ABSTRACT
OBJECTIVE: To evaluate a training program in paediatric critical care for residents in paediatrics. METHODS: Description of a paediatric critical care training program for residents in paediatrics. To evaluate the results of the program an initial, and final written test, an evaluation by the physician responsible for the program, a self-evaluation by the residents, and a written survey on the quality of the training program, were performed. RESULTS: From April 1998 to August 2009, 156 residents were included in the training program. All residents showed an improvement between the initial and final written test; initial score (5.6+/-1.2), final score (8.6+/-0.7) (P<0.001). Only 14.1% of the residents answered at least 70 % of the questions correctly in the initial test, compared with 96.6 % in the final test (P<0.001). The score in final test was significantly higher than the self-evaluation by the residents (6.7+/-1.2) and the evaluation by the tutor (6.9+/-0.9) (P<0.001). There were no differences between the practical self-evaluation by the residents (6.2+/-1.0) and the practical evaluation by the tutor (6.7+/-0.9). Residents considered the training program as adequate: theoretical education (8.5+/-0.8), resident handbook (9+/-0.9), practical training (8.3+/-1.0), investigation (7.6+/-2.0) and human relationship (9.2+/-0.9). CONCLUSIONS: This training program is an useful educational method for training paediatric intensive care residents. The evaluation of the training program is essential to improve the education in paediatric residents.
Subject(s)
Critical Care , Internship and Residency , Pediatrics/education , Curriculum , HumansABSTRACT
Objetivo: Evaluar los resultados de un programa de formación en cuidados intensivos pediátricos para residentes de Pediatría. Métodos: Se diseñó un programa de formación en cuidados intensivos pediátricos para médicos residentes de Pediatría y se evaluaron los resultados con una prueba teórica escrita inicial y final, una evaluación por el médico responsable, una autoevaluación de los residentes y una encuesta escrita sobre la calidad del programa. Resultados: Desde abril del 1998 hasta agosto de 2009, se incluyeron a 156 residentes en el programa de formación. Los residentes mostraron mejoría entre la evaluación teórica inicial (5,6±1,2) y la final (8,6±0,7) (p<0,001). Un 14,1% contestó correctamente al menos el 70 % de las preguntas de la evaluación inicial y un 96,6 % de la final (p<0,001). La puntuación teórica final fue significativamente más alta que la autoevaluación de los residentes (6,7±1,2) y la evaluación de los tutores (6,9±0,9) (p<0,001). No hubo diferencias entre la autoevaluación práctica de los residentes (5,8±1,3) y la evaluación práctica del tutor (6,7±0,9). Los residentes consideraron adecuado el programa formativo: formación teórica (8,5±0,8), manual de residentes (9±0,9), educación práctica (8,3±1,0), investigación (7,6±2,0) y trato humano (9,2±0,9). Conclusiones: El programa descrito es un método educativo útil para la formación teórica y práctica de los residentes de Pediatría en cuidados intensivos. La evaluación del programa de entrenamiento es esencial para mejorar la formación de los residentes de Pediatría (AU)
Objective: To evaluate a training program in paediatric critical care for residents in paediatrics. Methods: Description of a paediatric critical care training program for residents in paediatrics. To evaluate the results of the program an initial, and final written test, an evaluation by the physician responsible for the program, a self-evaluation by the residents, and a written survey on the quality of the training program, were performed. Results: From April 1998 to August 2009, 156 residents were included in the training program. All residents showed an improvement between the initial and final written test; initial score (5.6±1.2), final score (8.6±0.7) (P<0.001). Only 14.1% of the residents answered at least 70 % of the questions correctly in the initial test, compared with 96.6 % in the final test (P<0.001). The score in final test was significantly higher than the self-evaluation by the residents (6.7±1.2) and the evaluation by the tutor (6.9±0.9) (P<0.001). There were no differences between the practical self-evaluation by the residents (6.2±1.0) and the practical evaluation by the tutor (6.7±0.9). Residents considered the training program as adequate: theoretical education (8.5±0.8), resident handbook (9±0.9), practical training (8.3±1.0), investigation (7.6±2.0) and human relationship (9.2±0.9). Conclusions: This training program is an useful educational method for training paediatric intensive care residents. The evaluation of the training program is essential to improve the education in paediatric residents (AU)
