ABSTRACT
Hemorrhagic shock is a leading cause of morbidity and mortality in pediatric patients. Interpretation of the clinical indicators validated in adults to guide resuscitation and comparison between different therapies is difficult in children due to the inherent heterogeneity of this population. As a result, compared to adults, appropriate management of pediatric hemorrhagic shock is still not well established. In addition, the scarcity of pediatric patients with hemorrhagic shock precludes the development of clinically relevant studies. For this reason, an experimental pediatric animal model is necessary to study the effects of hemorrhage in children as well as their response to different therapies. We present an infant animal model of volume-controlled hemorrhagic shock in anesthetized young pigs. Hemorrhage is induced by withdrawing a previously calculated blood volume, and the pig is subsequently monitored and resuscitated with different therapies. Here, we describe a precise and highly reproducible model of hemorrhagic shock in immature swine. The model yields hemodynamic data that characterizes compensatory mechanisms that are activated in response to severe hemorrhage.
Subject(s)
Shock, Hemorrhagic , Adult , Humans , Infant , Animals , Child , Swine , Shock, Hemorrhagic/therapy , Blood Volume , Models, Animal , ResuscitationABSTRACT
Introducción: La analgosedación es una prioridad en el cuidado de pacientes en unidades de intensivos pediátricos. La combinación de ketamina y propofol puede ser una alternativa para aquellos pacientes con necesidad de sedación prolongada, con dificultad para la sedación y para disminuir el empleo de benzodiacepinas y opiáceos. El objetivo de este estudio es analizar la eficacia y seguridad de la combinación de ketamina y propofol en perfusión continua para la analgosedación en unidades de cuidados intensivos pediátricos.Materiales y métodos: Estudio de cohorte única prospectivo observacional en pacientes de 1 mes a 16 años ingresados en unidades de cuidados intensivos pediátricos entre 2016 y 2018 que recibieron tratamiento con ketamina y propofol en perfusión continua para analgosedación. Se recogieron datos clínicos y demográficos, scores de analgesia y sedación (MAPS, COMFORT-B y SOPHIA), parámetros hemodinámicos y efectos adversos. Resultados: Treinta y dos pacientes fueron incluidos. La dosis máxima de ketamina fue de 1,5mg/kg/h (RI 1-2mg/kg/h) y la duración, 5 días (RI 3-5 días). La dosis máxima de propofol fue de 3,2mg/kg/hora (RI 2,5-3,6mg/kg/hora) y la duración, 5 días (RI 3-5 días). Treinta pacientes (93,7%) habían recibido midazolam y 29 (90,6%) fentanilo previamente. Tras el inicio de la perfusión de ketamina y propofol la puntuación en la escala de analgesia no se modificó. El COMFORT-B mostró un incremento estadísticamente significativo, pero se mantuvo dentro del rango de sedación adecuada (12-17). Se produjo una leve disminución en la presión arterial media tras una hora de administración, que fue estadísticamente significativa (de 64mmHg a 60mmHg; P=0,006) así como en la presión arterial diastólica (de 50,5 a 48mmHg; P=0,023). Esta diferencia desapareció a las 12 horas del inicio y no requirió uso de drogas vasoactivas. No se detectaron efectos adversos graves durante la administración. (AU)
Introduction: Analgesia and sedation are a priority in paediatric intensive care. The combination of ketamine and propofol is a possible option in patients requiring prolonged or difficult sedation and to reduce the use of benzodiazepines and opiates. The aim of this study was to assess the efficacy and safety of combination ketamine and propofol in continuous infusion for prolonged analgesia/sedation in the paediatric intensive care setting. Patients and methods: Prospective, observational single-group cohort study in patients aged 1 month to 16 years admitted to the paediatric intensive care unit in 20162018 that received ketamine and propofol in continuous infusion for analgesia and sedation. We collected data on demographic and clinical characteristics, analgesia and sedation scores (MAPS, COMFORT-B and SOPHIA), haemodynamic parameters and adverse events. Results: The study included 32 patients. The maximum dose of ketamine was 1.5mg/kg/h (interquartile range [IQR], 12mg/kg/h) and the infusion duration was 5 days (IQR, 35 days). The maximum dose of propofol was 3.2mg/kg/h (IQR, 2.53.6mg/kg/h) and the infusion duration, 5 days (IQR, 35 days). Thirty (93.7%) patients had previously received midazolam and 29 (90.6%) fentanyl. Analgesia scores did not change after initiation of the ketamine and propofol infusion. There was a statistically significant increase in the COMFORT-B score, but the score remained in the adequate sedation range (1217). There were small but statistically significant decreases in the mean arterial pressure (from 64mmHg to 60mmHg; P=.006) and the diastolic blood pressure (from 50.5 to 48mmHg; P=.023) 1h after the initiation of the ketamine and propofol infusion, but this difference was not observed 12h later and did not require administration of vasoactive drugs. No other major adverse events were detected during the infusion. (AU)
