ABSTRACT
Objetivos. Dada la creciente evidencia a favor de una relación entre el tiempo de conservación de los concentrados de hematíes y las complicaciones postransfusionales, nos planteamos analizar la relación existente entre los niveles de enzima arginasa, parámetros bioquímicos y de hemólisis, con el tiempo de conservación de concentrados de hematíes transfundidos. Material y métodos. Diseñamos un estudio prospectivo que incluyó 24 unidades de concentrado de hematíes, que habían sido transfundidos consecutivamente a pacientes de nuestro hospital. Luego de registrar el tiempo de conservación de cada bolsa, se extrajeron 15ml de sangre para determinar la actividad arginasa, los datos bioquímicos y de hemólisis. Se realizó un análisis univariante de todos los parámetros registrados y se incluyeron aquellos que resultaron significativos en un modelo de regresión múltiple (p<0,05). Resultados. El tiempo promedio de conservación fue de 18,6±6,1 días (rango: 6-31 días), con un hematocrito de 59,8%±0,05%, una hemoglobina 20,3±1,8g/dl, un pH de 6,5±0,1 y una actividad arginasa de 140,1±124,0 mU/ml. Se observó una relación lineal en el análisis univariante entre el tiempo de conservación y el pH (p=0,001), el HCO3act (p=0,001), el índice hemolítico (p=0,035) y la SpO2 (p=0,01). Una vez ajustados las variables de confusión procedentes del modelo univariante, se observó una relación lineal entre la actividad arginasa y el tiempo de conservación (p=0,031). Conclusiones. Nuestro trabajo muestra una relación lineal directamente proporcional entre el tiempo de conservación de los concentrados de hematíes y la actividad arginasa presente en los mismos. Sugerimos que estos hallazgos podrían estar relacionados con la elevada incidencia de complicaciones tras la transfusión que puede ser directamente proporcional a su tiempo de conservación(AU)
Objectives. Given the increasing evidence regarding a relationship between packed red blood cells storage time and post-transfusion complications, we decided to determine the relationship between the arginase enzyme levels, biochemical parameters and haemolysis, with the storage time of transfused packed red blood cells. Material and methods. We designed a prospective study that included 24 units of packed cells that had been consecutively transfused to patients of our hospital. After recording the storage time of each bag, 15ml of blood was removed to determine arginase activity, biochemical parameters and haemolysis. A univariate analysis was performed on all the recorded parameters, and included those that were significant in the multiple regression model (P<.05). Results. The mean storage time was 18.6±6.1 days (range: 6-31 days), with a haematocrit of 59.8%±0.05%, a haemoglobin of 20.3±1.8g/dl, a pH of 6.5±0.1, and an arginase activity of 140.1±124.0mU/ml. A linear relationship was observed in the univariate analysis between the storage time and the pH (P=.001), the actualHCO3 (P=.001), the haemolysis index (P=.035) and the SpO2 (P=.01). Once adjusted for the confounding variables of the univariate model, a linear relationship was observed between the arginase activity and the storage time (P=.031). Conclusions. Our study shows a directly proportional linear relationship between the storage time of packed red blood cells and their arginase activity. We suggest that these findings could be associated with the high incidence of complications after transfusion that may be directly proportional to their storage time(AU)
Subject(s)
Humans , Male , Female , Arginase/metabolism , Erythrocytes/metabolism , Erythrocytes/physiology , Blood Transfusion/methods , Hemolysis , Hemolysis/physiology , Blood Component Transfusion/trends , Prospective Studies , Analysis of VarianceABSTRACT
OBJECTIVES: Given the increasing evidence regarding a relationship between packed red blood cells storage time and post-transfusion complications, we decided to determine the relationship between the arginase enzyme levels, biochemical parameters and haemolysis, with the storage time of transfused packed red blood cells. MATERIAL AND METHODS: We designed a prospective study that included 24 units of packed cells that had been consecutively transfused to patients of our hospital. After recording the storage time of each bag, 15 ml of blood was removed to determine arginase activity, biochemical parameters and haemolysis. A univariate analysis was performed on all the recorded parameters, and included those that were significant in the multiple regression model (P<.05). RESULTS: The mean storage time was 18.6±6.1 days (range: 6-31 days), with a haematocrit of 59.8%±0.05%, a haemoglobin of 20.3±1.8 g/dl, a pH of 6.5±0.1, and an arginase activity of 140.1±124.0 mU/ml. A linear relationship was observed in the univariate analysis between the storage time and the pH (P=.001), the actual HCO(3) (P=.001), the haemolysis index (P=.035) and the SpO(2) (P=.01). Once adjusted for the confounding variables of the univariate model, a linear relationship was observed between the arginase activity and the storage time (P=.031). CONCLUSIONS: Our study shows a directly proportional linear relationship between the storage time of packed red blood cells and their arginase activity. We suggest that these findings could be associated with the high incidence of complications after transfusion that may be directly proportional to their storage time.
