Academic literature on the topic 'Air Pediatric respiratory diseases Air Pediatric respiratory diseases'

The history of hyperbaric oxygen therapy (HBOT) makes for fascinating reading. From pneumatic chambers and compressed air baths to empirical therapeutic applications during the nineteenth century, the impetus to scientific application of HBOT began in seeking solution for decompression sickness during various construction ventures. French physiologist Paul Bert’s research was pathbreaking and provided a scientific explanation on the etiology of the “bends.” In 1908, JS Haldane’s experiments recommended staged decompression and made diving safe. In 1921, OJ Cunningham employed HBOT to treat hypoxia secondary to lung infections successfully. It was cardiac surgeon Ite Boerema who put HBOT on a solid footing with his open-heart surgery results in various pediatric cardiac conditions and rightly deserved the title of father of modern-day hyperbaric medicine. From 1937 onwards, HBOT research snowballed into treating a wide variety of diseases. In 1999, the Undersea and Hyperbaric Medical Society and Food and Drug Administration recognized the value of HBOT, and this led to its becoming a major tool in the armamentarium of clinicians, either as a primary or adjunctive therapy for a spectrum of diseases.

Asthma and cystic fibrosis (CF) are examples of childhood pulmonary illnesses with significant psychological impacts. These disorders have in common an induced difficulty with a primal drive, the drive to breathe. Acute impairment with the drive to breathe is highly anxiety provoking, and chronic impairment is life-altering. Pulmonary illnesses like asthma and CF can have direct impacts on brain functioning through systemic hypoxia (low blood oxygen [O2] level) or hypercapnia (high blood carbon dioxide [CO2] level) due to poor respiratory gas exchange. With chronic respiratory problems in children, hypoxia is the more clinically pertinent issue in that hypoxia seems to produce developmental impacts. Studies that have looked at the outcomes of pulmonary hypoxia have found associations with adverse effects even from oxygen levels that were just slightly below the normal range (Bass et al. 2004). A drop of only 4% O2 saturation from baseline is associated with attentiondeficit hyperactivity (ADHD)-like symptoms. Persistent oxygen saturation levels that are even lower than this have been associated with decreased IQ and delays in motor development (Bass et al. 2004). Negative neurobehavioral effects of the hypercapnia side of impaired respiratory status are less well documented. In fact, hypercapnia, besides triggering an increase in cerebral blood flow and driving a sense of air hunger particularly in people with trait anxiety, seems to have no lasting neurocognitive impact (Wan et al. 2008). Research on the use of intentional ‘‘permissive’’ hypercapnia when using mechanical ventilation assistance (allowing higher blood carbon dioxide levels to minimize barotrauma from the assist device) has shown no common neurocognitive complications from this strategy. There are even suggestions of some improved neurocognitive outcomes for neonates managed in this manner (Miller and Carlo 2007). These results are tempered by a higher reported frequency of intraventricular hemorrhage in hypercapnic very-low-birth-weight infants, and there is at least one case report of subarachnoid hemorrhage in a child ventilated with permissive hypercapnia for an asthma episode (Edmunds and Harrison 2003; Kaiser et al. 2006). The severe hypercapnia of complete respiratory failure goes hand in hand with hypoxia, so the effects of each in that potentially fatal scenario are difficult to separate.

This chapter presents vignettes on commonly encountered pulmonary issues in a general pediatric practice. It details the clinical presentation, evaluation, and management of upper and lower airway disorders, parenchymal lung diseases, respiratory control disorders, and ventilatory muscle disorders. Clinical pearls in the recognition of rare pulmonary diseases are discussed. Illustrative cases highlight the appropriate use of procedures and laboratory and radiographic tests such as chest radiographs, computerized tomography scans, pulmonary function tests, blood gases, polysomnography, and bronchoscopy to aid diagnosis. Also reviewed are clinical guidelines and current data that impact the management approach.