ABSTRACT
The SARS-CoV-2 pandemic has created new scenarios that require modifications to the usual cardiopulmonary resuscitation protocols. The current clinical guidelines on the management of cardiorespiratory arrest do not include recommendations for situations that apply to this context. Therefore, the National Cardiopulmonary Resuscitation Plan of the Spanish Society of Intensive and Critical Care Medicine and Coronary Units (SEMICYUC), in collaboration with the Spanish Group of Pediatric and Neonatal CPR and with the Teaching Life Support in Primary Care program of the Spanish Society of Family and Community Medicine (SEMFyC), have written these recommendations, which are divided into 5 parts that address the main aspects for each healthcare setting. This article consists of an executive summary of them.
Subject(s)
COVID-19/complications , Cardiopulmonary Resuscitation/standards , SARS-CoV-2 , Adult , Advanced Cardiac Life Support/methods , Advanced Cardiac Life Support/standards , Age Factors , Airway Management/methods , Airway Management/standards , COVID-19/epidemiology , COVID-19/prevention & control , COVID-19/transmission , Cardiopulmonary Resuscitation/methods , Child , Disease Progression , Electric Countershock , Heart Arrest/therapy , Humans , Pandemics , Patient Positioning/methods , Personal Protective Equipment , Protective Clothing , Societies, Medical , SpainABSTRACT
OBJETIVO: Estudiar la organización del transporte interhospitalario pediátrico y neonatal en la península ibérica y Latinoamérica. DISEÑO: Estudio observacional prospectivo mediante una encuesta enviada por correo electrónico con preguntas sobre el sistema de transporte nacional, regional y local, el tipo y vehículo de traslado, el material y el personal y su formación. Ámbito: Responsables pediátricos de hospitales de España, Portugal y Latinoamérica. RESULTADOS: Se analizaron 117 encuestas provenientes de 15 países. De ellas, 55 (47%) procedían de 15 comunidades autónomas de España y el resto de Portugal y de 13 países latinoamericanos. Muy pocas regiones y ciudades tienen un sistema de transporte pediátrico y neonatal específico. El transporte solo está unificado en las comunidades españolas de Baleares y Cataluña y en Portugal. En Chile el sistema de transporte es mixto, pediátrico y del adulto. Solo un 51,4% de los hospitales tiene un sistema de formación del personal de transporte, y solo en el 36,4% la formación es específica en transporte pediátrico. En España y Portugal los sistemas de transporte son fundamentalmente públicos, mientras que en Latinoamérica coexisten sistemas públicos y privados. Los equipos de transporte de la península ibérica tienen más material pediátrico y neonatal y reciben más formación en transporte pediátrico que los de Latinoamérica. CONCLUSIONES: Existe una gran variabilidad en la organización del transporte pediátrico en cada país y región. En la mayoría de los países y ciudades no existe un sistema unificado y específico de transporte pediátrico con un personal cualificado y un material de traslado específico
OBJECTIVE: To study the organization of inter-hospital transport of pediatric and neonatal patients in Spain, Portugal and Latin America. DESIGN: An observational study was performed. An on-line survey was sent by email including questions about characteristics of national, regional and local health transport systems, vehicles, material, and composition of the transport team and their training. SETTING: Hospital pediatric healthcare professionals treating children in Spain, Portugal and Latin America RESULTS: A total of 117 surveys from 15 countries were analyzed. Of them, 55 (47%) come from 15 regions of Spain and the rest from Portugal and 13 Latin American countries. The inter-hospital transport of pediatric patients is unified only in the Spanish regions of Baleares and Cataluña and in Portugal. Chile has a mixed unified transport system for pediatric and adult patients. Only 51.4% of responders have an educational program for the transport personnel, and only in 36.4% of them the educational program is specific for pediatric patients. In Spain and Portugal the transport is executed mostly by public entities, while in Latin America public and private systems coexist. Specific pediatric equipment is more frequent in the transport teams in the Iberian Peninsula than in Latin American teams. The specific pediatric transport training is less frequent for teams in Latin America than on Spain and Portugal. CONCLUSIONS: There is a great variation in the organization of children transport in each country and region. Most of countries and cities do not have unified and specific teams of pediatric transport, with pediatric qualified personnel and specific material
