Pediatric pulmonology. Supplement
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Pediatr Pulmonol Suppl · Jan 1999
ReviewNew tools in ventilatory support: high frequency ventilation, nitric oxide, tracheal gas insufflation, non-invasive ventilation.
Protection of the lungs against ventilator-induced lung injury is becoming one of the main concerns in pediatric and neonatal intensive care. High frequency ventilation using a constant distending pressure with small variations during respiratory cycles allows adequate recruitment. High frequency oscillation is the most promising HFV mode especially in premature neonates but clinical studies are contradictory. ⋯ It is however still experimental. Maintenance of spontaneous ventilation during conventional ventilation improves gas exchange, hemodynamic functions, mobilization, active coughing, and avoids prolonged muscle weakness. Non invasive modes of ventilation like BiPAP have certain indications in pediatrics but need to become more familiar to the pediatric intensivist.
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International guidelines indicate that the primary goals of asthma treatment are minimizing symptoms and preventing exacerbations. Symptoms last for short periods of time (minutes or hours) and usually disappear either spontaneously or with the use of bronchodilator therapy. Exacerbations last for 1 or more days and need more extensive bronchodilator therapy with the possible addition of a course of oral corticosteroids. ⋯ Two recent studies in adults revealed addition of salmeterol superior to increasing inhaled corticosteroid dose. So far, no data in children are available, but theoretically it might be attractive to add a long-acting beta 2-agonist to on-going therapy for children who remain symptomatic, especially at nighttime, despite the use of inhaled corticosteroids. There is no place for the use of long-acting beta 2-agonists as monotherapy in pediatric patients.