Treating acute severe asthma attacks in children: using aminophylline.

Aminophylline does have a role in treating severe asthma attacks in children with asthma. Clinicians just need to be aware of the toxic side-effects of the drug and manage the drug carefully. https://bit.ly/3o7IJV1.

Stabilisation of critically ill children at the district general hospital prior to intensive care retrieval: a snapshot of current practice.

OBJECTIVE: To describe current practice during stabilisation of children presenting with critical illness to the district general hospital (DGH), preceding retrieval to intensive care. DESIGN: Observational study using prospectively collected transport data. SETTING: A centralised intensive care retrieval service in England and referring DGHs. PATIENTS: Emergency transports to intensive care during 2-month epochs from 4 consecutive years (2005-2008). INTERVENTIONS: None. MAIN OUTCOME MEASURES: Proportion of key airway, breathing, and circulatory and neurological stabilisation procedures, such as endotracheal intubation, mechanical ventilation, vascular access, and initiation of inotropic agents, performed by referring hospital staff prior to the arrival of the retrieval team. RESULTS: 706 emergency retrievals were examined over a 4-year period. The median age of transported children was 10 months (IQR, 18 days to 43 months). DGH staff performed the majority of endotracheal intubations (93.7%, CI 91.3% to 95.5%), initiated mechanical ventilation in 76.9% of cases (CI 73.0% to 80.4%), inserted central venous catheters frequently (67.4%, CI 61.7% to 72.6%), and initiated inotropic agents in 43.7% (CI 36.6% to 51.1%). The retrieval team was more likely to perform interventions such as reintubation for air leak, repositioning of misplaced tracheal tubes, and administration of osmotic agents for raised intracranial pressure. The performance of one or more interventions by the retrieval team was associated with severity of illness, rather than patient age, diagnostic group, or team response time (OR 3.62, 95% CI 1.47 to 8.92). CONCLUSIONS: DGH staff appropriately performs the majority of initial stabilisation procedures in critically ill children prior to retrieval. This practice has not changed significantly for the past 4 years, attesting to the crucial role played by district hospital staff in a centralised model of paediatric intensive care.

Capillary refill time in term neonates: bedside assessment.

Capillary refill time (CRT) is yet to be established as a specific clinical sign of peripheral circulation in neonates. This study was conducted to assess the influence of four body sites used for measurement, interobserver variability, sex, birth weight, age at assessment and room temperature on CRT recorded in healthy term neonates, at bedside. Two observers measured CRT in four different body sites (forehead, chest, palm and heel) of each of 155 healthy term neonates. Significant differences occurred between the mean CRT recorded by the two observers in forehead (mean +/- SD: 2.62 +/- 0.8 s and 1.88 +/- 0.57 s; p < 0.001), palm (2.99 +/- 0.61 s and 2.75 +/- 1.12 s; p < 0.05) and heel (3.08 +/- 0.79 s and 4.24 +/- 1.84 s; p < 0.001). Only CRT in chest (2.7 +/- 0.42 s and 2.62 +/- 0.74 s) produced no significant differences in the means with a statistically significant and clinically fair, but not strong, interobserver agreement (r = 0.4; p < 0.001). No significant associations occurred between CRT and sex or birth weight. The associations of chest CRT with age at assessment (r = -0.23; p < 0.01) and room temperature (r = 0.27; p < 0.01) were clinically not important. In conclusion, CRT in neonates needs to be validated further before it can be useful as a specific clinical sign of peripheral circulation.