Paediatric respiratory reviews
-
Mechanical ventilation is a complex therapy with several different parameters which can be altered. In preterm and term infants, more attention has been paid to the levels of peak inspiratory pressure than to the positive end-expiratory pressure (PEEP). An awareness that lung protection can be conferred by an appropriate level of PEEP has increasingly stimulated a renewed interest in achieving the "best PEEP" strategy. ⋯ Some of this work has been performed in adults with the acute respiratory distress syndrome. In newborns, we are regrettably forced to conclude that there is, for the immediate present, no easy substitute for sensible clinical observations coupled with a judicious and cautious adjustment of PEEP. We anticipate that a more logical application of PEEP with individualisation of therapy, based on a pressure-volume relationship, will in future enable targeted tests of PEEP as a lung-protection strategy.
-
Trauma is a significant cause of morbidity and mortality in children and radiological investigations are almost always used in its management. This article reviews the radiological findings in thoracic trauma, in relation to their effects on lung parenchyma, the airways, the pleura, the great vessels, the diaphragms and the bony skeleton. Particular emphasis is given to plain radiographical and computed tomography findings, since these are the commonest imaging modalities used.
-
Paediatr Respir Rev · Sep 2002
ReviewThe development of childhood asthma: lessons from the German Multicentre Allergy Study (MAS).
Epidemiological surveys have indicated that there has been a notable increase in the prevalence of both asthma and other allergic symptoms in children and young adults. Since it seems unlikely that genetic factors would contribute to the rising trend, environmental factors might play a major part in the development of childhood asthma. In a prospective birth-cohort study, we assessed the relevance of different exposures such as mite and cat allergen exposure, environmental tobacco smoke (ETS) exposure, early infectious diseases and vaccinations for the development of childhood asthma up to the age of 10 years. ⋯ Our data do not support the hypothesis that exposure to environmental allergens directly causes asthma in childhood but that induction of specific IgE responses and the development of childhood asthma are determined by independent factors. Indoor allergen avoidance is recommended as first line treatment in secondary and tertiary prevention; however, conclusions should be drawn with caution about the possible effect of primary preventative measures. Since allergic asthma seems to be a Th2-disease, immunomodulating factors such as early childhood infections, LPS-exposure or other factors influencing gene-environment interaction and individual susceptibility seem to be relevant for the development of childhood asthma.
-
With increasing survival in cystic fibrosis (CF) there is an increasing need to deal with the desires of CF patients to become parents. In the context of 98% male infertility in CF, new techniques offer the prospect of successful parenthood. For females, successful pregnancy is possible but careful planning is required. The practical and ethical aspects of reproductive health in CF are discussed.