ABSTRACT
Objetivo Conocer la incidencia de síndrome de abstinencia tras perfusión prolongada de fentanilo y midazolam en niños, y los factores de riesgo asociados. Diseño Estudio de cohorte histórica o retrospectiva. Ámbito UCI pediátrica de seis camas de un hospital universitario. Pacientes Se incluyen 48 pacientes pediátricos que recibieron sedoanalgesia en perfusión continua con midazolam y fentanilo exclusivamente, durante al menos 48 horas. Intervenciones Ninguna. Variables de interés principales Se recogen datos clínicos y demográficos, dosis y duración de sedoanalgesia recibida, aparición de síndrome de abstinencia, gravedad y tratamiento del mismo. Resultados El 50% desarrolló síndrome de abstinencia. Hubo diferencias significativas entre los que lo desarrollaron y los que no en cuanto a duración del tratamiento previo y dosis acumulada de ambos fármacos. Una dosis acumulada de fentanilo de 0,48mg/kg o de midazolam de 40mg/kg, y una duración de la perfusión de ambos de 5,75 días fueron factores de riesgo para el desarrollo de abstinencia. La mayoría presentó un cuadro leve o moderado, que comenzó a las 12-36 horas de suspender la perfusión. El fármaco más utilizado en el tratamiento fue la metadona. Conclusiones La incidencia de síndrome de abstinencia en niños tras perfusión prolongada de midazolam y fentanilo es elevada. El desarrollo del síndrome se relaciona con tiempos de perfusión prolongados y con dosis acumuladas elevadas de ambos fármacos (AU)
Objective To determine the incidence of withdrawal syndrome after prolonged infusion of fentanyl and midazolam in children, and the associated risk factors. Design Historic or retrospective cohort study. Setting Pediatric Intensive Care Unit in an academic center. Patients Forty-eight pediatric patients who received sedation and analgesia only with fentanyl and midazolam through continuous infusion for at least 48hours.InterventionsNone.Main variables of interest Collected data included demographic and clinical parameters, dose and duration of sedation received, and incidence, severity and treatment of withdrawal syndrome. Results Fifty percent of the patients developed withdrawal syndrome. There were significant differences between the patients who developed withdrawal syndrome and those who did not, in terms of the duration of infusion and the cumulative doses of both drugs. A cumulative fentanyl dose of 0.48mg/kg, a cumulative midazolam dose of 40mg/kg, and a duration of infusion of both drugs of 5.75 days were risk factors for the development of withdrawal syndrome. Most children developed mild or moderate disease, beginning about 12-36hours after weaning from infusion. Methadone was used in most cases for treating with drawal. Conclusions There is a high incidence of withdrawal syndrome in children following the continuous infusion of midazolam and fentanyl. The duration of infusion of both drugs and higher cumulative doses are associated with the development of withdrawal syndrome (AU)
Subject(s)
Humans , Male , Female , Infant, Newborn , Neonatal Abstinence Syndrome/epidemiology , Fentanyl/adverse effects , Midazolam/adverse effects , Critical Care/methods , Intensive Care Units/statistics & numerical data , Retrospective Studies , Pregnancy Complications/drug therapyABSTRACT
OBJECTIVE: To determine the incidence of withdrawal syndrome after prolonged infusion of fentanyl and midazolam in children, and the associated risk factors. DESIGN: Historic or retrospective cohort study. SETTING: Pediatric Intensive Care Unit in an academic center. PATIENTS: Forty-eight pediatric patients who received sedation and analgesia only with fentanyl and midazolam through continuous infusion for at least 48 hours. INTERVENTIONS: None. MAIN VARIABLES OF INTEREST: Collected data included demographic and clinical parameters, dose and duration of sedation received, and incidence, severity and treatment of withdrawal syndrome. RESULTS: Fifty percent of the patients developed withdrawal syndrome. There were significant differences between the patients who developed withdrawal syndrome and those who did not, in terms of the duration of infusion and the cumulative doses of both drugs. A cumulative fentanyl dose of 0.48 mg/kg, a cumulative midazolam dose of 40 mg/kg, and a duration of infusion of both drugs of 5.75 days were risk factors for the development of withdrawal syndrome. Most children developed mild or moderate disease, beginning about 12-36 hours after weaning from infusion. Methadone was used in most cases for treating withdrawal. CONCLUSIONS: There is a high incidence of withdrawal syndrome in children following the continuous infusion of midazolam and fentanyl. The duration of infusion of both drugs and higher cumulative doses are associated with the development of withdrawal syndrome.
