ABSTRACT
Objetivo: Valorar la utilidad de la medición de la presión intraabdominal (PIA) intravesical para identificar a los pacientes con riesgo de desarrollar hipertensión intraabdominal; analizar los factores que influyen en la PIA, y valorar su relación con el pronóstico. Pacientes y métodos: Estudio prospectivo observacional en niños en estado crítico en los que se monitorizó la PIA en el momento de presentar clínica de hipertensión intraabdominal. Se analizaron las siguientes variables: edad, sexo, motivo de ingreso, patología de base, cirugía previa, presión arterial, frecuencia cardíaca, presión venosa central, diuresis, tratamiento con fármacos vasoactivos, sedación, relajación muscular, ventilación mecánica, técnicas de depuración extrarrenal, oxigenación con membrana extracorpórea y mortalidad. Resultados: Se estudió a 39 pacientes. A las 24 h de iniciar la monitorización, un 74,4% presentaba una PIA ≥12mmHg, un 33,3%>15mmHg y un 15,4% >20mmHg. A las 48h un 59% presentaba PIA ≥12mmHg. Se observó correlación de la PIA con la presión venosa central a las 24 y 48h (r=0,500; p=0,001 y r=0,360; p=0,04, respectivamente). No existió correlación con el resto de los parámetros analizados. Solo 9 pacientes precisaron descompresión urgente y ningún paciente desarrolló síndrome compartimental abdominal. Conclusiones: La medición de la PIA puede resultar útil para diagnosticar y tratar precozmente la hipertensión intraabdominal y prevenir el síndrome compartimental abdominal, por lo que se debería realizar en los niños críticos con patología abdominal(AU)
Objective: To assess the usefulness of intra-abdominal pressure (IAP) measurement, by the intra-vesical method, in order to identify those patients at risk of developing intra-abdominal hypertension, as well as to analyse the factors that affect the IAP, and to determine their influence on the prognosis in critically ill patients. Patients and methods: Prospective observational study in critically ill children in whom the IAP was monitored as soon as signs of intra-abdominal hypertension appeared. The following variables were analysed: age, sex, reason for admission, underlying disease, previous surgeries, blood pressure, heart rate, central venous pressure, urine output, inotropic therapy, sedation, muscle relaxation, mechanical ventilation, renal replacement techniques, extracorporeal membrane oxygenation, and mortality. Results: A total of 39 patients were studied. At 24hours from initiating the monitoring of IAP, 74.4% showed IAP ≥ 12mmHg, 33.3%>15mmHg, and 15.4%>20mmHg. After 48hours, 59% had intra-abdominal hypertension. There was a correlation between the central venous pressure (CVP) and IAP at 24 and 48hours (r=0.500, P=0.001 and r=0.360, P=0.040, respectively). There was no correlation with the other parameters. Only 9 patients required urgent decompression and none developed abdominal compartment syndrome. Conclusions: AP monitoring can be useful to diagnose and to promptly treat intra-abdominal hypertension, and thus to prevent the abdominal compartment syndrome. Therefore, it should be measured in critically ill children with abdominal pathology
Subject(s)
Humans , Male , Female , Child , Critical Illness , Monitoring, Physiologic/methods , Intra-Abdominal Hypertension/diagnosis , Blood Pressure Determination/methods , Compartment Syndromes/diagnosis , Critical Care/methodsABSTRACT
Objetivo: Describir la sedación con perfusión continua de propofol en niños en estado crítico. Diseño: Estudio observacional descriptivo retrospectivo. Ámbito: Unidad de cuidados intensivos pediátricos. Pacientes: Pacientes que requirieron sedoanalgesia entre el 1 de octubre de 2009 y el 30 de septiembre de 2010.Intervenciones: Ninguna. Variables recogidas: Demográficas, clínicas, de laboratorio, diagnóstico, tratamiento, complicaciones y evolución de cada paciente. Se analizaron los posibles efectos adversos asociados a la administración de propofol, comparando el grupo de pacientes a los que se les administró con el resto de los niños críticos. Resultados: Recibieron propofol en perfusión continua 71 de los 222 pacientes recogidos (32%). Los fármacos sedoanalgésicos más utilizados fueron el midazolam, seguido del fentanilo y del propofol. La dosis media de propofol fue de 2,1mg/kg/h [desviación estándar (DE) 1,3, rango: 0,5-6)] y la duración media de 6,7 días (DE 8,5; rango: 0,5-40). La edad media fue de 45,8 meses (mediana 24; rango intercuartil: 7-65), siendo el 52% varones. Ningún paciente presentó síndrome de infusión por propofol ni otros efectos adversos graves. Los pacientes tratados con propofol presentaron con mayor frecuencia algunas alteraciones analíticas que el resto, pero no se demostró relación causa efecto con la administración del fármaco. No existieron diferencias significativas en los niveles de lactato ni en la incidencia de infecciones entre ambos grupos. Conclusión: el propofol a una dosis de 1 a 4mg/kg/h puede utilizarse como un fármaco alternativo para la sedación de mantenimiento en los niños críticamente enfermos. Sin embargo son necesarios más estudios que valoren su eficacia y seguridad (AU)
