The number of children dependent on home mechanical ventilation has been reported to be increasing in many countries around the world. Home mechanical ventilation has been well accepted as a standard treatment of children with chronic respiratory failure. Some children may need mechanical ventilation as a lifelong therapy. To send mechanically ventilated children back home may be more difficult than adults. However, relatively better outcomes have been demonstrated in children. Children could be safely ventilated at home if they are selected and managed properly. Conditions requiring home ventilation include increased respiratory load from airway or lung pathologies, ventilatory muscle weakness and failure of neurologic control of ventilation. Home mechanical ventilation should be considered when the patient develops progressive respiratory failure or intractable failure to wean mechanical ventilation. Polysomnography or overnight pulse oximetry plus capnometry are used to detect nocturnal hypoventilation in early stage of respiratory failure. Ventilator strategy including non-invasive and invasive approach should be individualized for each patient. The author strongly believes that parents and family members are able to take care of their child at home if they are trained and educated effectively. A good team work with dedicated members is the key factor of success.

FCI and cFC better reflect the dynamic changes of adrenal function of critically ill children.

This study aimed to investigate the effects of PM10 concentrations exceeding the Thai national standard (24-hr average, >120 microg/m3) on daily reported respiratory symptoms and peak expiratory flow rate (PEFR) of schoolchildren with and without asthma in Bangkok. The 93 asthmatic and 40 nonasthmatic schoolchildren were randomly recruited from a school located in a highly congested traffic area. Daily respiratory symptoms and PEFR of each child were evaluated and recorded in the diary for 31 successive school days. During the study period, 24-hr average PM10 levels ranged between 46-201 microg/m3. PM10 levels exceeded 120 microg/m3 for 14 days. We found that when PM10 levels were >120 microg/m3, the daily reported nasal irritation of asthmatic children was significantly higher than when PM10 levels were < or =120 microg/m3. In addition, when PM10 levels were >120 microg/m3, nonasthmatic children had a significantly higher daily reported combination of any respiratory symptoms. PEFR did not change with different ambient PM10 levels in both groups. This study suggests that elevated levels of PM10 concentrations in Bangkok affect respiratory symptoms of schoolchildren with and without asthma.