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 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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To review the various challenges of providing mechanical ventilation to pediatric patients with diseases of increased airway resistance, diseases of abnormal lung compliance or normal lungs. ⋯ The last decade was marked by significant advances in the management of pediatric respiratory failure. The choice of mechanical ventilation strategy can significantly influence the subsequent course of lung injury. Mechanical ventilation can no longer be viewed simply as a harmless support modality that is employed to keep patients alive while disease-specific treatments are used to ameliorate the underlying pathology.
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Jornal de pediatria · May 2007
ReviewEnd-of-life care in children: the Brazilian and the international perspectives.
To analyze the medical practices and the end-of-life care provided to children admitted to pediatric intensive care units in different parts of the globe. ⋯ The adoption of LSL with children in the final phases of irreversible diseases has ethical, moral and legal support. In Brazil, these measures are still being adopted in a timid manner, demanding a change in behavior, especially in the involvement of families in the decision-making process.
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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.