Subject(s)
Humans , Internship and Residency/methods , Critical Care , Education, Medical/methods , Educational Measurement , Program Evaluation , Curriculum/trendsABSTRACT
Antecedentes: Los potenciales evocados auditivos (PEA) recogen los cambios en las ondas auditivas cerebrales frente a un estímulo sonoro y estiman el grado de actividad eléctrica erebral. Los potenciales de latencia media o respuesta cortical temprana se correlacionan con las variaciones del estado de conciencia. Los PEA se han utilizado para valorar la hipnosis durante la cirugía, pero existe poca experiencia en el paciente crítico. Objetivo: Analizar la utilidad de la monitorización con PEA de latencia media en niños críticamente enfermos. Métodos: Se monitorizó el estado de conciencia mediante los PEA colocando unos auriculares de emisión de sonidos y 3 sensores en región frontal y preauricular. Simultáneamente se recogió la puntuación de la escala clínicas de sedación COMFORT y el Índice Biespectral (BIS), analizándose la puntuación de los PEA y su relación con los otros parámetros de sedación en niños en distintas situaciones clínicas. Resultados: Se estudiaron 6 niños críticamente enfermos en los que los PEA ayudaron a valorar el estado de conciencia: sedación superficial, sueño espontáneo, sedación profunda, sedación en el paciente relajado y muerte cerebral. Los PEA mostraron una buena correlación con las escalas clínicas y el BIS en los casos de sedación superficial y profunda, y diagnosticaron precozmente un paciente con muerte cerebral. En un paciente relajado los PEA permitieron detectar la infrasedación. En un caso se observó que el marcapasos cardíaco producía interferencias en la medición de los potenciales evocados. Conclusión: Los PEA pueden ser útiles en la valoración del estado de conciencia y sedación de los niños críticamente enfermos. Son necesarios estudios amplios que analicen su fiabilidad y limitaciones en las diferentes edades
Background: Middle latency auditory evoked potentials (MLAEP) reflect changes in electroencephalogram waves after an auditory signal and represent the earliest cortical response to acoustic stimulus. They are therefore used to measure variations in the level of consciousness. MLEAP have been used to measure the depth of anesthesia during surgical procedures, but experience in critical care patients is very limited. Objective: To analyze the utility of MLAEP for monitoring the level of sedation in critically ill children. Methods: Level of consciousness was monitored through MLAEP by placing special headphones and three sensors situated in the frontal and preauricular regions. Simultaneously, the level of sedation was measured using the COMFORT scale and the Bispectral Index (BIS) in distinct clinical situations. Results: We studied six critically ill children in whom MLAEP helped us to evaluate the level of consciousness: light sedation, natural sleep, deep sedation, sedation in a paralyzed child, and brain death. MLAEP showed a good correlation with the COMFORT scale and BIS in light and deep sedation and were effective in the early detection of brain death in one patient. In the paralyzed patient, MLAEP was able to detect undersedation. In one patient, a pacemaker interfered with the MLAEP signal. Conclusions: MLAEP can be useful in evaluating the level of consciousness and sedation in critically ill children. Further studies with larger samples are required to analyze the limitations and reproducibility of this type of monitoring in children of different ages
Subject(s)
Infant , Child , Humans , Critical Illness , Evoked Potentials, Auditory , Unconsciousness/diagnosis , Brain Death/diagnosis , Critical CareABSTRACT
The Bispectral Index (BIS) is a single numeric value that indicates the depth of hypnosis by estimating the level of electrical activity in the brain through analysis of the frequency bands in the electroencephalogram. The BIS was primarily developed to monitor the level of hypnosis during surgery and has recently begun to be used in critically-ill patients. Currently, there is little experience of the BIS in critically-ill children. We present 6 cases that illustrate the utility of BIS monitoring in the PICU. We assessed sedation and analgesia during mechanical ventilation with and without neuromuscular block in two patients, and the effect of anesthetic agents during a surgical procedure in the PICU. The BIS was also useful in the continuous monitoring of the level of consciousness in a patient with encephalitis and in the early detection of brain death. Pacer-induced artefacts in the BIS value are also described. We conclude that BIS monitoring may be a useful, noninvasive method for assessing the level of hypnosis in critically-ill children.
