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1.
Pediatr Crit Care Med ; 20(2): e77-e82, 2019 02.
Article in English | MEDLINE | ID: mdl-30575700

ABSTRACT

OBJECTIVES: It is currently recommended that after return of spontaneous circulation following cardiac arrest, fever should be prevented using TTM through a servo-controlled system. This technology is not yet available in many global settings, where manual physical measures without servo-control is the only option. Our aim was to compare feasibility, safety and quality assurance of servo-controlled system versus no servo-controlled system cooling, TTM protocols for cooling, maintenance and rewarming following return of spontaneous circulation after cardiac arrest in children. DESIGN: Prospective, multicenter, nonrandomized, study. SETTING: PICUs of 20 hospitals in South America, Spain, and Italy, 2012-2014. PATIENTS: Under 18 years old with a cardiac arrest longer than 2 minutes, in coma and surviving to PICU admission requiring mechanical ventilation were included. METHODS: TTM to 32-34°C was performed by prospectively designed protocol across 20 centers, with either servo-controlled system or no servo-controlled system methods, depending on servo-controlled system availability. We analyzed clinical data, cardiac arrest, temperature, mechanical ventilation duration, length of hospitalization, complications, survival, and neurologic outcomes at 6 months. PRIMARY OUTCOME: feasibility, safety and quality assurance of the cooling technique and secondary outcome: survival and Pediatric Cerebral Performance Category at 6 months. MEASUREMENTS AND MAIN RESULTS: Seventy patients were recruited, 51 of 70 TTM (72.8%) with servo-controlled system. TTM induction, maintenance, and rewarming were feasible in both groups. Servo-controlled system was more effective than no servo-controlled system in maintaining TTM (69 vs 60%; p = 0.004). Servo-controlled system had fewer temperatures above 38.1°C during the 5 days of TTM (0.1% vs 2.9%; p < 0.001). No differences in mortality, complications, length of mechanical ventilation and of stay, or neurologic sequelae were found between the two groups. CONCLUSIONS: TTM protocol (for cooling, maintenance and rewarming) following return of spontaneous circulation after cardiac arrest in children was feasible and safe with both servo-controlled system and no servo-controlled system techniques. Achieving, maintaining, and rewarming within protocol targets were more effective with servo-controlled system versus no servo-controlled system techniques.


Subject(s)
Cardiopulmonary Resuscitation/methods , Clinical Protocols/standards , Heart Arrest/therapy , Hypothermia, Induced/methods , Hypothermia, Induced/standards , Adolescent , Body Temperature , Child , Child, Preschool , Europe , Female , Humans , Infant , Intensive Care Units, Pediatric , Male , Prospective Studies , Rewarming/methods , South America
2.
Rev Chilena Infectol ; 31(3): 249-53, 2014 Jun.
Article in Spanish | MEDLINE | ID: mdl-25146197

ABSTRACT

BACKGROUND: In critically ill pediatric patients vancomycin distribution and elimination is altered underscoring the need for pharmacokinetic monitoring; however the therapeutic trough ranges have not been validated for children. OBJECTIVE: To describe the pharmacokinetics of intravenous vancomycin in critically ill pediatric patients using plasmatic vancomycin monitoring. METHODS: Retrospective, descriptive study performed in a paediatric critical care unit. Vancomycin serum levels (Cmin and Cpeak), t ½ and Vd were determined in 1 month to 12 year old patients receiving ≥ 40 mg per-kg-per day. Plasmatic levels were measured at therapy onset and during follow up, evaluating the proportion of trough level determinations within therapeutic range, the average trough concentration, and the Cpeak achieved. RESULTS: A total of 65 plasmatic vancomycin monitorings were analysed in 45 patients. The average values for Ctrough, Cpeak, t1/2 and Vd were 10.4 µg/mL, 22.7 µg/mL, 3,1 h and 0.7 L/kg, respectively. An average dose of 47,1 mg/kg/day achieved initial Ctrough levels < 10 mg/mL in 60% of patients (n = 27), between 10 and 14,9 µg/mL in 22,2% (n = 10), between 15 to 20 µg/mL in 4% (n: 2), and > 20 µg/mL in 13,3% (n: 6). CONCLUSIONS: Vancomycin doses of 40 mg/kg/day are insufficient for critically ill paediatric patients without renal failure. A higher starting dose and monitoring of plasma levels must be considered in this population.


