Paediatric respiratory reviews
-
Paediatr Respir Rev · Jun 2004
ReviewTransition of young people with respiratory diseases to adult health care.
As many more young people with chronic health conditions survive well into adulthood, transition of affected young people from paediatric to adult health care is increasingly becoming the expected standard of care. Despite this, there is still little objective or long-term evidence to guide the development or deployment of developmentally appropriate transition processes or to define the precise manner in which the transfer of care should take place. ⋯ In this paper, the rationale for transition is discussed, practical strategies for transition are described, the existing evidence base supporting transition is reviewed and limitations in our knowledge are outlined. Ultimately, a carefully planned transition to adult health care should improve self-reliance, enhance autonomy and independence and support young people in attaining their maximum potential and meaningful adult lives.
-
Acquired upper airway obstruction is a common cause of respiratory emergencies in children. Most pathologic processes that result in upper airway compromise are a consequence of infection, trauma or aspiration. Today, many of the infectious causes of upper airway obstruction have lost their threat as a result of the progress made in preventing and treating these infections. ⋯ A correct diagnosis can often be made by history and physical examination, but additional studies may be useful in selected cases. The child's clinical appearance is the most reliable indicator of severity, and measurable signs are of less value. If respiratory failure is imminent, airway protection and endoscopy for definitive diagnosis may have priority over any other therapeutic or diagnostic procedure.
-
Many situations exist imposing the use of bronchoscopy in intensive care units (ICU). There are many diagnostic and therapeutic indications. ⋯ These situations seem quite frequent in paediatric ICU. This field has been developed with the availability of small endoscopes on the market and progress in instrumental and anaesthetic techniques.
-
Paediatr Respir Rev · Jan 2004
ReviewSurfactant use for neonatal lung injury: beyond respiratory distress syndrome.
Surfactant has led to a significant reduction in neonatal mortality for premature infants with lung immaturity and respiratory distress. However, surfactant therapy has been shown to be effective in the treatment of a number of other neonatal respiratory disorders and the evidence for surfactant use in such circumstances is presented. Meconium aspiration is characterised by severe atelectasis, the influx of neutrophils, edema, and hyaline membranes, with decreased levels of SP-A and SP-B and the large aggregate fraction of lung surfactant, and altered surfactant surface morphology. ⋯ Case reports have reported a benefit of surfactant for infants with CDH. In the near-term infants with severe respiratory distress, surfactant is one of the therapies along with inhaled nitric oxide and high frequency ventilations, that have resulted in improved outcomes. Surfactant treatment may be of significant benefit in newborn infants with respiratory compromise secondary to a number of insults, and further prospective evidence of its efficacy in such disorders is needed.