to correct deviations in cardiac output, oxygenation, or hemoglobin content, the overall therapeutic goal is to maintain perfusion and oxygen delivery to the tissues. ⋯ The mixed venous oxygen saturation serves as an excellent monitor of the adequacy of oxygen delivery in relation to oxygen consumption. As discussed in this review, controversy exists as to whether such VO2/DO2 relationships exist in patients with sepsis or the adult respiratory distress syndrome.
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Curr. Opin. Pediatr. · Oct 1993
Review Comparative StudyTransthoracic versus transesophageal echocardiography in the pediatric patient.
The development of pediatric transesophageal ultrasound imaging represents an important advance in the diagnosis and treatment of the child with congenital heart disease. Although primary diagnostic transesophageal studies are seldom indicated in infants and unoperated children, they have an important role in the older child especially where there has been prior cardiac surgery. Diagnostic studies are most appropriate for abnormalities of venous return, the atria, atrioventricular valves, and the left ventricular outflow tract. Two other important areas in which transesophageal imaging is playing an increasing role in the treatment of the pediatric patient is in monitoring interventional catheterization and in the intraoperative and immediate postoperative monitoring of surgical repair.
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Advances in pediatric anesthesia can contribute to improved care of children in other environments. As an example, drugs and dosages established in preoperative sedation of children provide a base for their application in sedation and pain relief of children undergoing painful procedures in the emergency unit, oncology treatment area, and radiology suite. ⋯ Monitoring techniques may similarly be developed in the operating suite then applied in emergency areas or critical care units. We examine a qualitative device for detecting carbon dioxide in the exhaled gases of an intubated child.
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Drowning and immersion injuries are leading causes of mortality and morbidity in children. An increasing amount of epidemiologic information is available. ⋯ Efforts at early neurologic prognostication and identification of victims who are likely to die or persist in a vegetative state are increasingly accurate and are highly relevant. Critical care physicians are more likely to withhold or withdraw support from victims who have minimal likelihood of meaningful recovery.