Bronchiolitis Guidelines and Evidence-Based Medicine …：毛细支气管炎指南和循证医学….pptVIP

下载本文档

2
0
约1.5万字
约 36页
2018-06-23 发布于浙江
举报
版权申诉

Bronchiolitis Guidelines and Evidence-Based Medicine …：毛细支气管炎指南和循证医学….ppt

1、原创力文档（book118）网站文档一经付费（服务费），不意味着购买了该文档的版权，仅供个人/单位学习、研究之用，不得用于商业用途，未经授权，严禁复制、发行、汇编、翻译或者网络传播等，侵权必究。。
2、本站所有内容均由合作方或网友上传，本站不对文档的完整性、权威性及其观点立场正确性做任何保证或承诺！文档内容仅供研究参考，付费前请自行鉴别。如您付费，意味着您自己接受本站规则且自行承担风险，本站不退款、不进行额外附加服务；查看《如何避免下载的几个坑》。如果您已付费下载过本站文档，您可以点击这里二次下载。
3、如文档侵犯商业秘密、侵犯著作权、侵犯人身权等，请点击“版权申诉”（推荐），也可以打举报电话：400-050-0827(电话支持时间：9:00-18:30)。
4、该文档为VIP文档，如果想要下载，成为VIP会员后，下载免费。
5、成为VIP后，下载本文档将扣除1次下载权益。下载后，不支持退款、换文档。如有疑问请联系我们。
6、成为VIP后，您将拥有八大权益，权益包括：VIP文档下载权益、阅读免打扰、文档格式转换、高级专利检索、专属身份标志、高级客服、多端互通、版权登记。
7、VIP文档为合作方或网友上传，每下载1次，网站将根据用户上传文档的质量评分、类型等，对文档贡献者给予高额补贴、流量扶持。如果你也想贡献VIP文档。上传文档

Bronchiolitis Guidelines and Evidence-Based Medicine …：毛细支气管炎指南和循证医学…

Oxygen Pulse oximetry detects hypoxemia not apparent on PE Significance of mild hypoxemia ( 90%) unclear Variability in saturation due to plugging / mismatch Indication for starting oxygen unclear Oxygen requirement associated with worse outcomes Increased risk of need for ventilation Wang et al. J Peds 1995; 126:212-219. 4 x increased inpatient LOS Wainwright et al. 2003 ? Continuous pulse oximetry vs. spot checking Protection against lower respiratory infection Natural immunity to RSV Antibody to F and G surface proteins protect against LRI Humoral immunity controls and terminates infection Reinfections with RSV Usually limited to URI Healthcare workers at risk Significant cause of illness in elderly Prevention Non-Specific Measures Avoidance Hygiene Nutrition Passive Immunization Palivizumab (Synagis?) RSV immunoprophylaxis Attempts to provide immunity to RSV Vaccine in 1960s worsened course of infection New intra-nasal vaccine undergoing trials Passive immunity via hyperimmune globulin Monoclonal antibody to F protein (palivizumab) 55% ? hospitalizations for preterm/chronic lung disease 45% ? hospitalizations for congenital heart disease The IMpact-RSV Study Group. Pediatrics. 1998;102(3):531-7; Palivizumab Outcomes Study Group. Pediatric Pulm. 2003;35:484-9; Hudak et al. J Perinatol. 2002;22:619, abstract P32; Data on file, MedImmune Inc. Reduction in RSV Hospitalization Rate IMpact-RSV study based on active collection of hospital data; Outcomes Registry based on passive reporting 8.1 11 9.8 12.8 4.8 1.8 5.8 2 7.9 2.9 2.1 4.5 1.6 5.8 1.5 1.2 1.7 1.3 2.2 1.1 1.2 1.6 1.9 10.6 0.7 0 2 4 6 8 10 12 14 All Patients Premature w/o CLD All 32 weeks GA All 32-35 weeks Patients with CLD RSV Hosp Rate 1996-1997 IMpact-RSV Trial-Placebo 1996-1997 IMpact-RSV Trial-Synagis 2000-2001 Synagis Outcomes Registry 2001-2002 Synagis Outcomes Registry 2002-2003 Synagis Outcomes Registry *Receiving medical therapy for CLD within 6 months Guidelines for RSV Prophylaxis