Paediatric respiratory reviews
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Tracheostomy involves the surgical formation of a stoma between the trachea and the skin. It is classically thought of as a treatment to alleviate airway obstruction; however, its clinical applications are varied and include long-term ventilatory support, being an aid in pulmonary toilet and use as a covering procedure during airway surgery. In this article, we review the surgical aspects of tracheostomy, including preoperative considerations, tracheostomy tube choice, operative technique and postoperative complications. Postoperative care of the child with a tracheostomy will also be discussed.
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Paediatr Respir Rev · Sep 2006
ReviewA rational approach to home oxygen use in infants and children.
The provision of supplemental oxygen for infants and children with hypoxaemia is expensive but advantageous because it facilitates earlier discharge from hospital and enhances quality of life in the home setting. It is seen as potentially cost effective and family friendly. However, the prescription of supplemental oxygen varies greatly between neonatologists, paediatric respiratory physicians and paediatric cardiologists. ⋯ Of the limited studies available, most are small studies reporting the treatment of infants with chronic neonatal lung disease with inconsistent outcome measures. Such data are not readily extrapolated to older children, who are also poorly served by existing data in adult studies. Further delineation of the indications for home oxygen therapy is required together with appropriately designed and funded multicentre trials to provide evidence for optimal oxygen therapy.
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Significant morbidity and mortality from smoke inhalation occurs in victims of fire. Lung injury can be caused by chemical and thermal insults. A variety of noxious gases, irritants and asphyxiants are generated depending on the material burnt. ⋯ There is no evidence that the routine use of corticosteroids or prophylactic antibiotics is beneficial. Through a better understanding of the pathophysiology of smoke-induced lung injury, the effects of exogenous surfactant, leukotriene inhibitors, antioxidants, nitric oxide synthase inhibitors and fibrinolytics suggest that these compounds may have a future therapeutic role in smoke-induced injury. Studies are needed to evaluate the safety and efficacy of these potential therapies before they are used clinically.
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This article describes some of the challenges that face trainers and trainees in medical education. There are ethical issues surrounding the use of real patients - particularly children and young people. How much can a young trainee "practise" on a patient? How can they best learn practical skills or gain experience of intimate examinations? The requirements of professional behaviour of trainers towards trainees and of both towards patients are described. Patients involvement in teaching, assessment and formal examinations is discussed.
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Pneumonia is one of the most common global childhood illnesses. The diagnosis relies on a combination of clinical judgement and radiological and laboratory investigations. Streptococcus pneumoniae remains the most important cause of childhood community-acquired pneumonia. ⋯ In the minority of cases only, the actual organism is isolated to guide treatment. Antibiotics effective against the expected bacterial pathogens should be instituted where necessary. The route and duration of antibiotic therapy, the role of emerging pathogens and the impact of pneumococcal resistance and conjugate pneumococcal vaccines are also discussed.