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 Table of Contents  
EDITORIAL
Year : 2018  |  Volume : 2  |  Issue : 3  |  Page : 36-37

Innovative interventions and approaches for pediatric respiratory problems


Department of Pediatrics, Lady Hardinge Medical College and Associated Kalawati Saran Children's Hospital, New Delhi, India

Date of Web Publication19-Oct-2018

Correspondence Address:
Varinder Singh
Department of Pediatrics, Lady Hardinge Medical College and Associated Kalawati Saran Children's Hospital, Bangla Sahib Marg, New Delhi - 110 001
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/prcm.prcm_15_18

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How to cite this article:
Singh V. Innovative interventions and approaches for pediatric respiratory problems. Pediatr Respirol Crit Care Med 2018;2:36-7

How to cite this URL:
Singh V. Innovative interventions and approaches for pediatric respiratory problems. Pediatr Respirol Crit Care Med [serial online] 2018 [cited 2018 Nov 17];2:36-7. Available from: http://www.prccm.org/text.asp?2018/2/3/36/243742



This issue brings up three very interesting articles related to paediatric pulmonology and critical care. Two of them bring up and share new ideas and experiences which are unique and tailored to develop the use of innovative lower cost models of health care in some very critical areas.

Interventions using flexible bronchoscopy have not been used as broadly and extensively among children as in adults. Limits to its use are largely due to lack of suitable size equipment and accessories, lack of skilled masters and lack of training in this field. The skills have developed rather patchily, are localised to few centres and there are few big size studies available.[1] This was highlighted in a recent effort by the European Respiratory Society to formulate guidelines on the subject.[2] In the US, most interventions in children are done either with rigid or a combination of rigid and flexible bronchoscopy with multi-disciplinary teams consisting of anaesthetist, ENT and paediatric respiratory physician.[3],[4] The federal regulations have also limited the expansion in this area. Soong from Taiwan has written a review article on paediatric interventional flexible bronchoscopy[5] which brings up many new facets as he largely quotes from his own expertise. He brings to forth the experience in the relatively less charted areas of pediatric airway dilatation and stenting in a sizeable number of cases. Many of the techniques described, particularly use of a method to maintain respiration during the procedure (Soong's Ventilation) are unique and not used elsewhere.[6] Likewise, he discussed his technique of using short length thin scopes to guide the instruments into the paediatric airway. The paper is going to arouse a lot of interest for his extra-ordinary pioneering work and generate discussions beyond curiosity.

The use of heated humidified high flow oxygen therapy and its other variants have raised a lot of interest recently, as more and more units are using this for oxygenating sick babies who if not intervened in time have the potential to progress to ventilatory failure.[7] The study from Thailand by Vareesunthorn and Preutthipan's unit shares their experience with a lower cost modified high flow nasal cannula technique for providing oxygen therapy to bigger babies.[8] The need for innovation and health-care cost-cutting goes beyond developing and resource-challenged societies and the present paper fills up that gap in information in the context of high flow oxygen therapy. They have made innovations to provide a simpler non-commercial method which has the potential to be replicated across other units in different countries.

Tuberculosis is a formidable disease which now is on the global agenda for disease control. This year saw an unprecedented effort, collaboration and partnership between multiple TB stakeholder leading to the adoption of the UN Political Declaration on TB on 26th September in New York, USA. As the work on stopping TB continues across countries, it is important to learn and share the clinical experiences so that the awareness about its myriad presentation is better understood and stays in focus. The present issue has a small study on extra-pulmonary tuberculosis from Indonesia documenting the presentation of the disease in various organ systems.[9]



 
  References Top

1.
Pastis NJ, Nietert PJ, Silvestri GA; American College of Chest Physicians Interventional Chest/Diagnostic Procedures Network Steering Committee. Variation in training for interventional pulmonary procedures among US pulmonary/critical care fellowships: A survey of fellowship directors. Chest 2005;127:1614-21.  Back to cited text no. 1
    
2.
Eber E, Antón-Pacheco JL, de Blic J, Doull I, Faro A, Nenna R, et al. ERS statement: Interventional bronchoscopy in children. Eur Respir J 2017;50. pii: 1700901.  Back to cited text no. 2
    
3.
Gilbert CR, Feller-Kopman D, Akulian J, Hayes M, Yarmus L. Interventional pulmonology procedures in the pediatric population. Pediatr Pulmonol 2014;49:597-604.  Back to cited text no. 3
    
4.
Faro A, Wood RE, Schechter MS, Leong AB, Wittkugel E, Abode K, et al. Official American Thoracic Society technical standards: Flexible airway endoscopy in children. Am J Respir Crit Care Med 2015;191:1066-80.  Back to cited text no. 4
    
5.
Soong WJ. PRCM. [In this issue].  Back to cited text no. 5
    
6.
Soong WJ, Jeng MJ, Lee YS, Tsao PC, Soong YH. Nasopharyngeal oxygen with intermittent nose-close and abdomen-compression: A novel resuscitation technique in a piglet model. Pediatr Pulmonol 2013;48:288-94.  Back to cited text no. 6
    
7.
Mayfield S, Jauncey-Cooke J, Hough JL, Schibler A, Gibbons K, Bogossian F, et al. High-flow nasal cannula therapy for respiratory support in children. Cochrane Database Syst Rev 2014;3:CD009850.  Back to cited text no. 7
    
8.
Vareesunthorn I, Preutthipan A. Modified High-Flow Nasal Cannula in Young Children with Pneumonia: A 3-year Retrospective Study PRCM; 2018. [In this issue].  Back to cited text no. 8
    
9.
Clinical Profiles and Outcome of Extra Pulmonary Tuberculosis in Children in Indonesia. PRCM; 2018. [In this issue].  Back to cited text no. 9
    




 

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