ABSTRACT
Introducción: El tratamiento, la estabilización y posterior traslado del neonato y niño críticamente enfermo implica la necesidad de equipos altamente especializados. Se suple así la carencia de unidades intensivas en los centros de menor nivel en donde no existen la disponibilidad de medios técnicos y personal experto para el manejo adecuado de estos pacientes. Objetivos: Describir la situación actual del transporte interhospitalario del niño y neonato grave en nuestro país, así como las diferentes fases del mismo, destacando la estabilización previa al traslado, la activación, las técnicas para una transferencia adecuada y los aspectos logísticos necesarios para el manejo de estos pacientes durante el transporte terrestre y aéreo. Así mismo, se describen los distintos estamentos implicados, su funcionamiento y gestión de los recursos disponibles. Discusión: El tratamiento y traslado del neonato y niño grave implica a un equipo multidisciplinar de personas con un fin común, que es la asistencia adecuada en los distintos eslabones de la cadena asistencial de transporte. Idealmente los equipos de transporte de estos niños deberían estar constituidos por personal vinculado a los servicios de críticos pediátricos y neonatales y enfermería especializada. En aquellas situaciones que no sea así, siempre debe ser obligada una formación teórico-práctica y un mantenimiento de la misma que garantice un manejo adecuado de estos pacientes. Es necesario disponer de guías clínicas que sirvan de apoyo para el adecuado diagnóstico, tratamiento y traslado de pacientes críticos (AU)
Introduction: The successful treatment, stabilization and transfer of critically ill newborns and children requires highly specialized teams. This approach overcomes the lack of intensive care units in less specialized lower-level hospitals, where and skilled personnel for the proper management of these patients is not available. Objectives: the aim is to describe the current state of inter-hospital transport of severely ill children and newborns in our country as well as to discuss the guidelines, correct management of resources and clinical management of these patients during ground and air transport. Additionally, the various procedures and processes involved and their operation are detailed. Discussion: The treatment and transfer of newborns and children require highly skilled, multi-disciplinary transport teams with a common goal. Ideally these teams should consist of highly specialized medical professionals with experience in the management of these types of patients (neonatologists, paediatric intensive care physicians and specialized nurses). In situations where these are not available, medical staff should be given theoretical and practical training, both initial and continuous, to ensure proper management of these patients. It is necessary to have clinical guidelines to promote that diagnosis, treatment and transportation of these patients is performed correctly (AU)
Subject(s)
Humans , Critical Illness/therapy , Prehospital Care , Transportation of Patients/methods , Critical Care/methodsABSTRACT
A 4-year-old girl suffered severe postoperative chest tube drainage bleeding after cardiac transplant surgery requiring extracorporeal membrane oxygenation. Transfusions of platelets and fresh frozen plasma failed to decrease the bleeding. At 2.5 hours a dose of 180 mcg/kg of recombinant activated Factor VII was administered. The hemorrhage decreased from 45 ml/kg/h in the first 2.5 hours to 17 ml/kg/h in the next 2.5 hours. The same dose of recombinant activated Factor VII was administered and the hemorrhage suddenly decreased to 1.5 ml/kg/h in the next 2.5 hours, with subsequent disappearance. No adverse events related to activated Factor VII were observed. Recombinant activated Factor VII may be useful in some cases of severe postoperative bleeding in children after cardiac surgery. Randomized controlled studies are needed to confirm its safety and efficacy, and to evaluate the most suitable dose.
Subject(s)
Extracorporeal Membrane Oxygenation/methods , Factor VIIa/therapeutic use , Postoperative Hemorrhage/therapy , Cardiac Surgical Procedures , Child, Preschool , Drug Administration Schedule , Factor VIIa/administration & dosage , Female , Humans , Postoperative Hemorrhage/drug therapy , Treatment OutcomeABSTRACT
Despite recent therapeutic advances, mortality due to septic shock remains high. The most important causes of mortality are refractory shock, uncontrollable alterations of coagulation, and multiorgan failure. Some authors have proposed the early use of plasmafiltration and high flow hemodiafiltration for refractory septic shock. Most authors initiate treatment with a short session of plasmafiltration followed by continuous hemodiafiltration. A 13-year-old girl presented refractory meningococcal septic shock, disseminated intravascular coagulation, and acute renal failure unresponsive to volume expansion and high doses of adrenalin and noradrenaline. She received simultaneous treatment with plasmafiltration and continuous venovenous hemodiafiltration for 30 hours. Two pumps of extrarenal purification placed in parallel through the same double line catheter were used. Fast hemodynamic stabilization and control of the coagulopathy were achieved. The patient survived with progressive recovery of renal function but required amputation of the inferior left limb. Continuous plasmafiltration and venovenous hemodiafiltration can be used simultaneously for the treatment of older children with septic shock, severe coagulopathy, and hypervolemia.
Subject(s)
Hemodiafiltration , Shock, Septic/therapy , Adolescent , Female , Hemodiafiltration/methods , Humans , PlasmaABSTRACT
A pesar de los avances terapéuticos recientes la mortalidad del shock séptico sigue siendo muy elevada. Las causas más importantes de mortalidad son el shock refractario, la alteración incontrolable de la coagulación y el fallo multiorgánico. Algunos autores han propuesto la utilización precoz de plasmafiltración y hemodiafiltración de elevado flujo como tratamiento del shock séptico refractario, realizando la mayoría la plasmafiltración en sesiones cortas y a continuación la hemodiafiltración de forma continua. Una niña de 13 años de edad presentó shock séptico meningocócico refractario a tratamiento con expansión y dosis elevadas de adrenalina y noradrenalina, coagulación intravascular diseminada (CID) e insuficiencia renal aguda. Se realizó tratamiento simultáneo con plasmafiltración y hemodiafiltración venovenosa continua durante 30 h, utilizando dos bombas de depuración extrarrenal colocadas en paralelo a través del mismo catéter de doble luz, consiguiendo una rápida estabilización hemodinámica y control de la coagulopatía. La paciente sobrevivió recuperando de manera progresiva la función renal, pero se tuvo que realizar amputación de miembro inferior izquierdo. La plasmafiltración continua y la hemodiafiltración venovenosa pueden utilizarse simultáneamente como tratamiento de niños mayores con shock séptico, coagulopatía e hipervolemia grave (AU)
Subject(s)
Adolescent , Female , Humans , Hemodiafiltration , Shock, Septic , PlasmaABSTRACT
Chylothorax is an infrequent complication of cardiac surgery in children. Most patients respond to a low-fat diet or to parenteral nutrition, but pleuroperitoneal drainage or thoracic duct ligature is sometimes required. We present the case of a 3-year-old girl with Down syndrome and complex atrioventricular canal defect who presented chylothorax 22 days after the Glenn procedure with bidirectional pulmonary-cava fistula. Low-fat diet and parenteral nutrition produced no improvement and the patient was treated with octreotide 1-2 mcg/kg/min in intravenous continuous perfusion, which produced remission of chylothorax. Subsequently, 20 mcg/kg/day of octreotide was subcutaneously administered in three doses, allowing progressive dietary normalization, without recurrence of chylothorax or adverse effects. In conclusion, octreotide is well tolerated and produces few adverse effects. It could be used as a therapeutic alternative in chylothorax refractory to conservative treatment.