Subject(s)
Humans , Male , Female , Infant , Child, Preschool , Child , Adolescent , Ketamine/therapeutic use , Propofol/therapeutic use , Analgesia , Prospective Studies , Intensive Care Units, PediatricABSTRACT
INTRODUCTION: Analgesia and sedation are a priority in paediatric intensive care. The combination of ketamine and propofol is a possible option in patients requiring prolonged or difficult sedation and to reduce the use of benzodiazepines and opiates. The aim of this study was to assess the efficacy and safety of combination ketamine and propofol in continuous infusion for prolonged analgesia/sedation in the paediatric intensive care setting. PATIENTS AND METHODS: Prospective, observational single-group cohort study in patients aged 1 month to 16 years admitted to the paediatric intensive care unit in 2016-2018 that received ketamine and propofol in continuous infusion for analgesia and sedation. We collected data on demographic and clinical characteristics, analgesia and sedation scores (MAPS, COMFORT-B and SOPHIA), haemodynamic parameters and adverse events. RESULTS: The study included 32 patients. The maximum dose of ketamine was 1.5â¯mg/kg/h (interquartile range [IQR], 1-2â¯mg/kg/h) and the infusion duration was 5 days (IQR, 3-5 days). The maximum dose of propofol was 3.2â¯mg/kg/h (IQR, 2.5-3.6â¯mg/kg/h) and the infusion duration, 5 days (IQR, 3-5 days). Thirty (93.7%) patients had previously received midazolam and 29 (90.6%) fentanyl. Analgesia scores did not change after initiation of the ketamine and propofol infusion. There was a statistically significant increase in the COMFORT-B score, but the score remained in the adequate sedation range (12-17). There were small but statistically significant decreases in the mean arterial pressure (from 64â¯mmHg to 60â¯mmHg; Pâ¯=â¯.006) and the diastolic blood pressure (from 50.5 to 48â¯mmHg; Pâ¯=â¯.023) 1â¯h after the initiation of the ketamine and propofol infusion, but this difference was not observed 12â¯h later and did not require administration of vasoactive drugs. No other major adverse events were detected during the infusion. CONCLUSIONS: The combination of ketamine and propofol in continuous infusion is a safe treatment in critically ill children that makes it possible to achieve an appropriate level of analgesia and sedation without relevant haemodynamic repercussions.
Subject(s)
Ketamine , Propofol , Child , Humans , Propofol/adverse effects , Ketamine/adverse effects , Hypnotics and Sedatives/adverse effects , Prospective Studies , Cohort Studies , Critical Care , PainABSTRACT
No disponible
Subject(s)
Humans , Infant, Newborn , Infant , Child, Preschool , Child , Adolescent , Intensive Care Units, Pediatric , Patient Simulation , Pandemics , Coronavirus Infections/epidemiology , Spain , Cross-Sectional Studies , Surveys and QuestionnairesSubject(s)
COVID-19 , Education, Medical , Child , Humans , Intensive Care Units, Pediatric , Pandemics , SARS-CoV-2ABSTRACT
No disponible
Subject(s)
Humans , Female , Infant , Cardiomyopathy, Dilated , Ventricular Dysfunction , Tissue Donors , Kidney Transplantation/methods , Severity of Illness Index , Fatal OutcomeSubject(s)
Heart Arrest , Tissue and Organ Harvesting/methods , Tissue and Organ Procurement/methods , Female , Humans , InfantABSTRACT
OBJECTIVE: To develop a quick and sensitive method for identification of children with presumed meningococcal septic shock at risk of death at admission to the pediatric intensive care unit (PICU) and to compare its performance with three other prognostic systems: Glasgow Meningococcal Septicaemia Prognostic Score (GMSPS), Malley score and the Paediatric Index of Mortality (PIM). DESIGN: Multicenter retrospective cohort study. SETTING: PICUs of 14 tertiary hospitals. PATIENTS: The developmental sample included 192 children consecutively admitted to the PICUs with presumed or confirmed meningococcal septic shock from 1983 to 1995. The validation sample included 158 children consecutively admitted from 1996 to 1998. INTERVENTIONS: Clinical and laboratory data gathered during the first 2 h after admission were used to develop the new score and to compute the other scoring systems. Logistic regression was applied to identify the independent predictors of death. MEASUREMENTS AND RESULTS: Overall mortality was 31.5%. The new score included seven variables: cyanosis (2 points), Glasgow coma scale less than 8 (2 points), refractory hypotension (2 points), oliguria (1 point), leukocytes less than 4000/mm(3) (1 point), partial thromboplastin time more than 150% of control value (1 point) and base deficit more than 10 mmol/l (1 point). The new score provided the best discriminative capability, as measured by the area under the ROC curve (SEM) in the validation sample =0.88 (0.03), PIM =0.82 (0.04), Malley I =0.80 (0.04), GMSPS =0.79 (0.04) and Malley II =0.76 (0.04). CONCLUSIONS: A new prognostic score is proposed for therapeutic stratification of children with presumed meningococcal septic shock.