Subject(s)
Anti-Bacterial Agents/pharmacokinetics , Critical Illness , Drug Monitoring/methods , Vancomycin/pharmacokinetics , Anti-Bacterial Agents/administration & dosage , Anti-Bacterial Agents/blood , Child , Child, Preschool , Dose-Response Relationship, Drug , Female , Humans , Infant , Infusions, Intravenous , Intensive Care Units, Pediatric , Male , Retrospective Studies , Vancomycin/administration & dosage , Vancomycin/blood
3.
Rev. chil. infectol ; 31(3): 249-253, jun. 2014. ilus, tab
Article in Spanish | LILACS | ID: lil-716975

ABSTRACT

Background: In critically ill pediatric patients vancomycin distribution and elimination is altered underscoring the need for pharmacokinetic monitoring; however the therapeutic trough ranges have not been validated for children. Objective: To describe the pharmacokinetics of intravenous vancomycin in critically ill pediatric patients using plasmatic vancomycin monitoring. Methods: Retrospective, descriptive study performed in a paediatric critical care unit. Vancomycin serum levels (Cmin and Cpeak), t ½ and Vd were determined in 1 month to 12 year old patients receiving ≥ 40 mg per-kg-per day. Plasmatic levels were measured at therapy onset and during follow up, evaluating the proportion of trough level determinations within therapeutic range, the average trough concentration, and the Cpeak achieved. Results: A total of 65 plasmatic vancomycin monitorings were analysed in 45 patients. The average values for Ctrough, Cpeak, t1/2 and Vd were 10.4 μg/mL, 22.7 μg/mL, 3,1 h and 0.7 L/kg, respectively. An average dose of 47,1 mg/kg/day achieved initial Ctrough levels < 10 mg/mL in 60% of patients (n = 27), between 10 and 14,9 μg/mL in 22,2% (n = 10), between 15 to 20 μg/mL in 4% (n: 2), and > 20 μg/mL in 13,3% (n: 6). Conclusions: Vancomycin doses of 40 mg/kg/day are insufficient for critically ill paediatric patients without renal failure. A higher starting dose and monitoring of plasma levels must be considered in this population.


Introducción: Los pacientes críticos pediátricos presentan alteraciones en la distribución y eliminación de vancomicina, lo que hace necesaria su monitorización terapéutica; sin embargo, los rangos basales óptimos no han sido validados en niños. Objetivo: Describir el monitoreo terapéutico de vancomicina intravenosa en pacientes críticos pediátricos, a través de medición de concentraciones plasmáticas terapéuticas. Metodología: Estudio descriptivo, retrospectivo, en una Unidad de Paciente Crítico Pediátrica. Se analizaron concentraciones plasmáticas de vancomicina Cbasales y Cpico, en niños entre 1 mes y 12 años de edad, que recibieron dosis ≥ 40 mg/kg/día. Se registraron concentraciones plasmáticas iniciales y de seguimiento, evaluándose la proporción de concentraciones sanguíneas basales en rango terapéutico, la concentración basal promedio y el Cpeak alcanzado. Resultados. Se analizaron 65 monitoreos terapéuticos, correspondientes a 45 pacientes. Los valores promedio de Cbasal, Cpico, t1/2 Vd fueron 10,4 μg/mL, 22,7 μg/mL, 3,1 h y 0,7 L/kg, respectivamente. Las Cbasales iniciales de los 45 pacientes, usando dosis promedio de 47,1 mg/kg/ día, se encontraron en 60% (n: 27) de los casos < 10 μg/mL, entre 10 y 14,9 μg/mL en 22% (n: 10), en 46% entre 15 y 20 μg/mL (n: 2) y en 13,3% (n: 6) fueron > 20 μg/mL. Conclusión: Vancomicina en dosis de 40 mg/kg/día, es insuficiente para pacientes pediátricos críticos sin disfunción renal, por lo que parece recomendable comenzar con dosis mayores y realizar monitoreo terapéutico de concentraciones plasmáticas en estos casos.


Subject(s)
Child , Child, Preschool , Female , Humans , Infant , Male , Anti-Bacterial Agents/pharmacokinetics , Critical Illness , Drug Monitoring/methods , Vancomycin/pharmacokinetics , Anti-Bacterial Agents/administration & dosage , Anti-Bacterial Agents/blood , Dose-Response Relationship, Drug , Infusions, Intravenous , Intensive Care Units, Pediatric , Retrospective Studies , Vancomycin/administration & dosage , Vancomycin/blood
4.
Bol. Hosp. San Juan de Dios ; 37(3): 158-62, mayo-jun. 1990. tab
Article in Spanish | LILACS | ID: lil-90147

ABSTRACT

Se realizó un análisis de las características clínicas y sociodemográficas de 331 pacientes epilépticos cuya primera consulta se realizó entre los años 1984-1986 en el Departamento de Neurología del Hospital San Juan de Dios. La población evaluada resultó ser predominantemente femenina, siendo la edad promedio de 29 ñ 14 años. La forma clínica predominante fue la tónicaclónica generalizada. La mayoría de los pacientes recibió monoterapia, siendo la droga más usada la fenitoína sódica y la asociación más frecuente prescrita la fenitoína sódica más fenobarbital. Se analizaron además antecedentes personales, familiares y factores desencadenantes


Subject(s)
Adolescent , Adult , Middle Aged , Humans , Male , Female , Epilepsy , Control Groups , Drug Therapy, Combination , Epilepsy/drug therapy , Phenytoin/therapeutic use , Phenobarbital/therapeutic use
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