Subject(s)
Humans , Child , Patient Transfer , Ambulances/organization & administration , Prehospital Care/methods , Intensive Care Units, Pediatric/organization & administration , Intensive Care Units, Neonatal/organization & administration , Health Personnel/statistics & numerical dataABSTRACT
OBJECTIVE: To study the organization of inter-hospital transport of pediatric and neonatal patients in Spain, Portugal and Latin America. DESIGN: An observational study was performed. An on-line survey was sent by email including questions about characteristics of national, regional and local health transport systems, vehicles, material, and composition of the transport team and their training. SETTING: Hospital pediatric healthcare professionals treating children in Spain, Portugal and Latin America RESULTS: A total of 117 surveys from 15 countries were analyzed. Of them, 55 (47%) come from 15 regions of Spain and the rest from Portugal and 13 Latin American countries. The inter-hospital transport of pediatric patients is unified only in the Spanish regions of Baleares and Cataluña and in Portugal. Chile has a mixed unified transport system for pediatric and adult patients. Only 51.4% of responders have an educational program for the transport personnel, and only in 36.4% of them the educational program is specific for pediatric patients. In Spain and Portugal the transport is executed mostly by public entities, while in Latin America public and private systems coexist. Specific pediatric equipment is more frequent in the transport teams in the Iberian Peninsula than in Latin American teams. The specific pediatric transport training is less frequent for teams in Latin America than on Spain and Portugal. CONCLUSIONS: There is a great variation in the organization of children transport in each country and region. Most of countries and cities do not have unified and specific teams of pediatric transport, with pediatric qualified personnel and specific material.
Subject(s)
Transportation of Patients/organization & administration , Adolescent , Child , Child, Preschool , Health Care Surveys , Humans , Infant , Infant, Newborn , Latin America , Portugal , Prospective Studies , SpainABSTRACT
La docencia y la investigación son actividades esenciales en un hospital y por esa razón la docencia pregrado y posgrado y la investigación deben desarrollarse y coordinarse de forma integrada con la asistencia clinica. El Hospital Materno Infantil Gregorio Marañón tiene una importante actividad docente pregrado, tanto en Medicina como parte de la Universidad Complutense de Madrid, como en enfermería. A nivel posgrado realiza la formación de residentes de Pediatría, Cirugía Pediátrica, Medicina Familiar y Comunitaria y Enfermería Pediátrica e imparte múltiples cursos de formación continuada a profesionales sanitarios y padres. El Hospital Materno Infantil Gregorio Marañón es uno de los hospitales españoles con mayor producción científica, mayor número de proyectos de investigación y mayor capacidad de formación de investigadores. El objetivo en el futuro debe ser desarrollar una política institucional docente e investigadora coordinadas que integre la docencia y la investigación médica y de enfermería. Es necesario potenciar la integración y el reconocimiento de la actividad docente e investigadora en la práctica clínica, aumentar la formación de los profesionales en metodología docente e investigadora, estimular las áreas del hospital con menor desarrollo, facilitar la participación en redes de investigación nacionales e internacionales, e integrar la docencia e investigación en los proyectos de cooperación (AU)