Subject(s)
Critical Care , Critical Illness , Diagnostic Techniques, Neurological/instrumentation , Brain Death/diagnosis , Child, Preschool , Conscious Sedation , Electroencephalography , Female , Humans , Infant , Intensive Care Units, Pediatric , Male , Monitoring, Physiologic/instrumentationABSTRACT
El índice biespectral (BIS) es un número que evalúa el grado de hipnosis al estimar el nivel de actividad eléctrica cerebral mediante el análisis de las frecuencias de las ondas del electroencefalograma (EEG). Desarrollado fundamentalmente para controlar la hipnosis durante la cirugía, ha empezado a utilizarse en los pacientes críticos, aunque hay muy poca experiencia en niños. Presentamos 6 casos en que el BIS permitió ajustar la sedación de 2 pacientes que recibían analgésicos, con y sin relajación muscular, controlar la sedación durante una intervención quirúrgica realizada en la unidad de cuidados intensivos pediátricos (UCIP), monitorizar de manera continuada el estado de consciencia en una niña con encefalitis y detectar precozmente el estado de muerte encefálica. También observamos que el marcapasos cardíaco produce interferencias que pueden alterar el valor del BIS. Concluimos que el BIS es un método no invasivo que puede ser útil para la monitorización del estado de consciencia de los niños enfermos críticos
The Bispectral Index (BIS) is a single numeric value that indicates the depth of hypnosis by estimating the level of electrical activity in the brain through analysis of the frequency bands in the electroencephalogram. The BIS was primarily developed to monitor the level of hypnosis during surgery and has recently begun to be used in critically-ill patients. Currently, there is little experience of the BIS in critically-ill children. We present 6 cases that illustrate the utility of BIS monitoring in the PICU. We assessed sedation and analgesia during mechanical ventilation with and without neuromuscular block in two patients, and the effect of anesthetic agents during a surgical procedure in the PICU. The BIS was also useful in the continuous monitoring of the level of consciousness in a patient with encephalitis and in the early detection of brain death. Pacer-induced artefacts in the BIS value are also described. We conclude that BIS monitoring may be a useful, noninvasive method for assessing the level of hypnosis in critically-ill children
Subject(s)
Infant , Child, Preschool , Humans , Critical Illness , Diagnostic Techniques, Neurological/instrumentation , Critical Care , Conscious Sedation , Electroencephalography , Intensive Care Units, Pediatric , Monitoring, Physiologic/instrumentation , Brain Death/diagnosisABSTRACT
OBJECTIVE: To study the utility and efficacy of transpyloric enteral nutrition (TEN) in critically-ill children by analyzing the factors that determine enteral tolerance. PATIENTS AND METHODS: We performed a prospective, observational study between 1994 and 2002 of all critically-ill children admitted to our pediatric intensive care unit who received TEN. The indications for enteral nutrition, type of nutrition and its duration were studied. RESULTS: A total of 286 patients (8.4 % of patients admitted to the PICU in the study period), aged between 3 days and 17 years received TEN. Fifty-five children (19.2 %) were aged less than 1 month and 165 (27.7 %) were aged less than 6 months. Seventy percent received TEN exclusively. The most frequent indication for TEN was mechanical ventilation in 255 children (89.2 %). One hundred seventy-six patients (61.5 %) received TEN in the postoperative period after cardiac surgery. The mean duration of TEN was 15.4 25 days, the maximum volume of nutrition was 118.7 41 ml/kg/day, and the maximum caloric intake was 88.6 26.7 kcal/kg/day. During TEN, 227 patients received sedation (79.3 %), and 124 were administered muscle relaxants (43.3 %), with no increase in complications. CONCLUSIONS: TEN is a useful method of nutrition in critically-ill children.
