Current opinion in pediatrics
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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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The major disorder of water and electrolyte metabolism in children is dehydrating diarrhea. The major advance in the treatment of this condition has been the development of oral rehydration therapy, ie, the enteral administration of a balanced glucose-electrolyte solution. ⋯ This review highlights current experimental and clinical studies that have focused on oral rehydration solutions that have the additional benefit of reducing the severity and duration of diarrheal disease. Recent results have been conflicting, however, and the search for the optimal solution continues.
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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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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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The growing popularity of nonoperative treatment of children with splenic injuries has seduced some physicians into a false sense of security regarding care of the injured child. Although it has been established that hemodynamically stable children with splenic, hepatic, and even renal injuries can safely be treated "expectantly," this concept cannot be applied indiscriminately. Accurate diagnosis and effective care of the child with blunt abdominal trauma is an exercise of clinical precision that demands attention to detail and thorough evaluation. This review addresses this process in light of recent advances in diagnostic imaging and in consideration of recent reports analyzing different protocols for therapeutic decision making.