Resp Care
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Ten million or more newborns worldwide each year need some type of resuscitation assistance. More than 1 million babies die annually from complications of birth asphyxia. Over the past 3 decades, neonatal resuscitation has evolved from disparate, word-of-mouth teaching methods to organized programs. ⋯ In this era of evidence-based medicine the most recent Neonatal Resuscitation Program guidelines were developed to provide recommendations based on the best currently-available science. A number of major proposals received considerable scrutiny during the evaluation process. Many areas of neonatal resuscitation still need to be studied.
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Acute obstructive respiratory emergencies in children are a common cause of emergency department visits. The severity of these conditions ranges from mild, self-limited disease to life-threatening forms of rapidly progressive airway obstruction. A high index of suspicion is necessary for prompt diagnosis and treatment. This review discusses general principles of assessing and managing respiratory emergencies in children, as well as clinical characteristics and treatment of specific conditions such as croup, epiglottitis, bacterial tracheitis, retropharyngeal abscess, foreign bodies, and inhalational injuries.
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Pediatric acute respiratory distress syndrome (ARDS) remains an important challenge for the intensive care clinician. ARDS, which can result from either direct lung injury or from a "downstream" inflammatory process, is manifested by profound hypoxemia and respiratory failure. ⋯ This review discusses the changing definition of ARDS and available intensive care treatment modalities, including newer lung-protective mechanical ventilation strategies and adjunct therapies. The prognosis of children suffering pediatric ARDS is examined with a look toward areas of potential future intervention in this often deadly disease.
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Cystic fibrosis is a genetic disease that typically produces malnutrition and chronic respiratory infections. Prolonged bronchial obstruction, infection, and inflammation result in bronchiectstasis and permanent lung damage. Most cystic fibrosis patients die because of this progressive respiratory disease. ⋯ Aerosol therapy, airway clearance techniques, and noninvasive ventilation can all improve quality of life and possibly extend survival. Close patient monitoring with pulmonary function testing, chest radiography, and induced sputum can result in earlier treatment, potentially reducing permanent lung damage. Earlier diagnosis has prevented serious complications through early initiation of preventive therapies such as improved nutrition.
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Though asthma cannot be cured, it can be effectively controlled with existing treatments. Management strategies for acute and chronic asthma often vary substantially within and among medical facilities and practices, often driven by physician preference and familiarity rather than by data. The use of carefully designed care paths can improve quality of care and decrease management costs of acute asthma in both the emergency department and in-patient setting. ⋯ Assessment-driven care paths can be safely and effectively administered by respiratory therapists and nurses. The major controversies in the management of chronic asthma center on what to do for the patient who fails to respond to low or moderate doses of inhaled corticosteroids. The addition of a long-acting beta agonist or a leukotriene receptor antagonist may be beneficial.