[Long-term consequences of pediatric trauma requiring intensive care]. / Consecuencias a largo plazo de los traumatismos pediátricos que precisaron cuidados intensivos.

INTRODUCTION: Trauma is a major cause of pediatric morbidity. The aim of the present study was to determine the long-term effects of severe trauma in children and their families. PATIENTS AND METHODS: We performed an observational, cross sectional study of 209 children admitted to our pediatric intensive care unit due to trauma between 1999 and 2003. Family members and/or children were interviewed at least 2 years after the event. Functional situation was assessed by means of the Pediatric Overall Performance Category (POPC) scale and neurological status by means of the Pediatric Cerebral Performance Category (PCPC) scale. Subjective perception of quality of life was also evaluated. RESULTS: At assessment, patient age was 13+/-4 years. The causes of trauma were traffic accidents (42.6%), falls (30.1%), bicycle accidents (15.3%) and other causes (12%). The trauma affected the brain and cranium in 78.9%, skeleton in 20.2%, abdomen in 16.3% and other body regions in 15.3% of the patients. At assessment, 1.5 % of the patients were in a persistent vegetative state, 0.5% had severe disability, and 1% had moderate disability. A total of 9.5% had some type of persistent psychological disorder and 3.8 % needed some kind of help to perform daily activities. The median (range) score for self-estimated quality of life by the family was 3 (0-6) for the group of children with moderate or severe disability, while 12.9% of parents reported serious alterations of family dynamics related to the trauma event. CONCLUSIONS: Most children who survive after severe trauma achieve a good functional situation in the long term. Although the number of children with severe sequelae is small, these children have serious difficulties in achieving normal social adaptation and their quality of life is clearly impaired.

[Ventilation in special situations. Mechanical ventilation in bronchiolitis]. / Ventilación en situaciones especiales. Ventilación mecánica en la bronquiolitis.

Bronchiolitis is a prevalent viral disease in infants. Many of these infants require hospital admission and mechanical ventilation due to respiratory failure or apnea. The clinical and pathophysiological spectrum of this disease can range from two extremes, obstructive and restrictive disease, on which the indication for mechanical ventilation and the modality used should be based. Non-invasive ventilation is especially indicated in both obstructive and hypoxemic restrictive patterns and a pressure-controlled modality is recommended. In obstructive patterns, air trapping must be monitored, while in restrictive patterns the addition of positive end-expiratory pressure (PEEP) is indicated. High-frequency oscillatory ventilation is indicated in restrictive patterns with sever hypoxemia despite conventional ventilatory support or in cases of significant air leak syndromes. In all cases, a permissive hypercapnia strategy is recommended to prevent barotrauma. Sedation and muscle relaxation should be considered to facilitate adaptation to the ventilator and to try to limit the risks of air trapping, air leak, and barotrauma.