Objective To describe sedation with continuous perfusion of propofol in critically ill children. Design A retrospective, descriptive observational study was carried out. Setting A pediatric intensive care unit. Patients Pediatric patients requiring sedoanalgesia between October 1, 2009 and September 30, 2010. Interventions None. Data collected Demographic, clinical and laboratory test variables, diagnosis, treatment, complications and evolution in each patient. In addition, the potential adverse effects associated with propofol administration were analyzed. Results: Midazolam, fentanyl and propofol were the most commonly used sedative and analgesic drugs. Seventy-one out of 222 patients (32%) received propofol in continuous infusion. The average dose was 2.1mg/kg/h (SD 1.3, range: 0.5 to 6), and the average duration of treatment was of 6.7 days (SD 8.5 range 0.5-40). Fifty-two percent were males, and the mean patient age was 45.8 months (median: 24; interquartile range: 7-65). No patient developed propofol infusion syndrome or other serious drug-related adverse effects. Patients treated with propofol showed more abnormal laboratory test findings, although no relationship to drug administration could be demonstrated. There were no significant differences in lactate level or in the incidence of infection in either group. Conclusions: Propofol at a dose of 1 to 4mg/kg/h is a safe alternative for sustained sedation in critically ill children. However, further studies are needed to assess its effects and safety profile (AU)
Subject(s)
Humans , Male , Female , Child , Propofol/therapeutic use , Ventilation-Perfusion Ratio , Deep Sedation/methods , Intensive Care Units, Pediatric/statistics & numerical data , Patient SafetyABSTRACT
OBJECTIVE: To assess the usefulness of intra-abdominal pressure (IAP) measurement, by the intra-vesical method, in order to identify those patients at risk of developing intra-abdominal hypertension, as well as to analyse the factors that affect the IAP, and to determine their influence on the prognosis in critically ill patients. PATIENTS AND METHODS: Prospective observational study in critically ill children in whom the IAP was monitored as soon as signs of intra-abdominal hypertension appeared. The following variables were analysed: age, sex, reason for admission, underlying disease, previous surgeries, blood pressure, heart rate, central venous pressure, urine output, inotropic therapy, sedation, muscle relaxation, mechanical ventilation, renal replacement techniques, extracorporeal membrane oxygenation, and mortality. RESULTS: A total of 39 patients were studied. At 24hours from initiating the monitoring of IAP, 74.4% showed IAP ≥ 12mmHg, 33.3%>15mmHg, and 15.4%>20mmHg. After 48hours, 59% had intra-abdominal hypertension. There was a correlation between the central venous pressure (CVP) and IAP at 24 and 48hours (r=0.500, P=.001 and r=0.360, P=.040, respectively). There was no correlation with the other parameters. Only 9 patients required urgent decompression and none developed abdominal compartment syndrome. CONCLUSIONS: IAP monitoring can be useful to diagnose and to promptly treat intra-abdominal hypertension, and thus to prevent the abdominal compartment syndrome. Therefore, it should be measured in critically ill children with abdominal pathology.
Subject(s)
Abdominal Cavity/physiology , Critical Illness , Intra-Abdominal Hypertension/diagnosis , Urinary Catheterization/methods , Blood Pressure Determination/methods , Central Venous Pressure/physiology , Child, Preschool , Female , Humans , Infant , Intra-Abdominal Hypertension/etiology , Male , Monitoring, Physiologic/methods , Pressure , Prospective Studies , Time Factors , Urinary BladderABSTRACT
OBJECTIVE: To describe sedation with continuous perfusion of propofol in critically ill children. DESIGN: A retrospective, descriptive observational study was carried out. SETTING: A pediatric intensive care unit. PATIENTS: Pediatric patients requiring sedoanalgesia between October 1, 2009 and September 30, 2010. INTERVENTIONS: None. DATA COLLECTED: Demographic, clinical and laboratory test variables, diagnosis, treatment, complications and evolution in each patient. In addition, the potential adverse effects associated with propofol administration were analyzed. RESULTS: Midazolam, fentanyl and propofol were the most commonly used sedative and analgesic drugs. Seventy-one out of 222 patients (32%) received propofol in continuous infusion. The average dose was 2.1 mg/kg/h (SD 1.3, range: 0.5 to 6), and the average duration of treatment was of 6.7 days (SD 8.5 range 0.5-40). Fifty-two percent were males, and the mean patient age was 45.8 months (median: 24; interquartile range: 7-65). No patient developed propofol infusion syndrome or other serious drug-related adverse effects. Patients treated with propofol showed more abnormal laboratory test findings, although no relationship to drug administration could be demonstrated. There were no significant differences in lactate level or in the incidence of infection in either group. CONCLUSIONS: Propofol at a dose of 1 to 4 mg/kg/h is a safe alternative for sustained sedation in critically ill children. However, further studies are needed to assess its effects and safety profile.