Subject(s)
Critical Illness , Enteral Nutrition/methods , Adolescent , Child , Child, Preschool , Humans , Infant , Infant, Newborn , Intensive Care Units, Pediatric , Prospective Studies , PylorusABSTRACT
OBJECTIVE: To study tolerance to transpyloric enteral nutrition (TEN) and the incidence of secondary complications in critically-ill children. PATIENTS AND METHODS: We performed a prospective, observational study between 1994 and 2002 of all critically-ill children admitted to our pediatric intensive care unit who received TEN. Tolerance and complications were analyzed. RESULTS: Of 286 patients aged between 3 days and 17 years who received TEN, gastrointestinal complications occurred in 13.6 %, abdominal distention and/or excessive gastric residue in 8 % and diarrhea in 6.3 %. Diarrhea was associated with shock (p 0.01), abdominal distension and/ or excessive gastric residue (p 0.008), hypophosphatemia (p 0.001), and duration of TEN (p < 0.001). TEN was discontinued in 2.1 % of the patients because of gastrointestinal complications. Thirty-two patients (11.2 %) died during TEN. No relationship was found between the characteristics of nutrition and complications and mortality. CONCLUSIONS: TEN is a well tolerated method of nutrition in critically-ill children that produces few complications.
Subject(s)
Critical Illness , Enteral Nutrition/adverse effects , Adolescent , Child , Child, Preschool , Enteral Nutrition/methods , Humans , Infant , Infant, Newborn , Intensive Care Units, Pediatric , Prospective Studies , PylorusABSTRACT
Objetivo: Estudiar la utilidad y eficacia de la nutrición enteral transpilórica (NET) en el niño críticamente enfermo, analizando los factores que influyen en la tolerancia digestiva. Pacientes y métodos Estudio prospectivo observacional realizado entre 1994 y 2002, de los niños críticamente enfermos, ingresados que recibieron NET. En este estudio se analizan las indicaciones, el tipo de nutrición y su duración. Resultados Se incluyen 286 pacientes (el 8,4 por ciento de los pacientes ingresados en la unidad de cuidados intensivos pediátricos), de edades entre 3 días y 17 años de edad recibieron nutrición transpilórica: 55 niños (19,2 por ciento) eran menores de un mes de vida, y 165 (57,7 por ciento), menores de 6 meses. El 70 por ciento recibieron exclusivamente NET. La indicación más frecuente de NET fue la ventilación mecánica, en 255 niños (89,2 por ciento). Recibieron NET en el postoperatorio de cirugía cardíaca 176 pacientes (61,5 por ciento). La duración media de la NET fue 15,4 25 días, el volumen máximo de 118,7 41 ml/kg/día y las calorías máximas de 88,6 26,7 kcal/kg/ día. Durante la NET, 227 pacientes recibieron sedantes y analgésicos (79,3 por ciento), y 124 relajantes musculares (43,3 por ciento), sin modificar la tolerancia. Conclusiones La NET es una técnica de alimentación útil en el niño críticamente enfermo (AU)
Subject(s)
Child, Preschool , Child , Adolescent , Infant , Infant, Newborn , Humans , Critical Illness , Intensive Care Units, Pediatric , Pylorus , Prospective Studies , Enteral NutritionABSTRACT
Objetivo: Estudiar la tolerancia e incidencia de complicaciones secundarias a la nutrición enteral transpilórica (NET) en el niño críticamente enfermo. Pacientes y métodos Estudio prospectivo observacional realizado entre 1994 y 2002, de los niños críticamente enfermos ingresados que recibieron NET. En este estudio se analizan la tolerancia y presencia de complicaciones de la nutrición. Resultados De los 286 pacientes que recibieron nutrición transpilórica, el 13,6 por ciento presentaron complicaciones digestivas, el 8 por ciento distensión abdominal y/o excesivos restos gástricos y el 6,3 por ciento diarrea. La diarrea se relacionó con la presencia de shock (p 0,01), distensión abdominal y/o excesivos restos digestivos (p 0,008), hipofosfatemia (p < 0,001) y duración de la NET (p 0,001). En un 2,1 por ciento de los pacientes la alimentación transpilórica tuvo que ser suspendida debido a complicaciones digestivas.32 pacientes (11,2 por ciento) fallecieron. La mortalidad no se relacionó con ninguna característica de la nutrición ni con las complicaciones. Conclusiones La NET es una técnica de alimentación bien tolerada y con escasas complicaciones en el niño críticamente enfermo (AU)
Subject(s)
