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Acute respiratory diseases inAcute respiratory diseases in
childrenchildren
Plan of the lecturePlan of the lecture
1. Etiology of ARD
2. Transmission mechanism in ARD
3. Hyperthermic syndrome
4. Tox...
ARDARD is etiologically heterogeneous group ofis etiologically heterogeneous group of
infectious diseases with similar epi...
Etiology of ARDEtiology of ARD
respiratory viruses
enteroviruses
coronaviruses
bacteria
atypical microorganisms like ...
As a rule ARD course isn’t severe andAs a rule ARD course isn’t severe and
rarely produce complications, butrarely produce...
Transmission mechanism in ARDTransmission mechanism in ARD
 Air way. Viruses has significantly minor sizes of
particles t...
Susceptibility for ARD infection is universal, but is moreSusceptibility for ARD infection is universal, but is more
promi...
The total viral serotypes count is about 180 andThe total viral serotypes count is about 180 and
they cause respiratory tr...
All viruses produce very similar clinicalAll viruses produce very similar clinical
picture – catarhhal events, running nos...
 Viral infection affect ciliary
epithelium, suppress topical
immunity of mucous membranes and
predispose to microbial ino...
Except mechanical defending mechanism, respiratory tract isExcept mechanical defending mechanism, respiratory tract is
pro...
Neonates after birth are defended by adequateNeonates after birth are defended by adequate
immune response. Besides this t...
Fever is the protective- accommodate reaction ofFever is the protective- accommodate reaction of
organism caused by pathol...
Types of feverTypes of fever
 “Pink fever” or moderate hyperemia of skin. Skin
is moist and hot by sensation, child’s beh...
Indications for antipyreticIndications for antipyretic
medicationsmedications
1. For children without anaemnestic problems...
Risk group for complicationsRisk group for complications
due to feverdue to fever
Children less than 2 mo old with T> 38,...
Hyperthermic syndrome isHyperthermic syndrome is
pathologic type of fever whenpathologic type of fever when
fast raising o...
Main signs of hyperthermiaMain signs of hyperthermia
condition:condition:
 Stable elevation of body T more than 40C withi...
Medication choice in fever areMedication choice in fever are
Paracetamol
Ibufen
 Antifebrile action of antipyretics is ...
ParacetamolParacetamol is the most safeis the most safe
antipyretic drug. It’s dosage isantipyretic drug. It’s dosage is
1...
Lytic mixture is prescribed only forLytic mixture is prescribed only for
hyperthermia condition and “pale”hyperthermia con...
If child has generalizedIf child has generalized
convulsions it’s necessaryconvulsions it’s necessary
 Turn him to one si...
To relief convulsions prescribeTo relief convulsions prescribe
parenterallyparenterally
 Diazepam (Seduxen, Relanium) 0,5...
Toxic syndrome –(Toxic syndrome –(acute infectious toxicosis,acute infectious toxicosis,
neurotoxicosis, toxic encephalopa...
Irritative phaseIrritative phase Nocturnal agitation, painful crying, fastNocturnal agitation, painful crying, fast
raisin...
Typical for toxicosis changes ( edema,Typical for toxicosis changes ( edema,
stasis, hemorrhages, acute dystrophy andstasi...
Toxicosis treatmentToxicosis treatment
Droperidol ( adrenolytic, neuroleptic
analgetic anticonvulsant and antiemetic
effe...
Neuro-vegetative protection is performedNeuro-vegetative protection is performed
taking into account such rules:taking int...
Typical symptoms of stridorTypical symptoms of stridor
 Voice mutation
 Noisy, hoarse breathing
 Tachypnoe
 Obstructiv...
Stridor degreesStridor degrees
 I ( compensation) is characterised with inspiration difficulties
with jugular retractions...
Treatment of stridor (only inTreatment of stridor (only in
hospital!)hospital!)
 I degree
-Fresh air access, oxygen thera...
Indications for invasiveIndications for invasive
treatmenttreatment
Growing respiratory failure
Pulse deficiency
Heart ...
Clinical peculiarities and signsClinical peculiarities and signs
of ARDof ARD
 Rhinitis can be isolated or combined sympt...
Rhinitis treatment isRhinitis treatment is
symptomatic:symptomatic:
Nasal lavage with physiological solution
Decongestan...
Pharyngitis -Pharyngitis - mucous layer inflammationmucous layer inflammation
of pharynx. It is frequently combined withof...