Teaching and research are very important activities in a children's hospital and for that reason undergraduate and graduate teaching and research must be developed and coordinated and integrated with clinical care. The Maternal and Children Gregorio Marañón Hospital has an important undergraduate teaching, both in medicine as part of the Complutense University of Madrid, as in nursing. The Maternal and Child Gregorio Marañón Hospital performs prostgraduate residency training in Pediatrics, Pediatric Surgery and Pediatric Nursing and provides multiple continuing education courses for health professionals and parents. The Maternal and Children Gregorio Marañón Hospital is one of the Spanish hospitals with higher scientific production, as many research projects and greater capacity for research training. The goal in the future must be to develop an educational institutional policy to coordinate and integrate medical and nursing research and teaching. It is necessary to enhance integration and recognition of the teaching and research activities in clinical practice, increase education of health professionals in teaching and research methodology, stimulate areas of the hospital with lower development, facilitate participation in research networks, and integrate teaching and research in the cooperation projects (AU)
Subject(s)
Humans , Male , Female , Pediatrics/education , Teaching/methods , Teaching/organization & administration , Research/organization & administration , Research/trends , Pediatric Nursing/organization & administration , Pediatric Nursing/standards , Education, Medical/organization & administration , Education, Medical/standards , Hospitals, General/organization & administration , Hospitals, General/standards , Hospitals, University/organization & administration , Hospitals, UniversityABSTRACT
No disponible
Subject(s)
Female , Humans , Male , Noninvasive Ventilation/methods , Clinical Clerkship/ethics , Bronchitis, Chronic/metabolism , Bronchitis, Chronic/pathology , Critical Care/methods , Noninvasive Ventilation/instrumentation , Clinical Clerkship , Bronchitis, Chronic/complications , Bronchitis, Chronic/diagnosis , Critical Care/standards , Observational StudyABSTRACT
OBJETIVOS: Estudiar la evolución durante 12 años del uso de la ventilación mecánica invasiva (VMI) y no invasiva (VNI) en niños con bronquiolitis ingresados en una unidad de cuidados intensivos pediátricos (UCIP). PACIENTES Y MÉTODOS: Estudio retrospectivo observacional de 12 años de duración (2001-2012) en el que se incluyó a todos los niños ingresados con bronquiolitis en UCIP que requirieron VMI y/o VNI. Se analizaron las características demográficas, el tipo de asistencia respiratoria y la evolución clínica, comparándose los primeros 6 años de estudio con los segundos. RESULTADOS: Se estudió a 196 pacientes. Un 30,1% requirió VMI y un 93,3% VNI. La mediana de duración de VMI fue de 9,5 días y la de VNI de 3 días. La duración de ingreso en UCIP fue de 7 días y falleció un 2% de los pacientes. La utilización de VNI aumentó del 79,4% en el primer periodo al 100% en el segundo periodo (p < 0,0001) y disminuyó el de VMI del 46% en el primer periodo al 22,6% en el segundo (p < 0,0001). La presión positiva continua en la vía aérea y el tubo endotraqueal cortado fueron la modalidad y la interfase más utilizadas, aunque en el segundo periodo aumentó significativamente el uso de ventilación con 2 niveles de presión (p < 0,0001) y de púas nasales (p < 0,0001), y disminuyó la duración de ingreso en la UCIP (p = 0,011). CONCLUSIONES: La mayor utilización de VNI en pacientes con bronquiolitis en nuestra unidad en los últimos años se asoció a una disminución de la necesidad de VMI y de la duración del ingreso en la UCIP