Subject(s)
Analgesics, Opioid/adverse effects , Fentanyl/adverse effects , Hypnotics and Sedatives/adverse effects , Midazolam/adverse effects , Substance Withdrawal Syndrome/epidemiology , Adolescent , Child , Child, Preschool , Cohort Studies , Female , Humans , Incidence , Infant , Infant, Newborn , Intensive Care Units, Pediatric , Male , Retrospective Studies , Risk Factors , Time FactorsABSTRACT
Objetivo: Valorar la fiabilidad de la medición de la presión transcutánea de dióxido de carbono (PtCO2) respecto a la medición de la presión arterial de dióxido de carbono (PaCO2). Material y métodos: Estudio analítico, observacional, longitudinal y prospectivo. Cohorte de pacientes ingresados en unidad de cuidados intensivos pediátricos. La PtCO2 se midió con el monitor digital SenTec, aplicando el sensor con un anillo específico (sensor V-sign, versión MDB 04.04.02). Se recogieron al mismo tiempo la PtCO2 y PaCO2. La significación estadística de la asociación se calculó mediante el test F de Snedecor, el coeficiente de correlación r2 de Pearson y el coeficiente de correlación intraclase. El grado de acuerdo se estimó con el método de Bland y Altman. La consistencia de los resultados se estudió con el ANOVA. Resultados: Se compararon 106 mediciones pareadas de PtCO2 y PaCO2, de 12 pacientes. Las PaCO2 y PtCO2 medias fueron 51,0±13mmHg y 50,1±14mmHg; r2=0,87 (p<0,001), CCI=0,96 (IC: 0,940,97). El análisis de Bland-Altman mostró una media de las diferencias de−0,9mmHg (IC:−2,0 a 0,2mmHg). La correlación fue mejor en ausencia de patología respiratoria, con asistencia respiratoria baja, con PaCO2>50mmHg y con aplicación frontal del sensor. Hubo consistencia de los resultados. No se observaron efectos secundarios derivados de la utilización del anillo. Conclusiones: La correlación obtenida entre la PtCO2 y PaCO2 fue muy buena. El monitor digital SenTec y el sensor de anillo específico constituyen una herramienta fiable, segura y fácil de utiliza (AU)
Objective: To estimate the accuracy of the transcutaneous carbon dioxide tension measurement (PtCO2) compared to the measurement of the arterial carbon dioxide tension (PaCO2). Material and methods: An analytical, longitudinal, prospective and observational study, of a dynamic cohort taken from the in-patients of a Paediatric Intensive Care Unit (PICU). The PtCO2 was measured with the SenTec AG analyzer, and the sensor was applied with the specific Multi-Site Attachment Ring. PtCO2 and PaCO2 were recorded at the same time. The statistical significance of the association between paired measurements was evaluated with the Snedecor's F test, the Pearson's r2 correlation coefficient and the Interclass Correlation Coefficient (ICC). The degree of agreement was evaluated with the Bland & Altman method. The consistency of the results was evaluated with the ANalysis Of the VAriance (ANOVA). Results: One hundred and six paired measurements, PtCO2 and PaCO2, from twelve patients, were compared. The means of the PaCO2 and PtCO2 were 51.0±13mmHg and 50.1±14mmHg, respectively; r2=0.87 (p<0.001), ICC=0.96, (95% CI: 0.940.97). The Bland-Altman analysis showed a mean difference of−0.9mmHg (95% CI:−2.0 to 0.2mmHg). The correlation was better in cases with no respiratory disease, with low respiratory assistance, with PaCO2>50mmHg and with the sensor applied on the forehead. The results were consistent. No side effects derived from the use of the ring were observed. Conclusion: The correlation between PtCO2 and PaCO2 is excellent and stable. The ring sensor was safe and easy to us (AU)
