Current opinion in pediatrics
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Curr. Opin. Pediatr. · Jun 2005
ReviewRenal replacement therapy in pediatric critical care medicine.
The use of continuous renal replacement therapy in pediatric critical care has increased in the last 10 years. Adaptive makeshift machinery has been replaced with dedicated volumetric and/or gravimetric devices that afford accurate blood flow and ultrafiltrate production rates. While renal dysfunction continues to be related to primary renal disease, the incidence of secondary causes of acute renal failure continue to grow, especially in patients following cardiothoracic surgery, bone marrow transplantation, respiratory failure and multi-organ dysfunction syndrome. ⋯ Though randomized placebo controlled trials are lacking at this time, center-based results suggest that continuous renal replacement therapy may prove beneficial to critically ill patients with sepsis and/or septic shock.
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A variety of pharmacologic agents used for procedural sedation in children to reduce pain and anxiety may produce respiratory depression and hypotension. Although standard monitoring guidelines include oxygen saturation, this measurement is limited as a guide to respiratory function. This review discusses two new monitoring techniques recently introduced to the pediatric emergency department that facilitate procedural sedation and reduce potential adverse effects of the medications administered. ⋯ Studies have illustrated the use of both devices as adjuncts to current standard monitoring of children in the outpatient setting. These modalities will facilitate the efficacy of procedural sedation in children and improve safety by enabling early recognition of hypoventilation and by reducing the risk of oversedation in children undergoing procedural sedation.
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Until recently, the diagnosis of idiopathic pulmonary arterial hypertension was virtually a death sentence, particularly for children. Although there is no cure for idiopathic pulmonary arterial hypertension, recent medical advances have dramatically changed the course of this disease in children. A review of some of the latest medical advances will provide the reader with a better understanding of the most current treatment options for children with idiopathic pulmonary arterial hypertension. ⋯ This article will provide an overview of how the current diagnostic and treatment strategies of idiopathic pulmonary arterial hypertension in children have advanced over the last several years and how this impacts on clinical practice.
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Cystic fibrosis results from disruption of the biosynthesis or function of the cystic fibrosis transmembrane conductance regulator. Cystic fibrosis transmembrane conductance regulator plays a critical role in the regulation of epithelial ion transport. Restoration of cystic fibrosis transmembrane conductance regulator function should improve the cystic fibrosis phenotype. ⋯ Strategies to improve mutant cystic fibrosis transmembrane conductance regulator function or to bypass mutant cystic fibrosis transmembrane conductance regulator function hold great promise for development of novel therapies aimed at correcting the underlying pathophysiology of cystic fibrosis.