RESUMO
Patients undergoing extracorporeal membrane oxygenation (ECMO) are at increased risk of infection. We present the first known report of nosocomial infection with Cupriavidus pauculus attributable to contamination from ECMO equipment and describe the measures taken to halt subsequent infections. A cluster of infections in ECMO patients should prompt team members to consider contamination of equipment with environmental pathogens as a possible cause.
Assuntos
Infecção Hospitalar/microbiologia , Contaminação de Equipamentos , Oxigenação por Membrana Extracorpórea/efeitos adversos , Infecções por Bactérias Gram-Negativas/etiologia , Antibacterianos/uso terapêutico , Cefepima , Cefalosporinas/uso terapêutico , Pré-Escolar , Ciprofloxacina/uso terapêutico , Infecção Hospitalar/tratamento farmacológico , Cupriavidus , Gentamicinas/uso terapêutico , Infecções por Bactérias Gram-Negativas/tratamento farmacológico , Humanos , Lactente , Recém-Nascido , Masculino , Meropeném , Ácido Penicilânico/análogos & derivados , Ácido Penicilânico/uso terapêutico , Piperacilina/uso terapêutico , Tazobactam , Tienamicinas/uso terapêuticoRESUMO
OBJECTIVE: To test the hypothesis that many critically ill children exhibit ionized hypomagnesemia despite having normal total magnesium (TMg) concentrations. DESIGN: A prospective, observational study with convenience sampling. SETTING: Pediatric and cardiovascular intensive care units of a large children's hospital. PATIENTS: Patients aged 1 day to 21 yrs admitted from January 1 to October 31, 1996. Patients with chronic renal failure or weight <3 kg were excluded. A group of healthy children involved in a school-based nutritional assessment study were also studied. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Sixty-seven patients (5.4+/-5.7 [SD] yrs) and 24 healthy children (10.84+/-0.93 yrs, p< .001) were studied. Plasma was assayed for ionized magnesium (IMg) using a blood analyzer. Forty (59%)/67 critically ill subjects had IMg concentrations <0.40 mmol/L, the lowest published normal value and the lowest value observed in our group of healthy children. Of these, 24 (60%)/40 had normal TMg concentrations. IMg was significantly (p=.00) lower in critically ill subjects than in the group of healthy children (0.37+/-0.10 mmol/L vs. 0.46+/-0.03 mmol/L). IMg did not correlate strongly with ionized calcium (r2=0.49), albumin (r2=0.09), or pH (r2=0.18). CONCLUSION: Many critically ill children exhibit ionized hypomagnesemia with normal TMg concentrations. These children would not be recognized as magnesium-deficient based on routine TMg testing. Critically ill children exhibited significantly lower concentrations of IMg than a group of healthy children.
Assuntos
Deficiência de Magnésio/sangue , Magnésio/sangue , Adolescente , Adulto , Estudos de Casos e Controles , Causalidade , Criança , Pré-Escolar , Estado Terminal , Humanos , Lactente , Recém-Nascido , Íons , Valor Preditivo dos Testes , Estudos Prospectivos , Valores de Referência , Reprodutibilidade dos Testes , Estudos de AmostragemRESUMO
Intraosseous infusion is a well accepted means of obtaining emergency intravascular access in children. Despite the low incidence of serious complications from intraosseous infusions, the potential exists for growth plate injury and subsequent growth disturbance following intraosseous infusion. We conducted a prospective, blinded observational study of 10 subjects to evaluate tibial length discrepancy radiographically one year or more following intraosseous infusion. We found no significant difference in mean tibial length between the legs that had intraosseous infusions and the opposite legs, which served as controls. We conclude that intraosseous infusion does not appear to produce subsequent leg length discrepancy one year after infusion.
Assuntos
Infusões Intraósseas/efeitos adversos , Tíbia/diagnóstico por imagem , Tíbia/crescimento & desenvolvimento , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Estudos Prospectivos , RadiografiaRESUMO
Glucagon has been used to treat the hypotension associated with calcium channel antagonist poisoning in adult patients. We describe the successful use of glucagon in a pediatric patient poisoned with nifedipine and clonidine whose hypotension was unresponsive to fluid resuscitation, calcium chloride, and dopamine.
Assuntos
Antídotos/uso terapêutico , Anti-Hipertensivos/intoxicação , Bloqueadores dos Canais de Cálcio/intoxicação , Clonidina/intoxicação , Glucagon/uso terapêutico , Nifedipino/intoxicação , Adolescente , Interações Medicamentosas , Overdose de Drogas , Feminino , Humanos , Intoxicação/tratamento farmacológicoAssuntos
Síndrome da Imunodeficiência Adquirida/diagnóstico , Doenças Neuromusculares/etiologia , Sorodiagnóstico da AIDS , Síndrome da Imunodeficiência Adquirida/tratamento farmacológico , Síndrome da Imunodeficiência Adquirida/fisiopatologia , Anti-Infecciosos/uso terapêutico , Antivirais/uso terapêutico , Pré-Escolar , Evolução Fatal , Humanos , Masculino , Doenças Neuromusculares/fisiopatologia , Combinação Trimetoprima e Sulfametoxazol/uso terapêutico , Zidovudina/uso terapêuticoRESUMO
T-lymphocyte subsets when measured in steroid responsive nephrotic syndrome (SRNS) have demonstrated significant variance from normal values. T-cell subsets were studied by using two-color flow cytometric analysis in 32 children (9.2 +/- 5 years of age) with SRNS. The children were divided into four groups: a) SRNS in acute relapse, on prednisone; b) SRNS in acute relapse, off prednisone; c) SRNS in long-term remission, off prednisone (nephrotic controls); d) patients in remission on long-term prednisone therapy; and e) 15 age-matched normal controls. Children suffering an acute relapse of SRNS showed an increase in Leu2a+/DR+ (CD8) activated lymphocytes (P less than 0.05), a decrease in Leu4a+ total T-lymphocytes (P = 0.01) and a decrease in Leu3a+ (CD4) helper T-cells (P less than 0.05) when compared to normal controls and nephrotic controls. Though some subset changes may represent a prednisone effect and the functional role of these lymphocytes in the disease process is unknown, this study provides additional evidence to support a role for abnormal T-cell subsets in the etiology of SRNS.