Seminars in pediatric surgery
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Semin. Pediatr. Surg. · Feb 2008
ReviewRespiratory failure and extracorporeal membrane oxygenation.
Conventional treatment of respiratory failure involves positive pressure ventilation with high concentrations of inspired oxygen. If adequate gas exchange still cannot be achieved extracorporeal membrane oxygenation (ECMO) may be an option. The general indication for ECMO for respiratory insufficiency is a reversible pulmonary disease, which cannot be managed by conventional means. ⋯ Aspiration and viral pneumonia are the pediatric diagnoses with the highest survival rates. Randomized controlled studies have shown a significant advantage of ECMO with regard to survival in neonates. In the pediatric age group, nonrandomized studies have shown lower mortality in ECMO-treated patients.
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Thoracic trauma is relatively frequent in children and causes considerable mortality. This is mainly due to the multiorganic nature of the trauma. The lung is more often affected even in the absence of rib fractures because of the considerable pliability of the chest wall that allows direct transfer of energy to this organ. ⋯ Most traumatic lung injuries may be treated with rest, respiratory support, and eventually intercostal drainage. Large hemorrhage may require thoracotomy, and persistent pneumothorax (indicative of tracheobronchial disruption) may require intubation with fiberoptic bronchoscopic assistance and eventually reparative or ablative surgery. Adult respiratory distress syndrome is very rarely seen in children with thoracic trauma, but it remains highly lethal.
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Semin. Pediatr. Surg. · Feb 2008
ReviewRespiratory infections: pneumonia, lung abscess, and empyema.
Pneumonia is an important clinical problem that affects children of all ages. Although effectively treated on an outpatient basis in the majority of cases, some children with respiratory infections still require hospitalization. ⋯ This article focuses on the clinical presentation, etiology, and treatment of childhood pneumonia, with special consideration given to the immunocompromised child. Two specific complications of pneumonia, lung abscess and empyema, are discussed.