Subject(s)
Arginase/blood , Blood Preservation , Erythrocytes/enzymology , Bicarbonates/blood , Erythrocyte Transfusion , Hematocrit , Hemoglobins/analysis , Hemolysis , Humans , Hydrogen-Ion Concentration , Prospective Studies , Time FactorsABSTRACT
OBJECTIVE: The demand for sedation for pediatric diagnostic procedures performed outside operating rooms has increased considerably, but the ideal method to choose has been the subject of debate. The aim of this study was to assess the efficacy of using a device for continuous positive airway pressure, connected to a Mapleson D circuit and a nasopharyngeal tube as the interface, in order to ventilate and administer sevoflurane for upper digestive tract endoscopy in children. MATERIAL AND METHODS: Prospective cohort study of children undergoing upper digestive tract endoscopy. We recorded epidemiologic variables, heart rate, mean arterial pressure, arterial oxygen saturation and procedure-related adverse events before, during and 10 minutes after the procedure. Time spent in the recovery room was also recorded. The endoscopist asked the patients about their level of satisfaction and whether they had noticed any irritating smell or gas smell. RESULTS: Data was collected on 29 patients (17 boys, 12 girls) with a mean (SD) age of 4.2 (3.9) years. The mean duration of endoscopy was 15 (7) minutes. Arterial oxygen saturation below 92% during the procedure did not occur and the endoscopic exploration was completed satisfactorily with this technique in 28 patients (96%). All were discharged from the recovery room within 30 minutes. The endoscopist reported that the technique was considered satisfactory in all cases, although 2 children noted an anesthetic "gas" smell. CONCLUSIONS: A modified Mapleson D circuit and nasopharyngeal tube can be used effectively as an interface for noninvasive ventilation and administration of sevoflurane during upper digestive endoscopy in pediatric patients.
Subject(s)
Anesthesia, Inhalation/instrumentation , Endoscopy, Gastrointestinal , Child, Preschool , Continuous Positive Airway Pressure/instrumentation , Equipment Design , Female , Humans , Male , Prospective StudiesABSTRACT
OBJETIVO: La demanda de sedación para procedimientosdiagnósticos realizados en áreas alejadas delquirófano ha aumentado considerablemente en pediatría.La técnica de elección continúa siendo objeto dedebate. El objetivo de este estudio fue valorar la eficaciade un dispositivo de CPAP formado por un circuito deMapleson D y un tubo nasofaríngeo como interfase,como técnica de ventilación, junto a la administración desevoflurano, en endoscopias digestivas altas en niños.MATERIAL Y MÉTODOS: Estudio prospectivo de cohortesde niños sometidos a endoscopia digestiva alta. Serecogieron datos epidemiológicos, frecuencia cardiaca,presión arterial media, saturación arterial de oxígeno,así como los efectos secundarios atribuibles antes,durante y 10 minutos después del procedimiento. Tambiénel tiempo de estancia en la sala de despertar. Se preguntópor el grado de satisfacción y percepción de olorirritante o a gas por el endoscopista.RESULTADOS: Se recogieron los datos de 29 pacientes(17 niños y 12 niñas), con una edad promedio de4,2 ± 3,9 años. La duración media de la prueba fue de15 ± 7 min. No se detectaron saturaciones arteriales deoxígeno inferiores a 92% durante los procedimientos,considerándose la técnica satisfactoria en 28 casos(96%). Todos los pacientes fueron dados de alta a los 30minutos de finalización del proceso. En todos los casos elendoscopista consideró adecuada la técnica y en 2 casosrefirió haber percibido olor a gas anestésico.CONCLUSIONES: La utilización de un circuito deMapleson D modificado y un tubo nasofaríngeo a modode interfase puede ser utilizada eficazmente como soporteventilatorio no invasivo, junto a la administración desevoflurano, durante la endoscopia digestiva alta enpacientes pediátricos(AU)
