Sospecha de infección urinaria en el lactante menor de 3 meses: ¿cuándo realizar una punción lumbar? / Suspicion of urinary tract infection among 0-3 monthinfants: when to perform a lumbar puncture?

Objetivo: Estudiar la incidencia de meningitis bacteriana en lactantes menores de 3 meses con sospecha de infección urinaria. Métodos: Estudio retrospectivo mediante revisión de historias clínicas de todos los niños menores de 3 meses en los que se obtuvo un sedimento de orina por sondaje vesical patológico en el servicio de urgencias. Se realizó una punción lumbar a todos los niños menores de 1 mes y a todos los niños con afectación del estado general durante el periodo comprendido entre octubre de 2004 y julio de 2010. Resultados: El estudio incluyó a 290 pacientes con sospecha de infección urinaria. El 76% eran niños y el 24% niñas; un 43% de los pacientes eran menores de 1 mes. La infección de orina se confirmó por urocultivo en 230 niños, y 9 (3,2%) de ellos asociaban bacteriemia. Se realizó una punción lumbar en 167 pacientes (58%), entre los que se encontraron 7 (4%) casos de pleocitosis, cuyo cultivo de líquido cefalorraquídeo fue negativo, y 1 caso de meningitis por Escherichia coli en un neonato de 24 días, con urocultivo positivo para el mismo germen. Conclusiones: La incidencia de meningitis bacteriana en niños menores de 3 meses con sospecha de infección de orina en el estudio fue del 0,6%. Es importante reconsiderar la realización de una punción lumbar sistemática en estos pacientes, aunque parece prudente mantener su indicación en los menores de 1 mes y en los casos de sospecha por clínica o analítica de infección bacteriana severa(AU)

Objective: To study the rate of bacterial meningitis among infants aged 0-3 months with suspicion of urinary tract infection. Methods: This retrospective chart review involved all children younger than 3 months with pathologic rapid urine testing by urethral catheterization in the emergency department. Lumbar puncture was performed in all children <1 month and every child 1-3 months with septic appearance. The study was conducted from October 2004 to July 2010.Results: The study sample included 290 children with suspicion of urinary tract infection, of whom 76% boys and 24% girls; 43% of all patients were younger than one month. Urinary tract infection was confirmed by positive urine culture in 230 children, 9 of whom (3.2%) had bacteraemia associated. Lumbar puncture was performed on 167 patients (58%), of whom 7 (4%) had CSF pleocytosis. All CSF cultures were negative except of a case of a neonate 24 days old with meningitis and urinary tract infection caused by Escherichia coli. Conclusions: The incidence of bacterial meningitis among infants aged 0-3 months with suspicion of urinary tract infection was 0.6% in our study. It is important to reconsider the performance of lumbar puncture systematically in these children, although it is still need in children aged less than 1 month and in cases where there is clinical or laboratory test suspicion of serious bacterial infection(AU)

[The effect of helium on ventilator parameters: in vitro study with a Servoi ventilator]. / Efecto del helio sobre los parámetros de los respiradores en ventilación mecánica: estudio in vitro con el respirador Servoi.

OBJECTIVE: To analyze the changes in respiratory parameters in a Servoi ventilator with heliox. MATERIAL AND METHODS: In vitro study with a Servoi (Maquet) ventilator in volume controlled (VC), pressure controlled (PC) and volume control regulated by pressure (VCPR) modes connected to an artificial lung. A heliox tank with a fixed concentration of helium 70 % and oxygen 30 % was connected to the air inlet of the ventilator. The ventilator was set in VC mode with tidal volumes of 30, 50, 100, 250 and 500 ml; in PC mode with pressure of 20 and 30 cmH(2)O and in VCPR mode with tidal volume of 150 ml. In each case FiO(2) of 21, 30, 40, 50, 60, 70, 80, 90 and 100 % was used. The FiO(2), inspired and expired tidal volume and inspiratory pressure measured by the ventilator and a pitot spirometer (Datex_S5) were compared. RESULTS: In VC and VCPR modes the increase in helium produced a progressive decrease in the pressure needed to administrate the set volume. Heliox also produced a decrease in the tidal volume measured by the spirometer and the tidal expired volume measured by the respirator. In PC mode, heliox produced a progressive increase in the inspired tidal volume, increasing the differences between inspired and expired tidal volumes. CONCLUSIONS: Heliox used with Servoi ventilator produces a decrease in inspiratory pressures in VC and VCPR modes, and an increase in inspiratory tidal volume in PC mode. In all modes heliox reduced the expired tidal volume measured by the ventilator and the spirometer. These changes should be borne in mind if heliox is used with this ventilator.