Pharyngitis treatmentPharyngitis treatment
 Proper feeding
 Gargling by antiseptic phytosolutions
 Sea salt solutions i...
Etiotropic therapy in ARDEtiotropic therapy in ARD
 For influenza treatment (especially A2) – Remantadin
may be prescribe...
Etiotropic therapy in ARDEtiotropic therapy in ARD
 Arbidol –interferon inductor. Dosages 6-12 y.o.0,1, 12 y.o. –
older -...
Etiotropic therapy in ARDEtiotropic therapy in ARD
 Interferones –are proteins that are synthesized by leucocytes
and hav...
Etiotropic therapy in ARDEtiotropic therapy in ARD
 Combined medication (Viferone – Reaferone +Vit E and
VitC) is produce...
Indications for antibiotics inIndications for antibiotics in
ARDARD
 Recurrent otitis in anamnesis
 Children of first 6 ...
Acute respiratory diseases in children
Acute respiratory diseases in children
Acute respiratory diseases in children
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Acute respiratory diseases in children

  1. 1. Acute respiratory diseases inAcute respiratory diseases in childrenchildren
  2. 2. Plan of the lecturePlan of the lecture 1. Etiology of ARD 2. Transmission mechanism in ARD 3. Hyperthermic syndrome 4. Toxic syndrome 5. Stridor 6. Clinical signs of ARD 7. Therapy in ARD
  3. 3. ARDARD is etiologically heterogeneous group ofis etiologically heterogeneous group of infectious diseases with similar epidemiologicinfectious diseases with similar epidemiologic and clinic characteristics.and clinic characteristics.  Typical clinical picture of ARD is characterized by respiratory tract mucous membranes inflammation with secret excessive production and activation of respiratory tract epithelium protective reactions and further secretion excess removal  There are upper ARD – all affected structures upper vocal cord ( rhinitis, sinusitis, pharyngitis, tonsillitis, otitis) and ARD of lower respiratory tract – inflammation of structures lower vocal cord ( laryngitis, tracheitis, bronchitis, pneumonia)  More frequent morbidity on ARD is find among children of first 3 y.o. ARD is more frequent in cities than in rural population and in industry developed regions with air pollutions. Toddlers and preschools are affected more frequently.
  4. 4. Etiology of ARDEtiology of ARD respiratory viruses enteroviruses coronaviruses bacteria atypical microorganisms like Chlamidia, Mycoplasma, Pneumocystis fungus
  5. 5. As a rule ARD course isn’t severe andAs a rule ARD course isn’t severe and rarely produce complications, butrarely produce complications, but sometimes it can initialize anothersometimes it can initialize another pathologies.pathologies. Among respiratory viral diseases theAmong respiratory viral diseases the most severe course is in influenza ormost severe course is in influenza or adenoviral infections, RS viruses oradenoviral infections, RS viruses or parainfluenza type 3. It’s quite commonlyparainfluenza type 3. It’s quite commonly accompanied by bacterial infection thataccompanied by bacterial infection that worsen condition and prognosis for life.worsen condition and prognosis for life.
  6. 6. Transmission mechanism in ARDTransmission mechanism in ARD  Air way. Viruses has significantly minor sizes of particles than microbes so they can stay longer in aerozol, combined with mucus particles discharged by affected person in surrounding air during the sneezing or coughing. These particles can spread for long distances.  Contact way (through dirty hands or by infected subjects as it can be in adenoviruses) also play its epidemiological role in infectious process, especially among children. In the case of bacterial ARD contact way is predominant.
  7. 7. Susceptibility for ARD infection is universal, but is moreSusceptibility for ARD infection is universal, but is more prominent in age of 6 mo to 3 y.o. It can be explained byprominent in age of 6 mo to 3 y.o. It can be explained by absence of previous contact with these microorganisms andabsence of previous contact with these microorganisms and absence of active immunity. Growing children get this immunityabsence of active immunity. Growing children get this immunity and lower their morbidity.and lower their morbidity. Postinfective specific immunity has its own peculiaritiesPostinfective specific immunity has its own peculiarities depending on etiology of disease. Influenza or vaccinationdepending on etiology of disease. Influenza or vaccination develop lifelong immunity but viral drift (i.e. not significantdevelop lifelong immunity but viral drift (i.e. not significant antigen changes) raise susceptibility of population andantigen changes) raise susceptibility of population and seasonal morbidity sometimes even epidemic. Influenza virusseasonal morbidity sometimes even epidemic. Influenza virus A except drift capable for spontaneous mutations andA except drift capable for spontaneous mutations and recombination of RNA fragments (so called antigen shift). Duerecombination of RNA fragments (so called antigen shift). Due to this pandemia can appear periodically (once per 10-40to this pandemia can appear periodically (once per 10-40 years), when all world population can be affected by theseyears), when all world population can be affected by these pathogenes.pathogenes.