OBJETIVE: The demand for sedation for pediatricdiagnostic procedures performed outside operatingrooms has increased considerably, but the ideal methodto choose has been the subject of debate. The aim of thisstudy was to assess the efficacy of using a device forcontinuous positive airway pressure, connected to aMapleson D circuit and a nasopharyngeal tube as theinterface, in order to ventilate and administersevoflurane for upper digestive tract endoscopy inchildren.MATERIAL AND METHODS: Prospective cohort study ofchildren undergoing upper digestive tract endoscopy.We recorded epidemiologic variables, heart rate, meanarterial pressure, arterial oxygen saturation andprocedure-related adverse events before, during and 10minutes after the procedure. Time spent in the recoveryroom was also recorded. The endoscopist asked thepatients about their level of satisfaction and whetherthey had noticed any irritating smell or gas smell.RESULTS: Data was collected on 29 patients (17 boys,12 girls) with a mean (SD) age of 4.2 (3.9) years. Themean duration of endoscopy was 15 (7) minutes. Arterialoxygen saturation below 92% during the procedure didnot occur and the endoscopic exploration was completedsatisfactorily with this technique in 28 patients (96%).All were discharged from the recovery room within 30minutes. The endoscopist reported that the techniquewas considered satisfactory in all cases, although 2children noted an anesthetic "gas smell. CONCLUSIONS: A modified Mapleson D circuit andnasopharyngeal tube can be used effectively as aninterface for noninvasive ventilation and administrationof sevoflurane during upper digestive endoscopy inpediatric patients(AU)
Subject(s)
Humans , Male , Female , Child , Endoscopy, Digestive System/instrumentation , Endoscopy, Digestive System/methods , Anesthesia/methods , Deep Sedation/instrumentation , Deep Sedation/methods , Endoscopy, Digestive System/trends , Prospective Studies , Cohort StudiesABSTRACT
No disponible
Subject(s)
Humans , Male , Female , 34628 , Hemostasis/immunology , Hemostasis/physiology , Thrombocytosis/complications , Thrombocytosis/diagnosis , Anticoagulants/therapeutic use , Fibrinogen , Hypoprothrombinemias/complications , Hypoprothrombinemias/diagnosis , Prothrombin Time/methodsABSTRACT
No disponible
Subject(s)
Humans , Male , Adolescent , Pheochromocytoma/surgery , Anesthesia/methods , Monitoring, Intraoperative/methods , Ultrasonography, Doppler, ColorSubject(s)
Epidermolysis Bullosa/complications , Thrombelastography , Thrombocytosis/etiology , Thrombophilia/etiology , Adolescent , Anemia, Iron-Deficiency/diagnosis , Anemia, Iron-Deficiency/etiology , Blood Coagulation Tests , Epidermolysis Bullosa/blood , Epidermolysis Bullosa/surgery , Fibrinogen/analysis , Hand/surgery , Humans , Male , Postoperative Complications/prevention & control , Preoperative Care , Skin Transplantation , Thrombocytosis/blood , Thrombocytosis/diagnosis , Thrombophilia/diagnosisABSTRACT
OBJETIVO: La CPAP en ventilación no invasiva es utilizadaampliamente en el paciente pediátrico con insuficienciarespiratoria aguda. Sin embargo la escasez deinterfases específicas, respiradores adecuados y la escasatolerancia de la técnica en estos pacientes pueden hacerfracasar su aplicación. El objetivo de este estudio fueanalizar la eficacia de un sistema de CPAP formado porun circuito respiratorio de Mapleson modificado, durantela IRA en pediatría.MATERIAL Y MÉTODOS: Estudio prospectivo observacionalrealizado en niños con insuficiencia respiratoriaaguda con indicación de ventilación no invasiva. LaCPAP se aplicó mediante un circuito respiratorio MaplesonD provisto de un manómetro y un tubo nasofaríngeocomo interfase. Se recogieron previo al tratamiento y 2horas después, frecuencia cardiaca, frecuencia respiratoria,fracción inspirada de oxígeno, presión arterial deoxígeno, de dióxido de carbono y pulsioximetría.RESULTADOS: Se incluyeron 16 pacientes de edadmedia 3,8 años durante un periodo de 18 meses. Observamosuna disminución PaCO2 desde 66,8±18,08 mmHga 46,48±5,9 mmHg tras CPAP (p=0,16) y un aumento enla relación PaO2/FiO2 de 201±111 a 262±115 mm Hg trasCPAP (p=0,30). La FC descendió de 156±22 a 127±18l/min (p=0,05) y la FR de 53±15 a 33±13 resp/min(p<0,05). No se registraron complicaciones graves y latolerancia fue adecuada. La técnica se consideró exitosaen 12 pacientes (75%).CONCLUSIONES: La aplicación de CPAP sin respiradormediante circuito Mapleson D puede ser utilizado comoventilación no invasiva en pacientes pediátricos con insuficienciarespiratoria aguda con elevada tasa de éxito (AU)
