Resp Care
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The pulse oximeter has become a vital instrument in the care of infants and children with cardiopulmonary disease. Recent advances in pulse oximetry technology have improved some aspects of pulse oximeter performance. ⋯ There is a growing body of evidence describing the effect of pulse oximeter utilization on processes and outcomes. This article describes the principles, limitations, current state of oximetry technology, and the impact of oximetry data and alarms on diagnosis and clinical decision-making.
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Both invasive and noninvasive mechanical ventilation techniques are inherent to the care of most patients admitted to intensive care units. Despite the everyday use of mechanical ventilation for thousands of patients and the availability of thousands of reports in the medical literature, there are no clear and consistent guidelines for the use of mechanical ventilation for pediatric patients. In many areas data are lacking, and in other areas data are extrapolated from studies performed with adult subjects. ⋯ This review highlights some of the major issues affecting the pediatric patient who requires invasive or noninvasive mechanical ventilation. These issues are pertinent to critical care clinicians because one of the most common reasons for admission to an intensive care unit is the need for mechanical ventilation. Furthermore, the duration of mechanical ventilation is one of the major determinants of the duration and cost of an intensive care unit stay.
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Extracorporeal membrane oxygenation (ECMO) is a technique developed to ensure adequate tissue oxygen delivery in patients suffering cardiac and/or respiratory failure. ECMO can provide this delivery without causing the iatrogenic damage associated with high mechanical ventilation pressures, high fraction of inspired oxygen, or high doses of inotropic medications. ⋯ The Extracorporeal Life Support Organization registry provides data on the over 20,000 ECMO cases performed to date and serves as a resource to refine this supportive therapy. This support is not without complications, and it should be used in appropriate populations, with specific criteria for initiation.
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Neonatal respiratory failure consists of several different disease entities, with different pathophysiologies. During the past 30 years technological advances have drastically altered both the diagnostic and therapeutic approaches to newborns requiring mechanical assistance. ⋯ The clinician has numerous choices among the noninvasive and invasive ventilatory treatments that are currently in use. This article reviews the pathophysiology of respiratory failure in the newborn and the available methods to treat it, including continuous positive airway pressure, conventional and high-frequency mechanical ventilation, extracorporeal membrane oxygenation, and styles of ventilation and monitoring.
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A summary of the 2-day Journal Conference on Current Trends in Neonatal and Pediatric Respiratory Care is provided. Topics included: diagnosis and management of common respiratory disorders of infants and children such as asthma, respiratory syncytial virus bronchiolitis, and cystic fibrosis; and common pediatric respiratory emergencies such as croup, epiglottitis, and inhalation injuries. ⋯ Evidence-based strategies for the resuscitation of critically ill newborns and subsequent ventilator management strategies were presented. Several faculty members discussed controversies regarding mechanical ventilation and extracorporeal membrane oxygenation for treatment of acute respiratory distress syndrome and other causes of respiratory failure in children and infants.