Current opinion in pediatrics
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Curr. Opin. Pediatr. · Aug 2001
ReviewTopical anesthetics in children: agents and techniques that equally comfort patients, parents, and clinicians.
Topical anesthetics are increasingly important, as the number of outpatient surgeries for dermatologic problems in infants and children is steadily growing. This noninvasive modality of anesthetic delivery in conjunction with a reassuring environment may minimize the discomfort of otherwise painful procedures. ⋯ Eutectic mixture of local anesthetics is currently the most frequently prescribed topical agent, though the use of ELA-max, another lidocaine-containing preparation, is gaining momentum, especially in the neonatal population. Amethocaine, tetracaine, iontophoresis, and the S-caine patch, a product on the horizon for use in the pediatric population, also are included in this discussion.
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Systemic inflammatory response syndrome may be viewed as the systemic expression of cytokine signals that normally function on an autocrine or paracrine level. Sepsis is defined as systemic inflammatory response syndrome caused by an infection. Multiple organ dysfunction syndrome may represent the end stage of severe systemic inflammatory response syndrome or sepsis. ⋯ The usefulness of immune modulating diets remains to be evaluated. Molecular immunomodulation is still of unclear value. The therapy of sepsis and multiple organ dysfunction syndrome remains mainly supportive.
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Curr. Opin. Pediatr. · Jun 2001
ReviewCurrent concepts in adult respiratory distress syndrome in children.
Acute respiratory distress syndrome (ARDS) is an acute form of severe alveolar-capillary injury that evolves after a direct or indirect lung insult. It begins as noncardiogenic pulmonary edema and develops into a neutrophilic alveolitis, and, later, pulmonary fibrosis. Mortality remains high among children with ARDS, particularly when serious underlying conditions co-exist, sepsis occurs, and when there is multi-organ failure. ⋯ Advances in the care of children with ARDS include the use of lung-protective ventilator strategies, permissive hypercapnia, inhaled nitric oxide, high-frequency ventilation, and extra-corporeal life support. These approaches reduce ventilator-associated lung injury and may improve survival when used in combination with one another. Interventions that reduce alveolar inflammation, enhance alveolar fluid removal, and reduce pulmonary fibrosis will further improve survival and recovery from ARDS in the future.
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Curr. Opin. Pediatr. · Apr 2001
ReviewPediatric poisonings from household products: hydrofluoric acid and methacrylic acid.
Household products continue to be a cause of poisoning morbibidity and mortality. Young children frequently are exposed to cleaning products and cosmetics in the course of exploring their environment. ⋯ This review discusses two products that have been responsible for serious injury and death in children: hydrofluoric acid and methacrylic acid. It also discusses federal initiatives designed to protect children from these and other household hazards.
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For decades, the overwhelming majority of infants requiring mechanical ventilation for respiratory failure were treated with standard time-cycled, pressure-limited intermittent mandatory ventilation. Technologic advances in the 1990s brought forth sophisticated transducers and microprocessor-based mechanical ventilators that enabled implementation of many newer modes of mechanical ventilation. ⋯ Some modes are even hybrids, combining the best features of both pressure-targeted and volume-targeted modes. This article reviews the principles and salient clinical features of the newer ventilatory modes for newborns with respiratory failure.