  8. 8. The total viral serotypes count is about 180 andThe total viral serotypes count is about 180 and they cause respiratory tract affection in 95 %they cause respiratory tract affection in 95 %  Immune-diffusion reaction is used to reveal as well antigens and antibodies (IgM, IgG) in viral infections. This method is helpful in detection bacteria toxicity  Reactions of passive or nondirect hemagglutination (i.e.RPGA, RNGA) are performed with using of erythrocytes, surfaces of which absorb antigens or antibodies.  Immune-enzyme analysis (IEA) used specific antibodies conjugated with enzymes that help to detect specific antigens.  Radio-immune method (RIM) is based on usage of radioisotopic mark of antigens or antibodies.  Polymerase Chain reaction (PCR) help to reveal specific sites of genetic information in RNA and DNA in assay. This method is highly sensible and quite fast ( about 3 hours) and is helpful in first hours of diseases to give all proper information about pathogen, its replicative activity and foresee course and outcome of disease.
  9. 9. All viruses produce very similar clinicalAll viruses produce very similar clinical picture – catarhhal events, running nose,picture – catarhhal events, running nose, cough and hyperthermia. But somecough and hyperthermia. But some peculiarities exist in various virusespeculiarities exist in various viruses diseases. For instance:diseases. For instance: adenovirusesadenoviruses cancan cause tonsillitis (frequently with thin coatingcause tonsillitis (frequently with thin coating on tonsils), produce lymphadenopathy,on tonsils), produce lymphadenopathy, prolonged course of intoxication and fever.prolonged course of intoxication and fever. EnterovirusesEnteroviruses can produce herpangina.can produce herpangina. ParainfluenzaParainfluenza viruses are the mostviruses are the most frequent reason of laryngitis and stridor infrequent reason of laryngitis and stridor in children.children. RSRS viruses produce obstructiveviruses produce obstructive bronchitis or bronchiolitis in infants.bronchitis or bronchiolitis in infants.
  10. 10.  Viral infection affect ciliary epithelium, suppress topical immunity of mucous membranes and predispose to microbial inoculation.  Very important defending of respiratory tract mucous membranes is mucociliar clearance mechanism that remove sputum from bronchi.  Another defending mechanism is cough. It is helpful to remove sputum and particles from respiratory tract  respiratory tract is protected by immune system.
  11. 11. Except mechanical defending mechanism, respiratory tract isExcept mechanical defending mechanism, respiratory tract is protected by immune systemprotected by immune system..  lysozyme ( split mucopolysaccharides and mucopeptides of bacterial wall)  transferrin ( band iron ions, necessary for syderophylic microbes growth)  fibronectin ( prevent microbe adhesion to membranes)  interferon ( has antiviral activity)  secretory IgA that perform primary defending of mucous membranes. It neutralize viruses and their toxins, opsonize bacteria (prepare to phagocytosis) and prevent penetration of allergen through membranes.
  12. 12. Neonates after birth are defended by adequateNeonates after birth are defended by adequate immune response. Besides this they are protected byimmune response. Besides this they are protected by mother’s Ig for 3 mo. But infants has peculiarities ofmother’s Ig for 3 mo. But infants has peculiarities of immune system.immune system. Polynuclear neutrophils are able to performPolynuclear neutrophils are able to perform phagocytosis but their mobilization is 2-3 times lowerphagocytosis but their mobilization is 2-3 times lower than in adults.than in adults. Cytotoxic activity of NK is significantly lower than inCytotoxic activity of NK is significantly lower than in adults.adults. Production of IgM is the same as in adults butProduction of IgM is the same as in adults but secretion of IgA and IgG and reach the proper level issecretion of IgA and IgG and reach the proper level is only at 5-7 years old.only at 5-7 years old. Interferon secretion is 10 times less than in adults.Interferon secretion is 10 times less than in adults. Deficiency of IL-2 predispose to Th-2 type of answerDeficiency of IL-2 predispose to Th-2 type of answer and efficient Th-1 way of defending as Th-2 induceand efficient Th-1 way of defending as Th-2 induce secretion of IgE and predispose to atopy.secretion of IgE and predispose to atopy.