OBJECTIVES: The aim of the study was to analyse the evolution, over a12-year period, of the use of non-invasive (NIV) and invasive ventilation (IV) in children admitted to a Paediatric Intensive Care Unit (PICU) due to acute bronchiolitis. PATIENTS AND METHODS: A retrospective observational study was performed including all children who were admitted to the PICU requiring NIV or IV between 2001 and 2012. Demographic characteristics, ventilation assistance and clinical outcome were analysed. A comparison was made between the first six years and the last 6 years of the study. RESULTS: A total of 196 children were included; 30.1% of the subjects required IV and 93.3% required NIV. The median duration of IV was 9.5 days and NIV duration was 3 days. The median PICU length of stay was 7 days, and 2% of the patients died. The use of NIV increased from 79.4% in first period to 100% in the second period (P<.0001) and IV use decreased from 46% in the first period to 22.6% in the last 6 years (P<.0001). Continuous positive airway pressure and nasopharyngeal tube were the most frequently used modality and interface, although the use of bi-level non-invasive ventilation (P<.001) and of nasal cannulas significantly increased(P<.0001) in the second period, and the PICU length of stay was shorter (P=.011). CONCLUSION: The increasing use of NIV in bronchiolitis in our PICU during the last 12 years was associated with a decrease in the use of IV and length of stay in the PICU
Subject(s)
Child , Female , Humans , Male , Respiration, Artificial/methods , Respiration, Artificial , Bronchiolitis/complications , Bronchiolitis/diagnosis , Bronchiolitis/therapy , Continuous Positive Airway Pressure/methods , Continuous Positive Airway Pressure , High-Frequency Ventilation/methods , Intermittent Positive-Pressure Breathing/methods , Intermittent Positive-Pressure VentilationABSTRACT
No disponible
Subject(s)
Child , Humans , Male , Cardiac Tamponade/etiology , Thrombolytic Therapy/adverse effects , Fibrinolytic Agents/adverse effects , Hypoplastic Left Heart Syndrome/surgery , Tissue Plasminogen Activator/adverse effects , Postoperative ComplicationsABSTRACT
OBJECTIVES: The aim of the study was to analyse the evolution, over a12-year period, of the use of non-invasive (NIV) and invasive ventilation (IV) in children admitted to a Paediatric Intensive Care Unit (PICU) due to acute bronchiolitis. PATIENTS AND METHODS: A retrospective observational study was performed including all children who were admitted to the PICU requiring NIV or IV between 2001 and 2012. Demographic characteristics, ventilation assistance and clinical outcome were analysed. A comparison was made between the first six years and the last 6 years of the study. RESULTS: A total of 196 children were included; 30.1% of the subjects required IV and 93.3% required NIV. The median duration of IV was 9.5 days and NIV duration was 3 days. The median PICU length of stay was 7 days, and 2% of the patients died. The use of NIV increased from 79.4% in first period to 100% in the second period (P<.0001) and IV use decreased from 46% in first period to 22.6% in the last 6 years (P<.0001). Continuous positive airway pressure and nasopharyngeal tube were the most frequently used modality and interface, although the use of bi-level non-invasive ventilation (P<.001) and of nasal cannulas significantly increased (P<.0001) in the second period, and the PICU length of stay was shorter (P=.011). CONCLUSION: The increasing use of NIV in bronchiolitis in our PICU during the last 12 years was associated with a decrease in the use of IV and length of stay in the PICU.
Subject(s)
Bronchiolitis/therapy , Noninvasive Ventilation/trends , Acute Disease , Female , Humans , Infant , Male , Noninvasive Ventilation/statistics & numerical data , Respiration, Artificial/statistics & numerical data , Respiration, Artificial/trends , Retrospective Studies , Time FactorsABSTRACT
OBJETIVO: Analizar la morbimortalidad asociada a daño renal agudo (DRA) definido por los criterios RIFLE adaptados a Pediatría en los niños que ingresan en la Unidad de Cuidados Intensivos Pediátricos (UCIP). DISEÑO: Estudio retrospectivo de cohorte. Ámbito: UCIP de un hospital terciario. Pacientes o participantes: Trescientos veinte niños ingresados en la UCIP en el año 2011. Se excluyeron los neonatos y los trasplantados renales. Variables principales El DRA fue definido con los criterios RIFLE adaptados a Pediatría. Para la valoración de la morbimortalidad se utilizó la duración de las estancias en la UCIP y en el hospital, la necesidad de ventilación mecánica y la mortalidad. RESULTADOS: Se estudiaron 315 niños, con una