ABSTRACT
Objetivo: Estudiar la eficacia de la hipotermia inducida (HI) en niños, su efecto sobre los parámetros hemodinámicos, hematológicos, bioquímicos y sus efectos secundarios. Diseño: Estudio observacional retrospectivo. Ámbito: Unidad de cuidados intensivos pediátricos. Pacientes: Pacientes que requirieron tratamiento con HI. Intervenciones: Ninguna. Variables recogidas: Previo al inicio de la HI y a las 4, 24, 48, 72 y 120h después, se recogieron las variables frecuencia cardíaca, presión arterial sistólica y diastólica, diuresis, dosis de inotrópicos, sedantes y relajantes musculares para el balance hídrico, hematocrito, leucocitos, porcentaje de granulocitos, plaquetas, glucemia, natremia, potasemia, proteína C reactiva, lactato y coagulopatía, úlceras, tiritona, infecciones y muerte. Resultados: Se estudió a 31 pacientes, con una edad media de 20 meses (DE: 39,8). El tiempo medio que permanecieron en HI fue de 3,97 días (rango: 1-11 días). Entre los efectos de la HI se observó un descenso significativo de la frecuencia cardíaca, sin cambios en el resto de las constantes (presión arterial sistólica, presión arterial diastólica y diuresis). Entre los parámetros analíticos destacaron la disminución progresiva del número de plaquetas y el aumento de la proteína C reactiva, ambos de forma significativa. El descenso en las cifras de hematocrito, la glucosa y el lactato no fueron significativos. Un 25,8% de los pacientes presentó cultivos positivos durante el empleo de la hipotermia y la localización más frecuente fue el broncoaspirado (65%). Conclusiones: La HI superficial puede ser útil en algunos niños críticamente enfermos y es en general bien tolerada y tiene escasos efectos secundarios, que se pueden controlar si se realiza una monitorización adecuada (AU)
Objective: To study the efficacy of induced hypothermia (IH) in children, its effect on hemodynamic, hematological, and biochemical parameters and its side effects. Design: Retrospective, observational study. Setting: Pediatric intensive care unit. Patients: Pediatric patients requiring induced hypothermia. Interventions: None. Data collected: The following variables were recorded prior to the initiation of IH and after 4, 24, 48, 72, and 120 hours: heart rate, systolic blood pressure (SBP), diastolic blood pressure (DBP), diuresis, dose of inotropic, sedative, and muscle relaxant drugs, fluid balance, hematocrit, white cell count, white cell differential percentages, platelet count, blood levels of glucose, sodium, and potassium, C reactive protein, lactate, coagulation times, pressure ulcers, shivering, infections and death. Results: Thirty-one patients with a mean age of 20 months (SD: 39.8) were included in the study. The mean duration of IH was 3.97 days (range: 1 to 11 days). Among the IH effects, there was a significant fall in heart rate, with no changes in SBP, DBP, or diuresis. The blood tests revealed a progressive and significant fall in platelet count and an increase in C reactive protein levels. The fall in hematocrit and glucose and lactate levels was not significant. Positive cultures were detected in 25.8% of the patients during IH, most commonly from the bronchial aspirate (65%). Conclusions: Induced hypothermia can be useful in some critically ill children. Tolerance is generally good and there are usually few side effects, which can be controlled through appropriate monitoring (AU)
Subject(s)
Humans , Male , Female , Infant , Child, Preschool , Child , Hypothermia, Induced , Hemodynamics/physiology , Critical Care/methods , Retrospective Studies , Respiratory Tract Infections/epidemiologyABSTRACT
La ventilación mecánica no invasiva constituye una nueva modalidad de terapia de soporte respiratorio en la que no se precisa invadir, mediante traqueostomía o intubación endotraqueal, la vía aérea. Se utiliza en pacientes con fallo respiratorio agudo o crónico como alternativa menos agresiva a la ventilación mecánica convencional, buscando evitar las complicaciones asociadas a la intubación endotraqueal y mejorar la calidad de vida del enfermo. Durante los últimos 5-10 años se ha generalizado su uso, debido en gran parte a los avances médicos y tecnológicos que han contribuido al aumento de supervivencia del paciente crítico, al mejor diagnóstico y conocimiento de enfermedades que cursan con aumento de resistencias de la vía aérea superior o con hipoventilación central o periférica así como al desarrollo de nuevos aparatos de fácil manejo adaptados al tratamiento domiciliario. La creación de un programa de control y seguimiento de ventilación no invasiva domiciliaria en pacientes pediátricos va a producir mejoras psicosociales para el paciente y su familia y beneficios económicos para el sistema de salud. En esta revisión nos vamos a referir al tratamiento ambulatorio y domiciliario de niños con insuficiencia respiratoria crónica y a la necesidad de creación de unidades especializadas multidisciplinares de intervención en este tipo de enfermos (AU)
