High-flow nasal cannula therapy versus non-invasive ventilation in children with severe acute asthma exacerbation: An observational cohort study.

INTRODUCTION: The present study describes our experience with the high-flow humidified nasal cannula (HFNC) versus non-invasive ventilation (NIV) in children with severe acute asthma exacerbation (SA). METHODS: An observational study of a retrospective cohort of 42 children with SA admitted to a Pediatric Intensive Care Unit (PICU) for non-invasive respiratory support was made. The primary outcome measure was failure of initial respiratory support (need to escalate from HFNC to NIV or from NIV to invasive ventilation). Secondary outcome measures were the duration of respiratory support and PICU length of stay (LOS). RESULTS: Forty-two children met the inclusion criteria. Twenty (47.6%) received HFNC and 22 (52.3%) NIV as initial respiratory support. There were no treatment failures in the NIV group. However, 8 children (40%) in the HFNC group required escalation to NIV. The PICU LOS was similar in both the NIV and HFNC groups. However, on considering the HFNC failure subgroup, the median length of respiratory support was 3-fold longer (63h) and the PICU LOS was also longer compared with the rest of subjects exhibiting treatment success. CONCLUSIONS: Despite its obvious limitations, this observational study could suggest that HFNC in some subjects with SA may delay NIV support and potentially cause longer respiratory support, and longer PICU LOS.

Oxigenoterapia de alto flujo frente a ventilación no invasiva en niños con estatus asmático: estudio observacional de cohortes / High-flow oxygen therapy versus non-invasive ventilation in children with asthmatic status: observational cohort study

Introducción El objetivo de este estudio es comparar nuestra experiencia con el uso de oxigenoterapia de alto flujo (OAF) frente a la ventilación no invasiva (NIV) en niños con estatus asmático (EA). Métodos Estudio observacional de una cohorte retrospectiva de 42 niños con EA ingresados en nuestra Unidad de Cuidados Intensivos Pediátricos (UCIP) con soporte respiratorio no invasivo. El objetivo principal del estudio fue valorar el éxito/fracaso del soporte respiratorio inicial (necesidad o no de escalar a un soporte respiratorio superior). El objetivo secundario fue comparar la duración del soporte respiratorio y del ingreso en la UCIP. Resultados Cuarenta y dos niños cumplieron con los criterios de inclusión. Veinte (47,6 por ciento) fueron tratados con OAF y 22 (52,3 por ciento) con VNI como soporte respiratorio inicial. No hubo fracaso terapéutico en el grupo VNI, si bien 8 niños (40 por ciento) del grupo OAF fueron cambiados a VNI. La duración de la estancia en la UCIP y en el hospital fue similar en ambos grupos NIV y HFNC. Sin embargo, en el subgrupo de fracaso de OAF, la duración del soporte respiratorio (el triple, 63h) y la estancia en la UCIP fueron mucho mayores en comparación con los sujetos que tuvieron éxito en el tratamiento. Conclusiones Este estudio observacional, con sus evidentes limitaciones, podría sugerir que el uso de HFNC en algunos sujetos con EA puede retrasar el inicio de la VNI y potencialmente causar un soporte respiratorio más prolongado y una mayor estancia en la UCIP.

[Analysis of tracheostomies in a pediatric intensive care unit during the period 2003-2013]. / Análisis de las traqueotomías en cuidados intensivos pediátricos durante el periodo 2003-2013.

INTRODUCTION: Tracheotomy in pediatric patients is a rare procedure. In this pediatric series, perioperative complications, mortality related to surgical procedure and overall mortality are analyzed. PATIENTS AND METHODS: This is a retrospective study conducted from January 2003 to December 2013. Data were retrieved from patients who were tracheotomized and admitted to our PICU in the postoperative period. RESULTS: Data were collected from 25 tracheotomized patients admitted during the study period. The mean age was 3.3 months (median 14 months, range 1-144 months), and PICU length of stay was 53 days (median 37 days, range 1-338 days). Most patients (68%) had comorbidities before their admission, with a higher prevalene of craniofacial anomalies/polymalformative syndromes (32%) and prematurity related disorders (12%) being obserevd. The most common etiologies related to the procedure were congenital airway obstruction (16%) and several types of spinal cord injury (16%), followed by tracheobronchomalacia (12%) and subglottic stenosis (12%). Some kind of complication was detected in 40% of patients, with accidental decannulation being the most frequent. Accidental or unexpected decannulation was present in a percentage as high as 20% of our patients, mainly in the first 24 hours after surgery. One of the patients died as a result of this. CONCLUSIONS: The postoperative course of a tracheotomy is associated with a high rate of complications, some of them related to life-threatening events.

