Pediatric pulmonology
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Pediatric pulmonology · Aug 2011
Randomized Controlled TrialHigh-frequency oscillatory ventilation associated with inhaled nitric oxide compared to pressure-controlled assist/control ventilation and inhaled nitric oxide in children: Randomized, non-blinded, crossover study.
To compare the acute oxygenation effects of high-frequency oscillatory ventilation (HFOV) plus inhaled nitric oxide (iNO) with pressure-controlled assist/control ventilation (PCACV) plus iNO in acute hypoxemic respiratory failure (AHRF) children. ⋯ Both ventilatory techniques with iNO improve oxygenation. HFOV causes earlier FiO(2) reduction and increased PO(2)/FiO(2) ratio compared to PCACV at 8 hr. However, at the end of the protocol, there was no significant difference and no clinical improvement derived from the application of both ventilatory strategies with iNO. It is not possible to say what would have happened if a different conventional ventilatory mode and a fully protective ventilatory strategy had been used, given the fact that our study is non-blind, and that a limited number of patients were included in each group.
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Pediatric pulmonology · Aug 2011
Nationwide trends in the medical care costs of privately insured patients with cystic fibrosis (CF), 2001-2007.
Longer survival of patients with cystic fibrosis (CF) has been linked to initiation of national newborn screening, new therapies that prevent and treat pulmonary exacerbations, and closer monitoring of health outcomes. However, few studies have examined the economic impact of these medical advances on costs, and none have examined these costs longitudinally. ⋯ Although improvements in diagnosis and treatment have yielded substantial benefits, they have come at considerable cost, both in terms of treatment burden and healthcare dollars.
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Pediatric pulmonology · Aug 2011
Case ReportsSinus vein thrombosis as presenting finding in the congenital central hypoventilation syndrome: an insight on the pathophysiology of the association.
Congenital central hypoventilation syndrome (CCHS) is an increasingly recognized diagnosis causing central hypoventilation and may be definitively diagnosed by genetic testing. Previous authors reported the association between CCHS and central sinus venous thrombosis (CSVT) and hypothesized that CCHS could be secondary to CSVT. ⋯ We assume that effects, secondary to CCHS, upon the central venous system may explain the etiological connection between CSVT and CCHS including dysautoregulation, venous stasis or polycythemia. We believe that CCHS should be included in the differential diagnosis of patients with CSVT accompanied by respiratory abnormalities.
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Pediatric pulmonology · Aug 2011
ReviewUse of continuous positive airway pressure (CPAP) in acute viral bronchiolitis: a systematic review.
Continuous positive airway pressure (CPAP), used either alone or associated with heliox (CPAP-He), has become a popular therapeutic option for bronchiolitis. This systematic review assesses the impact of CPAP on endotracheal intubation, carbon dioxide pressure (PCO(2) ) and respiratory distress in patients with bronchiolitis. ⋯ The evidence supporting the use of CPAP to reduce PCO(2) and respiratory distress in bronchiolitis is of low methodological quality, and there is no conclusive evidence that CPAP reduces the need for intubation. No definitive conclusions could be drawn about the CPAP-He effect. Further research using higher quality methodology is needed to clarify the beneficial role of these interventions.
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Pediatric pulmonology · Aug 2011
Comparative StudyIn vitro comparison of heliox and oxygen in aerosol delivery using pediatric high flow nasal cannula.
Drug administration via high flow nasal cannula (HFNC) has been described in pediatrics but the amount of albuterol delivery with an HFNC is not known. The purpose of this study is to quantify aerosol delivery with heliox and oxygen (O(2)) in a model of pediatric ventilation. A vibrating mesh nebulizer (Aeroneb Solo, Aerogen) was placed on the inspiratory inlet of a heated humidifier and heated wire circuit attached to a pediatric nasal cannula (Optiflow, Fisher & Paykel). ⋯ The percent inhaled dose (mean ± SD) was similar with heliox and O(2) at 3 L/min (11.41 ± 1.54 and 10.65 ± 0.51, respectively; P = 0.465). However at 6 L/min drug deposition was ≥ 2-fold greater with heliox (5.42 ± 0.54) than O(2) (1.95 ± 0.50; P = 0.01). Using a pediatric model of HFNC, reducing delivered flow from 6 to 3 L/min increased inhaled albuterol delivery ≥ 2-fold but eliminated the increase in inhaled drug efficiency associated with heliox.