Paediatric respiratory reviews
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Paediatr Respir Rev · Dec 2006
ReviewEffect of bariatric surgery on obstructive sleep apnoea in adolescents.
Obese adolescents, particularly those with extreme obesity (body mass index > or =40 kg/m(2)), are developing serious medical complications at an unexpectedly high rate. As non-operative approaches to weight loss have shown less than optimal results, paediatric patients are increasingly seeking bariatric surgical intervention. Bariatric surgical procedures are designed to restrict stomach size or impair macronutrient absorption. ⋯ As with adult studies, paediatric studies generally report good obstructive sleep apnoea (OSA)-related outcomes after bariatric surgery. Therefore, in patients meeting eligibility criteria, bariatric surgery can be a valuable approach for achieving significant weight loss and resolution of serious comorbidities such as OSA. Studies that focus on long-term assessment of OSA are needed to understand whether OSA resolution after adolescent bariatric surgery is sustainable over the lifetime.
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Progressive respiratory failure is a common modality of death in children with a terminal illness. The management of respiratory failure, and in particular symptoms of dyspnoea and musculoskeletal chest pain in children receiving palliative care, remains challenging. The emergence of palliative care paediatricians and the application of non-invasive ventilation to children with progressive respiratory failure are the two major advances in the care of children with respiratory complaints in the palliative care setting. This article outlines current approaches to palliative care in children with progressive respiratory symptoms.