Resp Care
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Acute obstructive respiratory emergencies in children are a common cause of emergency department visits. The severity of these conditions ranges from mild, self-limited disease to life-threatening forms of rapidly progressive airway obstruction. A high index of suspicion is necessary for prompt diagnosis and treatment. This review discusses general principles of assessing and managing respiratory emergencies in children, as well as clinical characteristics and treatment of specific conditions such as croup, epiglottitis, bacterial tracheitis, retropharyngeal abscess, foreign bodies, and inhalational injuries.
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Review
Systematic review of the biology and medical management of respiratory syncytial virus infection.
Respiratory syncytial virus, the leading cause of serious upper and lower respiratory tract infection in infants and children, accounts for 125,000 hospitalizations and 450 deaths annually in the United States. It also may predispose to development of asthma later in life. Annual epidemics occur from November to April, and virtually all infants are infected by age 2. ⋯ The cost of the prophylactic antibody treatment is high; it is cost-effective for only the highest risk patients. Development of a vaccine remains far in the future. Application of evidence-based clinical practice guidelines is making both out-patient and in-patient therapy as effective and economical as possible.
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Respiratory distress syndrome is the most common respiratory disorder in preterm infants. Over the last decade, because of improvements in neonatal care and increased use of antenatal steroids and surfactant replacement therapy, mortality from respiratory distress syndrome has dropped substantially. ⋯ To obtain best results, a multidisciplinary approach is crucial. This review discusses surfactant replacement therapy and some of the current strategies in ventilatory management of preterm infants with respiratory distress syndrome.
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Ten million or more newborns worldwide each year need some type of resuscitation assistance. More than 1 million babies die annually from complications of birth asphyxia. Over the past 3 decades, neonatal resuscitation has evolved from disparate, word-of-mouth teaching methods to organized programs. ⋯ In this era of evidence-based medicine the most recent Neonatal Resuscitation Program guidelines were developed to provide recommendations based on the best currently-available science. A number of major proposals received considerable scrutiny during the evaluation process. Many areas of neonatal resuscitation still need to be studied.
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Pediatric acute respiratory distress syndrome (ARDS) remains an important challenge for the intensive care clinician. ARDS, which can result from either direct lung injury or from a "downstream" inflammatory process, is manifested by profound hypoxemia and respiratory failure. ⋯ This review discusses the changing definition of ARDS and available intensive care treatment modalities, including newer lung-protective mechanical ventilation strategies and adjunct therapies. The prognosis of children suffering pediatric ARDS is examined with a look toward areas of potential future intervention in this often deadly disease.