Paediatric respiratory reviews
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Paediatr Respir Rev · Mar 2005
ReviewDevelopment of medicines for children in Europe: ethical implications.
Ethics of clinical trials in children have been a longstanding topic for debate. Children are vulnerable, unable to consent to participation in trials from a legal perspective and deserve to be protected. Ethical principles and the European legal framework define the safeguards that need to be put in place in any paediatric trial, be it performed in developed or in developing countries. ⋯ However, there is an ethical need to study medicines as data obtained in adults cannot be extrapolated to children. It is our collective responsibility to obtain sufficient information to be able to prescribe medicines safely whilst protecting children who are exposed in the trials. Future European paediatric regulations should encourage the development of medicines in high-quality ethical research and ensure availability of information to the public.
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From the earliest stage of lung development, there is an accompanying blood circulation. In the adult lung, the pulmonary arteries are closely associated with the airways. During early fetal development, the airways act as a template for pulmonary blood vessel development in that the vessels form by vasculogenesis around the branching airways. ⋯ As blood vessels increase in size, they develop a muscle wall that is relatively thick during fetal life and shows a rapid reduction after birth. The control of development by growth factors and the physiological changes immediately after birth are described in this review. Abnormal pulmonary vascular development leading to pulmonary arterial hypertension and strategies for treatment are also discussed.
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Paediatr Respir Rev · Mar 2005
ReviewSome chronic obstructive pulmonary disease will originate in neonatal intensive care units.
Chronic lung disease is the most common adverse outcome in survivors of prematurity. These infants experience frequent hospitalisation because of respiratory-related illness in their first year, as well as persistent cough, wheeze and oxygen dependence. ⋯ Although there is little longitudinal follow-up data beyond adolescence, imaging studies suggest that these infants are highly likely to suffer with respiratory problems akin to chronic obstructive pulmonary disease in later adulthood. The nature of their long-term respiratory problems, the impact of cigarette smoking and the effect on life expectancy are all unanswered questions that need addressing as these infants grow up.
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Paediatr Respir Rev · Dec 2004
ReviewHigh frequency oscillatory ventilation in acute respiratory failure.
High frequency oscillatory ventilation (HFOV) has emerged over the past 20 years as a safe and effective means of mechanical ventilatory support in patients with acute respiratory failure. During HFOV, lung recruitment is maintained by application of a relatively high mean airway pressure with superimposed pressure oscillations at a frequency of 3 to 15Hz, creating adequate ventilation using tidal volumes less than or equal to the patient's dead space volume. ⋯ Data in the neonatal population suggests significant benefits in pulmonary outcomes when HFOV is applied with a recruitment strategy in preterm infants with respiratory distress syndrome (RDS). Use of HFOV in the paediatric and adult populations has not as yet been associated with significant improvements in clinically important outcome measures.
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Paediatr Respir Rev · Sep 2004
ReviewNovel approaches in conventional mechanical ventilation for paediatric acute lung injury.
Acute lung injury remains a major cause of morbidity and mortality in paediatric intensive care units. Research over the past decade has altered our understanding of the pathophysiology of acute lung injury and the effects of mechanical ventilation on the lung. ⋯ Current techniques for accomplishing these goals include adjusting the ventilator based on the measurement and interpretation of pressure-volume curves, limitation of inspiratory tidal volumes, use of elevated levels of positive end-expiratory pressure, recruiting manoeuvres and prone positioning. The currently available data regarding the efficacy and appropriate use of these techniques are reviewed.