Sedation and subglottic stenosis in critically ill children
Journal Title: Jornal de Pediatria - Year 2017, Vol 93, Issue 4
Abstract
As mortality rates have decreased over the past few decades, the focus of contemporary pediatric critical care has shifted toward minimizing long-term morbidity. Children requiring endotracheal intubation and mechanical ventilation are at risk for a number of lasting sequelae, including chronic respiratory failure, neuropathy/myopathy, and cognitive impairment.1 Risk factors for individual complications have been described, and actions to avoid these risk factors should be considered. However, avoiding one action invariably causes a reaction that may confer its own adverse effects. For example, a dry lung strategy shortens the duration of mechanical ventilation in the acute respiratory distress syndrome (ARDS), but may worsen long-term neurologic status.2,3 A lung-protective strategy may reduce ventilator-associated lung injury and the risk of chronic respiratory failure, but the resultant acidosis and elevated intrathoracic pressures can be poorly tolerated in children with fluid-refractory shock, pulmonary hypertension, and/or intracranial hypertension.4 When faced with multiple therapeutic options, pediatric intensivists must be cognizant of the risks and benefits of all possible paths.
Authors and Affiliations
Alexandre Rotta
Keywords
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- EP ID EP503555
- DOI 10.1016/j.jped.2017.03.001
- Views 55
- Downloads 0
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