Child , Child, Preschool , Adolescent , Infant , Infant, Newborn , Humans , Critical Illness , Intensive Care Units, Pediatric , Pylorus , Prospective Studies , Enteral NutritionABSTRACT
La adenitis es una patología usual en pediatría y la localización cervical suele ser una de las más habituales. Su etiología es muy variada, desde procesos autolimitados hasta cuadros graves que ponen en peligro la vida del paciente. La causa más frecuente es la infecciosa, sobre todo la de origen vírico, seguido del bacteriano, principalmente adenitis secundarias a infecciones por Staphylococcus aureus, Streptococcus pyogenes y Mycobacterium sp. Se describe el caso de un niño de 4 años que es visto en el servicio de urgencias por un proceso febril de 4 días de evolución y que presenta una tumoración cervical de 6 X 6 cm. En su investigación etiológica aparece una faringitis estreptocócica (AU)
Subject(s)
Child, Preschool , Male , Humans , Parotitis/microbiology , Streptococcal Infections/complications , Streptococcus pyogenes/pathogenicity , Lymphadenitis/microbiologyABSTRACT
OBJETIVO: Analizar la eficacia docente de los cursos de reanimación cardiopulmonar básica y avanzada en pediatría MATERIAL Y MÉTODOS: Desde febrero de 1994 hasta octubre de 1996 se impartieron 23 cursos teórico-prácticos de reanimación cardiopulmonar (RCP) pediátrica, 6 de RCP básica, con 265 alumnos, y 17 de RCP avanzada, con 409 alumnos. Se realizaron una evaluación teórica inicial y final, evaluaciones prácticas de RCP básica y RCP avanzada y una encuesta de satisfacción a los alumnos y profesores. RESULTADOS: Evaluación teórica: en los cursos de RCP básica la puntuación media de la evaluación inicial fue de 6,6 (1,7) y la de la evaluación final, de 9,3 (0,9) (p < 0,001). En los cursos de RCP avanzada la puntuación inicial fue de 25,7 (5,5) y la final, de 36,2 (2,5) (p < 0,001). En la evaluación práctica tanto en los cursos de RCP básica como de avanzada las puntuaciones medias de cada una de las maniobras superaron el valor mínimo exigido de 3, sobre un máximo de 5. La evaluación del curso por los alumnos y profesores ofreció una elevada valoración de los contenidos teóricos, prácticos y metodología docente empleada, y sirvió para rectificar las deficiencias encontradas. CONCLUSIÓN: Los cursos de RCP básica y avanzada en pediatría son métodos docentes adecuados para la formación teórico-práctica de sanitarios, parasanitarios y población general. Los alumnos y profesores están satisfechos con la docencia y metodología empleada. Las evaluaciones téoricas y prácticas y la encuesta de satisfacción son métodos útiles de control de calidad de la docencia (AU)
Subject(s)
Humans , Teaching , Cardiopulmonary Resuscitation , Pediatrics , Quality Control , Advanced Cardiac Life Support , Curriculum , Program EvaluationABSTRACT
OBJECTIVE: Our aim was to analyze the incidence of metabolic disturbances in critically ill children and to evaluate their correlation with severity of illness, complications, mortality and length of hospital stay. PATIENTS AND METHODS: We retrospectively studied 360 children who were admitted into a Pediatric Intensive Care Unit (PICU) between January 1995 and May 1996. We analyzed age, sex, initial diagnosis, complications, length of hospital stay and initial and final concentrations of serum glucose, calcium, phosphorus, magnesium and alkaline phosphatase. RESULTS: The incidence of different metabolic disturbances at admission to the PICU was: hyperglycemia 51.9%, hypoglycemia 1.9%, hypocalcemia 24.5%, hypercalcemia 5.8%, hyperphosphatemia 7.3%, hypophosphatemia 7.9%, hypomagnesemia 47.4% and hypermagnesemia 3%. Patients with shock had lower concentrations of calcium and higher phosphorus levels, while children with sepsis had lower magnesium concentrations. Patients who died had a higher incidence of hyperphosphatemia and higher values of serum glucose and magnesium at admission, while patients who survived had lower concentrations of calcium and higher incidence of hypomagnesemia. We did not find any correlation between the initial values for metabolites and length of stay in the PICU. CONCLUSIONS: Metabolic disturbances in critically ill children are frequent findings, correlate with important complications and can be prognostic markers. Thus, regular controls of different metabolites must be performed so we can precociously detect these disturbances and correct them.