Subject(s)
Humans , Male , Female , Child , Critical Care/methods , Critical Care/methods , Partial Pressure , Carbon Dioxide/administration & dosage , Carbon Dioxide/therapeutic use , Monitoring, Physiologic/methods , Drug Monitoring/trends , Signs and Symptoms , Prospective Studies , Longitudinal Studies , Analysis of VarianceABSTRACT
OBJECTIVE: To estimate the accuracy of the transcutaneous carbon dioxide tension measurement (PtCO(2)) compared to the measurement of the arterial carbon dioxide tension (PaCO(2)). MATERIAL AND METHODS: An analytical, longitudinal, prospective and observational study, of a dynamic cohort taken from the in-patients of a Paediatric Intensive Care Unit (PICU). The PtCO(2) was measured with the SenTec AG analyzer, and the sensor was applied with the specific Multi-Site Attachment Ring. PtCO(2) and PaCO(2) were recorded at the same time. The statistical significance of the association between paired measurements was evaluated with the Snedecor's F test, the Pearson's r(2) correlation coefficient and the Interclass Correlation Coefficient (ICC). The degree of agreement was evaluated with the Bland & Altman method. The consistency of the results was evaluated with the ANalysis Of the VAriance (ANOVA). RESULTS: One hundred and six paired measurements, PtCO(2) and PaCO(2), from twelve patients, were compared. The means of the PaCO(2) and PtCO(2) were 51.0+/-13mmHg and 50.1+/-14mmHg, respectively; r(2)=0.87 (p<0.001), ICC=0.96, (95% CI: 0.94-0.97). The Bland-Altman analysis showed a mean difference of-0.9mmHg (95% CI:-2.0 to 0.2mmHg). The correlation was better in cases with no respiratory disease, with low respiratory assistance, with PaCO(2)>50mmHg and with the sensor applied on the forehead. The results were consistent. No side effects derived from the use of the ring were observed. CONCLUSION: The correlation between PtCO(2) and PaCO(2) is excellent and stable. The ring sensor was safe and easy to use.
Subject(s)
Blood Gas Monitoring, Transcutaneous , Critical Illness , Adolescent , Child , Child, Preschool , Female , Humans , Infant , Infant, Newborn , Male , Prospective StudiesSubject(s)
Accidents, Home , Diazinon/poisoning , Insecticides/poisoning , Child , Child, Preschool , Female , Humans , MaleABSTRACT
No disponible
Subject(s)
Humans , Anti-Bacterial Agents/therapeutic use , Lymphadenitis/drug therapy , Drug Therapy, Combination , Lymphadenitis/microbiologyABSTRACT
BACKGROUND: In recent years, lymphadenitis caused by atypical mycobacteria (also called nontuberculous mycobacteria [NTMB] or, more recently, environmental) have played a significant role in the differential diagnosis of adenitis in non-immunocompromised children. OBJECTIVES: To describe the clinical and pathological findings in childhood NTMB adenitis and study the possible usefulness of antimicrobial therapy in addition to surgery. METHODS: We present eight cases of neck lymphadenitis occurring over a 5-year period. All of the children received combined chemotherapy, and six also underwent surgery. Of the two remaining patients, the parents of one child refused surgery and a watchful approach was adopted in the other. RESULTS: Complete clinical recovery was achieved in all patients except one who did not undergo surgery. CONCLUSIONS: Prolonged administration of two antibiotics (of which one must be clarithromycin) in addition to surgery was well-tolerated and could be useful in patients with NTMB neck lymphadenitis.