  13. 13. Fever is the protective- accommodate reaction ofFever is the protective- accommodate reaction of organism caused by pathologic agents andorganism caused by pathologic agents and characterized by remodeling of thermoregulationcharacterized by remodeling of thermoregulation process with elevation of body T and stimulation ofprocess with elevation of body T and stimulation of natural organism reactivitynatural organism reactivity Subfebrile fever (37,2-37,8C) Low febrile (37,8-39 C) High febrile (38,1-40 C) Hyperthermic excessive (more than 41 C)
  14. 14. Types of feverTypes of fever  “Pink fever” or moderate hyperemia of skin. Skin is moist and hot by sensation, child’s behavior is normal ( heat emission correlates with heat production)  “Pale fever” – chill, paleness of skin, cool foots and hands, condition of child is disturbed ( heat emission isn’t equivalent to heat production due to impairment of peripheral microvasculature).
  15. 15. Indications for antipyreticIndications for antipyretic medicationsmedications 1. For children without anaemnestic problems - if body T more than 39C - manifested myalgias - manifested head ache 2. For children with convulsions in anamnesis - if body T more than 38,0 C 3. For children with pathology of heart and lungs - if body T more than 38,5 C 4. For children of first 3 mo old - if body T more than 38,0 C
  16. 16. Risk group for complicationsRisk group for complications due to feverdue to fever Children less than 2 mo old with T> 38,0 C Children with febrile seizures in anamnesis Children with CNS diseases Children with chronic pathology of cardio-vascular system Children with inherited metabolic disorders Risk group patients need to get antipyretics even for subfebrile temperature!
  17. 17. Hyperthermic syndrome isHyperthermic syndrome is pathologic type of fever whenpathologic type of fever when fast raising of body T isfast raising of body T is accompanied withaccompanied with microvasculature metabolicmicrovasculature metabolic impairment and progressiveimpairment and progressive dysfunction of essential organsdysfunction of essential organs
  18. 18. Main signs of hyperthermiaMain signs of hyperthermia condition:condition:  Stable elevation of body T more than 40C within 3-6 hours in newborns and more than 6 hours in infants  Motley, grey-lilic, “marmour” skin discoloration  Cold extremities despite fever  Hemodynamic impairment  Inadequate child’s behavior – flaccidity, drowsiness or irritation
  19. 19. Medication choice in fever areMedication choice in fever are Paracetamol Ibufen  Antifebrile action of antipyretics is based on supression of prostoglandin synthesis predominantly of cyclooxygenase (COG-1 and 2)  Ibufen blocks COG in CNS in inflammative site ( antipyretic and antiinflammative effect)  Paracetamol inhibit prostoglandine synthesis predominantly in CNS ( antipyretic and analgetic effect).
  20. 20. ParacetamolParacetamol is the most safeis the most safe antipyretic drug. It’s dosage isantipyretic drug. It’s dosage is 10-15 mg/kg tid or 4 times /day10-15 mg/kg tid or 4 times /day.. Daily dosage mustn’t exceed 60mg/kg.Daily dosage mustn’t exceed 60mg/kg. Sirup forms of paracetamol start itsSirup forms of paracetamol start its effect after 30-60 min after admission;effect after 30-60 min after admission; In suppositories – effect is realized 2-3In suppositories – effect is realized 2-3 hours later. They are convenient forhours later. They are convenient for night time.night time. Ibuprofen dosage isIbuprofen dosage is 5-10 mg/kg5-10 mg/kg tid.tid.