OBJETIVE: Noninvasive continuous positive airwaypressure (CPAP) is widely used in pediatric patients withacute respiratory failure. However, the lack of specificinterfaces and appropriate ventilators and poor tolerance ofthe technique by these patients can lead to failure of theapplication. The aim of this study was to analyze the efficacyof a CPAP system using a modified Mapleson breathingcircuit during acute respiratory failure in pediatric patients.MATERIAL AND METHODS: We performed a prospectiveobservational study in children with acute respiratoryfailure in whom noninvasive ventilation was indicated.CPAP was applied through a Mapleson D circuit fittedwith a manometer and a nasopharyngeal tube as theinterface. Heart rate, respiratory rate, inspired oxygenfraction (FiO2), PaO2, PaCO2, and pulse oximetry weremeasured before treatment and after 2 hours of treatment.RESULTS: Sixteen patients with a mean age of 3.8 yearswere studied for a period of 18 months. We observed amean (SD) change in PaCO2 from 66.8 (18.08) mm Hg to46.48 (5.9) mm Hg after CPAP (P=.16) and a mean changein the PaO2/FiO2 ratio from 201 (111) to 262 (115) afterCPAP (P=.30). The mean heart rate fell from 156 (22)beats/min to 127 (18) beats/min (P=.05) and the meanrespiratory rate from 53 (15) breaths/min to 33 (13)breaths/min (P<.05). No severe complications wererecorded and tolerance was satisfactory. The techniquewas considered a success in 12 patients (75%).CONCLUSIONS: CPAP without a ventilator, through aMapleson D circuit, can be used with a high success rateto provide noninvasive ventilation for pediatric patientswith acute respiratory failure (AU)
Subject(s)
Humans , Male , Female , Child , Continuous Positive Airway Pressure/instrumentation , Respiratory Insufficiency/therapy , Prospective Studies , Respiratory Insufficiency/complications , Respiration, Artificial/methodsABSTRACT
No disponible
Subject(s)
Humans , Male , Child , Methemoglobinemia/complications , Methemoglobinemia/diagnosis , Beta vulgaris/adverse effects , Cyanosis/complications , Cyanosis/diagnosis , Methylene Blue/therapeutic use , Nitrates/adverse effects , Food/adverse effects , Vomiting/diagnosis , Vomiting/etiology , Blood Pressure/physiology , Heart Rate/physiology , Food Analysis/methodsABSTRACT
OBJECTIVE: Noninvasive continuous positive airway pressure (CPAP) is widely used in pediatric patients with acute respiratory failure. However, the lack of specific interfaces and appropriate ventilators and poor tolerance of the technique by these patients can lead to failure of the application. The aim of this study was to analyze the efficacy of a CPAP system using a modified Mapleson breathing circuit during acute respiratory failure in pediatric patients. MATERIAL AND METHODS: We performed a prospective observational study in children with acute respiratory failure in whom noninvasive ventilation was indicated. CPAP was applied through a Mapleson D circuit fitted with a manometer and a nasopharyngeal tube as the interface. Heart rate, respiratory rate, inspired oxygen fraction (FiO2), PaO2, PaCO2, and pulse oximetry were measured before treatment and after 2 hours of treatment. RESULTS: Sixteen patients with a mean age of 3.8 years were studied for a period of 18 months. We observed a mean (SD) change in PaCO2 from 66.8 (18.08) mm Hg to 46.48 (5.9) mm Hg after CPAP (P=.16) and a mean change in the PaO2/FiO2 ratio from 201 (111) to 262 (115) after CPAP (P=.30). The mean heart rate fell from 156 (22) beats/min to 127 (18) beats/min (P=.05) and the mean respiratory rate from 53 (15) breaths/min to 33 (13) breaths/min (P<.05). No severe complications were recorded and tolerance was satisfactory. The technique was considered a success in 12 patients (75%). CONCLUSIONS: CPAP without a ventilator, through a Mapleson D circuit, can be used with a high success rate to provide noninvasive ventilation for pediatric patients with acute respiratory failure.
