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Innovation in Pediatric Respiratory Emergencies
PREFACE
Innovation in Pediatric Respiratory Emergencies
R
espiratory illness is a leading reason for children to receive emergency care. Given its clinical importance, efforts to improve respiratory therapy have played a key role in the development of pediatric emergency medicine as both a physician specialty and a broader system of care involving many disciplines and resources. Any attempt to review innovation in pediatric respiratory care is a risky business, given the nearly constant evolution of the literature; however, the articles included here represent a few common principles that are likely to endure.
Recycling The memory span of modern medicine is short, and often, therapies discarded in prior generations deserve reevaluation. This is particularly true in respiratory medicine, where anticholinergics, magnesium, and other therapies have been resurrected as the pendulum of care has swung back in their direction. Helium is another of these older therapies that is currently being reevaluated, with particular attention to the method of delivery.
Strength in Numbers Even with common illnesses such as bronchiolitis, the ability of one investigator or group to answer key questions is limited. Systematic combinations of data through metaanalysis have been a useful addition but, ultimately, are limited by the details of the smaller studies included. Recent years have seen the formation of several large federally funded research networks that have begun to tackle key questions definitively. With a problem as frustrating as bronchiolitis, we will need all the help we can get.
1522-8401/$ - see front matter © 2009 Elsevier Inc. All rights reserved. doi:10.1016/j.cpem.2009.03.008
New Toys Technology provides a continual influx of new devices and techniques that can renew old approaches. Recent times have seen rapid introduction of technologies (eg, pulse oximetry), perhaps before clinicians were fully prepared to use the results. Capnography is currently undergoing a more thoughtful evaluation as an adjunct to clinical assessment, whereas noninvasive ventilation shows promise as a therapy for severe patients. Genomics is a rapidly evolving field that promises to explain some of the variability that is a confounding part of research in respiratory disease.
Lost in Translation As effective therapies become known, evidence suggests that there are often long delays before they are widely used at the bedside. The science of implementing new knowledge is in its infancy, and some examples of improving quality across a system are provided here. In our fragmented health system, new advances are particularly late in coming to underserved populations, and the emergency department presents an opportunity to identify and address disparities in care using novel methods.
Joseph J. Zorc, MD, MSCE Associate Professor of Pediatrics and Emergency Medicine University of Pennsylvania School of Medicine Attending Physician The Children's Hospital of Philadelphia Philadelphia, PA
67
Innovation in Pediatric Respiratory Emergencies
R
espiratory illness is a leading reason for children to receive emergency care. Given its clinical importance, efforts to improve respiratory therapy have played a key role in the development of pediatric emergency medicine as both a physician specialty and a broader system of care involving many disciplines and resources. Any attempt to review innovation in pediatric respiratory care is a risky business, given the nearly constant evolution of the literature; however, the articles included here represent a few common principles that are likely to endure.
Recycling The memory span of modern medicine is short, and often, therapies discarded in prior generations deserve reevaluation. This is particularly true in respiratory medicine, where anticholinergics, magnesium, and other therapies have been resurrected as the pendulum of care has swung back in their direction. Helium is another of these older therapies that is currently being reevaluated, with particular attention to the method of delivery.
Strength in Numbers Even with common illnesses such as bronchiolitis, the ability of one investigator or group to answer key questions is limited. Systematic combinations of data through metaanalysis have been a useful addition but, ultimately, are limited by the details of the smaller studies included. Recent years have seen the formation of several large federally funded research networks that have begun to tackle key questions definitively. With a problem as frustrating as bronchiolitis, we will need all the help we can get.
1522-8401/$ - see front matter © 2009 Elsevier Inc. All rights reserved. doi:10.1016/j.cpem.2009.03.008
New Toys Technology provides a continual influx of new devices and techniques that can renew old approaches. Recent times have seen rapid introduction of technologies (eg, pulse oximetry), perhaps before clinicians were fully prepared to use the results. Capnography is currently undergoing a more thoughtful evaluation as an adjunct to clinical assessment, whereas noninvasive ventilation shows promise as a therapy for severe patients. Genomics is a rapidly evolving field that promises to explain some of the variability that is a confounding part of research in respiratory disease.
Lost in Translation As effective therapies become known, evidence suggests that there are often long delays before they are widely used at the bedside. The science of implementing new knowledge is in its infancy, and some examples of improving quality across a system are provided here. In our fragmented health system, new advances are particularly late in coming to underserved populations, and the emergency department presents an opportunity to identify and address disparities in care using novel methods.
Joseph J. Zorc, MD, MSCE Associate Professor of Pediatrics and Emergency Medicine University of Pennsylvania School of Medicine Attending Physician The Children's Hospital of Philadelphia Philadelphia, PA
67