  21. 21. Lytic mixture is prescribed only forLytic mixture is prescribed only for hyperthermia condition and “pale”hyperthermia condition and “pale” fever IMfever IM Analgini 50% sol 0,1-0,2 ml/10 kg  Diprasini 2,5% sol. (Pipolfeni) 0,01 ml/kg for infants 0,1-0,15 ml/per year for children more 1 year old Papaverini hydrochloridi 2% sol – 0,1- 0,2 ml for infants 0,2 ml/per year for elder children
  22. 22. If child has generalizedIf child has generalized convulsions it’s necessaryconvulsions it’s necessary  Turn him to one side  Band his head backward for more easy breathing  Don’t open mouth by force because you can harm his teeth and produce aspiration  Inject anticonvulsants  If convulsions were eliminated but fever is still present give patient paracetamol  If both convulsions and fever continue inject lytic mixture IM
  23. 23. To relief convulsions prescribeTo relief convulsions prescribe parenterallyparenterally  Diazepam (Seduxen, Relanium) 0,5% sol (5 mg in 1 ml) Dosage – 0,3-0,5 mg/kg ( max 0,6 mg/kg for every 8 hours) IM, IV  If this medication not effective Sodium oxybutirate 20% sol with 5% glucose 50- 100mg/kg IV.  Phenobarbital (5 mg/kg/per day) per os – can’t produce fast saturation and is recommended for prolonged treatment.
  24. 24. Toxic syndrome –(Toxic syndrome –(acute infectious toxicosis,acute infectious toxicosis, neurotoxicosis, toxic encephalopathy) is typical forneurotoxicosis, toxic encephalopathy) is typical for initial period and has several phases.initial period and has several phases. Transforming of one phase into another can beTransforming of one phase into another can be seen if child don’t get proper treatment.seen if child don’t get proper treatment. Initial phaseInitial phase Child is apathic, refuse feeding, don’tChild is apathic, refuse feeding, don’t smile, sometimes is irritated, pale with bluishsmile, sometimes is irritated, pale with bluish discoloration under the eyes. His sleeping isdiscoloration under the eyes. His sleeping is disturbed, regurgitation or even vomiting candisturbed, regurgitation or even vomiting can appear. Tachycardia isn’t correlated with T,appear. Tachycardia isn’t correlated with T, muscle dystonia, contractility of muscle groups,muscle dystonia, contractility of muscle groups, not stable nystagmus can be find.not stable nystagmus can be find.
  25. 25. Irritative phaseIrritative phase Nocturnal agitation, painful crying, fastNocturnal agitation, painful crying, fast raising of T, tachypnoe and tachycardia, elevation of BPraising of T, tachypnoe and tachycardia, elevation of BP are common signs of second stage Neurologicare common signs of second stage Neurologic symptoms appear like tremor and seizures, meningismsymptoms appear like tremor and seizures, meningism symptoms.symptoms. Hypotonic phaseHypotonic phase Irritation subsides by adynamiaIrritation subsides by adynamia sopor, decreasing of BP muffled heart sound,sopor, decreasing of BP muffled heart sound, depressed respiration, tonic convulsions with apnoe.depressed respiration, tonic convulsions with apnoe. Deep coma phaseDeep coma phase Child is slightly react or don’t toChild is slightly react or don’t to pain, T decreased. Respiration become aperiodic,pain, T decreased. Respiration become aperiodic, hasping type respiration, bradycardia. Skin becomeshasping type respiration, bradycardia. Skin becomes grayish with marmoreal discoloration due to vasculargrayish with marmoreal discoloration due to vascular picture, hemorrhagic rash can appear, DIC syndromepicture, hemorrhagic rash can appear, DIC syndrome can produce bleeding. Child can die without propercan produce bleeding. Child can die without proper emergency aid.emergency aid.
  26. 26. Typical for toxicosis changes ( edema,Typical for toxicosis changes ( edema, stasis, hemorrhages, acute dystrophy andstasis, hemorrhages, acute dystrophy and alteration) will more visible in systems andalteration) will more visible in systems and organs impaired beforehand. Dominatingorgans impaired beforehand. Dominating syndrome like encephalopathic, cardiacsyndrome like encephalopathic, cardiac hemorrhagic, kidney failure, respiratoryhemorrhagic, kidney failure, respiratory distress syndrome will be developed in locusdistress syndrome will be developed in locus minoris. Such conditions as lost ofminoris. Such conditions as lost of conscience, prolonged convulsions, signs ofconscience, prolonged convulsions, signs of brain hypoxia, cardiac failure, hemorrhagicbrain hypoxia, cardiac failure, hemorrhagic syndrome, kidney failure need emergencysyndrome, kidney failure need emergency treatment.treatment.
  27. 27. Toxicosis treatmentToxicosis treatment Droperidol ( adrenolytic, neuroleptic analgetic anticonvulsant and antiemetic effects) 0,1 mg/kg ( 0,3-0,5 ml of 0,25% sol) Dopamine ( epinephrine antagonist) – dilate vessels, bronchi, stimulate heart contractility without tachycardia only IV 3- 5 mcg/kg per min by lineomat.
