ABSTRACT
El documento presenta la situación de la Sección de Urgencias-Cuidados Intensivos Pediátricos (CIP). Tras una introducción que pretende enmarcar la sección en su contexto histórico y demográfico, se describe la misión, visión, valores y la cartera de servicios de la sección. Posteriormente se detalla la actividad asistencial, la labor docente y los proyectos y líneas de investigación. Para finalizar, se explica brevemente nuestro compromiso con la calidad y seguridad del paciente y nuestras líneas estratégicas para la integración con atención primaria (AU)
The paper presents the status of the Section of Emergency-CIP. Alter an introductory section aims to frame the historical and demographic background, mission, vision, values and the range 01 services described in section. Subsequently those services, the teaching and research projects and detailed lines. To conclude briefly describes our commitment to quality and patient safety and lar our strategic integration lines with primary care (AU)
Subject(s)
Humans , Emergency Service, Hospital/organization & administration , Pediatrics/organization & administration , Intensive Care Units, Pediatric/organization & administration , Critical Illness , Hospitals, University/organization & administration , Comprehensive Health Care/organization & administration , Delivery of Health Care, Integrated/organization & administrationABSTRACT
INTRODUCTION: Bronchodilators administrated through a metered-dose inhaler (MDI) with spacer are as effective as nebulizers in the treatment of acute asthma exacerbations in childhood. However, consensus is lacking on the most suitable dosage. OBJECTIVE: To assess the effectiveness of distinct salbutamol and terbutaline doses delivered via an MDI with spacer for the treatment of acute asthma in the pediatric emergency department. METHODS: This was a prospective, double-blind randomized study. All consecutive children (n = 324) between 2 and 14 years of age with acute asthma exacerbations treated in the pediatric emergency department between October 1 and November 30, 2004, were included. Two treatment groups were established: one group received a number of puffs equivalent to half the child's weight (1 puff of salbutamol = 100 microg and 1 puff of terbutaline = 250 microg) and the other group received a number of puffs equivalent to one-third of the child's weight. RESULTS: Three hundred twenty-four episodes were studied; there were 164 children in the first group and 160 in the second. There were no significant differences between the two groups in the mean (6 SD) age (58.34 +/- 34.72 vs 66.04 +/- 36.45 months), arterial oxygen saturation (95.49 +/- 1.93 vs 95.56 +/- 1.97) or pulmonary score (4.04 +/- 1.55 vs 3.97 +/- 1.51) at recruitment and after treatment in the emergency department (arterial oxygen saturation [96.34 +/- 1.60 vs 96.18 +/- 1.77], pulmonary score [1.87 +/- 1.33 vs 1.64 +/- 1.31]). The number of doses administered (2.17 +/- 0.91 vs 2.24 +/- 1.00) and the hospitalization rate (8.56 % vs 6.87 %) were also similar in both groups. CONCLUSIONS: The distinct bronchodilator doses administered via an MDI with spacer showed similar effectiveness. These findings should contribute to a reevaluation of the use of high doses of bronchodilators, at least in most acute asthma exacerbations in children.
Subject(s)
Asthma/drug therapy , Bronchodilator Agents/administration & dosage , Inhalation Spacers , Metered Dose Inhalers , Adolescent , Albuterol/administration & dosage , Child , Child, Preschool , Double-Blind Method , Emergency Service, Hospital , Humans , Pediatrics , Prospective Studies , Terbutaline/administration & dosageABSTRACT
Introducción. Los broncodilatadores administrados mediante aerosol dosificador presurizado (MDI) con cámara espaciadora son tan eficaces como la nebulización en el tratamiento de las crisis asmáticas en la infancia. No existe consenso sobre cuál es la equivalencia de dosis entre ambos sistemas de inhalación. Objetivo. Determinar la eficacia de diferentes dosis de salbutamol o terbutalina administrados mediante dispositivo MDI con cámara espaciadora, en el tratamiento de la crisis asmática en urgencias. Métodos. Estudio prospectivo, aleatorio y ciego. Fueron incluidos de forma consecutiva, todos los niños entre 2 y 14 años que consultaron por una crisis asmática en el servicio de urgencias entre el 1 de octubre y el 30 de noviembre de 2004. Se establecieron dos grupos de tratamiento: un grupo recibió un número de puffs equivalente a la mitad del peso del niño (1 puff de salbutamol = 100 μg y 1 puff de terbutalina = 250 μg) y el segundo grupo recibió un número de puffs equivalente a un tercio del peso. Resultados. Fueron estudiados 324 episodios; 164 niños en el primer grupo y 160 en el segundo grupo. La edad media de ambos grupos fue similar (58,34 ± 34,72 meses frente a 66,04 ± 36,45 meses), y no se encontraron diferencias significativas en la saturación de oxígeno (95,49 ± 1,93 frente a 95,56 ± 1,97), ni en la puntuación del pulmonary score (PS) (4,04 ± 1,55 frente a 3,97 ± 1,51) en el momento de la llegada a urgencias, ni tras el tratamiento administrado, saturación de oxígeno (96,34 ± 1,60 frente a 96,18 ± 1,77) y puntuación del PS (1,87 ± 1,33 frente a 1,64 ± 1,31). El número de dosis de broncodilatador administradas fue similar en ambos grupos (2,17 ± 0,91 frente a 2,24 ± 1,00). No se observaron diferencias en el porcentaje de niños que precisaron ingreso en la unidad de observación (8,56 % frente a 6,87 %). Conclusiones. Las diferentes dosificaciones de broncodilatadores administradas a través de MDI con espaciador, utilizadas en este estudio, tuvieron una eficacia similar. Estos hallazgos deberían contribuir a reconsiderar el uso de dosis elevadas de broncodilatadores, al menos en la mayoría de las crisis asmáticas en niños
Introduction. Bronchodilators administrated through a metered-dose inhaler (MDI) with spacer are as effective as nebulizers in the treatment of acute asthma exacerbations in childhood. However, consensus is lacking on the most suitable dosage. Objective. To assess the effectiveness of distinct salbutamol and terbutaline doses delivered via an MDI with spacer for the treatment of acute asthma in the pediatric emergency department. Methods. This was a prospective, double-blind randomized study. All consecutive children (n = 324) between 2 and 14 years of age with acute asthma exacerbations treated in the pediatric emergency department between October 1 and November 30, 2004, were included. Two treatment groups were established: one group received a number of puffs equivalent to half the child's weight (1 puff of salbutamol = 100 μg and 1 puff of terbutaline = 250 μg) and the other group received a number of puffs equivalent to one-third of the child's weight. Results. Three hundred twenty-four episodes were studied; there were 164 children in the first group and 160 in the second. There were no significant differences between the two groups in the mean (6 SD) age (58.34 ± 34.72 vs 66.04 ± 36.45 months), arterial oxygen saturation (95.49 ± 1.93 vs 95.56 ± 1.97) or pulmonary score (4.04 ± 1.55 vs 3.97 ± 1.51) at recruitment and after treatment in the emergency department (arterial oxygen saturation [96.34 ± 1.60 vs 96.18 ± 1.77], pulmonary score [1.87 ± 1.33 vs 1.64 ± 1.31]). The number of doses administered (2.17 ± 0.91 vs 2.24 ± 1.00) and the hospitalization rate (8.56 % vs 6.87 %) were also similar in both groups. Conclusions. The distinct bronchodilator doses administered via an MDI with spacer showed similar effectiveness. These findings should contribute to a reevaluation of the use of high doses of bronchodilators, at least in most acute asthma exacerbations in children