mediana de edad de 19 meses (6-72). Presentaron DRA 128 niños (40,6%) (73 en la categoría de Risk [riesgo] y 55 en las categorías Injury [daño] y Failure [fallo]). Los niños con DRA presentaron mayor mortalidad (11,7%) que el resto de pacientes (0,5%), una estancia más prolongada en UCIP (6,0 [4,0-12,5] frente a 3,5 [2,0-7,0] días) y en el hospital (17 (10-32) frente a 10 (7-15] días) y más niños precisaron ventilación mecánica (61,7 frente a 36,9%). El desarrollo de DRA fue un factor independiente de morbilidad, asociado a una mayor estancia en UCIP y hospitalaria y a una ventilación mecánica más prolongada, incrementándose esta morbilidad de forma paralela a la gravedad del daño renal. CONCLUSIÓN: El desarrollo de DRA en niños en estado crítico se asocia a un incremento en la morbimortalidad, que es directamente proporcional a la magnitud de la gravedad del daño renal
AIM: To describe the morbimortality associated to the development of acute kidney injury (AKI) defined by the pediatric adaptation of the RIFLE criteria in a Pediatric Intensive Care Unit (PICU). DESIGN: A retrospective cohort study was carried out. SETTING: Children admitted to a PICU in a tertiary care hospital. Patients or participants A total of 320 children admitted to a tertiary care hospital PICU during the year 2011. Neonates and renal transplant patients were excluded. Primary endpoints AKI was defined and classified according to the pediatric adaptation to the RIFLE criteria. PICU and hospital stays, use of mechanical ventilation and mortality were used to evaluate morbimortality. RESULTS: A total of 315 children met the inclusion criteria, with a median age of 19 months (range 6-72). Of these patients, 128 presented AKI (73 reached the Risk category and 55 reached the Injury and Failure categories). Children with AKI presented a longer PICU stay (6.0 [4.0-12.5] vs. 3.5 [2.0-7.0] days) and hospital stay (17 [10-32] vs. 10 [7-15] days), and a greater need for mechanical ventilation (61.7 vs. 36.9%). The development of AKI was an independent factor of morbidity, associated with a longer PICU and hospital stay, and with a need for longer mechanical ventilation, with a proportional relationship between increasing morbidity and the severity of AKI. CONCLUSION: The development of AKI in critically ill children is associated with increased morbimortality, which is proportional to the severity of renal injury
Subject(s)
Humans , Male , Female , Child , Acute Kidney Injury/epidemiology , Critical Care/methods , Indicators of Morbidity and Mortality , Intensive Care Units, Pediatric/statistics & numerical data , Retrospective Studies , Severity of Illness IndexABSTRACT
AIM: To describe the morbimortality associated to the development of acute kidney injury (AKI) defined by the pediatric adaptation of the RIFLE criteria in a Pediatric Intensive Care Unit (PICU). DESIGN: A retrospective cohort study was carried out. SETTING: Children admitted to a PICU in a tertiary care hospital. Patients or participants A total of 320 children admitted to a tertiary care hospital PICU during the year 2011. Neonates and renal transplant patients were excluded. Primary endpoints AKI was defined and classified according to the pediatric adaptation to the RIFLE criteria. PICU and hospital stays, use of mechanical ventilation and mortality were used to evaluate morbimortality. RESULTS: A total of 315 children met the inclusion criteria, with a median age of 19 months (range 6-72). Of these patients, 128 presented AKI (73 reached the Risk category and 55 reached the Injury and Failure categories). Children with AKI presented a longer PICU stay (6.0 [4.0-12.5] vs. 3.5 [2.0-7.0] days) and hospital stay (17 [10-32] vs. 10 [7-15] days), and a greater need for mechanical ventilation (61.7 vs. 36.9%). The development of AKI was an independent factor of morbidity, associated with a longer PICU and hospital stay, and with a need for longer mechanical ventilation, with a proportional relationship between increasing morbidity and the severity of AKI. CONCLUSION: The development of AKI in critically ill children is associated with increased morbimortality, which is proportional to the severity of renal injury.
