Crit Care Resusc
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To review the recent advances in ventilatory therapy for acute respiratory failure in children. ⋯ High frequency ventilation exists in three forms, although only high frequency oscillation appears to show any benefit in the management of acute respiratory failure refractory to conventional mechanical ventilation. Extracorporeal oxygenation has halved mortality in neonates with acute respiratory failure, and has been used successfully in non-neonate patients. Inhaled nitric oxide from 6 to 20 parts per million improves oxygenation in paediatric patients with acute respiratory failure and congenital heart disease (particularly in the presence of pulmonary arterial hypertension). Liquid ventilation or perfluorocarbon-associated gas exchange has also been used to treat acute respiratory failure in paediatric patients, with partial liquid ventilation particularly appearing to show promise.
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To review the indications and complications of the percutaneous tracheostomy compared with the standard surgical tracheostomy in the critically ill patient. ⋯ In the critically ill patient who requires a tracheostomy, the percutaneous rather than the standard surgical technique is the method of choice as it can be performed at the bedside, leaves a smaller scar after decannulation and may be associated with fewer complications compared with the standard surgical technique.
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To review the pathophysiology of gastroparesis and present a practical approach to the management of this disorder in the critically ill patient. ⋯ Gastric dysmotility is common in the critically ill patient. However, treatment of the underlying conditions leading to gastroparesis and the introduction of prokinetic agents will allow the majority of patients to be successfully fed enterally.
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To describe and evaluate clinically applicable approaches to measurement of respiratory mechanics in critically ill patients. ⋯ Some of this information is available on modern ventilators, but greater insight requires measurement and manipulation of flow and pressure data using a pneumotachograph and pressure transducers. Given the importance of respiratory mechanics in the management of many critically ill patients, and given how poorly the respiratory system is monitored compared with the cardiovascular system, it is worth considering making this simple but additional effort.