Negative pressure ventilation via chest cuirass to decrease ventilator-associated complications in infants with acute respiratory failure: a case series.

Pulmonary and nonpulmonary complications of invasive positive pressure ventilation are well documented in the medical literature. Many of these complications may be minimized by the use of noninvasive ventilation. During various periods of medical history, negative pressure ventilation, a form of noninvasive ventilation, has been used successfully. We report the use of negative pressure ventilation with a chest cuirass to avoid or decrease the complications of invasive positive pressure ventilation in three critically ill infants at two institutions. In each of these cases, chest cuirass ventilation improved the patient's clinical condition and decreased the requirement for more invasive therapy. These cases illustrate the need for further clinical evaluation of the use of negative pressure ventilation utilizing a chest cuirass.

The screening and diagnosis of cystic fibrosis-related diabetes in the United Kingdom.

INTRODUCTION: The cystic fibrosis-related diabetes (CFRD) guidelines produced by the UK CF Trust differ from those used in Europe and the US. We conducted a study to establish current practice. METHOD: Paediatric and adult questionnaires were devised and emailed to the 48 specialist UK CF centres. RESULTS: Completed questionnaires were returned by 39/48 (81%) centres. Only 3/21 (14%) paediatric centres begin annual screening at 12 years (as per UK guidelines), 11/21 (52%) start to screen at 10 years (as per European and US guidelines) and 5/21 (24%) begin screening at a child's first annual review. The oral glucose tolerance test is used as a screening test in 33/39 (85%) of centres but only 3/33 (9%) use it in isolation. Home glucose monitoring is the most frequently used diagnostic test undertaken in 32/39 (82%) centres, and again this is rarely used in isolation. The decision to initiate insulin is often shared between specialist nurses and doctors. CONCLUSIONS: In the UK the majority of CF centres use the OGTT to screen and HGM to diagnose CFRD. The use of other tools varies with poor adherence to UK guidelines. These 2004 guidelines would benefit from being updated to reflect current best evidence.