  28. 28. Neuro-vegetative protection is performedNeuro-vegetative protection is performed taking into account such rules:taking into account such rules:  Lytic mixture is injected immediately in irritation period of hyperthermia syndrome  If there are signs of circulary failure (hypotonia, shoc) adrenomimetics are used in twice less dosage with IV infusions  Duration of neuro-vegetative blockage must be minimal  If there are signs of suprarenal gland failure glucocorticoids parenterally must be prescribed in daily dosage 10mng/kg equivalent to prednisone.
  29. 29. Typical symptoms of stridorTypical symptoms of stridor  Voice mutation  Noisy, hoarse breathing  Tachypnoe  Obstructive, difficult inspiration ( in 1 degree)  In the case of croup progression ( 2 degree) accessory muscle of chest and neck involvement, jugular retractions, tachycardia, cyanosis.
  30. 30. Stridor degreesStridor degrees  I ( compensation) is characterised with inspiration difficulties with jugular retractions. These symptoms are visible during physical or emotional loadings. Voice is hoarse.  II ( subcompensation) – dyspnea at rest. Accessory musculature is involved during inspiration, noisy breathing. Child is irritated, pale, has perioral cyanosis tachycardia. PaCO2 is N PaO2 is decreased  III ( decompensation) –hoarse, noisy breathing, retractions of all chest spaces, acrocyanosis, paleness, sweatning. Child is flaccid, periodically irritated. Cardiac sound is muffled, tachycardia, PaO2 is decreased ( to 70 mm Hg and more); Pa CO2 is elevated ( to 60 mmHg and more)  IV ( asphyxia) – together with respiratory failure cardiovascular failure and brain edema is developed. It leads to coma and respiration arrest
  31. 31. Treatment of stridor (only inTreatment of stridor (only in hospital!)hospital!)  I degree -Fresh air access, oxygen therapy, warm bath for legs and hands, adequate basic drinking, decongestants for nose Physiologic solution, hydrocortisone inhalations  II degree -Listed above +prednisone IM or IV 2-5 mg/kg, constant oxygen therapy -Berodual, salbutamol inhalations through nebuliser or bebihaler -Expectorants  III degree -Listed above +prednisone 5-10 mg/kg per day, naso- tracheal intubation ( or tracheostomy)
  32. 32. Indications for invasiveIndications for invasive treatmenttreatment Growing respiratory failure Pulse deficiency Heart borders dilation, decreasing of oxygen saturation despite of treatment and high levels of PaCO2.
  33. 33. Clinical peculiarities and signsClinical peculiarities and signs of ARDof ARD  Rhinitis can be isolated or combined symptom in ARD  Clinical signs: sneezing, rhinorrhea (nasal mucus discharges), impaired nasal breathing (can be essential in breast feeding abnormality in infants). Mucus run-off by pharynx and can produce cough, especially at night. Cough is stimulated by dryness of mucous because of respiration through mouth. If nasal discharges prolonged more than 10-14 days it’s indicative for sinusitis
  34. 34. Rhinitis treatment isRhinitis treatment is symptomatic:symptomatic: Nasal lavage with physiological solution Decongestants ( xylomethazoline, nafazoline, oxymetazoline) in spray or drops (precaution concentration of solution mustn’t exceed 0.01% for infants; 0.02% for toddlers and 0.05% for preschools – 2-4 times per day not more than 5 days.
  35. 35. Pharyngitis -Pharyngitis - mucous layer inflammationmucous layer inflammation of pharynx. It is frequently combined withof pharynx. It is frequently combined with rhinitis and is called nasopharyngitis – therhinitis and is called nasopharyngitis – the most frequent syndrome in ARD.most frequent syndrome in ARD. Symptoms: sudden tickling feeling in theSymptoms: sudden tickling feeling in the throat dryness, thore throat whilethroat dryness, thore throat while swallowing or taking meals. Commonswallowing or taking meals. Common condition is usually normal or slightlycondition is usually normal or slightly impaired, body T can be elevated or not.impaired, body T can be elevated or not. Prognosis is good. Recovery usually in 5-Prognosis is good. Recovery usually in 5- 7 days.7 days.
