A child with severe asthma does not respond well to inhaled β agonist plus ipratropium and oral steroid. Should you then give intravenous salbutamol or aminophylline? Researchers in London (

) have come down in favour of aminophylline. They randomised 44 children to a single bolus of salbutamol (15 μg/kg over 20 minutes then saline infusion) or aminophylline infusion (5 mg/kg over 20 minutes then 0.9 mg/kg/h). Asthma severity at 2 hours was similar in the two groups but the salbutamol group needed oxygen for longer, and stayed in hospital longer (85 v 57 hours) than the aminophylline group. More work is needed to compare salbutamol infusion or multiple boluses with aminophylline infusion (or both drugs). For partial liquid ventilation (PLV) the lungs are filled with perfluorocarbon and ventilated with gas using a conventional ventilator. There is evidence from experiments on newborn lambs that PLV with continuous distending pressure might improve lung growth. A study in six US centres (

) of 13 neonates with congenital diaphragmatic hernia and on extracorporeal life support has been said by the researchers to have produced encouraging, though not statistically significant, results. Compared with the five patients on standard mechanical ventilation the eight given PLV with continuous positive airway pressure of 5–8 cm H₂O had a shorter time on ECMO (9.8 v 14.5 days), …