Non-invasive mechanical ventilation is a new respiratory support therapy modality in which it is not necessary to invade the airway with tracheostomy or endotracheal intubation. It is used in patients with acute or chronic respiratory failure as a less aggressive alternative to conventional mechanical ventilation, seeking to avoid the complications associated to endotracheal intubation and to improve the patient´s quality of life. During the last 5-10 years, its use has become generalized, largely due to the medical and technological advances that have contributed to the increased survival of the critical patients, to the better diagnosis and knowledge of diseases that occur with increased resistances of the upper airway or with central and/or peripheral hypoventilation and to the development of new easily used apparatus adapted to home treatment. The creation of a control and follow-up program of non-invasive home ventilation in pediatric patients will produce psychosocial and economic benefits for the health care system. In this review, we are going to mention the out-patient and home treatment of children with chronic respiratory failure and the need to create specialized multidisciplinary intervention units in this type of patient (AU)
Subject(s)
Humans , Respiration, Artificial/methods , Respiratory Insufficiency/therapy , Chronic Disease/therapy , Assisted Living Facilities/methodsABSTRACT
OBJECTIVE: To study the efficacy of induced hypothermia (IH) in children, its effect on hemodynamic, hematological, and biochemical parameters and its side effects. DESIGN: Retrospective, observational study. SETTING: Pediatric intensive care unit. PATIENTS: Pediatric patients requiring induced hypothermia. INTERVENTIONS: None. DATA COLLECTED: The following variables were recorded prior to the initiation of IH and after 4, 24, 48, 72, and 120 hours: heart rate, systolic blood pressure (SBP), diastolic blood pressure (DBP), diuresis, dose of inotropic, sedative, and muscle relaxant drugs, fluid balance, hematocrit, white cell count, white cell differential percentages, platelet count, blood levels of glucose, sodium, and potassium, C reactive protein, lactate, coagulation times, pressure ulcers, shivering, infections and death. RESULTS: Thirty-one patients with a mean age of 20 months (SD: 39.8) were included in the study. The mean duration of IH was 3.97 days (range: 1 to 11 days). Among the IH effects, there was a significant fall in heart rate, with no changes in SBP, DBP, or diuresis. The blood tests revealed a progressive and significant fall in platelet count and an increase in C reactive protein levels. The fall in hematocrit and glucose and lactate levels was not significant. Positive cultures were detected in 25.8% of the patients during IH, most commonly from the bronchial aspirate (65%). CONCLUSIONS: Induced hypothermia can be useful in some critically ill children. Tolerance is generally good and there are usually few side effects, which can be controlled through appropriate monitoring.
Subject(s)
Critical Care/methods , Critical Illness/therapy , Hypothermia, Induced , Arrhythmias, Cardiac/blood , Arrhythmias, Cardiac/physiopathology , Arrhythmias, Cardiac/therapy , Child , Child, Preschool , Diuresis , Electrolytes/blood , Female , Hemodynamics , Humans , Hypothermia, Induced/adverse effects , Infant , Male , Pressure Ulcer/etiology , Retrospective Studies , Shock/blood , Shock/physiopathology , Shock/therapyABSTRACT
La afección pulmonar es una complicación frecuente en los pacientes inmunodeprimidos, y en muchas ocasiones condiciona de forma significativa su evolución. Teniendo en cuenta laalta morbimortalidad de las complicaciones pulmonares, un diagnóstico precoz y un abordaje terapéutico adecuado son un auténtico reto para los pediatras que se enfrentan diariamente al cuidado de estos pacientes. En las últimas décadas, el desarrollo de nuevas terapéuticas en el tratamiento de la enfermedad oncológica, la práctica habitual de trasplantes de órganos y la mayor supervivencia de muchos de estos pacientes han condicionado que el pediatra, con independencia de su ámbito de actuación, deba conocer el abordaje del enfermo inmunodeprimido y sus complicaciones. Pretendemos que este artículo sea una herramienta útil para el adecuado manejo de las complicaciones respiratorias de estos pacientes (AU)
Pulmonary disease is a common complication in immunocompromised patients and in many cases to a large extent determines the patients evolution. In view of the high morbidity and mortality of pulmonary complications, its early diagnosis and an appropriate therapeutic approach are a true challenge for paediatricians faced with the care of these patients on a daily basis. In recent decades, the development of new therapeutics for the treatment of oncological disease, the usual practice of organ transplants and the increased survival of many of these patients, mean that paediatricians, independently of their field of action, must know how to approach immunocompromised patients and their complications. We aim for this article to be a useful tool for the appropriate management of respiratory complications in those patients (AU)
Subject(s)
Humans , Male , Female , Immunocompromised Host/immunology , Immunocompromised Host/physiology , Bronchoalveolar Lavage/instrumentation , Bronchoalveolar Lavage/methods , Bronchoalveolar Lavage , Staphylococcus aureus/classification , Staphylococcus aureus/pathogenicity , Aspergillus/classification , Aspergillus/pathogenicity , Cytomegalovirus/classification , Cytomegalovirus/pathogenicity , Pulmonary Edema/diagnosis , Pulmonary Edema/pathologyABSTRACT
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