Subject(s)
Metabolic Diseases/diagnosis , Adolescent , Brain Diseases/complications , Child , Child, Preschool , Critical Illness , Female , Heart Diseases/complications , Humans , Infant , Infant, Newborn , Male , Metabolic Diseases/etiology , Multiple Trauma/complications , Reference Values , Respiratory Tract Diseases/complications , Retrospective Studies , Sepsis/complicationsABSTRACT
OBJECTIVE: The aim of this study was to analyze the effectiveness of pediatric cardiopulmonary resuscitation training of medical students in pediatric basic life support (PBLS) courses. PATIENTS AND METHODS: Between 1995 and 1998, four theoretical and practical PBLS courses were given to 304 fifth and sixth-year medical students. The theoretical classes provided conceptual information about cardiorespiratory arrest and prevention, basic cardiopulmonary resuscitation maneuvers and practice sessions in basic cardiopulmonary resuscitation of infants and older children to groups of 6 to 8 students. At the beginning of the course, students took a theoretical test that consisted of 10 or 20 multiple-choice questions. At the end of the course, the theoretical test was repeated and a practical test of basic cardiopulmonary resuscitation skills for infants and children was given. Students evaluated the course by completion of an anonymous written questionnaire. RESULTS: The mean initial score (out of a maximum of 10) was 6.4 and the mean score on the final theoretical test was 9.6 (p < 0.001). The practical evaluation showed that 95% of the students mastered the skills of the basic pediatric cardiopulmonary resuscitation maneuvers. The student evaluation of the course yielded scores (on a scale of 5 points) of 4.4 for the theoretical classes, 4.4 for presentation, 4.7 for practical classes and 4.8 for professors' teaching skills. CONCLUSIONS: The pediatric basic life support courses were a useful method for providing theoretical-practical training to students of medicine and should be an essential part of the pediatric curricula in medical studies.
Subject(s)
Cardiopulmonary Resuscitation/education , Teaching , Cardiopulmonary Resuscitation/methods , Child , Curriculum/statistics & numerical data , Educational Measurement/statistics & numerical data , Humans , Infant , Spain , Teaching/statistics & numerical dataABSTRACT
OBJECTIVE: The purpose of this study was to analyze the clinical evolution, acute toxicity and factors which influence the response to nitric oxide treatment in children. PATIENTS AND METHODS: We studied prospectively 25 children, 14 boys and 11 girls, between 15 days and 16 years of age. Seventeen patients were diagnosed with ARDS and 8 with PHT. All patients presented hypoxemia and/or PHT refractory to conventional therapy and were treated with inhaled NO (1.5 to 45 ppm) between 45 minutes to 47 days. We studied the secondary effects, morbidity and mortality, and analyzed the relationship between NO effects and age, sex, diagnosis, infection, previous PaO2/FiO2 ratio, previous oxygenation index and previous mean pulmonary arterial pressure (mPAP)/mean systemic arterial pressure (mSAP). RESULTS: The effect of NO was maintained during the time of administration without tachyphylaxis. There were no secondary effects of NO administration. NO2 was always < 2 ppm and metahemoglobinemia was below 3.5%. There was no relationship between the effect of NO and the rest of the factors analyzed. Twelve patients (48%) survived, 9 of the children with ARDS (53%) and 3 of the children with PHT (38%). Eleven of the 21 patients who improved with NO treatment survived (52%), as did 1 of the 4 patients who did not improve (25%). CONCLUSIONS: Prolonged administration of inhaled NO at low concentrations maintains the improvement of oxygenation and pulmonary hypertension without acute secondary effects. We have not found factors that could predict the clinical response to NO.