Subject(s)
Lymphadenitis/drug therapy , Lymphadenitis/surgery , Mycobacterium Infections, Nontuberculous/drug therapy , Mycobacterium Infections, Nontuberculous/surgery , Child, Preschool , Ciprofloxacin/therapeutic use , Clarithromycin/therapeutic use , Combined Modality Therapy , Drug Therapy, Combination/therapeutic use , Female , Humans , Infant , Lymphadenitis/microbiology , Male , Mycobacterium Infections, Nontuberculous/diagnosis , Retrospective StudiesABSTRACT
Antecedentes: Las infecciones por micobacterias atípicas (también denominadas no tuberculosas [MNTB] o más recientemente ambientales) están desempeñando en los últimos tiempos un papel preponderante en el diagnóstico diferencial de las adenitis en niños inmunocompetentes. Objetivos: Los objetivos de este estudio han sido describir las características clinicopatológicas de las adenopatías por MNTB y evaluar el posible efecto de la terapia antibiótica asociada a cirugía. Métodos: Se presentan 8 casos recogidos en 5 años, todos ellos con afectación cervical. Todos recibieron antimicrobianos combinados junto a cirugía en seis de los casos. En los dos restantes, en uno existió negativa por parte de los padres del paciente y en otro se mantuvo una actitud expectante. Resultados La evolución fue satisfactoria en todos los pacientes menos uno de los no tratados quirúrgicamente. Conclusiones: La asociación prolongada de dos antibióticos siendo uno de ellos claritromicina junto al tratamiento quirúrgico presenta una adecuada tolerancia y podría ser de utilidad en linfadenitis cervical por MNTB
Background: In recent years, lymphadenitis caused by atypical mycobacteria (also called nontuberculous mycobacteria [NTMB] or, more recently, environmental) have played a significant role in the differential diagnosis of adenitis in non-immunocompromised children. Objectives: To describe the clinical and pathological findings in childhood NTMB adenitis and study the possible usefulness of antimicrobial therapy in addition to surgery. Methods: We present eight cases of neck lymphadenitis occurring over a 5-year period. All of the children received combined chemotherapy, and six also underwent surgery. Of the two remaining patients, the parents of one child refused surgery and a watchful approach was adopted in the other. Results: Complete clinical recovery was achieved in all patients except one who did not undergo surgery. Conclusions: Prolonged administration of two antibiotics (of which one must be clarithromycin) in addition to surgery was well-tolerated and could be useful in patients with NTMB neck lymphadenitis
Subject(s)
Infant , Humans , Lymphadenitis/drug therapy , Lymphadenitis/surgery , Mycobacterium Infections, Nontuberculous/drug therapy , Mycobacterium Infections, Nontuberculous/surgery , Ciprofloxacin/therapeutic use , Clarithromycin/therapeutic use , Combined Modality Therapy , Lymphadenitis/microbiology , Retrospective Studies , Drug Therapy, Combination/therapeutic use , Mycobacterium Infections, Nontuberculous/diagnosisABSTRACT
INTRODUCTION: There are few cross-sectional studies describing the current situation of HIV-1-infected children. Such studies would be useful to determine patients' clinical and immunologic and virologic status, currently prescribed therapies and their associated toxicity. OBJECTIVES: To perform a descriptive analysis of the clinical, immunological and virological status of HIV-1-infected children followed-up in the pediatric unit of a tertiary hospital and describe the current antiretroviral therapies used to treat them. MATERIAL AND METHODS: A cross-sectional study was performed. Data were collected from all HIV-1-infected children followed-up until January 2002 in a large pediatric referral hospital (Hospital 12 de Octubre in Madrid). Clinical evaluation and laboratory investigations were scheduled to be performed every 3 months. The most recent CD4 and plasma viral loads were evaluated. Viral loads were considered undetectable when there were less than 300 copies/ml at the last evaluation. RESULTS: Sixty-six HIV-1-infected children who were followed-up to January 2002 were analyzed. All the children acquired the infection through vertical transmission except one, in whom the mode of transmission was unknown. The median age was 111 months (18-216). Twenty children were category C. The median CD4 cell count was 953 cells/mm3 (276-3137), 28 % +/- 8 (12.42). One child was receiving no therapy, four were on combination therapy with two nucleoside reverse transcriptase inhibitors (NRTI) and 61 were receiving highly active anti-retroviral therapy (HAART). Twenty-seven children (44 %) were receiving the first HAART regimen, 23 the second, and 11 had already been switched more than twice. Overall, 37 of the 61 patients receiving HAART had an undetectable plasma viral load. CONCLUSIONS: Most children in our study had gone through several antiretroviral regimens, although not all children were being treated with HAART. Fifty-six percent of the patients with HAART had an undetectable plasma viral load. However, new complications associated with this therapy have begun to appear.
