Predictive value of brain-stem auditory evoked potentials in children with post-traumatic coma produced by diffuse brain injury.

In the present study, brain-stem auditory evoked potentials (BAEPs) in 31 children in post-traumatic coma with diffuse brain injury were examined. The BAEPs were recorded in the first 72 h after hospital admission and the findings of 29 patients related to the level of neurological recovery at 6 months after head injury. On the basis of the results, children were divided into three groups: the first consisted of children with bilateral and normal BAEPs (n = 19); the second of those with asymmetrical BAEPs (n = 6); and the third of those in whom BAEPs has disappeared or in whom only responses of the seventh cranial nerve and cochlear nucleus were recorded (n = 4). All the patients in the first group presented a good clinical outcome, with excellent recovery in 80%. In the second group three children (42.8%) had a good recovery, two (28.6%) were moderately disabled and one (14.3%) died of extraneurological causes. All the patients in the third group died. Abnormal BAEPs showed a significant correlation with absence of pupillary and/or corneal reflex, but not with the Glasgow Coma Score and anisocoria. Good statistical correlation was observed between normal BAEPs and visualization of basal cisterns on computed tomographic scan. The incidence of increased intracranial pressure was higher in patients with abnormal BAEPs, but the differences were not significant (P = 0.06). Our study confirms the predictive value of BAEPs in children's post-traumatic coma due to diffuse brain injury.

[Treatment of status asthmaticus. Experience of intravenous beta-adrenergic bronchodilator therapy in 71 cases]. / Tratamiento del estado asmático. Experiencia del tratamiento broncodilatador beta-adrenérgico EV sobre 71 casos.

A retrospective study of the patients admitted during the last 8 years with status asthmaticus is reported. We compare the requirement of mechanical ventilation with the beta-agonist therapy received and the type of asthma. About 71 patients admitted, 67% were IgE dependent asthmatic (EDA) children and 31% no-IgE dependent asthmatic (nEDA) ones. They needed intermittent positive pressure ventilation (IPPV) in 20 instances; no difference was found between both types of asthma. We studied the ventilatory parameters used. The 33% of EDA children was treated using a continuous IV infusion of hexoprenalina, requiring IPPV in 5 (31%) of them. The rest received a continuous IV of isoproterenol, and only the 16% required IPPV. We found isoproterenol to be more effective than hexoprenalina in the treatment of status asthmaticus. Similar results were obtained with the nEDA group. The Downes score was showed to be a good predictor-index scoring system in many cases.