Efecto del helio sobre los parámetros de los respiradores en ventilación mecánica: estudio in vitro con el respirador Servoi / The effect of helium on ventilator parameters: in vitro study with a Servoi ventilator

Objetivo: Analizar las modificaciones de los parámetros en el respirador Servoi con distintas concentraciones de héliox. Material y métodos: Estudio experimental en el que se utilizó un respirador Servoi (Maquet) en modalidades de volumen control (VC), presión control (PC) y volumen controlado regulado por presión (VCRP) conectado a un pulmón de artificial. El héliox se administró mediante una bombona con el 70 % de helio y el 30 % de oxígeno conectada a la entrada de aire del respirador. Se programó el respirador en VC con volúmenes corrientes de 30, 50, 100, 250 y 500 ml, en PC con presión de 20 y 30 cmH2O, y en VCRP con volumen corriente de 150 ml. En cada modalidad se programó una FiO2 de 21, 30, 40, 50, 60, 70, 80, 90 y 100 % y se comparó el volumen corriente inspirado, el espirado y la presión inspiratoria pico medidas por el respirador y por un espirómetro colocado entre la tubuladura y el pulmón de prueba y conectado a un monitor Datex_S5. Resultados: En modalidad de VC y VCRP el aumento de la concentración de helio produjo una disminución progresiva del pico de presión necesario para administrar el volumen programado y una disminución en el volumen corriente medido por el espirómetro y el volumen espirado medido por el respirador. En modalidad de PC el héliox produjo un aumento progresivo del volumen corriente inspirado con incremento en las diferencias entre el volumen corriente inspirado y el espirado. Conclusiones: La administración de héliox en el respirador Servoi produce una disminución de las presiones inspiratorias en las modalidades de VC y VCRP y un aumento del volumen corriente inspirado en la modalidad de PC. En todas las modalidades produce una falsa disminución en el volumen corriente espirado medido por el respirador y el espirómetro. Es necesario tener en cuenta estas alteraciones si se utiliza héliox con este respirador (AU)

Objective: To analyze the changes in respiratory parameters in a Servoi ventilator with heliox. Material and methods: In vitro study with a Servoi (Maquet) ventilator in volume controlled (VC), pressure controlled (PC) and volume control regulated by pressure (VCPR) modes connected to an artificial lung. A heliox tank with a fixed concentration of helium 70 % and oxygen 30 % was connected to the air inlet of the ventilator. The ventilator was set in VC mode with tidal volumes of 30, 50, 100, 250 and 500 ml; in PC mode with pressure of 20 and 30 cmH2O and in VCPR mode with tidal volume of 150 ml. In each case FiO2 of 21, 30, 40, 50, 60, 70, 80, 90 and 100 % was used. The FiO2, inspired and expired tidal volume and inspiratory pressure measured by the ventilator and a pitot spirometer (Datex_S5) were compared. Results: In VC and VCPR modes the increase in helium produced a progressive decrease in the pressure needed to administrate the set volume. Heliox also produced a decrease in the tidal volume measured by the spirometer and the tidal expired volume measured by the respirator. In PC mode, heliox produced a progressive increase in the inspired tidal volume, increasing the differences between inspired and expired tidal volumes. Conclusions: Heliox used with Servoi ventilator produces a decrease in inspiratory pressures in VC and VCPR modes, and an increase in inspiratory tidal volume in PC mode. In all modes heliox reduced the expired tidal volume measured by the ventilator and the spirometer. These changes should be borne in mind if heliox is used with this ventilator (AU)

[Experience with high-flow nasal cannula oxygen therapy in children]. / Experiencia con la oxigenoterapia de alto flujo en cánulas nasales en niños.

OBJECTIVE: To analyze the efficacy of a high-flow oxygen therapy system in children with moderate respiratory failure and/or high oxygen requirements. PATIENTS AND METHODS: We performed a prospective, observational clinical study of patients treated with a high-flow oxygen therapy system via nasal cannulae. The following variables were analyzed: clinical severity score, respiratory rate, heart rate, clinical improvement, oxygen saturation, blood gases, complications, and the need for ventilation after starting the treatment. RESULTS: Eighteen treatments were studied in 16 patients (two girls and 14 boys) aged between 2 and 156 months. With the high-flow oxygen therapy system, respiratory rate slightly decreased from 34.5 bpm to 32.2 bpm (p<0.04) and O2 saturation increased from 90.2% to 93.5% (p<0.02). Fourteen patients showed a clinical improvement and/or tolerated the change from the previous respiratory assistance. The duration of treatment was 3 days (range: 6 hours to 25 days). Mild complications (initial irritability and excessive humidity) were observed in two patients, but treatment interruption was not required. No secondary respiratory tract infections were observed. The system was withdrawn in four patients, due to lack of improvement in two patients, deterioration after initial improvement in one patient, and failure of the system's temperature regulation in one patient. CONCLUSIONS: The high-flow oxygen therapy system is effective in a large percentage of children with high oxygen requirements and/or moderate respiratory failure.

