Jornal de pediatria
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Jornal de pediatria · May 2007
ReviewNew guidelines for the clinical management of febrile neutropenia and sepsis in pediatric oncology patients.
To provide a foundation for the diagnostic, prophylactic and therapeutic management of febrile neutropenia and sepsis in children with oncological diseases, with special attention to new protocols and guidelines. ⋯ Oncology patients are particularly vulnerable to infectious complications. Early identification and treatment are fundamental to improving survival rates.
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To examine electrolyte-free water requirements that should be considered when administering maintenance fluids in a critically ill child. We examine some of the difficulties in estimating these requirements, and discuss the controversies with respect to the traditional recommendations. ⋯ Maintenance fluid prescriptions should be individualized. No single intravenous solution is ideal for every child during all phases of illness, but there is evidence to suggest that the safest empirical choice is an isotonic solution. Hypotonic solutions should only be considered if the goal is to achieve a positive free-water balance. Critically ill children may require a reduction by as much as 40-50% of the currently recommended maintenance volumes. All patients receiving intravenous fluids should be monitored closely with daily weights, fluid balances, biochemical and clinical parameters in order to best guide this therapy.
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To review current concepts related to the procedure of tracheal intubation in children. ⋯ Tracheal intubation of children requires knowledge, skill and experience, since, if the procedure is carried out by inexperienced pediatricians, it can result in life-threatening complications.
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To review the literature relevant to diagnosis and management of meningococcal disease (MD). ⋯ MD is a life-threatening infection that requires early recognition and treatment. Time sensitive fluid resuscitation and antibiotic therapy are the most effective therapies for MD. Other therapies such as steroids may have a place in MD treatment but more definitive studies are necessary.
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Jornal de pediatria · May 2007
ReviewPharmacologic support of infants and children in septic shock.
Septic shock (SS) is a frequent cause for admission to the pediatric intensive care unit, requiring prompt recognition and intervention to improve outcome. Our aim is to review the relevant literature related to the diagnosis and management of SS and present a sequential management for its treatment. ⋯ Septic shock hemodynamics is a changing process that requires frequent assessment and therapeutic adjustments.