Resp Care
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The mixture of oxygen and nitrogen is usually sufficient to achieve the therapeutic objective of supporting adequate gas exchange. Pediatric and neonatal patients have an assortment of physiologic conditions that may require adjunctive inhaled gases to treat the wide variety of diseases seen in this heterogeneous population. Inhaled nitric oxide, helium oxygen mixtures, inhaled anesthetics, hypercarbic mixtures, hypoxic mixtures, inhaled carbon monoxide, and hydrogen sulfide have been used to alter physiology in an attempt to improve patient outcomes. Balancing the therapeutic potential, possible adverse effects, and the complexity of the technical aspects of gas delivery, it is essential that clinicians thoroughly understand the application of medical gas therapy beyond the traditional nitrogen/oxygen mixture.
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Asthma is a multifactorial, chronic inflammatory disease of the airways. The knowledge that asthma is an inflammatory disorder has become a core fundamental in the definition of asthma. Asthma's chief features include a variable degree of air-flow obstruction and bronchial hyper-responsiveness, in addition to the underlying chronic airways inflammation. ⋯ However, this underlying chronic airway inflammation has implications for the diagnosis, management, and potential prevention of the disease. This review for the respiratory therapy community summarizes these developments as well as providing an update on asthma epidemiology, natural history, cause, and pathogenesis. This paper also provides an overview on appropriate diagnostic and monitoring strategies for asthma, pharmacology, and newer therapies for the future as well as relevant management of acute and ambulatory asthma, and a brief review of educational approaches.
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Natural and man-made disasters are inevitable and appear to be more common in the current age. Substantial time and effort have been invested and millions of dollars spent on disaster prevention and management. ⋯ Importantly, reunification with family and assurance of safety in this vulnerable group is a priority. This paper addresses issues related to pediatric needs, the medical system's shortcomings in caring for children, and recommendations for action.
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Neonatal and pediatric respiratory care continues to move forward at a truly impressive pace. Recent technologic advances and an increasing number of randomized clinical trials are leading to improved outcomes for neonates, infants, children, and adolescents with respiratory illness. ⋯ It is important to note that of the prior 46 Journal Conferences, only 2 have been dedicated to neonatal and/or pediatric respiratory care topics. It is our hope that the publication of these proceedings will provide respiratory therapists, physicians, and other members of the clinical care team a foundation on which to ponder the future of neonatal and pediatric respiratory care.
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Pediatric clinicians strive to base their management decisions on best available evidence. In the quantitative research paradigm, the highest level of evidence is derived from a conclusive randomized controlled clinical trial (RCT). ⋯ We are all obligated to ensure the relevance of our research, to mentor junior investigators, and to support knowledge development in our field. This paper reviews the hurdles faced by clinical investigators in the field of pediatric critical care and offers suggestions for future clinical studies.