Subject(s)
Anti-Retroviral Agents/therapeutic use , HIV Infections/drug therapy , HIV-1 , Adolescent , Child , Child, Preschool , Cross-Sectional Studies , Female , Humans , Infant , MaleABSTRACT
Introducción: Hay pocos estudios transversales que muestren la situación actual de los niños con infección por el virus de la inmunodeficiencia humana de tipo 1 (VIH-1). Estos estudios serían muy útiles para determinar cómo están nuestros pacientes clínica e inmunovirológicamente, las terapias que reciben en la actualidad y la toxicidad asociada. Objetivos: Realizar un análisis descriptivo de la situación clínica, inmunológica y virológica de los pacientes con infección por VIH-1, seguidos hasta enero del 2002 en un hospital terciario, y analizar las terapias antirretrovirales que reciben en la actualidad. Material y métodos Se realizó un corte transversal de los niños con infección por el VIH-1 seguidos hasta enero de 2002 en la Consulta de Inmunodeficienciencias del Hospital 12 de Octubre. La evaluación de todos los pacientes fue clínica y analítica. Se analizaron los últimos recuentos de CD4. Se consideraron indetectables aquellos pacientes con carga viral inferior a 300 copias/ml en el último control. Resultados: Se analizaron 66 niños con infección por el VIH-1, seguidos hasta enero de 2002. Todos salvo uno, de transmisión desconocida, adquirieron la infección por transmisión vertical. La mediana de edad fue de 111 meses (rango, 18-216). Veinte niños se encuentran en categoría C. La mediana de CD4 fue de 953 +/- 497 cél./ml (límites, 276-3.137), el 28% +/- 8 (límites, 12-42). En cuanto al tratamiento uno de los pacientes no recibía tratamiento, cuatro recibían biterapia con dos análogos inhibidores de la transcriptasa inversa y 61 en tratamiento antirretroviral de gran actividad (TARGA). Veintisiete niños (44 %) se encontraban en su primer ciclo de TARGA, 23 en el segundo y 11 habían recibido tres o más ciclos. Treinta y siete de los 61 pacientes que recibían TARGA tenían una carga viral inferior a 300 copias/ml. Conclusión: La mayoría de nuestros pacientes han recibido varios regímenes de tratamiento, si bien actualmente no todos reciben terapia antirretroviral. De los que reciben TARGA, el 56 % tiene una carga viral indetectable. En contrapartida, se están observando nuevas complicaciones asociadas al tratamiento
Introduction: There are few cross-sectional studies describing the current situation of HIV-1-infected children. Such studies would be useful to determine patients clinical and immunologic and virologic status, currently prescribed therapies and their associated toxicity. Objectives: To perform a descriptive analysis of the clinical, immunological and virological status of HIV-1-infected children followed-up in the pediatric unit of a tertiary hospital and describe the current antiretroviral therapies used to treat them. Material and methods: A cross-sectional study was performed. Data were collected from all HIV-1-infected children followed-up until January 2002 in a large pediatric referral hospital (Hospital 12 de Octubre in Madrid). Clinical evaluation and laboratory investigations were scheduled to be performed every 3 months. The most recent CD4 and plasma viral loads were evaluated. Viral loads were considered undetectable when there were less than 300 copies/ml at the last evaluation. Results: Sixty-six HIV-1-infected children who were followed-up to January 2002 were analyzed. All the children acquired the infection through vertical transmission except one, in whom the mode of transmission was unknown. The median age was 111 months (18-216). Twenty children were category C. The median CD4 cell count was 953 cells/mm3 (276-3137), 28% +/- 8 (12.42). One child was receiving no therapy, four were on combination therapy with two nucleoside reverse transcriptase inhibitors (NRTI) and 61 were receiving highly active anti-retroviral therapy (HAART). Twenty-seven children (44 %) were receiving the first HAART regimen, 23 the second, and 11 had already been switched more than twice. Overall, 37 of the 61 patients receiving HAART had an undetectable plasma viral load. Conclusions: Most children in our study had gone through several antiretroviral regimens, although not all children were being treated with HAART. Fifty-six percent of the patients with HAART had an undetectable plasma viral load. However, new complications associated with this therapy have begun to appear