Unidad de Cuidados Intensivos Pediátricos de puertas abiertas / Open door Pediatric Intensive Care unit

Mediante este documento se pretende mostrar una idea de la organización actual de la Sección de Cuidados Intensivos Pediátricos (UCIP) del Hospital Universitario de Cruces. En primer lugar, se realiza un breve recuerdo histórico de la Unidad desde su apertura hasta la situación actual A continuación se define la misión de la misma, para continuar con la descripción de la arquitectura de la Unidad y de los profesionales que trabajan en ella. Se define la Cartera de Servicios y se detalla la actividad asistencial de los últimos años. La actividad docente es una parte fundamental dentro de los objetivos de la Unidad, tanto en la docencia pregrado como en el postgrado y la formación continuada; dentro de esta se mencionan los cursos impartidos anualmente. La Unidad está comenzando a desarrollar una actividad investigadora creciente en los últimos años con la incorporación de nuevos proyectos por lo que se comentan las líneas de investigación actuales. Por último, se analiza el impacto que ha supuesto la apertura de la unidad a los familiares las 24 horas del día y los objetivos previstos para los años futuros (AU)

This report is intended to give a general overview on the current organization of Pediatric Intensive Care Unit (PICU) at Cruces University Hospital. First of all, a brief historical background is made from the beginning to nowadays. Secondly, we describe PICU's mission, following with the description of PICU' s architecture and medical team. Portfolio is defined and PICU activities in recent years are detailed. Medical education and training is an essential part in daily activity, teaching both medical students and residents, being our annual courses mentioned. PICU is beginning to develop a growing body of research in recent years with new projects, so current investigation areas are discussed. Finally, the impact produced by opening PICU (24/7) to families and our targets for the coming years are analyzed (AU)

Hipertensión intracraneal secundaria a neurocisticercosis / Intracranial hypertension secondary to neurocysticercosis

No disponible

Neumonía aspirativa tras administración de polietilenglicol / Aspiration pneumonia after administration of a polyethylene glycol solution

No disponible

[Acute renal failure in critically-ill children. A preliminary study]. / Insuficiencia renal aguda en niños críticamente enfermos. Estudio preliminar.

OBJECTIVE: To analyze the characteristics of acute renal failure (ARF) in critically-ill children and develop a protocol for a multicenter study. METHODS: A prospective, descriptive study was performed in four pediatric intensive care units (PICU) over 5 months. Epidemiological, clinical and laboratory data from children aged between 7 days and 16 years with ARF were analyzed. Premature neonates were excluded. RESULTS: There were 16 episodes of ARF in 14 patients and 62.5 % were male (mean 6 SD age: 50 +/- 49 months). The incidence of ARF was 2.5 % of PICU patients. The most frequent primary diseases were nephro-urological (50 %) and heart disease (31 %). The main risk factors for ARF were hypovolemia (44 %) and hypotension (37 %). Six patients (37.5 %) developed ARF following surgery (cardiac surgery in four, kidney transplantation in one and urological surgery in one). Furosemide was used in 13 patients (as continuous perfusion in nine), inotropes in nine and renal replacement therapy in 12. Medical complications were found in 94 % and some organic dysfunction was found in 81 %. The length of stay in the PICU was 21 +/- 21 days. The probability of death according to the Pediatric Risk of Mortality was 14 +/- 8 %. Five patients died (36 % of the patients and 31.2 % of ARF episodes). CONCLUSIONS: The incidence of ARF in critically-ill children is low but remains a cause of high mortality and prolonged stay in the PICU. Mortality was caused not by renal failure but by multiple organ failure.

Insuficiencia renal aguda en niños críticamente enfermos. Estudio preliminar / Acute renal failure in critically-ill children. A preliminary study