Subject(s)
Acute Kidney Injury/complications , Acute Kidney Injury/mortality , Child , Child, Preschool , Cohort Studies , Female , Humans , Infant , Intensive Care Units, Pediatric , Male , Patient Admission , Retrospective StudiesABSTRACT
Introducción: La ventilación mecánica domiciliaria (VMD) es una técnica cada vez más frecuente en el niño. Existen pocos estudios que hayan analizado las características y necesidades de los niños sometidos a esta técnica. Material y métodos: Estudio descriptivo observacional transversal multicéntrico de pacientes entre un mes y 16 años dependientes de ventilación mecánica domiciliaria. Resultados: Se estudiaron 163 pacientes de 17 hospitales españoles con una edad media de 7,6 años. La causa más frecuente de VMD fueron los trastornos neuromusculares. El inicio de la VMD fue a una edad media de 4,6 años. Un 71,3% recibieron ventilación no invasiva. Los pacientes con ventilación invasiva tenían menor edad, menor edad de inicio de la VMD y mayor tiempo de uso diario. El 80,9% precisaban VM solo durante el sueño, y un 11,7% durante todo el día. Únicamente un 3,4% de los pacientes tiene asistencia sanitaria externa como ayuda a la familia. Un 48,2% es controlado en consultas específicas de VMD o consultas multidisciplinares. Un 72,1% de los pacientes está escolarizado (recibiendo enseñanza adaptada un 42,3%). Solo un 47,8% de los pacientes escolarizados cuentan con cuidadores específicos en su centro escolar. Conclusiones: La VMD en niños se utiliza en un grupo muy heterogéneo de pacientes iniciándose en un importante porcentaje en los primeros 3 años de vida. A pesar de que un significativo porcentaje de pacientes tiene una gran dependencia de la VMD pocas familias cuentan con ayudas específicas tanto a nivel escolar como en el domicilio, y el seguimiento sanitario es heterogéneo y poco coordinado(AU)
Introduction: Domiciliary mechanical ventilation (DMV) use is increasing in children. Few studies have analysed the characteristics of patients using this technique. Materials and methods: An observational, descriptive, transversal, multicentre study was conducted on patients between 1 month and 16 years of age dependent on domiciliary mechanical ventilation. Results: A total of 163 patients with a median age of 7.6 years from 17 Spanish hospitals were studied. The main reasons for DMV were neuromuscular disorders. The median age at beginning of DMV was 4.6 years. Almost three-quarters (71.3%) received non-invasive ventilation. Patients depending on invasive ventilation were younger, started DMV at an earlier age, and had more hours of mechanical ventilation per day. The large majority (80.9%) used DMV during sleep time only, and 11.7% during the whole day. Only 3.4% of patients had external health assistance. Just under half (48.2%) were being followed up in specific DMV or multidisciplinary clinics. Almost three-quarters (72.1%) of patients attended school (42.3% with adapted schooling). Only 47.8% of school patients had specific caregivers in their schools. Conclusions: DMV in children is used in a very heterogeneous group of patients, and in an important number of patients it is started before the third year of life. Despite there being a significant proportion of patients with a high dependency on DMV, few families receive specific support at home or at school, and health care surveillance is variable and poorly coordinated(AU)
Subject(s)
Humans , Male , Female , Child , Respiration, Artificial , Assisted Living Facilities/methods , Respiratory Insufficiency/therapy , Tracheostomy , Neuromuscular Diseases/complicationsABSTRACT
INTRODUCTION: Domiciliary mechanical ventilation (DMV) use is increasing in children. Few studies have analysed the characteristics of patients using this technique. MATERIALS AND METHODS: An observational, descriptive, transversal, multicentre study was conducted on patients between 1 month and 16 years of age dependent on domiciliary mechanical ventilation. RESULTS: A total of 163 patients with a median age of 7.6 years from 17 Spanish hospitals were studied. The main reasons for DMV were neuromuscular disorders. The median age at beginning of DMV was 4.6 years. Almost three-quarters (71.3%) received non-invasive ventilation. Patients depending on invasive ventilation were younger, started DMV at an earlier age, and had more hours of mechanical ventilation per day. The large majority (80.9%) used DMV during sleep time only, and 11.7% during the whole day. Only 3.4% of patients had external health assistance. Just under half (48.2%) were being followed up in specific DMV or multidisciplinary clinics. Almost three-quarters (72.1%) of patients attended school (42.3% with adapted schooling). Only 47.8% of school patients had specific caregivers in their schools. CONCLUSIONS: DMV in children is used in a very heterogeneous group of patients, and in an important number of patients it is started before the third year of life. Despite there being a significant proportion of patients with a high dependency on DMV, few families receive specific support at home or at school, and health care surveillance is variable and poorly coordinated.