  36. 36. Pharyngitis treatmentPharyngitis treatment  Proper feeding  Gargling by antiseptic phytosolutions  Sea salt solutions inhalations  Lysozym in tablets  Topical analgetics and antiseptic drugs in elder children ( Sebedin, Strepsils, Septolete,)  Topical antibiotic bacteriostatic drug – nasal aerosol Fusafunzhine (Bioparox). It can stop spreading of microbe agents and prevent contamination of sinuses and ears.
  37. 37. Etiotropic therapy in ARDEtiotropic therapy in ARD  For influenza treatment (especially A2) – Remantadin may be prescribed (antiviral action is due to inhibition of specific virus reproduction on the early stages before RNA transcription). Dosages: 1,5 mg/kg daily bid. Treatment course 5 days, Medication can be prescribed only to patients more than 3 y.o.  For children more than 1 y.o. remantadin is prescribed in mixture with alginatum –ALGIREM _ 0,2 % sirup. Dosage for 1-3 y.o. -15 ml; 1 day- tid, 2-3 day 0bid, 4 day –once per day.  RNA-za, DNA-za
  38. 38. Etiotropic therapy in ARDEtiotropic therapy in ARD  Arbidol –interferon inductor. Dosages 6-12 y.o.0,1, 12 y.o. – older -0,2 4 times per day. Treatment duration 3 days. In cases with complications – 5 days, then 1 intake/per week for 4 weeks.  Anaferon contain purified antibodies for interferon –γ of humans. Drug stimulate humoral and cell response, raise antibodies production including IgA, activates T-effectors, T- helpers function, normalize its ratio.  Ribavirin (nucleotide analogue of guanozine)- is used in RS viral bronchitis, bronchiolities in severe cases. Dosage 20 mg/kg/daily in form of aerosol through inhaler. In USA monoclonal antibodies to RS viral F-protein used and it help rapidly decrease virus quantity in respiratory tract. Inhibitors of neraminidase (Zanamivir –Relenca) – inhalations 20 mg bid, Ozeltamivir –Tamiflu ) 2 mg/kg bid are allowed for children of 5 y/o/ and elder These medications shorten fever and all symptoms duration for 24-36 hours. They can prevent flu development.
  39. 39. Etiotropic therapy in ARDEtiotropic therapy in ARD  Interferones –are proteins that are synthesized by leucocytes and have properties of cytokines (native leucocyte interferone, recombinant interferone –reaferon, toleron). Antiviral activity is due to cell resistance or viral inoculation. Interferons bind to specific sites on cell membrane, change its properties, stimulate specific enzymes, block viral RNA replication. Besides these Interferons activates macrophages and NK-cells.  For influenza and ARD treatment leucocyte interferone (1000 IU) can be used. It is used intranasaly in dosage 2 ml. Recombinant interferon ( Reaferon, Roferon) is more active (10 000 IU/ml) and is prescribed at the first signs of ARD intranasaly 3-4 drops every 15-20 min for 3-4 hours, then 4-5 times per day within 3-4 days.
  40. 40. Etiotropic therapy in ARDEtiotropic therapy in ARD  Combined medication (Viferone – Reaferone +Vit E and VitC) is produced in form of rectal suppositorium with cacao butter. It can recirculate for long time, decreasing of its concentration is seen only 12 hours later. Dosages 150 000- 500000 IU bid for 5 days. In cases of Chlamidium or Mycoplasma infection one can use 2-3 treatment courses with 5 days intervals. The only contraindication is intolerance of cacao butter.  Cycloferone and Neovir (Cridanimod) –are specific substancies that stimulate endogene synthesis of Interferone. Elevation of Interferone titer is 60-80 U/ml 2-4 hours after medication intake. Dosage of Cycloferone is 6 mg/kg once pr day parenterally for 2 days.  The same activity has another interferone inductors – Poludan and Amixin (Teloron).
  41. 41. Indications for antibiotics inIndications for antibiotics in ARDARD  Recurrent otitis in anamnesis  Children of first 6 mo with severe protein-energy malnutrition, rickets, inherited malformations etc.  With clinical signs of immunodeficiency  In case of complications ( purulent otitis, purulent lymphadenitis, paratonsilar abscess)  Streptococcal (typeA) tonsillitis  Anaerobe tonsillitis  Acute middle otitis  Sinusitis  Respiratory Chlamidiosis, Mycoplasmosis  Bacterial pneumonia.

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