Objetivo Describir las características de la insuficiencia renal aguda (IRA) en el niño críticamente enfermo y desarrollar un protocolo de estudio multicéntrico.Métodos Se realizó un estudio prospectivo, descriptivo, desarrollado en cuatro unidades de cuidados intensivos pediátricos (UCIP) durante 5 meses, analizando los datos epidemiológicos, clínicos y analíticos de todos los niños ingresados con IRA, con edades comprendidas entre 7 días y 16 años, excluyendo recién nacidos prematuros.Resultados Hubo 16 episodios de IRA en 14 pacientes, con edad de 50 +/- 49 meses (media +/- desviación estándar), el 62,5 por ciento varones. La incidencia fue del 2,5 por ciento de los pacientes ingresados en la UCIP. La patología primaria más frecuente fue la nefrourológica (50 por ciento) seguida de la cardíaca (31 por ciento). Los factores principales de riesgo de IRA fueron la hipovolemia (44 por ciento) y la hipotensión (37 por ciento). Tenían antecedentes de cirugía 6 pacientes (37,5 por ciento), cuatro cirugía cardíaca, un trasplante renal y una cirugía urológica. Durante el tratamiento se utilizó furosemida en 13 casos (nueve en perfusión), inotrópicos en nueve y depuración extrarrenal en 12. El 94 por ciento presentaron alguna complicación médica y el 81 por ciento alguna disfunción orgánica. La estancia en la UCIP fue de 21+/- 21 días. La probabilidad de muerte calculada por el Pediatric Risk of Mortality Score (PRISM) fue de 14+/- 8 por ciento. Fallecieron 5 pacientes (36 por ciento de los pacientes y 31,2 por ciento de los episodios de IRA).Conclusiones La incidencia de IRA en los niños críticamente enfermos es baja, pero con elevada mortalidad y larga estancia en la UCIP. La causa de mortalidad no fue la insuficiencia renal, sino el fallo multiorgánico (AU)

Síndrome de disfunción autonómica secundario a meningitis tuberculosa / Autonomic dysfunction syndrome secondary to tuberculous meningitis

No disponible

[Long-term prognosis of childhood IgA nephropathy in adult life]. / Pronóstico en la vida adulta de la nefropatía IgA diagnosticada en la edad pediátrica.

BACKGROUND: To evaluate long-term prognosis in a group of children with IgA nephropathy and to analyse which clinical factors were associated with progression to chronic renal failure in adulthood. PATIENTS AND METHOD: Retrospective study. 58 young adults with IgA nephropathy diagnosed at 10.6(SD 2.9) years old and studied after a follow-up of 11.8 (SD 2.9) years. RESULTS: Relapses of macroscopic hematuria and proteinuria were the most frequent symptoms at onset (75.9%). In 25.9% of patients high plasmatic IgA levels were also detected. Most cases had grade I (44.8%)or grade II (44.8%) histological lesions at diagnosis. At the last control, clinical remision was observed in 21 patients (36.2%) and 50% of the whole group remained with abnormal urine. 8 patients(13.8%) reached terminal renal failure. Mean renal survival (defined as glomerular filtration rate above 50 ml/min/1.73 m2)was 100, 93.3 and 81.1% at 5, 10 and 15 years of evolution, respectively. CONCLUSIONS: About 14% of children with IgA nephropathy had long-term renal bad prognosis. Hypertension at onset, plasma creatinine elevation and proteinuria during adolescence were significant risk factors associated with chronic renal failure during adulthood. Minimal lesions at IgA nephropathy diagnosis in children did not exclude long-term poor prognosis.

[Aortic valve stenosis. Surgical treatment in children]. / Estenosis aórtica valvular. Tratamiento quirúrgico en la infancia.

OBJECTIVES: The results of aortic commissurotomy, as the first step in the treatment of aortic valve stenosis in children, have been estimated after a medium-term follow-up. MATERIAL AND METHODS: Twenty-two patients were operated at a mean age of 7.3 +/- 3.6 years of age. Surgery was performed under cardiopulmonary bypass and moderate hypothermia. Twenty patients underwent cardiac catheterization (the systolic gradient pressure was 67.9 +/- 24.7 mmHg and the end diastolic pressure was 17 +/- 7.1 mmHg). We evaluated 10 patients with Doppler flow echocardiography (the valvular area was 0.8 +/- 0.2 cm2/m2). After surgery, we made a follow-up of 8.6 +/- 5.4 years. RESULTS: The aortic valve was bicuspid in 13 cases and tricuspid in 9 cases. There was no mortality. Before the age of 7, 7 patients developed restenosis. The mean pressure gradient was 92.5 +/- 16.6 mmHg, so six of them underwent valvuloplasty and the other one was operated with an aortic valvulated homograft. The pressure gradient, which was estimated in 20 patients, was lowered to 43.5 +/- 17.5 mmHg and the aortic area was increased to 2.4 cm2/m2. Six patients had a pressure gradient above 40 mmHg. Six patients had previous aortic regurgitation and this reappeared in 3 patients after valvulotomy. At this time, 12 patients have aortic regurgitation, being mild in 9 patients, mild to moderate in 1 and moderate in 2 patients. CONCLUSION: Valvulotomy is a palliative therapeutic method. We had no mortality. Restenosis appeared in 7 patients, before the age of seven years, and it can be easily corrected. The aortic regurgitation is usually mild. Valve replacement can be avoided in childhood.