Experiencia con la oxigenoterapia de alto flujo en cánulas nasales en niños / Experience with high-flow nasal cannula oxygen therapy in children

Objetivo. Analizar la eficacia de un sistema de oxigenoterapia de alto flujo en niños con insuficiencia respiratoria moderada y/o necesidades elevadas de oxígeno. Pacientes y métodos.Estudio clínico prospectivo observacional en el que se incluyeron los pacientes tratados con un sistema de oxigenoterapia de alto flujo en cánulas nasales. Se analizaron las siguientes variables: puntuación de gravedad clínica, frecuencia respiratoria, cardíaca, mejoría clínica, saturación de oxígeno, gasometría, aparición de complicaciones y necesidad de ventilación no invasiva tras el inicio del tratamiento. Resultados. Se estudiaron 18 tratamientos en 16 pacientes, 2 niñas y 14 niños, de edades comprendidas entre 2 meses y 13 años. Con el sistema de alto flujo se observó una ligera disminución de la frecuencia respiratoria de 34,5 a 32,2 resp./min; p < 0,04, y un aumento de la saturación de oxígeno (SatO2) del 90,2 al 93,5 %; p < 0,02. Un total de 14 pacientes mejoraron clínicamente y/o permitieron el cambio desde la asistencia respiratoria previa. La duración del tratamiento fue de 3 días (rango 6 h a 25 días). En 2 pacientes se observaron complicaciones leves que no obligaron a suspender el tratamiento (irritabilidad inicial y excesiva humedad). No se observaron infecciones respiratorias secundarias. En cuatro pacientes el sistema fue retirado: en dos por falta de mejoría, en otro por empeoramiento tras mejoría inicial, y en el cuarto por fallo en la regulación de temperatura del aparato. Conclusiones. El sistema de oxigenoterapia de alto flujo es eficaz en un elevado porcentaje de niños con necesidades elevadas de oxígeno y/o insuficiencia respiratoria moderada

Objective. To analyze the efficacy of a high-flow oxygen therapy system in children with moderate respiratory failure and/or high oxygen requirements. Patients and methods. We performed a prospective, observational clinical study of patients treated with a high-flow oxygen therapy system via nasal cannulae. The following variables were analyzed: clinical severity score, respiratory rate, heart rate, clinical improvement, oxygen saturation, blood gases, complications, and the need for ventilation after starting the treatment. Results. Eighteen treatments were studied in 16 patients (two girls and 14 boys) aged between 2 and 156 months. With the high-flow oxygen therapy system, respiratory rate slightly decreased from 34.5 bpm to 32.2 bpm (p < 0.04) and O2 saturation increased from 90.2 % to 93.5 % (p < 0.02). Fourteen patients showed a clinical improvement and/or tolerated the change from the previous respiratory assistance. The duration of treatment was 3 days (range: 6 hours to 25 days). Mild complications (initial irritability and excessive humidity) were observed in two patients, but treatment interruption was not required. No secondary respiratory tract infections were observed. The system was withdrawn in four patients, due to lack of improvement in two patients, deterioration after initial improvement in one patient, and failure of the system's temperature regulation in one patient. Conclusions. The high-flow oxygen therapy system is effective in a large percentage of children with high oxygen requirements and/or moderate respiratory failure

[Necrotizing fasciitis due to Streptococcus pyogenes]. / Fascitis necrosante por Streptococcus pyogenes.

Necrotizing fasciitis is a severe infection, with systemic involvement and tissue necrosis. The clinical course is rapid and often fatal. Although this entity is uncommon, early recognition and treatment is essential to improve prognosis. Necrotizing fasciitis should be suspected when there are symptoms of toxicity and there is severe pain, frequently out of proportion to the clinical findings. In addition, in the last few years the incidence of invasive disease due to Streptococcus pyogenes in children has increased. Treatment is based on life support, aggressive debridement, and antimicrobial therapy. Intravenous immunoglobulin (IVIG) as adjunctive therapy seems useful and reduces mortality. The case of an infant with necrotizing fasciitis of four extremities is presented.

Fascitis necrosante por Streptococcus pyogenes / Necrotizing fasciitis due to Streptococcus pyogenes

La fascitis necrosante es una infección grave, con afectación sistémica y necrosis de tejidos, con un curso rápido y con frecuencia fatal. Aunque es una entidad poco frecuente, debe ser sospechada y tratada precozmente ya que mejora el pronóstico. Pensaremos en ella ante un cuadro tóxico con dolor desproporcionado a los hallazgos en la exploración. La incidencia de enfermedad invasiva por Streptococcus pyogenes en niños está en aumento en los últimos años. El tratamiento se basa en medidas de soporte, desbridamiento quirúrgico amplio y antibioterapia; la asociación de inmunoglobulina inespecífica intravenosa parece beneficiosa, reduciendo la mortalidad. Se presenta el caso de un lactante con fascitis necrosante de las cuatro extremidades

Necrotizing fasciitis is a severe infection, with systemic involvement and tissue necrosis. The clinical course is rapid and often fatal. Although this entity is uncommon, early recognition and treatment is essential to improve prognosis. Necrotizing fasciitis should be suspected when there are symptoms of toxicity and there is severe pain, frequently out of proportion to the clinical findings. In addition, in the last few years the incidence of invasive disease due to Streptococcus pyogenes in children has increased. Treatment is based on life support, aggressive debridement, and antimicrobial therapy. Intravenous immunoglobulin (IVIG) as adjunctive therapy seems useful and reduces mortality. The case of an infant with necrotizing fasciitis of four extremities is presented