Childhood obesity trends: Association with same-day hospital admission in a National Outpatient Surgical Population.

BACKGROUND: Although the prevalence of obesity in the general population and its perioperative implications among children undergoing inpatient surgeries are well known, little is known about obesity prevalence among children scheduled for ambulatory surgery. AIMS: Here, we report the trends of obesity and severe obesity among children who underwent ambulatory surgery across multiple centers in the United States and explore the association of obesity status with admission following elective ambulatory surgery. MATERIALS AND METHODS: Using data from the American College of Surgeons National Surgical Quality Improvement Program-Pediatric (2012-2019), we selected children 2-18 years old who underwent outpatient surgical procedures under general anesthesia and had documented height, weight, and body mass index (BMI) data. We estimated the prevalence of overweight, obesity (class 1), and severe obesity (class 2 and class 3) patients and explored their association with same-day hospital admission, defined as hospital length of stay ≥1 day. RESULTS: Data from 152 918 children (mean age: 9.7 ± 4.7 years) were analyzed. Of these, 16.4% (n = 25 007) were overweight, 13.8% (n = 21 085) were class 1 obese, 5.2% (n = 7879) were class 2 obese, and 3.0% (n = 4623) were class 3 obese. From 2012 to 2019, class 2 or 3 obesity prevalence increased by 26.7% and 32.5%, respectively. Overweight and obese children had relatively higher odds of same-day hospital admission compared to healthy weight children (overweight odds ratio [95% confidence interval]: 1.05 [1.02, 1.08]; class 1 obesity: 1.04 [1.00, 1.07]; class 2 obesity: 1.09 [1.02, 1.16]; class 3 obesity: 1.20 [1.11, 1.30]). DISCUSION AND CONCLUSION: The burden of obesity continues to increase in children scheduled for ambulatory surgery. Children with class 2 and class 3 obesity have higher rates of same-day hospital admission following elective ambulatory surgery compared to healthy weight children, a factor that should be considered in scheduling these patients.

Ortner's Syndrome in an Infant With Congenital Heart Disease.

Cardio-vocal or Ortner's syndrome is dysphonia or hoarseness resulting from left recurrent laryngeal nerve palsy caused by a mechanical effect on the nerve due to enlarged cardiovascular or mediastinal structures. It was first described in adults with left atrial enlargement due to mitral stenosis. To date, there are a paucity of reports regarding its occurrence in infants and children. We report hoarseness and left vocal cord paresis in an infant with a large left-to-right shunt associated with a patent ductus arteriosus. The history of Ortner's syndrome is presented, its pathogenesis described, and previous reports of its occurrence in infants and children reviewed.

Noninvasive Blood Pressure Measurement Using the NICCI Monitor in Adolescents During Intraoperative Anesthetic Care.

Background: The intermittent measurement of blood pressure (BP) remains the standard of care during anesthesia or procedural sedation. To improve the early identification of hemodynamic compromise, various noninvasive BP devices have been developed which provide a continuous BP reading. The current study evaluates the accuracy of a novel continuous BP device, the NICCI system, in adolescents weighing 40 - 80 kg. Methods: During intraoperative anesthetic care, BP readings (systolic, diastolic, and mean) were captured from the arterial cannula and the NICCI device every second. Results: The study cohort included 44 pediatric patients undergoing major orthopedic, cardiac, and neurosurgical procedures. A total of 383,126 pairs of systolic blood pressure (SBP), diastolic blood pressure (DBP), and mean arterial pressure (MAP) values from the arterial cannula and the NICCI device were analyzed. The absolute difference for SBP, DBP, and MAP values from the NICCI monitor and the arterial cannula were 10 ± 8, 9 ± 7, and 9 ± 7 mm Hg, respectively. The difference between the BP values from the NICCI and the arterial cannula was ≤ 10 mm Hg for 60% of the SBP readings, 67% of the DBP readings, and 56% of the MAP readings. Using Bland-Altman analysis, the bias was 2, 3, and 4 mm Hg for the SBP, DBP, and MAP. Conclusions: Although there were technical limitations related to patient size that affected its ability to meet the strict accuracy criteria set by the American National Standards Institute/Association for the Advancement of Medical Instrumentation standards for noninvasive BP measurement (ANSI/AAMI SP10), the NICCI system provided a continuous noninvasive beat-to-beat BP measurement which was clinically relevant during a significant portion of intraoperative care.

