Pediatric respiratory diseases: 2011 update for the Rogers' Textbook of Pediatric Intensive Care
ABSTRACT To review articles relevant to the field of pediatric respiratory disease that were published after the 2008 Rogers' Textbook of Pediatric Intensive Care.
The authors searched the PubMed database (http://www.ncbi.nlm.nih.gov/sites/entrez) from the National Library of Medicine for citations from the pediatric and adult literature relevant to pediatric status asthmaticus, bronchiolitis, pneumonia, acute lung injury, acute respiratory distress syndrome, and neonatal respiratory failure. The authors also searched the reference lists of key primary publications and recent review articles, and queried the National Institutes of Health's ClinicalTrials.gov Web site (www.clinicaltrials.gov) to obtain information about ongoing clinical trials for acute lung injury. The authors had knowledge of new publications in the field of respiratory monitoring, which were considered for inclusion in the review.
The authors reviewed the promising articles and the decision to include any article in the review was based on its potential to inform pediatric intensive care practice or future research.
Articles in six categories were selected for inclusion: status asthmaticus, bronchiolitis, pneumonia, acute lung injury/acute respiratory distress syndrome, respiratory monitoring, and neonatal respiratory failure.
There have been important new developments relevant to the pathogenesis and management of pediatric respiratory diseases. In particular, new insights into the causal pathways of respiratory syncytial virus-induced airways disease can potentially lead to novel therapies. Computed tomography imaging of the injured lung during mechanical ventilation has opened new avenues for future research directed at testing new treatments in acute lung injury subpopulations defined according to lung mechanics. Promising new monitoring techniques may play a supporting role in the conduct of these studies. Finally, evidence from the neonatal literature recently has shown how the course and future consequences of respiratory failure in this population may be modified through more widespread use of noninvasive support.
- Pediatric Critical Care Medicine 11/2012; 13(6):623-4. DOI:10.1097/PCC.0b013e31826b773d · 2.33 Impact Factor
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ABSTRACT: Respiratory diseases are still a frequent pathology of the infant and toddler, which determine morbidity and sometimes even mortality. Many respiratory diseases, of di�erent etiology and with di�erent physiopathological mechanisms associate acute respiratory failure. In the last decades more and more therapeutic options of acute respiratory failure (ARF) in infant and toddler are available. �e patient with respiratory disease and acute respiratory failure require etiologic therapy and pathogenetic treatment with oxygenotherapy. �is treatment is essential to maintain adequate tissue oxygenation, which is achieved physiologically through spontaneous ventilation and adequate circulation.
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ABSTRACT: Respiratory syncytial virus (RSV) infection can progress to acute respiratory distress syndrome (ARDS) in infants. ARDS is a life-threatening condition that is characterized by severe hypoxemia, defined as PaO2 /FiO2 ratio <300 mmHg. This ratio is used in many trials as the sole oxygenation criterion for ARDS. Recently, however, it has been shown in adults with ARDS that FiO2 , independently of the PaO2 /FiO2 ratio predicts mortality. Because epidemiology and outcome of ARDS differ strongly between children and adults, we determined if FiO2 on admission (baseline FiO2 ) independently predicted the duration of mechanical ventilation (MV) and length of stay (LOS) in the pediatric intensive care unit (PICU) in infants with RSV-induced ARDS. Retrospective observational study. A 14-bed pediatric intensive care unit. One hundred twenty-nine mechanically ventilated infants with RSV-induced ARDS. None. Independent predictors for outcome, including baseline FiO2 and PEEP, were analyzed using the cox regression model. Endpoints were duration of MV and LOS in the PICU. A higher baseline FiO2 was independently associated with a longer duration of MV (HR 0.12, CI 0.02-0.87, P = 0.036) and increased LOS in the PICU (HR 0.09, CI 0.01-0.57, P = 0.023). Neither baseline PEEP nor PaO2 /FiO2 ratio correlated with outcome. FiO2 level independently predicted outcome in infants with RSV-induced ARDS, whereas both PEEP and the PaO2 /FiO2 ratio did not. This suggests that FiO2 should be taken into account in defining disease severity in infants with RSV-induced ARDS. Pediatr Pulmonol. © 2013 Wiley Periodicals, Inc.Pediatric Pulmonology 11/2014; 49(11). DOI:10.1002/ppul.22974 · 2.30 Impact Factor