Subject(s)
Home Care Services , Respiration, Artificial , Adolescent , Child , Child, Preschool , Cross-Sectional Studies , Female , Humans , Infant , Male , SpainABSTRACT
No disponible
Subject(s)
Humans , Child , Monitoring, Physiologic/methods , Critical Care/methods , Shock/diagnosis , Intensive Care Units, Pediatric , Hemodynamics/physiology , Cardiac Output, High/diagnosis , Cardiac Output, Low/diagnosis , Microcirculation/physiology , Blood Gas Monitoring, Transcutaneous/methods , Manometry/methods , Hypoxia/diagnosis , Atrial Natriuretic Factor/analysis , Troponin/analysisABSTRACT
Objetivo: Analizar la mortalidad y el consumo de recursos de los niños con ingreso prolongado en unidades de cuidados intensivos pediátricos (UCIP).Diseño: Estudio descriptivo retrospectivo de una serie de casos.Ámbito: UCIP médico-quirúrgica de un hospital de tercer nivel.Pacientes: Se recogieron los datos de los pacientes ingresados durante 28 o más días en la UCIPentre 2006 y 2010. De los 2.118 pacientes ingresados entre 2006 y 2010, 83 (3,9%) requirieron ingreso prolongado.Variables de interés: Se analizaron la morbimortalidad y el consumo de recursos por los pacientescon ingreso prolongado.Resultados: La mortalidad de los pacientes con ingreso prolongado fue mayor (22,9%) que la del resto de los pacientes (2%) (p < 0,001). En un 52,6% de estos pacientes el fallecimiento se produjo tras la limitación del esfuerzo terapéutico o por no iniciar medidas de reanimación. Los pacientes con ingreso prolongado presentaron una elevada incidencia de infección nosocomial (96,3%) y un elevado consumo de los recursos asistenciales (el 97,6% precisó ventilación mecánica;el 90,2%, transfusión de hemoderivados; el 86,7% fármacos vasoactivos intravenosos, y el22,9%, oxigenación por membrana extracorpórea (ECMO).Conclusiones: Los niños en estado crítico con ingreso prolongado en la UCIP tienen una elevada morbimortalidad y requieren un elevado consumo de recursos asistenciales. Son necesarias medidas específicas que permitan identificar precozmente a los pacientes susceptibles de presentar ingreso prolongado para adecuar las medidas terapéuticas y los recursos disponibles y mejorar la eficiencia del tratamiento (AU)
Objective: To analyze mortality and resource consumption in patients with long stays in pediatric intensive care units (PICUs).Design: A retrospective, descriptive case series study.Scope: Medical-surgical PICU in a third level hospital.Patients: Data were collected from patients with a stay of 28 days or more in PICU between 2006 and 2010. Of the 2118 patients assisted in this period, 83 (3.9%) required prolonged stay.Study variables: Morbidity-mortality and resource consumption among patients with prolonged stay in the PICU. Results: Mortality was higher in patients with a long stay (22.9%) than in the rest of patients (2%)(p < 0.001). In 52.6% of these patients, death occurred after with drawal of treatment or after not starting resuscitation measures. Patients with prolonged stay showed a high incidence of nosocomial infection (96.3%) and an important consumption of healthcare resources (97.6% required conventional mechanical ventilation, 90.2% required transfusion of blood products, 86.7% required intravenous vasoactive drugs and 22.9% required extracorporeal membrane oxygenation[ECMO]).Conclusions: Critical children with prolonged stay in the PICU show important morbidity and mortality, and an important consumption of healthcare resources. The adoption of specific measures permitting early identification of patients at risk of prolonged stay is needed in order to adapt therapeutic measures and available resources, and to improve treatment efficiency (AU)
Subject(s)
Humans , Male , Female , Child , /statistics & numerical data , Intensive Care Units/statistics & numerical data , Risk Factors , Cost of Illness , Child, Hospitalized/statistics & numerical data , Tracheotomy , /statistics & numerical data , Cross Infection/epidemiologyABSTRACT
