Respiratory care clinics of North America
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Respir Care Clin N Am · Mar 1997
ReviewVentilatory support following burns and smoke-inhalation injury.
The first major improvement in the treatment of burn injury came with the recognition of the importance of fluid resuscitation to prevent shock and renal failure. Subsequently, the use of topical antibiotics to control burn-wound infection and prevent invasive burn-wound sepsis led to the next significant reduction in morbidity and mortality of burn patients. ⋯ A better understanding of pathogenic mechanisms will lead to the development of therapeutic agents and treatment regimens that will modulate the cascades of humoral mediators of organ dysfunction and reduce the morbidity and mortality associated with inhalation injury. The recognition of ventilator-induced lung injury has led to adoption of alternative ventilatory techniques such as high-frequency percussive ventilation, which has been shown to substantially reduce the morbidity associated with inhalation injury.
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Respir Care Clin N Am · Dec 1996
ReviewMetabolic measurements during mechanical ventilation in the pediatric intensive care unit.
The metabolism of critically ill infants and children is significantly influenced by their underlying diseases, and standard predictive equations result in inappropriate nutritional support in most of these patients. Furthermore, significant day-to-day variability in energy expenditure may be present in individual patients. ⋯ With the wide availability of proprietary metabolic carts suitable for use in mechanically ventilated pediatric patients, serial metabolic measurements via indirect calorimetry are feasible in most critically ill infants and children. The use of indirect calorimetry should also be considered in this population to assess changes in oxygen consumption and the relationship of oxygen consumption to oxygen delivery in response to changes in therapy, such as manipulation of cardiac output using vasoactive medications, or during weaning of mechanical ventilation.
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Respir Care Clin N Am · Dec 1996
Review Comparative StudyVolume and pressure modes of mechanical ventilation in pediatric patients.
There are few controlled pediatric studies comparing the various modes of ventilation in terms of patient outcomes. Thus at this time the choice of ventilator mode depends largely on the apparatus available, the patient's disease state, and personal preference based on one's experience. The next generation of ventilators may well allow the use of the best of both modes, setting both pressure and volume minimums and maximums, safely meeting ventilation targets. Today's challenges are to become familiar with the various modes of ventilators available, understand the developing physiology of the lung and lung disease pathophysiology, and incorporate all this into proper ventilator strategies to prevent ventilator-induced lung injury.
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Respir Care Clin N Am · Dec 1996
ReviewNitric oxide administration during pediatric mechanical ventilation.
The administration of inhaled NO in the management of pulmonary hypertension and respiratory failure is an important development in pediatric critical care. The long-term effects of this therapy are yet to be understood. An appreciation for the potential hazards and the development of accurate and safe delivery systems are paramount to the successful application of this new therapy.
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Respir Care Clin N Am · Dec 1996
ReviewSedation, analgesia, and neuromuscular blockade during pediatric mechanical ventilation.
The mechanically ventilated PICU patient is subjected to multiple noxious stimuli ranging from a bright, noisy, and intimidating environment to painful but necessary procedures. His or her primary disease process or processes obviously constitutes another potential source of noxious stimuli as well. As a result, these patients almost certainly need some combination of medications to allay anxiety, treat discomfort, and perhaps otherwise optimize medical management. ⋯ Although the frequent need for analgesics, sedatives, and NMBDs in the PICU is undisputed, the development of reliable methods for accurately assessing the degree of patient sedation or analgesia will greatly facilitate efforts to improve patient care Appropriate use of sedatives, analgesics, and NMBDs provides an invaluable service. It is important to remember, however, that even in the high-technology PICU environment verbal and physical reassurance remains a powerful tool for providing comfort and anxiolysis to critically ill children. There is no pharmacologic equivalent of human compassion.