Subject(s)
Continuous Positive Airway Pressure/methods , Respiratory Insufficiency/therapy , Acute Disease , Carbon Dioxide/blood , Child , Child, Preschool , Continuous Positive Airway Pressure/instrumentation , Equipment Design , Female , Heart Rate , Humans , Hypercapnia/etiology , Hypercapnia/prevention & control , Hypercapnia/therapy , Hypoxia/etiology , Hypoxia/prevention & control , Hypoxia/therapy , Infant , Intensive Care Units, Pediatric , Intubation , Male , Nasal Cavity , Oxygen/blood , Partial Pressure , Patient Acceptance of Health Care , Prospective Studies , Respiratory Insufficiency/blood , Respiratory Insufficiency/complicationsABSTRACT
No disponible
Subject(s)
Humans , Female , Adolescent , Polyneuropathies/diagnosis , Critical Illness , Sepsis/complications , Muscle Weakness/etiology , Multiple Organ Failure/complicationsABSTRACT
La anestesia general en niños con infección devía respiratoria alta (IRA) tiene mayor riesgo decomplicaciones respiratorias, siendo la causa másfrecuente de suspensiones de intervenciones quirúrgicasprogramadas en pediatría. La falta de criteriosde actuación claros crea el dilema de posponer o nola intervención quirúrgica, que se ve agravado porlos inconvenientes (familiares, organizativos y degestión clínica) que provoca la suspensión de unaintervención quirúrgica programada y por la reiteraciónde los procesos de IRA en estos pacientes.Ante un niño con IRA que va a ser sometido aanestesia general es necesario valorar la relaciónriesgo beneficio de la intervención, necesidad de intubación,presencia de secreciones abundantes,presencia de congestión nasal, niños fumadores pasivos,cirugía de la vía aérea e historia de prematuridady teniendo en cuenta otros factores, como la lejaníadel lugar de residencia o la cancelación previade la cirugía. Es necesario disponer de criterios deactuación basados en la experiencia y en la evidenciacientífica y conocer los factores de riesgo relacionadosantes de posponer una intervención quirúrgicaprogramada, siendo muy importante la informacióna los padres para que avisen con antelación suficientey evitar cancelaciones el mismo día
One of the most frequency dilemmas during paediatricanesthesia is the children with upper respiratorytract infection scheduled for programmed surgery.General anesthesia in these patients has anelevated risk of respiratory complications and is themayor cause of suspensions at scheduled programmedsurgery in paediatrics. The criterias based onup-to-date literature absence induces the dilemma ofcancelling or not the surgery, which is made heavierby the family, organized and clinical management difficultiesthat the cancelling of a scheduled programmedsurgery provokes and for the recurrence of theupper respiratory tract infection in this patients.In children with upper respiratory tract infection thatare being anesthetized for a scheduled programmedsurgery is necessary to asses the interventions riskbenefit relationship, presence of abundant nasal congestion,intubation necessity, premature and passivesmoking history, airway surgery and economical andemotional implications for patients and their families.To obtain optimal results, criteria based on up-to-dateliterature reviews should be put into effect and parents should be given appropriate information (AU)
Subject(s)
Humans , Male , Female , Child , Respiratory Tract Infections/complications , Anesthesia, General , Surgical Procedures, Operative/methods , Laryngismus/complications , Influenza, Human/complications , Risk FactorsABSTRACT
La mascarilla laríngea (ML) es un dispositivo supraglóticoque permite el control de la vía aérea.Hay distintos tamaños diseñados a escala del adulto.La anatomía y la fisiología de las vías aéreas pediátricascambian con la edad. Hemos realizado unestudio en el que pretendemos evaluar la eficacia ylas complicaciones del uso de la mascarilla laríngeaen quirófano y por personal parcialmente adiestradoen pacientes pediátricos, y aplicar los resultados deeste estudio a la actividad de personal no adiestradoen áreas fuera de quirófano
The laringeal mask airway is a supraglotic devicethat allows airway management. There are severalsizes designed in the adult scale. Anatomy and physiologyof the pediatric airway change with the age.We have performed a study in order to evaluate theefficiency and complications when we use laryngealmask airway in pediatric patients and we intend toput forward our outcomes to emergency situations
Subject(s)
Male , Female , Infant , Child , Child, Preschool , Adolescent , Humans , Laryngeal Masks , Respiration Disorders/therapy , Laryngeal Masks/adverse effects , Surgical Procedures, Operative/methods , Respiration, ArtificialABSTRACT
La mascarilla laríngea (ML) es un dispositivo supraglóticoque permite el control de la vía aérea.Hay distintos tamaños diseñados a escala del adulto.La anatomía y la fisiología de las vías aéreas pediátricascambian con la edad. Hemos realizado unestudio en el que pretendemos evaluar la eficacia ylas complicaciones del uso de la mascarilla laríngeaen quirófano y por personal parcialmente adiestradoen pacientes pediátricos, y aplicar los resultados deeste estudio a la actividad de personal no adiestradoen áreas fuera de quirófano
The laringeal mask airway is a supraglotic devicethat allows airway management. There are severalsizes designed in the adult scale. Anatomy and physiologyof the pediatric airway change with the age.We have performed a study in order to evaluate theefficiency and complications when we use laryngealmask airway in pediatric patients and we intend toput forward our outcomes to emergency situations