Subject(s)
Male , Female , Infant , Child , Humans , Anti-Retroviral Agents/therapeutic use , HIV Infections/drug therapy , HIV-1 , Cross-Sectional StudiesABSTRACT
No disponible
Subject(s)
Humans , Female , Child , Arthritis, Infectious , Meningococcal Infections , BacteremiaABSTRACT
Antecedentes En los países desarrollados, con la introducción del tratamiento antirretroviral de gran actividad (TARGA), la supervivencia y la calidad de vida de los niños infectados por el virus de la inmunodeficiencia humana (VIH) ha mejorado de manera espectacular. Sin embargo, empiezan a observarse en estos pacientes algunas alteraciones metabólicas y óseas que son preocupantes. Objetivo Evaluar la prevalencia de alteraciones en la mineralización ósea y los posibles factores asociados en una cohorte de niños infectados por el VIH y que reciben TARGA. Pacientes y métodos Se ha realizado una densitometría ósea (DEXA) a 50 niños con infección por VIH de un hospital terciario de Madrid tras una media de 54 meses con TARGA. Posteriormente se ha comparado el grupo con disminución en la mineralización ósea con el que no tiene disminución. Resultados Un 40 por ciento de los niños presentaban disminución en la densidad mineral ósea (DMO) de los cuales un 36 por ciento correspondía a osteopenia (18/50) y un 4 por ciento a osteoporosis (2/50). Al comparar el grupo con disminución en la densidad mineral ósea con el que no tiene disminución no se han encontrado diferencias estadísticamente significativas en ninguno de los factores estudiados. Conclusiones Existe una elevada prevalencia de disminución en la DMO en nuestra cohorte de niños con infección VIH en TARGA. Todavía se conoce poco la etiología y los factores asociados de esta afectación (AU)
Subject(s)
Child, Preschool , Male , Humans , Female , Child , HIV Infections , Surveys and Questionnaires , Antiretroviral Therapy, Highly Active , Cross-Sectional Studies , Bone DensityABSTRACT
BACKGROUND: In developed countries, the introduction of highly active antiretroviral therapy (HAART) has greatly improved survival and quality of life in HIV-infected children. Nevertheless, worrisome metabolic and bone alterations are beginning to be observed. OBJECTIVE: To evaluate the prevalence of alterations in bone mineral density and possible associated factors in a cohort of HIV-infected children receiving HAART. PATIENTS AND METHODS: Bone dual energy X-ray absorptiometry (DEXA) was performed in 50 HIV-infected children in a tertiary hospital in Madrid after a median length of HAART of 54 months. Subsequently, the group with bone mineral loss was compared with the group without bone mineral loss. RESULTS: Forty percent of the children studied had decreased bone mineral density, of which 36 % had osteopenia (18/50) and 4 % had osteoporosis (2/50). No statistically significant differences were found between the two groups in any of the factors analyzed. CONCLUSIONS: The prevalence of decreased bone mineral density in our cohort of HIV-infected children receiving HAART is high. The etiology and factors associated with this alteration are still not well known.
Subject(s)
Antiretroviral Therapy, Highly Active/adverse effects , Bone Density/drug effects , HIV Infections/drug therapy , Child , Child, Preschool , Cross-Sectional Studies , Female , Humans , Male , Surveys and QuestionnairesABSTRACT
No disponible
Subject(s)
Adolescent , Male , Infant , Female , Humans , Syndrome , Erythema Infectiosum , Skin Diseases, Papulosquamous , Purpura , BCG Vaccine , Lymphadenitis , Fever , Hand Dermatoses , Foot DermatosesABSTRACT
No disponible