Relación entre el momento de la realización de la traqueotomía y la incidencia de neumonía asociada a ventilador, y la mortalidad en adultos en la Unidad de Cuidados Intensivos / Relationship between the tracheostomy and the incidence of ventilator-associated pneumonia and mortality in adults admitted to the Intensive Care Unit

Objetivos: Determinar la asociación entre la traqueotomía precoz (TP) (< 7 días) y la incidencia de neumonía asociada al ventilador (NAV). Materiales y métodos: Estudio observacional analítico de una cohorte retrospectiva de una población de pacientes que requirieron traqueotomía durante su ingreso en la Unidad de Cuidados Intensivos (UCI). Se compararon dos grupos de pacientes: a) traqueotomía precoz (TP) en los primeros siete días; b) traqueotomía tardía (TT) a partir del octavo día. Variables estudiadas: edad, género, compromiso, momento y duración de la intubación orotraqueal (IOT), microorganismos aislados en cultivos de secreción traqueal, incidencia de neumonía asociada a ventilación mecánica (NAV), duración de la estancia en la UCI y mortalidad. Se realizó un modelo de regresión logística multivariado, para determinar los factores asociados al desarrollo de neumonía. Resultados: Se estudiaron 85 pacientes. La media +/– desviación estándar de edad fue de 61,5 +/– 2 años. Los microorganismos aislados con mayor frecuencia fueron Klebsiella pneumoniae (10%), Enterobacter cloacae (6,6%) y Pseudomonas aeruginosa (6,6%). La mediana (rango intercuartílico) del momento (día) de realización de la traqueotomía (p 0,0000) y de la duración de la estancia (días) en la UCI (p 0,0010) fue estadísticamente mayor en el grupo sometido a traqueotomía tardía. La incidencia de NAV fue del 10,5% (9) y la mortalidad en adultos en la UCI fue del 27,3% (23). Conclusiones: La traqueotomía precoz no se asoció significativamente con la incidencia de NAV y la mortalidad, tanto en el análisis crudo como en el ajustado...

Objectives: To determine the association between early tracheostomy (TP) (< 7 days) and incidence of ventilator-associated pneumonia (VAP). Materials and Methods: Observational study of a retrospective cohort of a population of patients who required tracheostomy for admission to Intensive Care Unit (ICU). Data were compared in two groups of patients: a) early tracheostomy (PT) in the first 7 days, b) late tracheostomy (TT) from the 8th day. Variables studied: age, gender, commitment, time and duration of intubation (OTI), microorganisms isolated from tracheal secretion cultures, incidence of ventilator-associated pneumonia (VAP), duration of stay and ICU mortality. We performed a multivariate logistic regression model to determine factors associated with the development of pneumonia. Results: We studied 85 patients, the mean +/– SD age was 61.5 +/– 2.02 years. The most frequently isolated microorganisms were Klebsiella pneumoniae (10%), Enterobacter cloacae (6.6%) and Pseudomonas aeruginosa (6.6%). The median (interquartile range) of time (day) of performing tracheotomy (p 0.0000) and length of stay (days) in the ICU (p 0.0010) was statistically higher in the group receiving late tracheostomy. The incidence of VAP was 10.5% (9) and Adult Mortality in ICU was 27.3% (23). Conclusions: Early tracheotomy was not significantly associated with the incidence of VAP and mortality is crude analysis as the ajusted analysis...

Monografía sobre eutanasia para estudiantes de medicina / Euthanasia

La realidad nos demanda, aceptar que el tiempo que estamos en la tierra, está circunscrito y morimos para que el mundo pueda continuar viviendo... Roldán. Resulta alarmante, como en nuestras sociedades los profesionales de la salud se ven frecuentemente involucrados en conflictos éticos-legales, especialmente por un soporte de vida artificial, sin contar con los argumentos éticos, morales y clínicos, que confieran los conocimientos suficientes para tomar una decisión objetiva. Ya que nuestra formación médica se basa en el modelo biopsicosocial, una visión personalizada e integral del paciente, es de nuestro particular interés evaluar la aplicación de modelos dominantes aprendidos en la práctica cotidiana del ejercicio médico, del cual hace parte el proceso de muerte frente a una medicina que abandona su propósito de prolongar la vida, por acciones que conducen a aumentar la agonía y retarda la llegada de una muerte tranquila, debemos aceptar la naturaleza mortal de la vida humana.