Objetivo: Analizar la eficacia y tolerancia de la ventilación mecánica no invasiva (VMNI) a través de unas cánulas de oxigenoterapia de alto flujo en niños con insuficiencia respiratoria moderada y/o tras retirada de ventilación mecánica. Pacientes y métodos: Estudio clínico prospectivo observacional en el que se estudió a 34 pacientes de edades comprendidas entre 9 meses y 17 años, tratados con VMNI a través de unas cánulas nasales de oxigenoterapia de alto flujo de adulto. Se analizaron las siguientes variables: edad, sexo, frecuencia respiratoria, cardiaca, saturación de oxígeno, gasometría, mejoría clínica, tolerancia, aparición de complicaciones y fracaso del tratamiento. Resultados: Trece pacientes recibieron VMNI de forma programada tras la retirada de la ventilación mecánica y 21 por insuficiencia respiratoria. El 82,3% de los pacientes mejoraron clínicamente y/o toleraron la retirada de ventilación mecánica, aunque no se observó un cambio significativo en la frecuencia respiratoria, frecuencia cardiaca, pH, pCO2 ni saturación. En 6 pacientes (17,6%) la VMNI no fue efectiva y precisó cambio a mascarilla nasal o buconasal (5 pacientes) o intubación (1 paciente). Otros dos pacientes (5,9%) precisaron cambio de interfase a mascarilla nasal o nasobucal, uno por presentar erosión nasal y otro porque aunque mejoró clínicamente, presentaba fugas excesivas. La duración del tratamiento fue de 48 h (rango 1 a 312 h). Conclusiones: La VMNI a través de cánulas nasales de alto flujo es eficaz y bien tolerada en un importante porcentaje de niños tras retirada de ventilación mecánica o con insuficiencia respiratoria moderada (AU)
Objective: To analyse the efficacy and tolerance of non-invasive mechanical ventilation (NIMV) via high-flow oxygen therapy nasal cannulae in children after withdrawal of mechanical ventilation and/or with moderate respiratory insufficiency. Patients and methods: A prospective observational clinical study including 34 children between9 months and 17 years treated with NIMV via high-flow oxygen therapy nasal cannulae. The following variables were analysed: age, sex, respiratory rate, heart rate, oxygen saturation, blood gases, clinical improvement, tolerance, onset of complications and treatment failure. Results: NIMV was used in 13 children after withdrawal of mechanical ventilation and in 21 with respiratory failure. A high percentage (82.3%) of patients improved clinically and/or allowed the mechanical ventilation to be withdrawn, but there were no significant changes in respiratory rate, heart rate, pH, pCO2 or saturation. NIMV was not effective in 6 patients (17.6%) and required change to a nasal or buconasal mask (5 patients) or intubation (1 patient). Two patients (5.9%) required change of interface to a nasal or buconasal mask, one had nasal erosion, and another, although improved clinically, showed excessive leakage. The duration of treatment was 48 hours (range 1 to 312 hours).Conclusions: Non-invasive mechanical ventilation via high-flow oxygen therapy nasal cannulae is effective and well tolerated in a high percentage of children after withdrawal of mechanical ventilation or with moderate respiratory insufficiency (AU)
Subject(s)
Humans , Male , Female , Infant , Child, Preschool , Child , Adolescent , Oxygen Inhalation Therapy/instrumentation , Oxygen Inhalation Therapy/methods , Oxygen Inhalation Therapy/trends , Respiratory Insufficiency/therapy , Respiration, Artificial/classification , Respiration, Artificial/trends , Prospective StudiesABSTRACT
OBJECTIVE: To analyze mortality and resource consumption in patients with long stays in pediatric intensive care units (PICUs). DESIGN: A retrospective, descriptive case series study. SCOPE: Medical-surgical PICU in a third level hospital. PATIENTS: Data were collected from patients with a stay of 28 days or more in PICU between 2006 and 2010. Of the 2118 patients assisted in this period, 83 (3.9%) required prolonged stay. STUDY VARIABLES: Morbidity-mortality and resource consumption among patients with prolonged stay in the PICU. RESULTS: Mortality was higher in patients with a long stay (22.9%) than in the rest of patients (2%) (p<0.001). In 52.6% of these patients, death occurred after withdrawal of treatment or after not starting resuscitation measures. Patients with prolonged stay showed a high incidence of nosocomial infection (96.3%) and an important consumption of healthcare resources (97.6% required conventional mechanical ventilation, 90.2% required transfusion of blood products, 86.7% required intravenous vasoactive drugs and 22.9% required extracorporeal membrane oxygenation [ECMO]). CONCLUSIONS: Critical children with prolonged stay in the PICU show important morbidity and mortality, and an important consumption of healthcare resources. The adoption of specific measures permitting early identification of patients at risk of prolonged stay is needed in order to adapt therapeutic measures and available resources, and to improve treatment efficiency.
